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Medical Services Review Board Nov. 9, 2006 minutes
Members present Beth Baker, M.D. Barbara Baum, MS PT Jeffrey Bonsell, D.C. Sharon Ellis, R.N. Michael Goertz, M.D. Rose Hatmaker Charles Hipp, M.D. Elizabeth Mangold William Martin, Esq. Reed Pollack Andrew Schmidt, M.D. Elizabeth Shogren, R.N. Andrea Trimble-Hart Members excused Robin Peterson, PT Jon Talsness, M.D. Members absent Philip Bachman, M.D. Gregory J. Hynan, D.C. Staff members present Kate Berger Penny Grev Julie Klejewski William Lohman, M.D. Julie Marquardt Philip Moosbrugger Visitors present Carolyn Blodgett, SFM Louise Montague, MOTA Sara Noznesky, MMA

1) Call to order, introductions, announcements Chairperson Beth Baker called the meeting to order at 4:02 p.m. A quorum was present. 2) Approval of the July 20, 2006 minutes A motion was made by Andrew Schmidt and seconded by Barbara Baum to approve the July 20, 2006, minutes as presented. All voted in favor of the motion and it passed. 3) Pay-for-performance initiative Dr. William Lohman reviewed the pay-for-performance project. The department has been contacting interested parties and will be having a series of informal meetings during the next couple of months, talking about the concept and models of pay-for-performance in workers' compensation. If any members are interested in attending, contact Debbie Caswell or Julie Klejewski at (651) 284-5018; they will incorporate you into the meetings being set up. The certified managed care plan groups have been scheduled and are meeting here at DLI Nov. 30; the provider association groups are meeting Nov. 28. The health systems and payer groups are being scheduled.

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Medical Services Review Board Minutes

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November 9, 2006

4) Draft rules for treatment parameters Lohman stated these draft rules are for discussion purposes and, basically, this is a draft of changes that improve the current rules from a procedural point of view in terms of clarifying cross-references and adding some definitions. The changes in the draft document shown as additions are underlined and deletions are crossed out. He reviewed a few high-points, listed below. • • Minnesota Rules 5221.6200, Subp. 3, F. (bottom of page 3 of 9) – a proposed expanded definition of what traction is. Minnesota Rules 5221.6200, Subp. 3, H. (top of page 4 of 9) – a similar elaboration of what manual therapy means; this incorporates the language used by the Medicare RBRBS schedule defining manual therapy. Those same changes about traction and manual therapy are made in each of the specific parameters – neck, upper back, low back and upper extremities, so they appear four times. Minnesota Rules 5221.6205, Subp. 1, I., 3 and 4 (bottom of page 4 of 9) – adding functional capacity evaluation back into the neck and upper back parameters, as it already exists in the others. Minnesota Rules 5221.6305, Subp. 1, A. (page 8 of 9) – reworked the definition of reflex sympathetic dystrophy so that the parameter applies if the diagnosis has been given and is uncontested, or if the criteria appears supporting the diagnosis.

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Baum expressed concern about the manual therapy language and whether it came from Medicare. She stated there is a contradiction in the CPT coding to include any form of message under manual therapy, because with CPT coding, one code is specific to massage and another is specific for manual therapy. Julie Marquardt indicated she can’t speak about where the actual language came from; however, she indicated the treatment parameters do not address coding and payment. Lohman indicated limitations are being added that currently do not exist, so the parameter can apply. Lohman summarized that if the board approves this draft to the department, the process would then begin to solicit comments from the public; those comments come to the board for final review. A motion was made by Charles Hipp and seconded by Trimble-Hart to move forward. All voted in favor and the motion passed. • Minnesota Rules 5221.6600 – Chronic Management Proposed Rules o Subp. 3. Long-term prescription of narcotic medication

Lohman pointed out that at the most recent MSRB meeting, the board approved the draft for circulation and comment. He stated the department would like to get a sense from the board of what needs to be done in response to the comments received so far and then staff members will work on the changes and send a final draft for one last vote. This will be done electronically as soon as it's available. The changes made to the draft will be clearly indicated by using color to show where they occurred. He distributed a grid of the comments that were received and reviewed each comment with the board members. Lengthy discussions followed. Lohman summarized that when he sends the electronic document to the board members for review and electronic vote, if they agree to everything so the department can say this is the MSRB’s

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recommendation, they should vote yes. If there is something they feel still needs further clarification and further discussion, vote no. o Draft rules – Subp. 1. Nonsteroidal anti-inflammatories

Lohman reviewed the draft with the board and stated this is the first time the board is seeing the document. Under item A, line 14, it was agreed to change “two-week” to “one-week.” Discussion followed, about using the term “brand” on line 17. Lohman stated they would look into the issue to see if there is a need to further define that term. Under item B, it was suggested to make it clear that this does not include refills. o Draft rules – Subp. 2. Muscle relaxants Lohman reviewed the draft with the board and stated this is the first time the board is seeing the document. It was agreed to change “two-week” to “one-week” on line 11 and also to add, on line 24, that there are no refills. o Draft rules – Subp. 3. Narcotic analgesics

Lohman reviewed the draft with the board and pointed out it only refers to all oral narcotics, not injectables. Lohman summarized he would like to address the changes the board has already identified and send each draft independently to the board for their yes or no vote. If the drafts are acceptable as written, the department will then disperse them for further comment. He pointed out that if, after contemplation about muscle relaxants, the vote is no, he would like the members to send him their ideas about how they would like to see it changed. 5) PPD issues Lohman pointed out the board had worked on a draft of changes to the PPD schedule in 1999 or 2000, and would now like to move forward on it. Most of the changes were typographical errors, omissions and cross-reference problems. However, there were four substantive issues on which the department is requesting advisement from the board. Lohman briefly reviewed all four issues and asked the board to take the documents, pass them around to constituents and prepare to discuss them, because these will be an agenda item at the next MSRB meeting.

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Issue 1 – 5223.0370 Subp. 4D and 4E; 5223.0380 Subp. 4D; 5223.0390, Subp. 4D and 4E – Radicular pain or paresthesia Issue 2 – 5223.0400 Subp. 6; 5223.0410, Subp. 7; 5223.0420, Subp. 6; 5223.0400, Subp. 6 – Reflex sympathetic dystrophy, causalgia and cognate conditions Issue 3 – 5223.0450, Subp. 3A and 3D – Chronic rotator cuff tear and acromioplasty Issue 4 – 5223.0470, Subp. 3A; 5223.0480, Subp. 2D – Arthroplasty and resection or implant

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November 9, 2006

Baker asked the board members whether they are interested in moving on to other treatment parameters. Hipp suggested opening the review of injections. There were no objections by other members. Baum asked if anything was coming that concerned the department or insurers. Lohman stated "injections" is an issue, "artificial discs" continues to arise, there is concern about traction and TENS technologies, especially on the pricing/fee schedule issue. There is a big interest in "implants"; however, it is more of a fee schedule issue, such as the enormous markups. Baker suggested reviewing implants after injections. Penny Grev introduced herself and stated she is attending on behalf of Patricia Todd. She gave the board an update that the department continues to work with a contractor on the work comp data-driven project and the effort is continuing. Baker asked for a motion to adjourn. A motion was made by Hipp and seconded by Baum to adjourn the meeting at 5:50 p.m. All voted in favor and the motion passed. Respectfully submitted,

Julie Klejewski
Julie Klejewski Executive Secretary