California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 5.5.2 - Medical Treatment Utilization Schedule › Section 9792.20 - Medical Treatment Utilization Schedule-Definitions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
As used in this Article:
(a) "ACOEM" means the American College of
					 Occupational and Environmental Medicine's Occupational Medicine Practice
					 Guidelines published by the Reed Group containing evidenced-based medical
					 treatment guidelines for conditions commonly associated with the workplace.
					 ACOEM guidelines may be obtained from the Reed Group (
http://go.reedgroup.com/mtus
).
(b) "Chronic pain" means pain lasting three
					 or more months from the initial onset of pain.
(c) "Claims administrator" is a
					 self-administered workers' compensation insurer, a self-administered
					 self-insured employer, a self-administered legally uninsured employer, a
					 self-administered joint powers authority, a third-party claims administrator,
					 or the California Insurance Guarantee Association.
(d) "Evidence-Based Medicine (EBM)" means a
					 systematic approach to making clinical decisions which allows the integration
					 of the best available research evidence with clinical expertise and patient
					 values.
(e) "Functional
					 improvement" means either a clinically significant improvement in activities of
					 daily living or a reduction in work restrictions as measured during the history
					 and physical exam, performed and documented as part of the medical evaluation
					 and treatment; and a reduction in the dependency on continued medical
					 treatment.
(f) "Medical treatment"
					 is care which is reasonably required to cure or relieve the employee from the
					 effects of the industrial injury consistent with the requirements of sections
					 9792.20-9792.26.
(g) "Medical treatment guidelines" means the
					 most current version of written recommendations which are systematically
					 developed by a multidisciplinary process through a comprehensive literature
					 search to assist in decision-making about the appropriate medical treatment for
					 specific clinical circumstances reviewed and updated within the last five
					 years.
(h) "Nationally recognized"
					 means published in a peer-reviewed medical journal; or developed, endorsed and
					 disseminated by a national organization with affiliates based in two or more
					 U.S. states and is the most current version.
(i) ODG" means the Official Disability
					 Guidelines published by the Work Loss Data Institute containing evidenced-based
					 medical treatment guidelines for conditions commonly associated with the
					 workplace. ODG guidelines may be obtained from the Work Loss Data Institute,
					 169 Saxony, #101, Encinitas, California 92024
					 (www.ODG@worklossdata.com).
(j)
					 "Peer reviewed" means that a study's content, methodology and results have been
					 evaluated and approved prior to publication by an editorial board of qualified
					 experts.
(k) "Scientifically based"
					 means based on scientific literature, wherein the body of literature is
					 identified through performance of a literature search, the identified
					 literature is evaluated, and then used as the basis to support a
					 recommendation.
(l) "Strength of
					 Evidence" establishes the relative weight that shall be given to scientifically
					 based evidence.
1. New
						article 5.5.2 (sections
						9792.20-9792.23) and section filed
						6-15-2007; operative 6-15-2007 pursuant to Government Code section
						11343.4
						(Register 2007, No. 24).
2. Amendment of subsection (b), new
						subsection (c), subsection relettering and amendment of newly designated
						subsection (g) filed 6-18-2009; operative 7-18-2009 (Register 2009, No.
						25).
3. Editorial correction of operative date in HISTORY 2
						(Register 2009, No. 30).
4. Amendment filed 4-20-2015; operative
						4-20-2015 pursuant to Government Code section
						11343.4(b)(3)
						(Register 2015, No. 17).
5. Amendment of subsection (a) filed
						1-11-2018; operative 12-1-2017. Submitted to OAL for filing and printing only
						pursuant to Labor Code section
						5307.27(a)
						(Register 2018, No. 2).
Note: Authority cited: Sections
						  133,
						  4603.5,
						  5307.3 and
						  5307.27, Labor
						  Code. Reference: Sections
						  77.5,
						  4600,
						  4604.5 and
						  5307.27, Labor
						  Code.