Rule Updates

Rules Under Development

Medical Aid Rules

Chapter 296-20, WAC

All updates for this rule:

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

The purpose of this rulemaking is to change Labor & Industries current rules related to Structured Intensive Multidisciplinary Programs (SIMP) for chronic, noncancer pain (WAC 296-20-12055 through 296-20-12095). The rules are currently inconsistent with the recent coverage decision made by the Washington State Health Technology Clinical Committee (HTCC) that lumbar fusion for uncomplicated degenerative disc disease (DDD) is not a covered procedure. HTCC made the coverage determination using an open and transparent process after considering the best available scientific evidence, agency utilization data, and public testimony regarding the safety, efficacy and cost-effectiveness of lumbar fusions for uncomplicated DDD. The HTCC made its final coverage determination January 15, 2016. Pursuant to RCW 70.14.120, participating agencies, which includes L&I, must comply with a determination of the HTCC. In addition to this rule change, the department will be reviewing the best available scientific evidence on the treatment of chronic pain, and will work with clinicians to develop and implement policies regarding new medical coverage decisions, medical treatment guidelines, and/or payment policies about chronic pain management. Program requirements are also contained in the fee schedule. Removing SIMP program requirements from rule will permit the department to be flexible and efficient when making these changes.762.

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 will be effective on 7/1/2016.744.

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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