WSR 04-08-091

PROPOSED RULES

DEPARTMENT OF

LABOR AND INDUSTRIES

[ Filed April 6, 2004, 12:39 p.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 04-04-099.

Title of Rule: What are the general obligations of a provider who provides medical or mental health services to a crime victim?

Purpose: To clarify that all providers must comply with the department's rules and fee schedules. Mental health providers must also comply with the crime victims' compensation program mental health treatment rules and fees.

Statutory Authority for Adoption: RCW 7.68.030.

Statute Being Implemented: RCW 7.68.030.

Summary: WAC 296-30-081 (1)(a) instructs medical providers that they must comply with this chapter and the department's rules and fee schedules.

WAC 296-30-081 (1)(b) instructs mental health providers that they must comply with chapter 296-30 WAC and the crime victims' compensation program's mental health treatment rules and fees, chapter 296-31 WAC.

WAC 296-31-070(1) instructs mental health providers that they must comply with the crime victims' compensation program's mental health treatment rules and fees.

Reasons Supporting Proposal: This rule is needed to clarify that all providers must comply with the department's rules and fee schedules and mental health providers must comply with both the department's rules and the crime victims' compensation program's mental health treatment rules and fees.

Name of Agency Personnel Responsible for Drafting: Janice Deal, Tumwater, Washington, (360) 902-5369; Implementation and Enforcement: Cletus Nnanabu, Tumwater, Washington, (360) 902-5340.

Name of Proponent: Department of Labor and Industries, governmental.

Rule is not necessitated by federal law, federal or state court decision.

Explanation of Rule, its Purpose, and Anticipated Effects: Currently WAC 296-30-081 (1)(a) instructs medical providers that they must comply with this chapter and the department's rules and fee schedules.

Currently WAC 296-30-081 (1)(b) instructs mental health providers that they must comply with chapter 296-30 WAC and the crime victims' compensation program's mental health treatment rules and fees, chapter 296-31 WAC.

Currently WAC 296-31-070(1) instructs mental health providers that they must comply with the crime victims' compensation program's mental health treatment rules and fees, chapter 296-31 WAC.

This rule making is needed to clarify that all providers must comply with the department's rules and fee schedules, and for mental health providers both the department's rules and the crime victims' compensation program's mental health treatment rules and fees.

Proposal Changes the Following Existing Rules: It is being proposed that WAC 296-30-081 and 296-31-070 be amended to clarify that all providers must comply with the department's rules and fees. Mental health providers must also comply with the crime victims' compensation program's mental health treatment rules and fees. A new section is being added that instructs providers that they must submit a bill within one year of the date of service, date of claim allowance, or date of primary insurer's payment.

No small business economic impact statement has been prepared under chapter 19.85 RCW. In this case, the rule will not impose more than a minor cost on the provider business as the providers were always required to comply with the department's medical aid rules and fee schedules. The department's proposed amendment is only clarifying.

RCW 34.05.328 does not apply to this rule adoption. The department's proposed amendment to WAC 296-30-081 and 296-31-070 are only clarifying thus exempt from the requirements of RCW 34.05.328.

Hearing Location: Department of Labor and Industries, 7273 Linderson Way S.W., Tumwater, WA 98501-4520, on May 25, 2004, at 1:00 p.m.

Assistance for Persons with Disabilities: Contact Jill Short by May 3, 2004, at TDD (360) 902-4974.

Submit Written Comments to: Janice Deal, P.O. Box 44250, Olympia, WA 98504-4520, fax (360) 902-5333, e-mail deal235@lni.wa.gov, by 5:00 p.m. on June 1, 2004.

Date of Intended Adoption: July 2, 2004.

April 6, 2004

Paul Trause

Director

OTS-7021.1


AMENDATORY SECTION(Amending WSR 00-03-056, filed 1/14/00, effective 2/14/00)

WAC 296-31-070   What are my general obligations as an approved mental health provider?   (1) When treating a crime victim who comes under our jurisdiction, you agree to accept and comply with this chapter, the department's rules, and the Crime Victims Compensation Program's Mental Health Treatment Rules and Fee((s)) Schedule.

(2) You must inform the client they may be entitled to benefits under the Crime Victims Act and provide whatever assistance is necessary for the client to apply for benefits. There is no charge for these services.

(3) It is the responsibility of the client to notify the provider if they believe their condition is related to a criminal act. If you discover a condition that you believe is crime related, you must notify the client. It is your responsibility to determine if you are the first treating provider.

