WSR 14-19-086 PROPOSED RULES DEPARTMENT OF LABOR AND INDUSTRIES [Filed September 16, 2014, 9:15 a.m.]
Original Notice.
Preproposal statement of inquiry was filed as WSR 14-15-112.
Title of Rule and Other Identifying Information: WAC 296-21-290 Physical medicine and 296-23-220 Physical therapy rules.
Hearing Location(s): Department of Labor and Industries, Room S119, 7273 Linderson Way S.W., Tumwater, WA 98501, on October 23, 2014, at 1:00 p.m.
Date of Intended Adoption: November 18, 2014.
Submit Written Comments to: Tom Davis, Department of Labor and Industries, Health Services Analysis, P.O. Box 44322, Olympia, WA 98504-4322, e-mail Thomas.Davis@Lni.wa.gov, fax (360) 902-4249, by 5 p.m. on October 29, 2014.
Assistance for Persons with Disabilities: Contact office of information and assistance by October 16, 2014, TTY (360) 902-5797 or (360) 902-6687.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: Previously, athletic trainers' (AT) scope of practice was limited to care provided to athletes. In 2014, the legislature passed a new law (HB 2430) expanding AT scope of practice to include treatment of injured workers. In April 2014, the AT organization requested that L&I update its reimbursement rules, consistent with their expanded scope of practice, to allow reimbursement for AT services to injured workers. The anticipated effect of the rule change would be to expand the pool of licensed and qualified providers who could (within their scope of practice) provide treatment to injured workers.
Reasons Supporting Proposal: The proposal would increase the number of licensed and qualified providers who could (within their scope of practice) provide treatment to injured workers.
Statutory Authority for Adoption: RCW 51.04.030(1) and 18.250.010 (4)(a)(v).
Statute Being Implemented: RCW 18.250.010 (4)(a)(v).
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: More qualified and licensed providers will be able to treat (within their scope of practice) injured workers. Quality of care for injured workers will also not be affected by this proposed rule change. Also there will be no additional cost to the medical aid fund.
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: Vickie Kennedy, Assistant Director, Tumwater, Washington, (360) 902-4997.
No small business economic impact statement has been prepared under chapter 19.85 RCW. This rule adoption will have no economic impact on providers. It is changing who may perform services under the rules but will not result in either increased or decreased payments to providers of physical medicine services.
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)(v).
September 16, 2014
Joel Sacks
Director
AMENDATORY SECTION (Amending WSR 00-09-078, filed 4/18/00, effective 7/1/00)
WAC 296-21-290 Physical medicine.
(1) Whom does the department authorize and pay for physical medicine or physical therapy services? The department or self-insurer may authorize and pay for physical medicine services from the following providers:
• A medical or osteopathic physician who is "board certified or board qualified" in the field of physical medicine and rehabilitation; or
• A licensed physical therapist; or
• The injured worker's attending doctor, within the limitations listed below.
The physical medicine services must be personally performed by the:
• Physical medicine and rehabilitation physician; or
• Attending doctor; or
• Licensed physical therapist; or
• Physical therapist assistant employed by and serving under the direction of a registered physical therapist, physical medicine and rehabilitation physician, or attending doctor; or
• Licensed athletic trainer employed by and serving under the direction of a licensed physical therapist, physical medicine and rehabilitation physician, or attending doctor.
(2) When may the department or self-insurer pay the attending doctor for physical medicine services? The department or self-insurer may pay the attending doctor to provide physical medicine modalities and/or procedures in the following situations:
(a) The attending doctor's scope of practice includes physical medicine modalities and procedures.
(b) Only the physical medicine modalities and procedures allowed under the department's fee schedules and payment policies will be authorized or paid.
(c) No more than six physical medicine visits may be authorized and paid to the attending doctor. If the worker requires treatment beyond six visits, the worker must be referred to a licensed physical therapist or a board certified or qualified physical medicine and rehabilitation physician for such treatment. Payments will be made in accordance with the department's fee schedules and payment policies.
