PERMANENT RULES
LABOR AND INDUSTRIES
Purpose: This rule relates to crime victim's compensation, provider obligations, WAC 296-30-081 and 296-31-070. This rule adoption:
• Clarifies the requirement that mental health providers must comply with department rules.
• Clarifies that mental health providers must comply with crime victim treatment rule; and
• Amends the rules to now require mental health providers to bill within one year of date of service, date of claim allowance, or date of denial from primary insurance.
Citation of Existing Rules Affected by this Order: Amending WAC 296-30-081 and 296-31-070.
Statutory Authority for Adoption: RCW 7.68.030.
Adopted under notice filed as WSR 04-08-091 on April 6, 2004.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 2, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 2, Repealed 0.
Date Adopted: July 2, 2004.
Joel Sacks
for 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. |
(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.]