WORKERS' COMPENSATION AND OCCUPATIONAL DISEASE

24.29.1566 PHYSICIAN FEES -- ANESTHESIA SPECIALTY AREA FOR SERVICES PROVIDED FROM APRIL 1, 1993, THROUGH DECEMBER 31, 2007 (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-704, MCA History: NEW, 1993 MAR p. 404, Eff. 4/1/93; AMD, 1994 MAR p. 680, E…

24.29.1571 CHIROPRACTIC FEES FOR SERVICES PROVIDED FROM APRIL 1, 1993 THROUGH JUNE 30, 2002 (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-704, MCA History: NEW, 1993 MAR p. 404, Eff. 4/1/93; AMD, 1993 MAR p. 1659, Eff. 8/1/93; AMD, 1994 MAR p. 6…

24.29.1572 CHIROPRACTIC FEES FOR SERVICES PROVIDED FROM JULY 1, 2002, THROUGH DECEMBER 31, 2007 (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-704, MCA History: NEW, 2002 MAR p. 1758, Eff. 7/1/02; AMD, 2007 MAR p. 1670, Eff. 10/26/07; REP, 2018 M…

24.29.1573 PRIOR AUTHORIZATION AND BILLING LIMITATIONS FOR CHIROPRACTIC SERVICES PROVIDED FROM JULY 1, 2002, THROUGH DECEMBER 31, 2007 (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-704, MCA History: NEW, 2002 MAR p. 1758, Eff. 7/1/02; AMD, 2007 …

24.29.1574 CHIROPRACTIC FEE SCHEDULE FOR SERVICES PROVIDED FROM JANUARY 1, 2008, THROUGH JUNE 30, 2011 (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-704, MCA History: NEW, 2007 MAR p. 1670, Eff. 10/26/07; AMD, 2011 MAR p. 1137, Eff. 6/24/11; REP…

24.29.1575 CHIROPRACTIC--PRIOR AUTHORIZATION AND BILLING LIMITATIONS FOR SERVICES PROVIDED FROM JANUARY 1, 2008, THROUGH JUNE 30, 2011 (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-704, MCA History: NEW, 2007 MAR p. 1670, Eff. 10/26/07; AMD, 201…

24.29.1581 PROVIDER FEES--OCCUPATIONAL AND PHYSICAL THERAPY SPECIALTY AREA FOR SERVICES PROVIDED FROM APRIL 1, 1993 THROUGH JUNE 30, 2002 (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-704, MCA History: NEW, 1993 MAR p. 404, Eff. 4/1/93; AMD, 199…

24.29.1582 PROVIDER FEES--OCCUPATIONAL AND PHYSICAL THERAPY SPECIALTY AREA FOR SERVICES PROVIDED FROM JULY 1, 2002 THROUGH SEPTEMBER 30, 2003 (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-704, MCA History: NEW, 2002 MAR p. 1758, Eff. 7/1/02; AMD…

24.29.1583 PRIOR AUTHORIZATION AND BILLING LIMITATIONS FOR SERVICES PROVIDED BY OCCUPATIONAL THERAPISTS AND PHYSICAL THERAPISTS FROM JULY 1, 2002, THROUGH DECEMBER 31, 2007 (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-704, MCA History: NEW, 200…

24.29.1584 PROVIDER FEES--OCCUPATIONAL AND PHYSICAL THERAPY SPECIALTY AREA FOR SERVICES PROVIDED FROM OCTOBER 1, 2003, THROUGH DECEMBER 31, 2007 (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-704, MCA History: NEW, 2007 MAR p. 260, Eff. 2/23/07; …

24.29.1585 OCCUPATIONAL AND PHYSICAL THERAPY FEE SCHEDULE FOR SERVICES PROVIDED FROM JANUARY 1, 2008, THROUGH JUNE 30, 2011 (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-704, MCA History: NEW, 2007 MAR p. 1670, Eff. 10/26/07; AMD, 2011 p. 1137, …

24.29.1586 OCCUPATIONAL AND PHYSICAL THERAPISTS--PRIOR AUTHORIZATION AND BILLING LIMITATIONS FOR SERVICES PROVIDED FROM JANUARY 1, 2008, THROUGH JUNE 30, 2011 (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-704, MCA History: NEW, 2007 MAR p. 1670,…

24.29.1601 DEFINITIONS As used in this subchapter, the following definitions apply: "Claim" means an injury or occupational disease where: liability has been accepted by the insurer; or payment has been made by the insurer pursuant to: 39-71-608, MCA; 39-71-615, MCA; or any other…

