Compliance Corner
What does it take for an injured worker in Rhode Island to receive palliative care? State regulations spell out the steps, as Simply Research subscribers know.
Here’s a look at those steps.
Glossary Check
“Palliative care” means the first 12 visits for medical services provided by a physician licensed by the State after maximum medical improvement has been attained. Palliative Care involves reasonable and necessary medical services in order to cure, rehabilitate or relieve an employee from the effects of his or her injury, including infrequent re-examination for prevention of further deterioration and follow-up examinations related to the administering of medications. Palliative Care does not include extensive diagnostic tests, comprehensive treatment programs, or frequent services of any type. Disputes as to the definition of “Palliative Care” are resolved by the Medical Advisory Board.
Additional Palliative Care
Additional palliative care beyond the 12 visits after the employee reaches maximum medical improvement, is conditioned on the authorization of the claim administrator (insurer, self-insured employer, third party administrator) upon the request of the employee’s treating physician (Medical Provider).
Requests
A request for additional palliative care shall be submitted to the claim administrator by the employee’s treating physician at least 10 working days prior to the delivery of the medical services and shall include:
1. Treatment plan, including nature and frequency of the proposed examinations
2. Measures to evaluate treatment plan’s objectives
3. Timetable for achieving objectives, including projected end date of treatment
4. Estimated total cost for the additional Palliative Care
The request for additional palliative care shall be submitted by the treating physician on a form prescribed by the Rhode Island Department of Labor and Training with a copy forwarded to the employee.
Response
Upon receipt of a request for additional palliative care, the claim administrator shall respond to the request in writing and forward a copy thereof to the RI Department of Labor and Training, Division of Workers’ Compensation, and the employee and his or her attorney within 10 working days of the receipt of the request. The response shall either approve, modify or deny said request and state the reasons in support of a modification or denial.
Disputes
In the event that a dispute exists regarding additional palliative care, either party may file a petition at the Workers’ Compensation Court pursuant to R.I. Gen. Laws 28-35-11.