(4) If you are the first treating provider, you must:

(a) Provide crisis intervention as necessary;

(b) Provide instructions or help the client complete their portion of the application for benefits; and

(c) Continue necessary treatment according to our mental health rules if the client remains in your care.

(5) If you are not the first treating provider, you should ask the client if an application for benefits has been filed for the condition.

(a) If an application for benefits has been filed, and you and the client agree that a change of provider is desirable, the department should be notified of the transfer according to WAC 296-31-068.

(b) If an application for benefits has not been filed:

(i) Provide instructions or help the client complete their portion of the application for benefits; and

(ii) Include the name and address of the original provider, if known.


Note: Providers must determine if the client has public or private insurance benefits available. If there is, the provider should make sure they would be able to continue treating under the client's primary insurance. Crime victims compensation is secondary to other benefits according to RCW 7.68.130.

(6) You must notify us and the client of the date they are released to regular work. Time-loss compensation terminates on the release date. We may allow further treatment if:

(a) You request it;

(b) Treatment is needed; and

(c) The accepted condition is not fixed and stable.

(7) You must notify us if permanent functional impairment or loss (permanent partial disability) is indicated after maximum recovery of the accepted condition is achieved. We will arrange to have impairments rated according to WAC 296-20-200 et al.

(8) A client must not be billed for treatment, except under the following condition:

A provider may require the client to pay for treatment if the client's eligibility is in question (e.g., when an investigation or claim determination is pending). If the claim is subsequently allowed, the provider must refund the client in full and bill us at their usual and customary fees if such rates are in excess of the public and private insurance entitlements.

(9) No fee is payable by the department for missed appointments unless the appointment is for an examination arranged by the department. Clients may be billed directly for missed or no show appointments.

[Statutory Authority: RCW 7.68.030, 7.68.060, 7.68.080. 00-03-056, 296-31-070, filed 1/14/00, effective 2/14/00. Statutory Authority: RCW 7.68.030, 51.04.020(1) and 51.04.030. 95-15-004, 296-31-070, filed 7/5/95, effective 8/5/95. Statutory Authority: RCW 43.22.050. 92-23-033, 296-31-070, filed 11/13/92, effective 12/14/92.]

OTS-6866.1


AMENDATORY SECTION(Amending WSR 00-03-056, filed 1/14/00, effective 2/14/00)

WAC 296-30-081   What are the general obligations of a provider who provides medical or mental health services to a crime victim?   (1) When treating a crime victim who comes under our jurisdiction, you agree to accept and comply with the department's rules and fees.

(a) ((Medical)) All providers must comply with this chapter and the department's medical aid rules and fee schedules.

(b) Mental health providers must comply with this chapter, the department's medical aid rules and fee schedules, and the Crime Victims Compensation Programs Mental Health Treatment Rules and Fees.

(2) You must inform the victim of his or her rights under the Crime Victims Act and give whatever assistance is necessary for the victim to apply for compensation and provide proof of other matters required by our rules. Providers may not charge the victim for these services.

(3) Providers are urged to bill on a monthly basis. In order to be considered for payment, bills must be submitted within one year from the date of service, or the date of claim allowance. If private or public insurance exists, bills must be received within one year of the primary insurer's payment decision. You must attach a copy of the primary insurer's explanation of benefits when submitting your bill for payment consideration.

[Statutory Authority: RCW 7.68.030, 7.68.060, 7.68.080. 00-03-056, 296-30-081, filed 1/14/00, effective 2/14/00. Statutory Authority: RCW 7.68.030, 7.68.080, 7.68.120, 51.36.010, 51.04.020 (1) and (4) and 51.04.030. 99-07-004, 296-30-081, filed 3/4/99, effective 4/4/99. Statutory Authority: RCW 51.36.010, 7.68.030, 51.04.020 (1) and (4), 51.04.030, 7.68.080 and 7.68.120. 97-02-090, 296-30-081, filed 12/31/96, effective 1/31/97. Statutory Authority: RCW 7.68.030, 51.04.020(1) and 51.04.030. 95-15-004, 296-30-081, filed 7/5/95, effective 8/5/95. Statutory Authority: Chapter 7.68 RCW. 94-02-015, 296-30-081, filed 12/23/93, effective 1/24/94; 92-23-034, 296-30-081, filed 11/13/92, effective 12/14/92; 92-16-033, 296-30-081, filed 7/30/92, effective 8/30/92; 86-01-028 (Order 85-37), 296-30-081, filed 12/11/85.]

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