24.29.1604 APPLICABILITY OF UTILIZATION AND TREATMENT RULES The following rules are subject to the applicability provisions of this rule: ARM 24.29.1611; ARM 24.29.1621; ARM 24.29.1641; and ARM 24.29.1609. The rules identified in (1) apply to: injuries that occurred on or before …

24.29.1607 APPLICABILITY OF FORMULARY RULES TO OUT-PATIENT SERVICES The provisions of these formulary rules apply to all claims arising on or after April 1, 2019, but only with respect to outpatient services. For claims arising before April 1, 2019, which are referred to as "lega…

24.29.1609 APPLICABILITY OF UTILIZATION AND TREATMENT GUIDELINES FOR MANAGED CARE ORGANIZATIONS OR PREFERRED PROVIDER ORGANIZATIONS Managed care organizations or preferred provider organizations providing any treatment for primary and secondary medical services to an injured work…

24.29.1611 UTILIZATION AND TREATMENT GUIDELINES The department adopts the utilization and treatment guidelines provided by this rule to set forth the level and type of care for primary and secondary medical services. As provided by 39-71-704, MCA, there is a rebuttable presumptio…

24.29.1616 INCORPORATION BY REFERENCE AND UPDATES TO THE FORMULARY The department will annually undertake formal rulemaking to select a formulary. The formulary may be any one of the following: a formulary published by a commercial vendor; a formulary published by another state f…

24.29.1621 PRIOR AUTHORIZATION Prior authorization must be obtained in cases where treatment(s) or procedure(s) are requested that: are not specifically addressed or recommended by the Montana Guidelines for a body part that is covered by a guideline or for body parts not covered…

24.29.1624 INTEGRATION OF FORMULARY WITH MONTANA UTILIZATION AND TREATMENT GUIDELINES – WHEN PRIOR AUTHORIZATION IS REQUIRED The formulary is considered to be a part of the Montana Guidelines established by the department. A medical provider is expected to write a prescription fo…

24.29.1631 SPECIAL PROVISIONS FOR TRANSITION OF LEGACY CLAIMS – WHEN APPLICABLE The insurer shall notify in writing the injured worker and the treating physician (who, for the purposes of this rule, also includes any other prescribing medical provider) that a claim constitutes a …

24.29.1641 INDEPENDENT MEDICAL REVIEW PROCESS An interested party who has requested and been denied authorization by the insurer for treatment, or an insurer, may request an independent medical review by the medical director designated by the department prior to mediation under 3…

24.29.1645 EXPEDITED CASE REVIEW FOR PRESCRIPTION MEDICATIONS BY DLI MEDICAL DIRECTOR Expedited case review is available only when insurer declines to authorize further dispensing of an already prescribed medication and halting the supply of that medication appears likely to resu…

24.29.1648 DISPUTE RESOLUTION FOR FORMULARY Disputes between the treating physician and the insurer regarding the formulary are subject to the same process available for other disputes regarding the Montana Guidelines, except as provided in ARM 24.29.1645. A dispute between the i…

24.29.1701 REHABILITATION PROVIDER DESIGNATION (REPEALED) (REPEALED) Authorizing statute(s): Sec. 39-71-203, MCA Implementing statute(s): Sec. 39-71-1014, 39-71-1015, and 39-71-1023, MCA History: NEW, 1987 MAR p. 1988, Eff. 10/30/87; REP, 2024 MAR p. 1066, Eff. 5/11/24.

24.29.1702 REHABILITATION PANELS FOR CLAIMS BETWEEN JULY 1, 1987 AND JUNE 30, 1991 (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-1015, 39-71-1016, 39-71-1017, 39-71-1018, 39-71-1019, MCA History: NEW, 1987 MAR p. 1988, Eff. 10/30/87; AMD, 2013 M…

24.29.1705 LOCAL JOB POOL AREA DEFINITION (REPEALED) (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-1011, 39-71-1012, MCA History: NEW, 1987 MAR p. 1988, Eff. 10/30/87; REP, 2024 MAR p. 1066, Eff. 5/11/24.

