In 1991, Gov. William Weld promulgated major workers' compensation reform legislation. This legislation provided a new direction for WC health care in Massachusetts. Central to this reform was the implementation of a utilization review and quality assessment program to monitor the appropriateness of medical services as well as the necessity and the effectiveness of treatment for injured and ill employees. These Medical Treatment Guidelines were accepted and per MGL c. 152, promulgated on July 1, 1993 to be used for all health care services rendered on or after October 1, 1993.
These Medical Treatment Guidelines are meant to cover the majority of tests and treatments for each condition for which they apply. MGL c. 152 requires an annual review of the guidelines currently in existence.
The Medical Treatment Guidelines are drafted by a group of highly respected expert clinicians that represent pertinent specialties in the medical community. A member of the Health Care Services Board (HCSB) will chair each guideline's drafting group. The drafting group bases the treatment guidelines on the best available medical evidence and on what reasonable practitioners in the community are recommending. After guidelines are drafted, they are subject to further review by medical societies, labor, insurers, employers groups, the general public and HCSB. Before each guideline is endorsed by the HCSB and adopted by the DIA, a notice for public comment will be published in four newspapers. After it has been approved, it will be presented to utilization review agents and insurers.
The guidelines provide guidance to clinicians, insurers, utilization review agents and other concerning what falls into an acceptable range of treatment.
The treatment guidelines are not mandatory and it is expected that up to 10% of treatments may deviate from the guidelines.
See the Treatment Guidelines