Ala. Admin. Code r. 480-5-5-.29

Current through Register Vol. 43, No. 1, October 31, 2024

Section 480-5-5-.29 - Medical Case Management

(1) Medical case management determination shall be the responsibility of the employer/agent unless delegated. This service may be performed in conjunction with utilization management; however, it is differentiated by its designation to promote optimal recovery and physical rehabilitation by professional involvement in the physical rehabilitation process.

(2) Since medical case management is an integral components of a utilization management program, it shall, at the discretion of the employer/agent, be used as a component in the physical rehabilitation of the injured worker. The overall goal of medical case management is to facilitate the organizing and sequencing of appropriate health care services. This shall be done in the most cost effective manner without compromising quality of care in order to promote optimal outcomes for all parties involved.

(3) The employer/agent is the responsible party for determining the necessity of medical case management.

(4) Individuals or entities performing medical case management shall comply with the most current standards adopted by the International Association of Rehabilitation Professionals (IARP), professional performance criteria for medical case management, which pertains to workers' compensation cases or other nationally recognized medical case management standards. Notwithstanding the foregoing, nothing in this rule shall require a case manager to become a member of any association with recognized standards used in medical case management.

(5) The dispute resolution process shall be in accordance with Rule 480-5-5-.23.

Ala. Admin. Code r. 480-5-5-.29

New Rule: Filed August 9, 1996; effective September 13, 1996.

Amended by Alabama Administrative Monthly Volume XL, Issue No. 06, March 31, 2022, eff. 5/15/2022.

Author: Workers' Compensation Division

Statutory Authority:Code of Ala. 1975, § 25-5-293.