Prior to appointment as a QME, a physician shall complete a
course of at least sixteen hours of instruction in disability evaluation report
writing. The course curriculum shall be specified by the Administrative
Director. Only report writing courses which are offered by education providers
as defined in subdivision
of Title
81(p) of Title 8 of the
California Code of Regulations shall qualify to satisfy this
requirement.
(a) An education provider
applicant shall submit:
(1) a completed QME
Form 118 (Application for Accreditation) (see, 8 Cal. Code Regs. §
118) which contains:
(A) the applicant's name; address; director
of education with contact information; type of organization; length of time in
business; nature of business; and past experience providing continuing
education courses (including a list of other accrediting agencies that have
approved such courses);
(B) a
description of the proposed education program or course which includes the
title; type (continuing education program or disability evaluation report
writing course); location(s); date(s); length of training in clock hours;
educational objectives; a complete description of the program or course
content; faculty; and the names of other accrediting agencies that have
approved the program.
(2) A curriculum vitae for each proposed
instructor. A proposed instructor shall have education and/or training and
recent work experience relevant to the subject of his/her or their
presentation.
(3) The application
for accreditation as an education provider, along with all required supporting
documents, shall be submitted to the Administrative Director, at least 60
calendar days before any public advertisement of the applicant's
course.
(b) The
Administrative Director shall accredit an applicant that: meets the definition
of an education provider; submits a completed, signed and dated application
which demonstrates past experience in providing continuing education programs;
and proposes a program which meets the requirements of section
55(b) or a course
which meets the requirements of section 11.5(a) and (i). The applicant must
demonstrate that adequate time is allocated to the curriculum set forth in
section 11.5(i) for the course to be approved by the Administrative Director.
Proposed content for continuing education program credit must relate directly
to disability evaluation or California workers' compensation-related medical
dispute evaluation. No credit shall be recognized by the Administrative
Director for material primarily discussing the business aspects of workers'
compensation medical practice, including but not limited to billing, coding and
marketing.
(c) The Administrative
Director shall notify the applicant within 20 calendar days after receipt of
the application containing all the information listed in section 11.5(a)
whether that education provider has been accredited for a two year period and
the proposed course has been approved. Incomplete applications will be returned
to the applicant.
(d) Each
education provider that has been accredited by the Administrative Director will
be given a number which must be displayed on course promotional
material.
(e) On or before the date
the course is first presented, the education provider shall submit the program
syllabus (all program handouts) to the Administrative Director.
(f) An approved course may be offered for two
(2) years. An accredited education provider shall notify the Administrative
Director in writing of any change to the faculty in an approved course. The
provider shall send the Administrative Director the program outline,
promotional material and faculty for each offering of the program at least 45
days prior to the date of the presentation of the program. The Administrative
Director may require submission of the program syllabi. The Administrative
Director may require changes in the program based on its review of the program
outline, program syllabi, promotional material or faculty if the Administrative
Director finds that any aspect of the program is not in compliance with these
regulations.
(g) To apply for
re-accreditation, the education provider applicant must submit a completed QME
Form 118 (Application for Accreditation) (see, 8 Cal. Code Regs. §
118), using the application process
in 11.5(a). The applicant may complete section
2 of the form using a new program
or course or one which was given by the applicant during the recent
accreditation period. The Administrative Director shall give the provider 90
days' notice of the need to seek re-accreditation.
(h) Promotional materials for a course must
state the education provider's educational objectives; the professional
qualifications of course faculty (at the least, all relevant professional
degrees); the content of course activities; and the intended
audience.
(i) The minimum of 16
hours of instruction in disability evaluation report writing shall include:
(1) The Qualified Medical Evaluator's Role in
the Disability Evaluation Process (minimum recommended 1 hour)
How disability evaluation reports are used
The reasons why reports must be clear, complete and
timely
The QME's role as an expert witness
Impact of the QME's report on the injured worker
QME ethics and the Confidentiality of Medical Information
Act
(2) Elements of the
Medical-Legal Report (minimum recommended 1 hour)
The Labor Code and regulatory requirements for
medical-legal reports
(3)
The Language of Reports (minimum recommended 4 hours)
Evaluation of disability in California (impairment and
disability)
The occupational history
The physician examination and the role of testing
The Medical Treatment Utilization Schedule (MTUS) adopted
by the Administrative Director pursuant to Labor Code section
5307.27, found
in section 9792.20
et seq of
Title 8 of the California Code of Regulations
Providing opinions that resolve disputed medical treatment
issues consistent with the evaluation criteria specified in section
of Title
835.5(d) of Title 8 of the
California Code of Regulations
Packard Thurber's Evaluation of Industrial Disability,
section 43 through
47 and section
of Title
89725 through
9727 of Title 8 of the California
Code of Regulations (for cases with dates of injury not subject to the AMA
guide-based impairment rating system, described below)
Factors of disability, including subjective and objective
factors, loss of pre-injury capacity and work restrictions, for cases involving
dates of injury not subject to the AMA guide-based impairment rating
system
Activities of Daily Living, for cases subject to the AMA
Guides
Work restrictions
Work Capabilities
American Medical Association, Guides to the Evaluation of
Permanent Impairment, [Fifth Edition] (AMA Guides) and its use in determining
permanent disability in accordance with the Schedule for Rating Permanent
Disabilities [effective January 1, 2005] (for all claims with dates of injury
on or after January 1, 2005, and for those compensable claims arising before
January 1, 2005, in which either there is no comprehensive medical-legal report
or no report by a treating physician indicating the existence of permanent
disability, or when the employer is not required to provide the notice to the
injured worker required by Labor Code section
4061)
Causation
Determination of permanent and stationary status
Apportionment including the requirements of Labor Code
sections
4660,
4663 and
4664 added by
SB 899 (Stats. 2004, ch. 34)
Future medical care
Review of records
Providing sufficient support for conclusions
(4) Instruction in anti-bias
training which meets the qualifications outlined in Regulation 11(h) (mandatory
minimum of at least 2 hours)
(5)
Instruction consisting of a review workers' compensation case law (minimum
recommended 2 hours)
(6) The
Administrative Director's Disability Evaluation Protocols (minimum recommended
1 hour)
An overview of the Neuromusculoskeletal, Pulmonary,
Cardiac, Immunologic, or Psychiatric protocols, and an in-depth discussion of
measurement of impairment, calculations and rationale for rating under the AMA
Guides, as relevant.
