Nicole Matoushek PT MPH CSHE CEES
Posts: 739
Joined: January 15, 2005
From: St. Petersburg, FL
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Therapy Visit Cap in WC---follow up to Forum thread on Standardization of Care
Recent changes and challenges in the workers’ compensation laws in some states have had a negative impact on the rehabilitation industry. For example, in 2004, in effort to reduce worker’s compensation costs, California passed several workers’ compensation reform laws. These laws included the Senate Bill 899- a visit cap visits for occupational therapy services, and the Senate Bill 228 and Assembly Bill 227- a visit cap for physical therapy services. In addition to visit caps for therapy services, the reform laws now also require that physicians treating workers’ compensation patients utilize the clinical practice guidelines established by the American College of Occupational and Environmental Medicine (A.C.O.E.M.). These guidelines provide general therapy and medical treatment recommendations and are used by both physicians and insurance carriers to recommend and authorize rehabilitation services. Unfortunately, these reform laws have had an adverse effect on the rehab industry in California. According to a recent article published in ADVANCE for Occupational Therapy Practitioners, titled “Work Hardening, Changes in California Workers’ Comp regs are weighing heavily on OT” (1), the author reports the laws have resulted in fewer rehab treatments, more denied claims and longer waiting times for treatments. Furthermore, a study performed by the American Occupational Therapy Association reports: the number of OT treatments dropped by 35% from January to June of 2004,the number of denies claims increased from 1030 in 2003 to nearly 15, 000 in 2004 and the average waiting time for approvals went from 6 to 15 days from 2003 to 2004. In addition, the California Physical Therapy Association reports many therapy requests were denied in 2004, based on a narrow interpretation of the A.C.O.E.M. guidelines. Other states are expected to follow California’s lead with work comp reform.
(1)LaGrossa, J. :”Work Hardening: Changes in Workers’ Comp regs are weighting heavily on OT”, ADVANCE for Occupational Therapy Practitioners, Jan. 24, 2005, Vo. 21, No.2., 2005
(2) [URL=http://www.ergorehabinc.com]www.ergorehabinc.com[/URL]
Could the therapists in Cal and other states with WC visit caps/UR guidelines, share their experience following these changes and how this relates to the standardization of therapy?
Truly
Nicole
[URL=http://www.ergorehabinc.com]www.ergorehabinc.com[/URL]
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Nicole Matoushek, PT, MPH, CSHE, CEES
http://www.ErgoRehabinc.com
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