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Medical Treatment Guidelines

MEDICAL TREATMENT GUIDELINES

INTRODUCTION

The Commissioner of the Kentucky Department of Workers’ Claims (DWC) has promulgated an administrative regulation (803 KAR 25:260) adopting the ODG by MCG Health treatment guidelines for use in the treatment of work-related injuries and occupational diseases. The adoption of treatment guidelines was mandated by House Bill 2 of the 2018 session of the General Assembly. Treatment options in the guidelines are generally designated as either “Recommended,” “Not Recommended,” or “Conditionally Recommended.” Treatment designated as “Recommended” does not require preauthorization and is presumed reasonable and necessary. When a medical provider seeks preauthorization for treatment designated as “Conditionally Recommended” or “Not Recommended,” the medical payment obligor must consider any sound medical reasoning submitted by the provider in support of that treatment.

The treatment guidelines are available by subscription at www.odgbymcg.com.

A training webinar co-presented by ODG by MCG and the Department of Workers’ Claims is available here.

The treatment guideline regulation, 803 KAR 25:260, is available online at https://apps.legislature.ky.gov/law/kar/803/025/260.pdf.

Contact Information

For more information about the formulary regulation contact Lucretia Johnson at 800-554-8601 or Scott.Wilhoit@ky.gov.

Support and training is also available through the ODG Helpdesk at 800-488-5548 or online at odghelp@mcg.com.