50-6-123 - Case management system for coordinating medical care services. - Tennessee Statutes

50-6-123. Case management system for coordinating medical care services.

(a)  The commissioner shall establish, pursuant to the commissioner's rule and regulation-making authority, a system of case management for coordinating the medical care services provided to employees claiming benefits under this chapter.

(b)  Employers may, at their own expense, utilize case management, and, if utilized, the employee shall cooperate with the case management. Case management shall include, but not be limited to:

     (1)  Developing a treatment plan to provide appropriate medical care services to an injured or disabled employee;

     (2)  Systematically monitoring the treatment rendered and the medical progress of the injured or disabled employee;

     (3)  Assessing whether alternate medical care services are appropriate and delivered in a cost-effective manner based on acceptable medical standards;

     (4)  Ensuring that the injured or disabled employee is following the prescribed medical care plan; and

     (5)  Formulating a plan for return to work with due regard for the employee's recovery and restrictions and limitations, if any.

(c)  The commissioner may contract with an independent organization, not owned by or affiliated with any carrier authorized to write workers' compensation insurance in the state, to assist with the administration of this section.

(d)  Nothing in this section shall prevent an employer from establishing its own program of case management that meets the guidelines promulgated by the commissioner in rules and regulations.

(e)  Medical care, treatment, therapy or services provided at the employee's residence pursuant to this chapter, shall not be considered home health services as defined in § 68-11-201 when provided pursuant to direction of the employee's attending physician in the following specific circumstances only:

     (1)  By a licensed health care provider who routinely provides services to employees at the place of employment, if the services rendered by the provider at the employee's residence are of the same type rendered by the provider at the place of employment; or

     (2)  By a licensed physical therapist, occupational therapist or speech therapist practicing independently of a home health agency, when the employee's attending physician determines that it is in the best interest of the employee to be treated by the independent therapist because of the therapist's expertise in workplace injuries.

[Acts 1992, ch. 900, § 7; 1996, ch. 944, § 9; 2001, ch. 148, § 1; 2004, ch. 962, §§ 28, 29.]