Ala. Admin. Code r. 480-5-5-.31

Current through Register Vol. 42, No. 8, May 31, 2024

Section 480-5-5-.31 - Pain Management Program

(1) Pain management program services shall receive authorization from the employer/agent prior to providing services. No health care provider may refer the employee to another pain management program without prior authorization from the employer/agent.

(2)Billing Information

(a) Pain management programs shall use the appropriate billing forms as stated in Rule 480-5-5-.22 to bill for services rendered. Any attachment to billing forms shall be labeled with the claimant's name, identifying number and date of accident prior to submission to the carrier.

(b) Pain management program services shall be billed using a total or global charge concept. The bill shall include charges for the performance of the basic professional service and the normal range of essential, associated services provided to achieve the objective of the program. Licensed personnel, including physicians, serving as part of the interdisciplinary team, shall not bill separately for their services.

(c) Any physician or other provider serving on a consulting basis to the pain management program, whose services have been authorized by the employer/agent in addition to the interdisciplinary team's services, shall bill on the appropriate form as defined in Rule 480-5-5-.22.

(3) If a Pain Management Program is utilized it shall follow the guidelines of the Commission of Accreditation of Rehabilitation Facilities and shall include, but not be limited to, one or more of the following programs:

(a) Relaxation Response Training. Activity or exercise group;

(b) Neuromuscular Training/Motor Education. Instruction and/or experiential activities designed to enhance the individual's use of the body, with emphasis on function and movement;

(c) Behavioral Counseling. Clinical interaction aimed at enhancing the individual's perceptual, emotional and cognitive framework as it relates to the present level of dysfunction and there by minimizes its influence as an obstacle to rehabilitation;

(d) Job Simulation. The use of real or simulated work tasks to progressively improve the biomechanical, neuromuscular, cardio vascular/metabolic and psychosocial functions of the individual in preparation for return to competitive employment; and/or

(e) Musculoskeletal Management. Specific clinical intervention of dysfunction relevant to the individual's clinical picture. Emphasis should be on those aspects of dysfunction that are either impractical to self correct, or that the individual is unable to self correct through exercise, instruction, or other independent means.

Ala. Admin. Code r. 480-5-5-.31

New Rule: Filed August 9, 1996; effective September 13, 1996. Amended: Filed December 5, 2008; effective January 9, 2009.

Author: Workers' Compensation Medical Services Board

Statutory Authority:Code of Ala. 1975, § 25-5-293.