52-4-3. Case management.
236 words·~1 min read·
/nm/chapter-52-workers-compensation/article-4-health-care-providers/52-4-3·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
A. The director shall establish a system of case management for coordinating the health care services provided to workers claiming benefits under the Workers' Compensation Act [Chapter 52, Article 1 NMSA 1978] or the New Mexico Occupational Disease Disablement Law [52-3-1 NMSA 1978].
B. As used in this section, "case management" means the ongoing coordination of health care services provided to an injured or disabled worker, including but not limited to:
(1)developing a treatment plan to provide appropriate health care services to an injured or disabled worker;
(2)systematically monitoring the treatment rendered and the medical progress of the injured or disabled worker;
(3)assessing whether alternate health care services are appropriate and delivered in a cost-effective manner based on acceptable medical standards;
(4)ensuring that the injured or disabled worker is following the prescribed health care plan; and
(5)formulating a plan for return to work.
C. The director shall contract with an independent organization to assist with the administration of the provisions of this section.
D. Nothing in this section shall prevent an employer from establishing his own program of case management; however, for the purposes of resolving choice of health care provider disputes, an employer or worker shall only use the program as provided by the workers' compensation administration, as set forth in Section 52-1-49 NMSA 1978.
History: 1978 Comp., § 52-4-3, enacted by Laws 1990 (2nd S.S.), ch. 2, § 51.