2010 changes to the Minnesota treatment parameters : Minn. R. 5221

Group 152

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There are new changes to the treatment parameters concerning the appropriate use of medications for treatment of work related injuries. Under the new rule, Minn. R. 5221.6105, there are now “strict” limits to use of certain types of medications. This rule severely limits the medication a health care provider can prescribe including the type and duration of the medication.

The Department of Labor and Industry (DOLI) on January 25, 2010, proposed various amendments to the Minnesota workers’ compensation treatment parameters, including new parameters for the use of non-steroidal anti-inflammatory drugs, muscle relaxant drugs, and opiod (narcotic) analgesic drugs; updates to general and medical imaging parameters and ICD-9 codes; functional capacity evaluations (FCE); traction; electrical muscle stimulation; acupuncture and manual therapy modalities; and complex regional pain syndrome and cognate conditions.

These changes were intended to “reflect new technology, changes in terminology, technology and health care provider techniques and practices, and decisions by the workers’ compensation court of appeals.”

These changes were addressed and adopted at a formal hearing held on March 2, 2010, by Administrative Law Judge Richard Luis. The written decision was issued on April 27, 2010, which can be found here. The changes to the rules can be found here.

DOLI argued at hearing that, “from 1997-2003, expenditures per claim for outpatient pharmacy in Minnesota workers’ compensation system increased 142%.” DOLI relied on comments and input from the Workers’ Compensation Advisory Council (WCAC) and the Medical Services Review Board (MSRB). They also relied on testimony from Dr. Lohman.

The Department stated that all involved parties, “will benefit from the proposed rules because the rules reflect the current standard of medical care and should reduce disputes and costs related to unnecessary or inappropriate treatment.”

Comments were heard from workers’ compensation attorneys who represent injured workers and summarily stated the changes “appear to favor employers and insurers over injured workers (e.g. by placing heavy restrictions on doctors’ abilities to treat their patients who are injured on the job as opposed to other patients).”

Attorney Charles Cochrane, speaking on behalf of the Minnesota Association of Justice, raised concerns regarding Minn. R. 5221.6195, pointing out that there was no evidence of “overprescription, overuse, overpayment of the converse” of medications. He pointed out that “7% of the total cost of work comp claims in Minnesota” are from medications. He also indicated that “the cost of drugs in workers’ compensation has declined since 2002.”

Other concerns raised by Attorney Cochrane included increased litigation, increased paperwork for physicians, forcing physicians to practice medicine a certain way, slowing down the administering of appropriate medication.

Despite the statements from DOLI, the driving forces behind the changes were cost, not the care and treatment of the injured worker. As Attorney Cochrane stated at the hearing, “infringing upon the providers discretion, the health of patients could be compromised.”

DOLI indicates these changes will not cause further litigation but instead “provide clear direction and clarity that should reduce litigation because the standards for prescribing the medications specified in the rules will be clear.”

We will have to wait and see how this plays out as to whether this truly reduces litigation or increases it. In my opinion, injured workers, especially those with debilitating pain, will be limited in the medication they can receive despite the prescription from their treating physician. We will most likely see an increase in litigation in order for the injured workers to get “reasonable and necessary” medical treatment.