24.29.1710 AUXILIARY REHABILITATION BENEFITS A claimant may request auxiliary rehabilitation benefits and must obtain the insurer's authorization prior to incurring such expenses. Mileage and per diem expenses may be paid for up to five round trips in searching for new employment…

24.29.1721 PAYMENT OF REHABILITATION EXPENSES FROM THE INDUSTRIAL ACCIDENT REHABILITATION ACCOUNT FOR CLAIMS ARISING BEFORE JULY 1, 1991 (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): Title 39, chap. 71, part 10, MCA (1987) (1989) and (1991) History: N…

24.29.1722 PAYMENT OF REHABILITATION EXPENSES FROM THE INDUSTRIAL ACCIDENT REHABILITATION ACCOUNT FOR CLAIMS ARISING ON OR AFTER JULY 1, 1991 AND BEFORE JULY 1, 1997 (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): Title 39, chap. 71, part 10, MCA Histor…

24.29.1725 INFORMATION TO BE INCLUDED IN THE REHABILITATION PLAN The rehabilitation plan must include the following information: plan objectives that summarize the type and duration of the training agreed to by the parties. It should include where the claimant will receive the tr…

24.29.1727 DEPARTMENT'S NOTICE OF AUTHORIZATION OR DENIAL OF USE OF TRUST FUNDS (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): Title 39, chap. 71, part 10, MCA History: NEW, 1998 MAR p. 2872, Eff. 11/1/98; REP, 2018 MAR p. 2527, Eff. 1/1/19.

24.29.1731 ALLOWABLE REHABILITATION EXPENSES (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): Title 39, chapter 71, part 10, MCA History: NEW, 1998 MAR p. 2872, Eff. 11/1/98; REP, 2018 MAR p. 2527, Eff. 1/1/19.

24.29.1733 DISALLOWED REHABILITATION EXPENSES (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): Title 39, chapter 71, part 10, MCA History: NEW, 1998 MAR p. 2872, Eff. 11/1/98; AMD, 2000 MAR p. 2701, Eff. 10/6/00; REP, 2018 MAR p. 2527, Eff. 1/1/19.

24.29.1735 DOCUMENTATION REQUIRED (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): Title 39, chapter 71, part 10, MCA History: NEW, 1998 MAR p. 2872, Eff. 11/1/98; REP, 2018 MAR p. 2527, Eff. 1/1/19.

24.29.1737 INSURER RESPONSIBILITY TO PROVIDE INFORMATION TO THE DEPARTMENT (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): Title 39, chap. 71, part 10, MCA History: NEW, 1998 MAR p. 2872, Eff. 11/1/98; REP, 2018 MAR p. 2527, Eff. 1/1/19.

24.29.1741 PAYMENT OF REHABILITATION EXPENSES The insurer must pay for tuition, fees, books, supplies, and equipment which are a prerequisite for the retraining and required by the provider of the training. Unless otherwise agreed upon by the insurer and the claimant, the insurer…

24.29.1761 DISPUTES OVER REHABILITATION EXPENSES (REPEALED) (REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): Title 39, chap. 71, part 10, MCA History: NEW, 1998 MAR p. 2872, Eff. 11/1/98; REP, 2024 MAR p. 1066, Eff. 5/11/24.

24.29.1801 DEFINITIONS As used in this subchapter, the following definitions apply: "Injured worker" means an individual who has filed a claim for a workers' compensation injury or occupational disease and who does not meet the definition of a disabled worker. "Insurer" means an …

24.29.1803 APPLICABILITY SAW/RTW assistance, pursuant to this subchapter, is applicable to workers who experience a work-related injury or occupational disease on or after July 1, 2012. Authorizing statute(s): 39-71-203, 39-71-1051, MCA Implementing statute(s): 39-71-105, 39-71-1…

24.29.1807 RESPONSIBILITIES OF THE INSURER Each insurer shall adopt a SAW/RTW policy and submit a current, complete copy of the policy to the department. The insurer shall provide the department with all SAW/RTW policy updates a minimum of ten business days in advance of implemen…

24.29.1811 DUTIES OF THE DEPARTMENT An injured worker is eligible for SAW/RTW assistance upon receipt by the department of a request for assistance from the injured worker, employer or health care provider. When the department is unable to identify the insurer within three busine…

24.29.1815 PAYMENT SCHEDULE FOR DEPARTMENT-PROVIDED SAW/RTW ASSISTANCE The department shall pay vocational rehabilitation counselors for SAW/RTW services in accordance with the following fee schedule: a maximum of $90 per hour for services provided, billed in 1/10 hour increments…

24.29.1821 VOCATIONAL REHABILITATION COUNSELOR FOR DEPARTMENT-PROVIDED SAW/RTW ASSISTANCE When the department provides SAW/RTW assistance, the department shall assign a vocational rehabilitation counselor to provide services to each eligible injured worker. The department shall s…

24.29.2001 TREATMENT AND REPORTING (IS HEREBY REPEALED) Authorizing statute(s): 39-71-203, MCA Implementing statute(s): 39-71-203, 39-71-604 and 39-71-704, MCA History: Eff. 12/31/72; AMD, 1990 MAR p. 2183, Eff. 12/14/90; REP, 1993 MAR p. 404, Eff. 4/1/93.