The revisions state that a reimbursement request submitted by a physical therapist or occupational therapist must be accompanied by a prescription and approval of such requests are valid for no longer than 30 days. Approval of all other medical treatment reimbursement requests will be valid for no longer than six months. The proposal also adds three circumstances under which a managed care organization may dismiss a medical treatment reimbursement request, including: 1) the underlying claim has been disallowed or dismissed, or the only allowances in the underlying claim are for substantial aggravation of a preexisting condition and the condition has been determined to be in a non-payable status; 2) the services or supplies being requested are never covered by the bureau; and 3) the managed care organization requested supporting medical documentation from the physician of record or treating provider necessary to the managed care organization's evaluation and determination, and such documentation is not provided to the managed care organization. The bureau also proposed revisions to rules regarding payments for outpatient medication that address clinical issues of patient safety. The bureau proposed changes to a rule on the vocational rehabilitation provider fee schedule that include fee increases, elimination of services, new local codes, changes in definitions, and changes in units of service.
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June 20, 2011
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