Treatment phase services may be provided for up to twenty consecutive days (excluding weekends and holidays) depending on individual needs and progress toward treatment goals. Each treatment day lasts six to eight hours. Services are coordinated and provided by an interdisciplinary team of physicians, psychologists, physical or occupational therapists, and may include nurses, vocational counselors, and care coordinators. Treatment must include all the following elements:
(1) Graded exercise: Progressive physical activities guided by a physical or occupational therapist that promote flexibility, strength, and endurance to improve function and independence;
(2) Cognitive behavioral therapy: Individual or group cognitive behavioral therapy with the psychologist, psychiatrist or psychiatric advanced registered nurse practitioner;
(3) Coordination of health services: Coordination and communication with the attending provider, claim manager, family, employer, and community resources as needed to accomplish the goals set forth in the treatment plan;
• For lumbar surgery candidates, communication and consultation with the spine surgeon is recommended;
(4) Education and skill development on the factors that contribute to pain, responses to pain, and effective pain management;
• For lumbar surgery candidates, this includes provision and review of a patient education aid, provided by the insurer, describing the risks associated with lumbar fusion;
(5) Tracking of pain and function: Individual medical assessment of pain and function levels using valid tests and instruments;
(6) Ongoing assessment of important associated conditions, medication tapering, and clinical assessment of progress toward goals; opioid and mental health issues can be treated concomitantly with pain management treatment;
(7) Performance of real or simulated work or daily functional tasks;
(8) SIMP vocational services may include instruction regarding workers' compensation requirements. Vocational services with return to work goals are needed in accordance with the return to work action plan when a vocational referral has been made;
(9) A discharge care plan for the worker to continue exercises, cognitive and behavioral techniques and other skills learned during the treatment phase;
(10) A report at the conclusion of the treatment phase that addresses all the following questions:
• To what extent did the worker meet his or her treatment goals?
• What changes, if any, have occurred in the worker's medical and psycho-social conditions, including dependence on opioids and other medications?
• What changes, if any, have occurred in the worker's pain level and functional capacity as measured by valid tests and instruments?
• What changes, if any, have occurred in the worker's ability to manage pain?
• What is the status of the worker's readiness to return to work or daily activities?
• What is the status of progress in achieving the goals listed in the return to work action plan, if applicable?
• How much and what kind of follow up care does the worker need?
• For lumbar surgery candidates, what is the worker's current expectation and interest in having surgery?
[Statutory Authority: RCW 70.14.120, 51.04.020, 51.04.030. 09-20-040, § 296-20-12075, filed 9/30/09, effective 11/1/09.]