Current through Register Vol. XLI, No. 40, October 4, 2024
Section 85-28-9 - Standard for Medically Unsupported Treatment West Virginia Code Section § 23-4-3 c(a)(5) requires the Commission to establish criteria for determining whether a health care provider has made medically unsupported recommendations regarding a percentage of disability or has prescribed medically unsupported treatment, including medication. The criteria shall include, but not be limited to, the following:
9.1. Recommendations and treatment must be reflective of accepted standards of good practice, within the scope of practice of the provider's license or certification;9.2. Treatment must be curative or rehabilitative. Care must be of a type to cure the effects of a work-related injury or illness, or it must be rehabilitative. Curative treatment produces permanent changes which eliminate or lessen the clinical effects of an accepted condition. Rehabilitative treatment allows an injured or ill worker to regain functional activity in the presence of an interfering accepted condition. Curative and rehabilitative care produce long-term changes. On a case-by-case basis, the Commission may, in its sole discretion, authorize the use of treatment for conditions that are defined as long-term or chronic even though the treatment is not curative or rehabilitative;9.3. Treatment shall not be proposed or delivered primarily for the convenience of the claimant, the claimant's doctor, or any other provider;9.4. Treatment shall be provided in the most cost-effective manner and in the least intensive setting consistent with the other criteria set forth herein;9.5. Treatment shall not present hazards in excess of the expected medical benefits;9.6. Treatment which is controversial, obsolete, investigational or experimental will be subject to strict scrutiny by the Commission and must be pre-authorized by the Commission; and9.7. Recommendations regarding a percentage of disability shall reflect a consistent and correct application of the guidelines for the calculation of permanent partial disability as contained in the applicable rules of the Commission.