1. What is the purpose of the medical treatment guidelines?
The 1991 workers' compensation reform law requires the HCSB to develop and endorse treatment guidelines. These guidelines provide a basis for evaluating the medical necessity of treatment. Massachusetts was one of the first states to develop such guidelines and they have been used by other states.
2. How are the medical treatment guidelines developed?
The guidelines are drafted by a group of highly respected expert clinicians who represent pertinent specialties in the medical community. A member of the 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 the guidelines have been drafted, they are subject to further review by medical societies, labor, insurers, employer groups, the general public, and the HCSB. Before each guideline is endorsed by the HCSB and adopted by the Department of Industrial Accidents, a notice asking for public comment will be published. After the guideline has been approved, it will be presented to UR agents and insurers.
3. What is the purpose of the medical treatment guidelines?
They provide guidance to clinicians, insurers, utilization review agents, and others concerning what falls into an acceptable range of treatment.
4. Are the medical treatment guidelines mandatory?
No, they are meant to be used as "guides", and it is expected that up to ten percent of treatments may deviate from the guidelines.