WSR 11-07-098

PROPOSED RULES

DEPARTMENT OF

LABOR AND INDUSTRIES

[ Filed March 23, 2011, 8:04 a.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 11-03-067.

Title of Rule and Other Identifying Information: Medical aid rules, conversion factors, WAC 296-20-135.

Hearing Location(s): Department of Labor and Industries, Room S117, 7273 Linderson Way S.W., Tumwater, WA 98501, on April 26, 2011, at 1:00 p.m.

Date of Intended Adoption: May 24, 2011.

Submit Written Comments to: Tom Davis, P.O. Box 44322, Olympia, WA 98504-4322, e-mail dato235@LNI.wa.gov, fax (360) 902-4249, by 5 p.m. on May 2, 2011.

Assistance for Persons with Disabilities: Contact Tom Davis by April 15, 2011, TTY (360) 902-5797 or fax (360) 902-4249.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The purpose of the rule is to update the department's payment rates for health care services by changing the conversion factor used to calculate payment levels for services payable through the resource based relative value scale (RBRVS) fee schedule.

WAC 296-20-135(2), change the RBRVS conversion factor from $60.78 to $55.34.

Reasons Supporting Proposal: This rule will provide budget neutral medical aid updates regarding rate setting for most professional health care services for injured workers.

Statutory Authority for Adoption: RCW 51.04.020(1) and 51.04.030.

Statute Being Implemented: RCW 51.36.080.

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

Agency Comments or Recommendations, if any, as to Statutory Language, Implementation, Enforcement, and Fiscal Matters: (1) Change the conversion factor used to calculate maximum payment for services paid with the RBRVS fee schedule.

(2) Failure to adjust the conversion factor would result in an estimated increase in RBRVS payments of $19.4 million.

Name of Proponent: Department of labor and industries, governmental.

Name of Agency Personnel Responsible for Drafting: Tom Davis, Tumwater, Washington, (360) 902-6687; Implementation and Enforcement: Beth Dupre, Assistant Director, Tumwater, Washington, (360) 902-4209.

No small business economic impact statement has been prepared under chapter 19.85 RCW. This rule adoption is exempt under RCW 34.05.328 (5)(b)(vi) and 19.85.025(3).

A cost-benefit analysis is not required under RCW 34.05.328. RCW 34.05.328 does not apply because the content of this rule is explicitly dictated by statute and fits within the exceptions listed in RCW 34.05.328 (5)(b)(vi).

March 23, 2011

Judy Schurke

Director

OTS-3907.1


AMENDATORY SECTION(Amending WSR 10-10-107, filed 5/4/10, effective 7/1/10)

WAC 296-20-135   Conversion factors.   (1) Conversion factors are used to calculate payment levels for services reimbursed under the Washington resource based relative value scale (RBRVS), and for anesthesia services payable with base and time units.

(2) Washington RBRVS services have a conversion factor of (($60.78)) $55.34. The fee schedules list the reimbursement levels for these services.

(3) Anesthesia services that are paid with base and time units have a conversion factor of $3.19 per minute, which is equivalent to $47.85 per 15 minutes. The base units and payment policies can be found in the fee schedules.

[Statutory Authority: RCW 51.04.020(1) and 51.04.030. 10-10-107, 296-20-135, filed 5/4/10, effective 7/1/10; 08-09-121, 296-20-135, filed 4/22/08, effective 7/1/08; 07-10-082, 296-20-135, filed 5/1/07, effective 7/1/07; 06-09-071, 296-20-135, filed 4/18/06, effective 7/1/06; 05-09-062, 296-20-135, filed 4/19/05, effective 7/1/05; 04-09-100, 296-20-135, filed 4/20/04, effective 7/1/04; 03-14-043, 296-20-135, filed 6/24/03, effective 8/1/03; 02-10-129, 296-20-135, filed 5/1/02, effective 7/1/02; 01-10-026, 296-20-135, filed 4/24/01, effective 7/1/01; 00-09-077, 296-20-135, filed 4/18/00, effective 7/1/00. Statutory Authority: RCW 51.04.020(4) and 51.04.030. 99-10-043, 296-20-135, filed 4/30/99, effective 7/1/99; 98-09-125, 296-20-135, filed 4/22/98, effective 7/1/98; 97-10-017, 296-20-135, filed 4/28/97, effective 7/1/97. Statutory Authority: RCW 51.04.020 and 51.04.030. 96-19-060. 296-20-135, filed 9/16/96, effective 10/17/96; 96-10-086, 296-20-135, filed 5/1/96, effective 7/1/96; 95-17-001 296-20-135, filed 8/2/95, effective 10/1/95; 95-05-072, 296-20-135, filed 2/15/95, effective 3/18/95. Statutory Authority: RCW 51.04.020, 51.04.030 and 1993 c 159. 94-02-045 and 94-03-008, 296-20-135, filed 12/30/93 and 1/6/94, effective 3/1/94; 93-16-072, 296-20-135, filed 8/1/93, effective 9/1/93. Statutory Authority: RCW 51.04.020(4) and 51.04.030. 91-02-063, 296-20-135, filed 12/28/90, effective 1/28/91; 88-24-011 (Order 88-28), 296-20-135, filed 12/1/88, effective 1/1/89; 87-03-004 (Order 86-45), 296-20-135, filed 1/8/87; 83-24-016 (Order 83-35), 296-20-135, filed 11/30/83, effective 1/1/84; 82-24-050 (Order 82-39), 296-20-135, filed 11/29/82, effective 7/1/83. Statutory Authority: RCW 51.04.020(4), 51.04.030, and 51.16.120(3). 81-24-041 (Order 81-28), 296-20-135, filed 11/30/81, effective 1/1/82; 80-18-033 (Order 80-24), 296-20-135, filed 12/1/80, effective 1/1/81. Statutory Authority: RCW 51.04.030 and 51.16.035. 79-12-086 (Order 79-18), 296-20-135, filed 11/30/79, effective 1/1/80; Order 77-27, 296-20-135, filed 11/30/77, effective 1/1/78; Order 76-34, 296-20-135, filed 11/24/76, effective 1/1/77; Order 75-39, 296-20-135, filed 11/28/75, effective 1/1/76; Order 74-7, 296-20-135, filed 1/30/74; Order 71-6, 296-20-135, filed 6/1/71; Order 68-7, 296-20-135, filed 11/27/68, effective 1/1/69.]

Washington State Code Reviser's Office