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The MedRisk Blog

Q4 2015 Legislative Update

Here is a summary of legislative and regulatory developments during the fourth quarter of 2015 and their practical implications:


In November the Division of Workers’ Compensation published a proposed revision of its 2009 Lower Extremity Injury Medical treatment Guideline (Rule 17, Exhibit 6), which addresses conditions relating to the foot, ankle, knee, hip and leg. Many topics are either newly introduced or greatly expanded, including psychosocial interventions and interdisciplinary programs.

  • Implications: Although the DWC guidelines are formally developed for advisory and educational purposes, they are also legally enforceable: medical treatment within the guidelines is reimbursable unless the payer proves that the care is clearly not medically necessary. Further, the DWC guidelines are used as models and resources by other jurisdictions, so they are influential beyond Colorado.

On October 20, 2015, the Louisiana Office of Workers’ Compensation Claims Administration posted a second draft of extensive amendments to the OWCA’s medical treatment guidelines, dental, hospital and medical reimbursement schedules. The proposed changes are to update the rules, guidelines and reimbursement with the ICD-10 information. It is likely that the revisions will be adopted without significant further changes.

  • Implications: Among the many revisions to the medical treatment guidelines are new treatment protocols for neck pain, acupuncture, interdisciplinary rehabilitation programs for patients with chronic low back pain and psychological/psychosocial intervention programs. In regard to the latter treatment, the guidelines endorse psychosocial treatment as “an important component in the total management of a patient with chronic low back pain and should be implemented as soon as the problem is identified.”

In November 2015 the NCCI published a research brief entitled “State Differences in the Diagnosis and Treatment of Joint Injuries,” which compares variations in the diagnosis and treatment of ankle, elbow, knee and shoulder injuries across 35 jurisdictions. The study concludes that variations in treatment (especially surgery and physical medicine) utilization rather than variations in diagnosis are the principal cause of wide differences in costs among the states (Illinois and Louisiana being highest and District of Columbia and Maine being lowest) and pointed to fee schedules and treatment guidelines as possible factors needing further study.

  • Implications: This research brief corroborates earlier WCRI findings but is both broader and more detailed. The study encompasses all of the jurisdictions for which the NCCI provides rate making or data collection services. Further, the study provides detailed analysis of an important group of common workplace injuries whose severity should be equivalent from one jurisdiction to another.