Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 05 - INDUSTRIAL COMMISSION OF ARIZONA › Article 13 - TREATMENT GUIDELINES › Section R20-5-1301 - Adoption and Applicability of the Article

Current through Register Vol. 30, No. 28, July 12, 2024
A. The Industrial Commission of Arizona
				(Commission) has adopted the Work Loss Data Institute's
Official
				Disability Guidelines - Treatment in Workers Compensation
(ODG) as the
				standard reference for evidence-based medicine used in treating injured workers
				within the context of Arizona's workers' compensation system. By adopting and
				referencing the most recent edition (at the time of treatment), and
				continuously updated Official Disability Guidelines, the Commission can ensure
				the latest available medical evidence is used in making medical treatment
				decisions for injured workers.
B.
				Until further action of the Commission, the guidelines shall apply to all body
				parts and conditions.
C. The
				Commission may modify or change the applicability of the guidelines as
				described in subsection (B) if the Commission determines that modification or
				changing the applicability of the guidelines will: 1) improve medical treatment
				for injured workers, 2) make treatment and claims processing more efficient and
				cost effective, and 3) if the Commission's modification expands the
				applicability of the guidelines, the guidelines adequately cover the relevant
				body parts or conditions. Before taking action to modify or change the
				applicability of the guidelines, the Commission shall provide an opportunity
				for public comment and hold a public hearing. A decision of the Commission
				under this subsection shall be made by a majority vote of a quorum of
				Commission members present at a public meeting.
D. Action taken by the Commission to modify
				or change the applicability of the guidelines under subsection (C) shall be
				published in the minutes of the Commission meeting when such action was taken.
				The minutes of this action shall be published on the Commission's website and
				shall be available from the Commission upon request.
E. The guidelines shall apply prospectively.
				Recommendations provided in the guidelines related to the management of chronic
				pain and the use of opioids for all stages of pain management shall apply to
				medical treatment or services occurring on or after October 1, 2016. For
				purposes of this process, chronic pain shall be defined by the guidelines.
				Recommendations provided in the guidelines related to all other body parts and
				conditions shall apply to medical treatment or services occurring on or after
				October 1, 2018.
F. This Article
				applies to all claims filed with the Commission.
G. This Article only applies to medical
				treatment and services for body parts and conditions that have been accepted as
				compensable.
H. The guidelines are
				to be used as a tool to support clinical decision making and quality health
				care delivery to injured employees. The guidelines set forth care that is
				generally considered reasonable and are presumed correct if the guidelines
				provide recommendations related to the requested treatment or service. This is
				a rebuttable presumption and reasonable medical care may include deviations
				from the guidelines. To support a request to deviate from the guidelines, the
				provider must produce documentation and justification that demonstrates by a
				preponderance of credible medical evidence a medical basis for departing from
				the guidelines. Credible medical evidence may include clinical expertise and
				judgment.
I. The Commission shall
				provide administrative review and oversight of this Article.