On May 4, 2020 the Minnesota Department of Labor and Industry (DLI) announced new Treatment Parameters for work-related post-traumatic stress disorder (PTSD). These new rules establish standards and procedures governing treatment for Minnesota workers' compensation PTSD claims. The new rules apply to all outpatient PTSD treatment after May 4, 2020, regardless of the date of injury. However, for employees who were treating for PTSD prior to the effective date of these rules, employers/insurers/TPAs must take certain steps prior to enforcing the rules. This article contains a brief discussion of the new Parameters, along with instructions for what employers/insurers/TPAs need to do now, and a link to the Parameters. We invite you to call or email our workers’ compensation attorneys with any questions.
The new rules provide detailed instructions for the diagnosis, evaluation, modalities, and medication for PTSD treatment. The rules also provide a helpful guide for those evaluating PTSD claims. Significant provisions include:
- A PTSD diagnosis must be made by a licensed psychologist or psychiatrist pursuant the criteria in the Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatric Association (DSM-5).
- Psychotherapy providers treating PTSD must prepare a detailed treatment plan using specific modalities identified in the new rules.
- If a provider wishes to use a modality not identified in the rules, they must give seven working days prior notice to the payer.
- Providers treating PTSD patients must provide a report of work ability to the patient once every two weeks.
- Initial psychotherapy treatment is limited to sixteen weeks. After the initial period of treatment, the provider must give the payer seven working days prior notice of an additional treatment period and provide a basis for the additional treatment.
- A payer must approve or deny the additional treatment period, schedule an IME, or request more information within seven working days of receiving prior notice from a provider.
- If a patient was receiving PTSD treatment prior to May 4, 2020, the payer must send the provider, the patient and the patient’s attorney (if any) written notice of the new PTSD treatment rules at least 90 before denying payment for failure to comply with the rules.
- A claimant may seek rare care exception status if provisions within the Rules and for departures from the Rules are not met.
A helpful checklist from DLI may be found here.
We recommend that employers/insurers/TPAs evaluate claims with current treatment for PTSD and send out notice, per the requirements in the Rule, of the intent to enforce the Rules. Again, this notice must be made in writing, sent to the patient, the provider and the attorney of record (if any) and must include a copy of the new Rules. Likewise, for all treatment commenced either before or after the effective date of the Rules, we recommend carefully monitoring treatment to make sure that it meets the requirements of the Rules.
Arthur Chapman’s Workers’ Compensation practice group is happy to answer any and all questions you may have about these new rules or any other workers' compensation concerns. Please call or email with any questions.
