The IMR provisions Current IMR Note Note borrow extensively from regulations, 8 CCR §§ the statutes creating IMR 9768.1 apply only to in the Health & Safety IMR under the MPN Code [even to the point statutes. where the cut and paste uses the word in timeframes and Note “plan” Labor Code § 4610.5(i)]. documentation requirements for New Labor Code § processing IMR Note 4610.6(m) gives the DWC the discretion to publish As mentioned in Note IMR decisions. This can other comments, there be as simple as doing what needs to be a is currently done in the clarification of which Department of Managed IMR process (“UR” Health Care and providing IMR or IMR is “MPN” access to the complete list to be used under what of IMR decisions or the circumstances.) Division may want to consider a more Consideration Note: significant linkage should be given to between utilization review adopting the regulations (UR) regulations, the UR of the DMHC regarding penalty regulations, and post-IMR filing the medical treatment additional information: utilization schedule medical records or “Any (MTUS). other relevant matters not available at the time of the Department's initial notification, or
Note The IMR provisions borrow extensively from the statutes creating IMR in the Health & Safety Code [even to the point where the cut and paste uses the word “plan” in Labor Code § 4610.5(i)]. Note New Labor Code § 4610.6(m) gives the DWC the discretion to publish IMR decisions. This can be as simple as doing what is currently done in the Department of Managed Health Care and providing access to the complete list of IMR decisions or the Division may want to consider a more significant linkage between utilization review (UR) regulations, the UR penalty regulations, and the medical treatment utilization schedule (MTUS). Note Current IMR regulations, 8 CCR §§ 9768.1 apply only to IMR under the MPN statutes. Note timeframes and documentation requirements for processing IMR Note As mentioned in other comments, there needs to be a clarification of which IMR process (“UR” IMR or “MPN” IMR is to be used under what circumstances.) Note: Consideration should be given to adopting the regulations of the DMHC regarding post-IMR filing additional information: “Any medical records or other relevant matters not available at the time of the Department's initial notification, or
SB863_ImplementationGuidev11072012.docx