PROPOSED STATEMENT OF BASIS AND PURPOSE FOR AMMENDMENTS TO

							 PROPOSED STATEMENT OF BASIS AND PURPOSE FOR AMMENDMENTS TO
        THE WORKERS' COMPENSATION RULES OF PROCEDURE
                         7 CCR 1101-3


BASIS: §8-47-107, C.R.S. provides the Director of the
Division of Workers’ Compensation with authority to adopt
proper rules and regulations to govern the proceedings and
hearings of the Division, and the discretion to amend said
rules. In addition, §8-42-101 (3) (a) (I) provides that the
Director shall adopt said rules regarding medical treatment
guidelines.
PURPOSE: Revise and update terminology, procedures,
recommendations, and implementation of Rule 17 - Exhibit 6
Lower Extremity Medical Treatment Guidelines.

The Rule Amendments to Rule 17 - Exhibit 6 addresses the
following subjects:

     Update of diagnosis, testing, and treatment procedures
      for injured workers.

     Changes to formatting, grammar, content and structure.

     Changes will make the revised exhibit more consistent
      with the other exhibits contained in Rule 17.

Pursuant to §24-4-103(4)(b), C.R.S., the Director finds
that: 1) there is a demonstrated need for these rule
amendments; 2) the proper statutory authority exists for
this regulation; 3) to the extent practicable, the rule is
clearly stated so that its meaning will be understood by any
party required to comply with the regulation; 4) the rule
does not conflict with other provisions of the law; and 5)
the duplicating or overlapping of regulations is explained
by the agency proposing the rule.




Bob Summers                               April 28, 2009
Director                                      DATE
                    REGULATORY ANALYSIS
     FOR PROPOSED REPEAL AND READOPTION OF THE WORKERS’
              COMPENSATION RULES OF PROCEDURE
                         7 CCR 1101-3


1. Description of the classes of persons who will be affected by the proposed rules,
   including classes that will bear the costs of the proposed rules and classes that will
   benefit from the rules.

   This rule applies to all persons and entities subject to the Colorado Workers’
   Compensation system, including but not limited to, injured workers, employers, health
   care providers, insurance carriers, and self-insured entities.

2. Description of the probable quantitative and qualitative impact of the proposed
   rule, economic or otherwise, upon the classes of affected persons.

   The revised Lower Extremity (Exhibit 6) Medical Treatment Guidelines includes changes
   to terminology, procedures and recommendations for updated diagnosis, testing and
   treatment procedures for injured workers. The changes to the exhibit will make it more
   consistent in concept and organization with respect to the other exhibits contained in Rule
   17.

   The treatment guidelines provide guidance to medical providers when making
   recommendations as to the appropriate treatment. Similarly these documents provide
   guidance to the injured worker, insurance companies, and third party administrators on
   recommended treatment, diagnostic procedures, etc., in cases of lower extremity injury.

   The complexity of diagnosing specific lower extremity disorders has increased since the
   last update. In response, the sections and subsections relating to diagnostic procedures
   have been expanded. The text includes suggestions and recommendations as to which
   diagnostic procedure(s) might be most appropriate for a specific disorder or condition.
   These changes in the diagnostic procedures sections should further aid in the diagnosis of
   a work-related injury and therefore initiate treatment that is more applicable to the
   diagnosis, ultimately leading to a positive influence on cost and quality of treatment.

   In general, effective medical treatment guidelines serve to make the system operate more
   efficiently. Their utilization should have a positive impact on return to work, costs (both
   personal and monetary) of temporary or permanent disability, and in some cases,
   survival.

3. Probable costs to the agency and other agencies of the implementation and
   enforcement of the proposed rule and any anticipated effect on state revenues.

   No additional costs are anticipated.

4. Comparison of the probable costs and benefits of the proposed rules to the probable
   costs and benefits of inaction.

   Medical Treatment Guidelines required updating to ensure that treatment
   recommendations are reasonable and necessary. Recommendations on diagnostic and
   therapeutic interventions quickly become obsolete as medical technology advances. As
   the efficacies of interventions are explored through the medical literature, changes on

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   recommendations undoubtedly occur. New technologies may incur higher initial costs,
   but good-quality medical studies can demonstrate favorable treatment outcomes, which
   may enable the injured worker to return to work sooner or suffer reduced permanent
   impairments. Regularly updated medical treatment guidelines provide some important
   ‘tools’ for the public: 1) the ability to ensure reasonable and necessary care for the
   injured worker, 2) a guide for the healthcare provider on recommendations and standards
   of care for the individual patient, 3) a mechanism for the insurer to question and be
   informed of diagnosis and treatment procedures.

   There are two Workers’ Compensation Rules of Procedure that rely in part on updated
   treatment guidelines. Rule 16 (Utilization Standards) requires that medical care and
   treatment procedures that do not fall within the medical treatment guidelines be subject to
   prior authorization. Rule 10 (Medical Utilization Review) provides a vehicle in which
   the treatment rendered by a healthcare provider to a workers’ compensation claimant may
   be professionally reviewed on issues of whether such treatment is reasonable and
   necessary. Additionally, Rule 17 (Medical Treatment Guidelines), and Rule 18 (Medical
   Fee Schedule), are somewhat interdependent in that time parameters, frequencies, and
   terminology of the two rules should not conflict and create confusion.

5. Determination of whether there are less costly or less intrusive methods for
   achieving the purpose of the proposed rule.

   There were no known less costly or intrusive means to achieve the rule’s purpose.

6. Description of any alternative methods for achieving the purpose of the proposed
   rule that were seriously considered by the agency and the reasons they were rejected
   in favor of the proposed rule.

   The adoption of medical treatment guidelines is required by statute. Having treatment
   guidelines in place help to ensure reasonable and necessary care and also help to control
   costs. The updates to the treatment guidelines in this proposed rule are based on medical
   evidence and consensus.

   The Colorado Medical Treatment Guidelines have been referenced in the Official
   Disability Guidelines. They have been recommended in the Western Occupational and
   Environmental Medical Association Quarterly Newsletter (Spring, 2005). Other state
   Workers' Compensation systems have adopted some of the medical treatment guidelines,
   either in part or in their entirety. Such national stature is due in part to the regular
   updating of the medical treatment guidelines.

   Copies of the Notice of Public Hearing were provided to the:


   Colorado Association of School Boards
   Colorado Counties, Inc.
   Colorado Municipal League
   Special District Association of Colorado
   Colorado Hospital Association
   Colorado Association of Commerce and Industry
   Mountain States Employers Council
   Colorado Self-Insurers Association
   Colorado Medical Society


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