(d) In remote areas, where no physical medicine and rehabilitation specialist, licensed physical therapist or physical therapist assistant is available, physical medicine visits required by the patient's accepted condition(s) may be authorized and paid to the attending doctor. Payments will be made in accordance with the department's fee schedules and payment policies.
(e) The attending doctor may bill for office visits in addition to the physical medicine services only when a separately identifiable office visit service is provided in addition to the physical medicine service.
(3) What codes and fees are payable for physical medicine services?
• The codes, reimbursement levels, and other policies for physical medicine services are listed in the department's Medical Aid Rules and Fee Schedules. Physicians licensed in physical medicine and licensed physical therapists use CPT and/or HCPCS codes, rules and payment policies as listed in the department's Medical Aid Rules and Fee Schedules or provider bulletins.
• Attending doctors must use the local codes, rules and payment policies published in the department's Medical Aid Rules and Fee Schedules or provider bulletins.
AMENDATORY SECTION (Amending WSR 14-09-094, filed 4/22/14, effective 7/1/14)
WAC 296-23-220 Physical therapy rules.
Practitioners should refer to WAC 296-20-010 through 296-20-125 for general information and rules pertaining to the care of workers.
Refer to WAC 296-20-132 and 296-20-135 regarding the use of conversion factors.
All supplies and materials must be billed using HCPCS Level II codes. Refer to chapter 296-21 WAC for additional information. HCPCS codes are listed in the fee schedules.
Refer to chapter 296-20 WAC (WAC 296-20-125) and to the department's billing instructions for additional information.
Physical therapy treatment will be reimbursed only when ordered by the worker's attending doctor and rendered by a licensed physical therapist ((or)), a physical therapist assistant serving under the direction of a licensed physical therapist, or a licensed athletic trainer serving under the direction of a licensed physical therapist. In addition, physician assistants may order physical therapy under these rules for the attending doctor. Doctors rendering physical therapy should refer to WAC 296-21-290.
The department or self-insurer will review the quality and medical necessity of physical therapy services provided to workers. Practitioners should refer to WAC 296-20-01002 for the department's rules regarding medical necessity and to WAC 296-20-024 for the department's rules regarding utilization review and quality assurance.
The department or self-insurer will pay for a maximum of one physical therapy visit per day. When multiple treatments (different billing codes) are performed on one day, the department or self-insurer will pay either the sum of the individual fee maximums, the provider's usual and customary charge, or $122.00 whichever is less. These limits will not apply to physical therapy that is rendered as part of a physical capacities evaluation, work hardening program, or pain management program, provided a qualified representative of the department or self-insurer has authorized the service.
The department will publish specific billing instructions, utilization review guidelines, and reporting requirements for physical therapists who render care to workers.
Use of diapulse or similar machines on workers is not authorized. See WAC 296-20-03002 for further information.
A physical therapy progress report must be submitted to the attending doctor and the department or the self-insurer following twelve treatment visits or one month, whichever occurs first. Physical therapy treatment beyond initial twelve treatments will be authorized only upon substantiation of improvement in the worker's condition. An outline of the proposed treatment program, the expected restoration goals, and the expected length of treatment will be required.
Physical therapy services rendered in the home and/or places other than the practitioner's usual and customary office, clinic, or business facilities will be allowed only upon prior authorization by the department or self-insurer.
No inpatient physical therapy treatment will be allowed when such treatment constitutes the only or major treatment received by the worker. See WAC 296-20-030 for further information.
The department may discount maximum fees for treatment performed on a group basis in cases where the treatment provided consists of a nonindividualized course of therapy (e.g., pool therapy; group aerobics; and back classes).
Biofeedback treatment may be rendered on doctor's orders only. The extent of biofeedback treatment is limited to those procedures allowed within the scope of practice of a licensed physical therapist. See chapter 296-21 WAC for rules pertaining to conditions authorized and report requirements.
Billing codes and reimbursement levels are listed in the fee schedules.
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