The permanent treatment parameters are covered under Minnesota Rules Part 5221.6010 through 5221.6600 and 5221.8900. The purpose of the rules is to establish parameters for reasonably required treatment of workers with compensable injuries. They are to prevent excessive treatment and do not affect determinations of liability. They are not intended to expand or restrict a health care provider's scope of practice under any other statute.
The treatment parameters are designed to assist insurers in identifying services that are performed at a level or at a frequency that is excessive, unnecessary or inappropriate, based upon accepted medical standards for quality health care. The insurer may deny payment for excessive services in accordance with the treatment parameters, which define treatment that is reasonable, necessary and appropriate.
The treatment parameters apply to treatment provided after Jan. 4, 1995, regardless of the date of the injury. The treatment must be medically necessary. If there is no specific treatment parameter for a medical condition, general parameters apply. The parameters do not apply to treatment of an injury for which the insurer has issued a denial of liability. If the insurer reverses a denial, the parameters apply for all treatment after acceptance of the claim. References to weeks and days mean calendar weeks and days unless specified otherwise. The rules apply only to conditions or types of treatment specified in the parameters.
General treatment parameters require that all treatment be medically necessary. They require the health care provider to assess the employee's condition through ongoing evaluations. A key concept included in the treatment parameters is the concept of effective care. Effective care means the patient is improving subjectively, the patient's objective clinical findings are improving and/or the patient's functional status is improving (i.e. workability). For care to be deemed effective, two of the three improvements must be occurring. If care is not effective, the provider must reassess the case and then stop care, alter the treatment plan or refer the patient.
The health care provider must use the least intensive appropriate setting and enable the employee to become independent in his or her own care. Providers must also be diligent in watching and referring (as necessary) any employee who might be or become chemically dependent upon any medication prescribed for his or her condition. Providers should also provide a trial of nonsurgical treatment before proceeding with surgery except:
in emergency situations;
when the condition requires immediate surgery; or
when the acceptable standard of initial treatment for the condition is surgery.
See Minnesota Rules Part 5221.6050 Subp. 1 through 4.
General parameters for medical imaging apply to all injuries (exception: Subpart 2 of the imaging parameters applies only to low back conditions and not to any other conditions). The general parameter for medical imaging:
requires the use of the single best test;
prohibits routine imaging; and
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