(7)
The Third Party Perspective (minimum recommended 1 hour)
The report from the perspective of those who read
it:
Judge(s), attorney(ies), insurer(s), rater(s), employer(s),
qualified rehabilitation representative(s).
(8) Anatomy of a Good Report (small group or
other interactive sessions -- minimum recommended 3 hours)
Discussion of examples of good reports and identification
of weaknesses in reports
Opportunities for the practitioner to critique and/or
correct reports.
If feasible, physician should have the opportunity to write
a sample report.
Review of results of Administrative Director's annual
report review and identification of common problems with reports.
(9) Mechanics of Report Writing
(minimum recommended 1 hour)
The QME Process
Face to face time
Timelines for submission of report
Completion of required forms
Service of reports
Final questions and answers
(10) Submission and Critique of Written
Medical/legal Report. As a condition of completion of the course taken to
satisfy the requirements of this section, each physician enrollee shall draft
at least one practice written medical/legal report, based on a sample case
library of materials, which written report shall be critiqued with notations by
the course education provider.
(j) All audio or video tapes, computer
programs and printed educational material used in the course must be submitted
to the Administrative Director on or before the date the course is first given.
Six (6) hours of instruction shall consist of in person or on site lecture,
didactic sessions and group discussion. Up to ten hours of instruction may be
completed by distance learning whenever the Administrative Director has
approved the submitted course prior to the first day the course is given. All
distance learning materials shall bear a date of release and shall be updated
yearly. The education provider shall notify the Administrative Director in
writing of the revision.
(k) No one
shall recruit members or promote commercial products or services in the
instruction room immediately before, during, or immediately after the
presentation of a course. Education providers or vendors may display/sell
educational materials related to workers' compensation or applications for
membership in an area adjoining a course. A course provider or faculty member
shall disclose on QME Form 119 (Faculty Disclosure of Commercial Interest)
(see, 8 Cal. Code Regs. §
119) any significant financial
interest held by faculty in or affiliation with any commercial product or
service which is discussed in a course and that interest or affiliation must be
disclosed to all attendees. An education provider shall file every Form 119 in
its possession with the Administrator Director.
(l) The provider shall maintain attendance
records for each disability evaluation report writing course for a period of no
less than three years after the course is given. A physician attending the
course must be identified by signature. The provider must submit a copy of the
signature list to the Administrative Director within 60 days of completion of
the course.
(m) The provider is
required to give the QME Evaluation Form 117 (Qualified Medical Evaluator
Continuing Education Response Form) (see, 8 Cal. Code Regs. §
117) to course attendees and
request they submit the form to the Administrative Director. This information
shall not be used in lieu of a certification of completion given by the
provider, as specified pursuant to section (n). Destruction by a provider or
its employee of a QME's Evaluation Form or failure by such provider or its
employee to distribute Form 117 as part of its course shall constitute grounds
for revocation of a provider's accredited status. The Administrative Director
shall tabulate the responses and return a summary to the provider within 90
days of completion of the course.
(n) The provider shall issue a certificate of
completion to the physician that states the name of the provider, the
provider's number, the date(s) and location and title of the course. To be
eligible for appointment as a QME, a physician must complete no less than 16
hours of the curriculum specified in Section 11.5(i) and must submit a copy of
that certificate to the Administrative Director.
(o) Joint sponsorship of courses (as between
an accredited and an unaccredited provider) must be approved by the
Administrative Director prior to presentation of the course.
(p) The Administrative Director may audit a
provider's course(s) at the request of the medical director to determine if the
provider meets the criteria for accreditation. The Administrative Director may
audit courses given by providers randomly, when a complaint is received, or on
the basis of responses on QME Form 117 (Qualified Medical Evaluator Continuing
Education Response Form) (see, 8 Cal. Code Regs. §
117). An auditor shall not receive
QME credit for auditing a course. The Administrative Director shall make
written results of the audit available to the provider no more than 30 days
after the audit is completed.
(q)
Accredited providers that cease to offer disability evaluation report writing
courses shall notify the Administrative Director in writing no later than 60
days prior to the discontinuing an approved course.
(r) The Administrative Director may withdraw
accreditation of a provider or deny such a provider's application for
accreditation on the following grounds (in addition to failure to meet the
relevant requirements of subsections 11.5(a):
(1) Conviction of a felony or any offense
substantially related to the activities of the provider.
(2) Any material misrepresentation of fact
made by the provider.
(3) Failure
to comply with Administrative Director regulations.
(4) False or misleading
advertising.
(5) Failure to comply
with Administrative Director's recommendations following an audit.
(6) Failure to distribute QME Form 117
(Qualified Medical Evaluator Continuing Education Response Form) (see, 8 Cal.
Code Regs. §
117) cards to course attendees.
NOTE: Forms referred to above are available at no charge by
downloading from the web at www.dir.ca.gov/dwc/forms.html or by
requesting at 1-800-794-6900.