WC

[Guest guest]

though not mentioned here, I have been informed that Acu treatments

have been capped at 12 per year.

 

 

Taking effect immediately, SB899 was signed into law by Governor Arnold

Schwarzenegger on April 19, 2004. It changes the Workers Compensation

system as it pertains to acupuncturists. I’ll try to map out some of

the pertinent changes as they relate to our profession.

• Firstly, we weren’t taken out as physicians as we had feared. Nor

was the language changed from cure or relieve to cure and relieve.

Labor Code (LC) 4600 is pretty clear in its intent to keep us in the

system.

• LC 4600 also refers to Section 5307.27, which hasn’t been written

yet, and may alter the treatment guidelines that are currently in use

by the American College of Occupational and Environmental Medicine

(ACOEM).

• These new guidelines are to be in place by January 1 st of 2005.

However, the ACOEM’s guidelines have already begun to prevent and/or

delay treatment authorization.

• In LC 4616(d), initiating in January 2005, employers are to create

medical provider networks (MPN) to provide treatment to all injured

workers. The MPN must include all types of physicians and in numbers

great enough to adequately treat injury. After the first visit to the

employers physician, the employee may choose to be treated by any other

physician in the network, including acupuncturists (4616.3 (b)).

• Out of network referrals are only allowed if there are no qualified

physicians in the network. If the employee is not satisfied with the

physicians diagnosis or treatment plan, he or she may choose another.

If the employee is still dissatisfied, he or she may choose yet another

treating physician. If there is still dispute, the worker may request

independent medical review (IMR) from a medical doctor or osteopath

assigned by the Administrative Director.

• The IMR physician will conduct a physical exam and/or review

clinical records at the employers’ discretion (LC 4616.4(e)). If the

IMR agrees with the injured worker, he or she is entitled to pursue

treatment from any physician, in or out of network. The new law does

not mention what happens if the IMR agrees with the insurer, although

the employee may still request opinions of other physicians in-network.

• Should the employer fail to create a MPN, the employee may choose a

treating physician of his/her choice after 30 days as stated in the

previous Workers Compensation Laws.

• Another item that didn’t change is our QME status (you can access

more information about QME/AME procedures in LC4602).

• What did change is our right to be pre-designated as personal

physician to the injured worker (LC 4600 (d)(2)(A)). Chiropractors and

acupuncturists can no longer be pre-designated.

• Per LC 5402, an employer, from the first day after an employee

reports an injury, must provide appropriate medical treatment up to

$10,000.00 or until liability for the claim is accepted or rejected.

• Our biggest hurdle, after rebutting the ACOEM guidelines is to

ensure that we are included in the Administrative Directors guidelines

pursuant to LC5307.27 as mentioned above. These guidelines for

treatment of typical work injuries need to be created by our

profession.

 

 

 

Chinese Herbs

 

 

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