7 Colo. Code Regs. § 1101-3-17-17
Current through Register Vol. 47, No. 24, December 25, 2024
Rule 7 CCR 1101-3-17-17 - Medical Treatment Guidelines17-1. STATEMENT OF PURPOSE The Director adopts the Medical Treatment Guidelines pursuant to § 8-42-101 (3.5)(a)(II). The purpose of these Guidelines is to comply with § 8-40-102(1) and assure the quick and efficient delivery of disability and medical benefits to injured workers at a reasonable cost to employers, without the necessity of any litigation.
17-2. USE OF THE MEDICAL TREATMENT GUIDELINES (A) All health care providers shall use the Medical Treatment Guidelines promulgated by the Director, as required by § 8-42-101(3)(B).(B) Payers shall routinely and regularly review claims to ensure that care is consistent with the Division's Medical Treatment Guidelines.17-3. PROVIDER'S RESPONSIBILITIES (A) The health care provider shall prepare a diagnosis-based treatment plan that includes specific treatment goals with expected time frames for completion in all cases where treatment falling within the purview of the Medical Treatment Guidelines continues beyond 6 weeks.(B) Within 14 days of request by any party, the provider shall supply a copy of the treatment plan both to the patient and to the payer. Should the patient otherwise require care that deviates from the Medical Treatment Guidelines, the provider shall supply the patient and the payer with a written explanation of the medical necessity for such care.17-4. PROCEDURE FOR QUESTIONING CARE(A) The Medical Treatment Guidelines set forth reasonable medical care for high cost or high frequency categories of occupational injury or disease. However, the Division recognizes reasonable medical care may include deviations from the Guidelines in individual cases. The provider shall request Prior Authorization if the proposed treatment falls outside the Medical Treatment Guidelines or if the Guidelines or Division Rules require Prior Authorization for a proposed treatment. The provider may submit a Notification to Treat to receive a guarantee of payment.
(B) Rule 16 governs the contest of a request for Prior Authorization or a claim for payment.17-5. EXHIBITS TO RULE 17 (A) Exhibit 1 - Low Back Pain(B) Exhibit 2A - Mild Traumatic Brain Injury(C) Exhibit 2B - Moderate/Severe Traumatic Brain Injury(D) Exhibit 3 - Thoracic Outlet Syndrome(E) Exhibit 4 - Shoulder Injury(F) Exhibit 5 - Cumulative Trauma Conditions(G) Exhibit 6 - Lower Extremity(H) Exhibit 7 - Complex Regional Pain Syndrome / Reflex Sympathetic Dystrophy(I) Exhibit 8 - Cervical Spine Injury(J) Exhibit 9 - Chronic Pain Disorder37 CR 13, July 10, 2014, effective 7/30/201438 CR 01, January 10, 2015, effective 2/1/201538 CR 05, March 10, 2015, effective 4/1/201538 CR 11, June 10, 2015, effective 7/1/201538 CR 17, September 10, 2015, effective 1/1/201639 CR 04, February 25, 2016, effective 3/16/201639 CR 13, July 10, 2016, effective 7/30/201639 CR 16, August 25, 2016, effective 9/14/201639 CR 19, October 10, 2016, effective 1/1/201740 CR 03, February 10, 2017, effective 3/2/201740 CR 11, June 10, 2017, effective 7/1/201740 CR 21, November 10, 2017, effective 11/30/201740 CR 18, September 25, 2017, effective 1/1/201840 CR 20, October 25, 2017, effective 1/1/201841 CR 11, June 10, 2018, effective 7/1/201841 CR 19, October 10, 2018, effective 1/1/201941 CR 20, October 25, 2018, effective 1/1/201941 CR 23, December 10, 2018, effective 1/1/201942 CR 01, January 10, 2019, effective 1/30/201942 CR 11, June 10, 2019, effective 6/30/201942 CR 12, June 25, 2019, effective 7/15/201942 CR 21, November 10, 2019, effective 11/30/201942 CR 20, October 25, 2019, effective 1/1/202042 CR 23, December 10, 2019, effective 1/1/202043 CR 03, February 10, 2020, effective 1/1/202043 CR 07, April 10, 2020, effective 4/30/202043 CR 11, June 10, 2020, effective 7/1/202043 CR 16, August 25, 2020, effective 10/14/202043 CR 21, November 10, 2020, effective 1/1/202144 CR 07, April 10, 2021, effective 4/30/202144 CR 08, April 25, 2021, effective 7/1/202144 CR 13, July 10, 2021, effective 7/30/202144 CR 20, October 25, 2021, effective 1/1/202244 CR 23, December 10, 2021, effective 1/1/202244 CR 23, December 10, 2021, effective 1/10/202245 CR 01, January 10, 2022, effective 1/30/202245 CR 11, June 10, 2022, effective 7/1/202245 CR 13, July 10, 2022, effective 8/10/202245 CR 21, November 10, 2022, effective 12/6/202246 CR 01, January 10, 2023, effective 12/6/202245 CR 19, October 10, 2022, effective 1/1/202346 CR 02, January 25, 2022, effective 1/1/202346 CR 02, January 25, 2023, effective 3/2/202346 CR 05, March 10, 2023, effective 3/30/2023