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Rules Under Development

Medical Aid Rules

Chapter 296-20, WAC

All updates for this rule:

Prescription Drug Program & Interchangeable Biologics (Chapter 296-20 WAC, Medical Aid Rules)

The purpose of this rulemaking is to update Chapter 296-20 WAC, Medical Aid Rules. This rulemaking will amend rules that are now inconsistent with Engrossed Senate Bill 5935 (Chapter 242, Laws of 2015), a new law related to interchangeable biologics, and new rule language from the Washington State Health Care Authority (HCA) related to the Washington State Prescription Drug Program (PDP). The proposed language will also incorporate by reference the provisions of the therapeutic interchange in HCA’s WAC 182-50-200. The proposed rule language will accomplish the following: - WAC 296-20-03011 will be amended to include new content regarding “interchangeable biologics” that is explicitly and specifically dictated by ESB 5935, now codified in statute in RCW 69.41.110. - Definitions in WAC 296-20-01002 will be amended to be consistent with recently amended definitions by the HCA regarding Washington State’s PDP. HCA definitions will be adopted without material change. - Language in WAC 296-20-03011 also will incorporate by reference the HCA’s rules for therapeutic alternatives and the therapeutic interchange. This will allow the department’s rules on this program to be consistent with HCA language now and for future HCA amendments.790.

5/15/2017

Public Hearing

5/15/2017

Comments Due

3/29/2017

PDF: Proposed Rulemaking (CR 102)

PDF: Proposed Rule Language

1/31/2017

PDF: Preproposal (CR-101)

Medical Aid Rules Update (WAC 296-20-135, WAC 296-23-220, WAC 296-23-230)

This rulemaking adopts amendments to update the Medical Aid Rules rates. Conversion factors provided in WAC 296-20-135 and maximum daily fees provided in WAC 296-23-220 and WAC 296-23-230 for certain professional health care services for injured workers are updated. Rule changes are necessary to maintain current overall fees for health care services, which are published annually in the Medical Aid Rules and Fee Schedules. These rules increase the resource based relative value scale (RBRVS), anesthesia conversion factors and the maximum daily caps to be consistent with the changes for other professional fees resulting from increases in the relative value units published by the Centers for Medicare and Medicaid Services. The changes were adopted 5/2/2017 and will be effective on 7/1/2017.786.

7/1/2017

Rule Changes Effective

5/2/2017

PDF: Adoption (Rule-Making Order CR-103)

PDF: Adopted Rule Language

3/29/2017

Public Hearing

3/29/2017

Comments Due

2/14/2017

PDF: Proposed Rulemaking (CR 102)

PDF: Proposed Rule Language

12/20/2016

PDF: Preproposal (CR-101)

Lumbar Fusion and Structured Intensive Multidisciplinary Program (SIMP) (Chapter 296-20 WAC - Medical Aid Rules)

The purpose of this rulemaking is to repeal the Structured Intensive Multidisciplinary Program (SIMP) rules, WACs 296-20-12055 through 296-20-12095, thereby bringing the Department’s rules into compliance with a recent coverage determination by the Washington State Health Technology Clinical Committee (HTCC). The HTCC made a determination that lumbar fusion for uncomplicated degenerative disc disease (UDDD) is no longer a covered procedure. Before this non-coverage determination was made, a previous HTCC determination required lumbar fusion candidates with UDDD to attend a SIMP prior to having surgery. This previous coverage determination is contained within the SIMP rules and is now inconsistent with this new HTCC non coverage determination. The Department’s payment policies, the lumbar fusion surgical guideline and a medical coverage decision have already been amended effective March 7, 2016 in response to the HTCC lumbar fusion for UDDD non-coverage determination. SIMP program requirements are currently also contained within the Department’s fee schedules’ payment policies and, other than removing the lumbar fusion for UDDD requirement, will remain in effect when the SIMP rules are repealed. The changes were adopted 11/1/2016 and became effective on 12/2/2016.762.

