(a) Each network must adopt treatment guidelines, return-to-work
guidelines, and individual treatment protocols, which must be evidence-based,
scientifically valid, outcome-focused, and be designed to reduce inappropriate
or unnecessary health care while safeguarding access to necessary
care.
(b) An insurance carrier or network may not deny treatment
for a compensable injury solely because its treatment guidelines do
not specifically address the treatment or injury.
(c) A network must, through its quality improvement
program under §10.81 of this title (relating to Quality Improvement
Program), assure that all treatment guidelines, return-to-work guidelines,
and individual treatment protocols are made accessible to all network
providers. The network must contractually require providers to follow
treatment guidelines, return-to-work guidelines, and individual treatment
protocols pursuant to §10.42(b)(2) of this title (relating to
Network Contracts with Providers).
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