(1) In promulgating these Utilization Review regulations, the Commissioner hereby utilizes the treatment guidelines developed and endorsed by the Health Care Services Board, recognizing that medical treatment cannot be reduced to regulation and that health care providers must be free to exercise their best judgments about the treatment of their patients.
(2) The Health Care Services Board will review and update treatment guidelines at least annually. Providers shall consider the treatment guidelines endorsed by the Health Care Services Board and adopted by the Commissioner when caring for injured employees or risk nonpayment. The guidelines should not be construed as including all proper methods of care reasonably directed to obtaining the same results. The ultimate judgement regarding any specific procedure or treatment must be made by the provider in light of all circumstances presented by the injured employee and the needs and resources particular to the locality or facility. The adopted guidelines shall be used by utilization review programs administered by insurers in a form required by the Department, taking into account that appropriate care may vary on a case by case basis.
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