12/2/2016

Rule Changes Effective

11/1/2016

PDF: Adoption (Rule-Making Order CR-103)

PDF: Adopted Rule Language

8/26/2016

Public Hearing

8/26/2016

Comments Due

7/19/2016

PDF: Proposed Rulemaking (CR 102)

PDF: Proposed Rule Language

5/3/2016

PDF: Preproposal (CR-101)

Medical Aid Rules (WAC Chapters 296-20-135, 296-23-220, 296-23-230)

The purpose of this rulemaking is to update conversion factors provided in WAC 296-20-135 and maximum daily fees provided in WAC 296-23-220 and WAC 296-23-230 for certain professional health care services for injured workers. Rule changes are necessary to maintain current overall fees for health care services, which are published annually in the Medical Aid Rules and Fee Schedules. The changes were adopted 5/3/2016 and became effective on 7/1/2016.744.

7/1/2016

Rule Changes Effective

5/3/2016

PDF: Adoption (Rule-Making Order CR-103)

PDF: Adopted Rule Language

3/29/2016

Comments Due

3/23/2016

Public Hearing

2/16/2016

PDF: Proposed Rulemaking (CR 102)

PDF: Proposed Rule Language

12/22/2015

PDF: Preproposal (CR-101)

ICD Rules updates (WACs 296-20-125, 296-20-01002, 296-20-025, 296-20-03001, and 296-20-06101)

The rules changes are needed to ensure the agency is current in its use of the federally adopted diagnosis code set. Although L&I is not required to make these changes, the agency is doing so to decrease administrative burden on the provider community if and when the federal government adopts a new code set. If L&I does not make the change, providers would need to maintain dual billing systems to accommodate the outdated L&I billing model while they adhere to the federally adopted, industry standard code set used by other payers. The changes were adopted 8/18/2015 and became effective on 10/1/2015.728.

10/1/2015

Rule Changes Effective

8/18/2015

PDF: Adoption (Rule-Making Order CR-103)

PDF: Adopted Rule Language

7/27/2015

Comments Due

7/21/2015

Public Hearing

6/16/2015

PDF: Proposed Rulemaking (CR 102)

PDF: Proposed Rule Language

4/21/2015

PDF: Preproposal (CR-101)

Travel Expense Reimbursement (WAC 296-20-1103)

In response to a petition for rulemaking, Labor and Industries is adopting changes to amend the travel expense rule, WAC 296-20-1103, to better align with RCW 51.32.099(3)(e) regarding the reimbursement of the cost of transportation for a worker who is actively participating in a retraining plan. The changes were adopted 6/30/2015 and became effective on 8/1/2015.725.

8/1/2015

Rule Changes Effective

6/30/2015

PDF: Adoption (Rule-Making Order CR-103)

PDF: Adopted Rule Language

6/3/2015

Comments Due

6/2/2015

Public Hearing

4/21/2015

PDF: Proposed Rulemaking (CR 102)

PDF: Proposed Rule Language

2/17/2015

PDF: Preproposal (CR-101)

Medical Aid Rules Updates (WAC 296-20-135 Conversion Factors, WAC 296-23-220 Physical Therapy Rules, WAC 296-23-230 Occupational Therapy Rules)

The affected rules describe elements used in the process of updating the maximum allowable payments for most professional health care services. These elements are set in rule in order to follow the established methodologies of L&I and maintain consistency with the Health Care Authority and Medicaid Purchasing Administration. The changes were adopted 4/21/2015 and became effective on 7/1/2015.722.

7/1/2015

Rule Changes Effective

4/21/2015

PDF: Adoption (Rule-Making Order CR-103)

PDF: Adopted Rule Language

3/31/2015

Comments Due

3/24/2015

Public Hearing

2/17/2015

PDF: Proposed Rulemaking (CR 102)

PDF: Proposed Rule Language

12/23/2014

PDF: Preproposal (CR-101)

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