2006 Minnesota Statutes

176.83 RULES.
    Subdivision 1. Generally. In addition to any other section under this chapter giving the
commissioner the authority to adopt rules, the commissioner may adopt, amend, or repeal rules
to implement the provisions of this chapter. The rules include but are not limited to the rules
listed in this section.
    Subd. 2. Rehabilitation. Rules necessary to implement and administer section 176.102,
including the establishment of qualifications necessary to be a qualified rehabilitation consultant
and the requirements to be an approved registered vendor of rehabilitation services.
The rules may also provide for penalties to be imposed by the commissioner against insurers
or self-insured employers who fail to provide rehabilitation consultation to employees pursuant to
section 176.102.
These rules may also establish criteria for determining "reasonable moving expenses" under
section 176.102.
The rules shall also establish criteria, guidelines, methods, or procedures to be met by an
employer or insurer in providing the initial rehabilitation consultation required under this chapter
which would permit the initial consultation to be provided by an individual other than a qualified
rehabilitation consultant. In the absence of rules regarding an initial consultation this consultation
shall be conducted pursuant to section 176.102.
    Subd. 3. Clinical consequences. Rules establishing standards for reviewing and evaluating
the clinical consequences of services provided by qualified rehabilitation consultants, approved
registered vendors of rehabilitation services, and services provided to an employee by health
care providers.
    Subd. 4. Excessive charges for medical services. Rules establishing standards and
procedures for determining whether or not charges for health services or rehabilitation services
rendered under this chapter are excessive. In this regard, the standards and procedures shall
be structured to determine what is necessary to encourage providers of health services and
rehabilitation services to develop and deliver services for the rehabilitation of injured employees.
The procedures shall include standards for evaluating hospital care, other health care and
rehabilitation services to insure that quality hospital, other health care, and rehabilitation is
available and is provided to injured employees.
    Subd. 5. Treatment standards for medical services. In consultation with the Medical
Services Review Board or the rehabilitation review panel, the commissioner shall adopt rules
establishing standards and procedures for health care provider treatment. The rules shall apply
uniformly to all providers including those providing managed care under section 176.1351. The
rules shall be used to determine whether a provider of health care services and rehabilitation
services, including a provider of medical, chiropractic, podiatric, surgical, hospital, or other
services, is performing procedures or providing services at a level or with a frequency that is
excessive, unnecessary, or inappropriate under section 176.135, subdivision 1, based upon
accepted medical standards for quality health care and accepted rehabilitation standards.
The rules shall include, but are not limited to, the following:
(1) criteria for diagnosis and treatment of the most common work-related injuries including,
but not limited to, low back injuries and upper extremity repetitive trauma injuries;
(2) criteria for surgical procedures including, but not limited to, diagnosis, prior conservative
treatment, supporting diagnostic imaging and testing, and anticipated outcome criteria;
(3) criteria for use of appliances, adaptive equipment, and use of health clubs or other
exercise facilities;
(4) criteria for diagnostic imaging procedures;
(5) criteria for inpatient hospitalization; and
(6) criteria for treatment of chronic pain.
If it is determined by the payer that the level, frequency or cost of a procedure or service of a
provider is excessive, unnecessary, or inappropriate according to the standards established by the
rules, the provider shall not be paid for the procedure, service, or cost by an insurer, self-insurer,
or group self-insurer, and the provider shall not be reimbursed or attempt to collect reimbursement
for the procedure, service, or cost from any other source, including the employee, another
insurer, the special compensation fund, or any government program unless the commissioner
or compensation judge determines at a hearing or administrative conference that the level,
frequency, or cost was not excessive under the rules in which case the insurer, self-insurer, or
group self-insurer shall make the payment deemed reasonable.
A rehabilitation provider who is determined by the Rehabilitation Review Panel Board, after
hearing, to be consistently performing procedures or providing services at an excessive level or
cost may be prohibited from receiving any further reimbursement for procedures or services
provided under this chapter. A prohibition imposed on a provider under this subdivision may
be grounds for revocation or suspension of the provider's license or certificate of registration
to provide health care or rehabilitation service in Minnesota by the appropriate licensing or
certifying body. The commissioner and Medical Services Review Board shall review excessive,
inappropriate, or unnecessary health care provider treatment under section 176.103.
    Subd. 5a. Reporting. Rules requiring insurers, self-insurers, and group self-insurers to report
medical and other data necessary to implement the procedures required by this chapter.
    Subd. 6. Certification of medical providers. Rules establishing procedures and standards
for the certification of physicians, chiropractors, podiatrists, and other health care providers in
order to assure the coordination of treatment, rehabilitation, and other services and requirements
of chapter 176 for carrying out the purposes and intent of this chapter.
    Subd. 7. Miscellaneous rules. Rules necessary for implementing and administering the
provisions of Minnesota Statutes 1990, section 176.131, Minnesota Statutes 1994, section
176.132, sections 176.238 and 176.239; sections 176.251, 176.66 to 176.669, and rules regarding
proper allocation of compensation under section 176.111. Under the rules adopted under section
176.111 a party may petition for a hearing before a compensation judge to determine the proper
allocation. In this case the compensation judge may order a different allocation than prescribed by
rule.
    Subd. 8. Change of provider. Rules establishing standards or criteria under which a
physician, podiatrist, or chiropractor is selected or under which a change of physician, podiatrist,
or chiropractor is allowed under section 176.135, subdivision 2.
    Subd. 9. Intervention. Rules to govern the procedure for intervention pursuant to section
176.361.
    Subd. 10. Joint rules. Joint rules with either or both the Workers' Compensation Court of
Appeals and the chief administrative law judge which may be necessary in order to provide for
the orderly processing of claims or petitions made or filed pursuant to this chapter.
    Subd. 11. Independent contractors. Rules establishing criteria to be used by the division,
compensation judge, and court of appeals to determine "independent contractor."
    Subd. 12. Compensation judge procedures. The chief administrative law judge shall adopt
rules relating to procedures in matters pending before a compensation judge in the Office of
Administrative Hearings.
    Subd. 13. Claims adjuster. The commissioner may adopt rules regarding requirements
which must be met by individuals who are employed by insurers or self-insurers or claims
servicing or adjusting agencies and who work as claims adjusters in the field of workers'
compensation insurance.
    Subd. 14.[Deleted, 1995 c 233 art 2 s 56]
    Subd. 15. Forms. The commissioner may prescribe forms and other reporting procedures to
be used by an employer, insurer, medical provider, qualified rehabilitation consultant, approved
vendor of rehabilitation services, attorney, employee, or other person subject to the provisions
of this chapter.
History: 1983 c 290 s 165; 1984 c 432 art 2 s 50; 1984 c 640 s 32; 1986 c 461 s 36; 1987
c 332 s 110-112; 1987 c 384 art 2 s 44; art 3 s 4; 1992 c 510 art 4 s 21,22; 1995 c 231 art 2 s
99; 1996 c 305 art 1 s 48; 1997 c 7 art 5 s 17