WSR 16-22-065
PERMANENT RULES
DEPARTMENT OF
LABOR AND INDUSTRIES
[Filed November 1, 2016, 9:52 a.m., effective December 2, 2016]
Effective Date of Rule: Thirty-one days after filing.
Other Findings Required by Other Provisions of Law as Precondition to Adoption or Effectiveness of Rule: This rule making is in direct response to a noncoverage determination made by the Washington state health technology clinical committee (HTCC). Pursuant to RCW 70.14.080 and 70.14.120 participating agencies including department of labor and industries (L&I) must comply with an HTCC determination.
Purpose: Lumbar fusion - structured intensive multidisciplinary program (SIMP) for chronic noncancer pain rule making. Repeal all SIMP WAC 296-20-12055, 296-20-12060, 296-20-12065, 296-20-12070, 296-20-12075, 296-20-12080, 296-20-12085, 296-20-12090, and 296-20-12095.
The purpose of this rule making is to bring L&I's rules into compliance with a recent noncoverage determination by HTCC that lumbar fusion for uncomplicated degenerative disc disease (UDDD) is no longer a covered procedure. A previous HTCC determination required lumbar fusion candidates with UDDD to attend a SIMP prior to having surgery. That coverage determination is contained within the SIMP rules and is now inconsistent with this new HTCC noncoverage determination. SIMP program requirements are currently also contained within L&I'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policies and, other than removing the lumbar fusion for UDDD requirement, will remain in effect when the SIMP rules are repealed.
Citation of Existing Rules Affected by this Order: Repealing WAC 296-20-12055, 296-20-12060, 296-20-12065, 296-20-12070, 296-20-12075, 296-20-12080, 296-20-12085, 296-20-12090, and 296-20-12095.
Statutory Authority for Adoption: RCW 70.14.080, 70.14.120, 51.04.020, and 51.04.030.
Adopted under notice filed as WSR 16-15-075 on July 19, 2016.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 9.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 0, Repealed 0.
Date Adopted: November 1, 2016.
Joel Sacks
Director
REPEALER
The following sections of the Washington Administrative Code are repealed:
WAC 296-20-12055
Structured intensive multidisciplinary program (SIMP) for chronic noncancer pain.
WAC 296-20-12060
SIMP requirements for lumbar fusion and artificial disc replacement candidates.
WAC 296-20-12065
SIMP definitions.
WAC 296-20-12070
SIMP evaluation phase.
WAC 296-20-12075
SIMP treatment phase.
WAC 296-20-12080
SIMP follow-up phase.
WAC 296-20-12085
Requirements the SIMP provider must meet.
WAC 296-20-12090
Requirements the worker must meet for a SIMP.
WAC 296-20-12095
SIMP referral and prior authorization requirements.