§ 9792.27.17. Formulary -- Dispute Resolution.
8 CA ADC § 9792.27.17Barclays Official California Code of Regulations
8 CCR § 9792.27.17
§ 9792.27.17. Formulary -- Dispute Resolution.
Disputes over the medical necessity of pharmaceutical treatment covered by the MTUS Drug Formulary are governed by the utilization review and independent medical review provisions of Labor Code sections 4610, 4610.5, and regulations at section 9792.6.1 et seq, and section 9792.10.1 et seq.
Disputes over failure to follow formulary rules, other than medical necessity disputes covered by subdivision (a), shall be resolved through the procedure for non-IMR/IBR disputes set forth in WCAB rules, title 8, California Code of Regulations, section 10451.2, Determination of Medical Treatment Disputes.
Credits
Note: Authority cited: Sections 133, 4603.5, 5307.3, 5307.1 and 5307.27, Labor Code. Reference: Sections 4600, 4604.5, 5307.1, 5307.27 and 5307.29, Labor Code.
History
1. New section filed 12-7-2017; operative 1-1-2018 pursuant to Government Code section 11343.4(b)(3) (Register 2017, No. 49).
This database is current through 6/21/24 Register 2024, No. 25.
Cal. Admin. Code tit. 8, § 9792.27.17, 8 CA ADC § 9792.27.17
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