WSR 05-18-058

PROPOSED RULES

DEPARTMENT OF

LABOR AND INDUSTRIES

[ Filed September 6, 2005, 10:10 a.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 05-15-134.

Title of Rule and Other Identifying Information: Special equipment rental and purchase prosthetic and orthotics equipment, WAC 296-20-1102.

Hearing Location(s): Department of Labor and Industries, 7273 Linderson Way S.W., Tumwater, WA 98501, on October 11, 2005, at 10:00 a.m.

Date of Intended Adoption: November 22, 2005.

Submit Written Comments to: John Elshaw, P.O. Box 44322, Olympia, WA 98504-4322, e-mail elsj235@wa.lni.wa.gov [elsj235@lni.wa.gov], fax (360) 902-4249, by October 4, 2005.

Assistance for Persons with Disabilities: Contact John Elshaw by October 4, 2005, TTY (360) 902-5797 or fax (360) 902-4249.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: This change is being proposed as to not violate WAC 296-20-1102 when oxygen equipment is rented for an extended period of time and the total rental fees would exceed the purchase price of the equipment. Also the change will bring the Department of Labor and Industries in line with normal industry and CMS standards, specifically, providing oxygen equipment primarily on a rental basis.

Reasons Supporting Proposal: Under this proposal certain types of oxygen equipment would be exempt from the following requirement: "In no case will the department or self-insurer pay for rental fees once the purchase price of the rented item has been reached." If an injured worker is on long-term or lifetime oxygen therapy, eventually rental fees will equal or exceed the purchase price of the equipment. If the equipment is then owned by the patient, maintenance fees, accessories, oxygen refills, etc. will still be billed on a recurring basis. Additionally, there is no guarantee that the now owned equipment is a new item and not part of the supplier's "rental fleet." This proposed amendment will benefit the injured worker, especially those on long-term or lifetime oxygen therapy. One monthly rental charge will insure an uninterrupted supply of oxygen equipment, maintenance services and accessories in addition to the reduced administrative burden for providers and labor and industries. Liability for equipment breakdown and replacement is with the provider and not labor and industries. As technology is upgraded it is anticipated that the supplier will upgrade their rental fleet also insuring the injured worker has up-to-date equipment.

Statutory Authority for Adoption: RCW 51.04.020 and 51.04.030.

Statute Being Implemented: Chapter 51.36 RCW.

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

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

Name of Agency Personnel Responsible for Drafting: John Elshaw, Tumwater, Washington, (360) 902-5131; Implementation and Enforcement: Robert Malooly, Assistant Director, Tumwater, Washington, (360) 902-4209.

No small business economic impact statement has been prepared under chapter 19.85 RCW. The proposed rule will not impose more than minor costs on business in an industry. RCW 19.85.030 (1)(a), and the rule is exempt from conducting a small business economic impact statement because it merely clarifies the language of the rule. RCW 34.05.310 (4)(d).

A cost-benefit analysis is not required under RCW 34.05.328. The rule is exempt from conducting a cost-benefit analysis because it merely clarifies the language of the rule, RCW 34.05.328 (5)(b)(iv).

September 6, 2005

Gary Weeks

Director

OTS-8224.1


AMENDATORY SECTION(Amending WSR 93-16-072, filed 8/1/93, effective 9/1/93)

WAC 296-20-1102   Special equipment rental and purchase prosthetic and orthotics equipment.   The department or self-insurer will authorize and pay rental fee for equipment or devices if the need for the equipment will be for a short period of treatment during the acute phase of condition. Rental extending beyond sixty days requires prior authorization. If the equipment will be needed on long term basis, the department or self-insurer will consider purchase of the equipment or device. The department's or self-insurer's decision to rent or purchase an item of medical equipment will be based on a comparison of the projected rental costs of the item with its purchase price. An authorized representative of the department or self-insurer will decide whether to rent or purchase certain items, provided they are appropriate and medically necessary for treatment of the worker's accepted industrial condition. Decisions to rent or purchase items will be based on the following information:

(1) Purchase price of the item.

(2) Monthly rental fee.

(3) The prescribing doctor's estimate of how long the item will be needed.

The prescribing doctor must obtain prior authorization from the department or self-insurer, for rental or purchase of special equipment or devices. Also, all equipment (rentals and purchases), prosthetics, and orthotics must be billed using the appropriate codes, and billing forms, as determined by the medical aid rules and fee schedules.

The department or self-insurer will authorize and pay for prosthetics and orthotics as needed by the worker and substantiated by attending doctor. If such items are furnished by the attending doctor, the department or self-insurer will reimburse the doctor his cost for the item. See chapter 296-20 WAC (including WAC 296-20-124) and the fee schedules for information regarding replacement of such items on closed claims.

The department or self-insurer will repair or replace originally provided damaged, broken, or worn-out prosthetics, orthotics, or special equipment devices upon documentation and substantiation from the attending doctor.

Provision of such equipment requires prior authorization.

THE GRAVITY GUIDING SYSTEM, GRAVITY LUMBAR REDUCTION DEVICE, BACKSWING AND OTHER INVERSION TRACTION EQUIPMENT MAY ONLY BE USED IN A SUPERVISED SETTING. RENTAL OR PURCHASE FOR HOME USE WILL NOT BE ALLOWED NOR PAID BY THE DEPARTMENT OR SELF-INSURER.

EQUIPMENT NOT REQUIRING PRIOR AUTHORIZATION INCLUDES CRUTCHES, CERVICAL COLLARS, LUMBAR AND RIB BELTS, AND OTHER COMMONLY USED ORTHOTICS OF MINIMAL COST.

PERSONAL APPLIANCES SUCH AS VIBRATORS, HEATING PADS, HOME FURNISHINGS, HOT TUBS, WATERBEDS, EXERCISE BIKES, EXERCISE EQUIPMENT, JACUZZIES, PILLOWS, CASSETTE TAPES, EDUCATIONAL MATERIALS OR BOOKS, AND OTHER SIMILAR ITEMS WILL NOT BE AUTHORIZED OR PAID.

In no case will the department or self-insurer pay for rental fees once the purchase price of the rented item has been reached with the exception of oxygen equipment. The department or self-insurer may pay for rental fees of oxygen equipment beyond its purchase price.

[Statutory Authority: RCW 51.04.020, 51.04.030 and 1993 c 159. 93-16-072, 296-20-1102, filed 8/1/93, effective 9/1/93. Statutory Authority: RCW 51.04.020(4) and 51.04.030. 87-22-052 (Order 87-22), 296-20-1102, filed 11/2/87; 86-06-032 (Order 86-19), 296-20-1102, filed 2/28/86, effective 4/1/86; 83-16-066 (Order 83-23), 296-20-1102, filed 8/2/83. Statutory Authority: RCW 51.04.020(4), 51.04.030, and 51.16.120(3). 81-24-041 (Order 81-28), 296-20-1102, filed 11/30/81, effective 1/1/82; 81-01-100 (Order 80-29), 296-20-1102, filed 12/23/80, effective 3/1/81.]

Washington State Code Reviser's Office