UPDATE (September 17, 2015)
The 2011 Legislature in HB 334 mandated the closure of medical benefits five years after date of injury and set up a process for workers' compensation claimants to petition the Department to reopen the closed medical benefits. Claims with a date of injury on or after July 1, 2011 will terminate the medical benefits effective July 1, 2016.
The Department has posted draft rules to implement the petition process and is seeking informal comments or questions from stakeholders. A formal rules promulgation process will be conducted in October with additional opportunity for public comment.
The Claims Assistance Bureau Chief, Bill Wheeler, will be making a presentation on the medical benefits closure/reopening process at the Governor's Conference on Workers' Compensation and Occupational Health at 1:30 pm on Wednesday, September 23.
Draft Rules: Petition to Reopen Five-Year Closure of Medical Benefits
Medical Regulations Unit
The Medical Regulations Unit is the primary liaison for the Department with providers, claims examiners and insurers who have questions, need assistance or require direction on all issues relating to the medical regulation of workers’ compensation claims, including medical fee schedules, utilization and treatment guidelines, and timely payments. The unit maintains and updates medical fee schedules for providers and payers and ensures access through a web based delivery system. The unit has a Medical Director, who is responsible for the maintenance, annual updates, distribution and training of the Montana Utilization and Treatment Guidelines. The Medical Director also performs independent medical reviews for denied services. The unit certifies injured workers for the Subsequent Injury Fund (SIF), applies the fee schedules to medical expenses, makes decisions on requested settlements as needed, manages the SIF fund balance, and authorizes payments for eligible SIF expenses.
Periodically the Department may post clarifications on the medical fee schedules. These can be located once the user has accepted the website usage permissions and logged into the site. See the Montana Facility Fee Schedule for the following clarification:
April 1, 2015: Facility Fee Schedule (outpatient) J1 Status Indicator
Professional Fee Schedule Modifier 59
For further information, please email or phone us at (406) 444-6604.
Work Comp Claims Assistance Bureau
PO Box 8011
Helena, MT 59604-8011
Dr. Carla Huitt, MD, MPH