WSR 18-10-083 PERMANENT RULES DEPARTMENT OF LABOR AND INDUSTRIES [Filed May 1, 2018, 11:12 a.m., effective June 1, 2018]
Effective Date of Rule: Thirty-one days after filing.
Purpose: The purpose of this rule making is to bring the rules in compliance with the statutory changes of ESHB 1739 (chapter 235, Laws of 2017), which became effective on July 23, 2017.
ESHB 1739 changed the crime victims' compensation law, chapter 7.68 RCW, in two ways. First, it clarified when a vehicular assault can be the basis for a claim. Second, it now requires labor and industries to pay providers at one hundred percent of the worker compensation fee schedule. The rules for the program are updated to comply with the law.
As a result of the changes to RCW 7.68.020(6), WAC 296-30-020 was no longer needed and is repealed.
As a result of the changes to RCW 7.68.030 (2)(g), WAC 296-30-090 was updated to reflect the updated fee schedule payment levels.
Citation of Rules Affected by this Order: Repealing WAC 296-30-020; and amending WAC 296-30-090.
Adopted under notice filed as WSR 18-03-161 on January 23, 2018.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 1, Repealed 1.
Number of Sections Adopted at the Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's own Initiative: New 0, Amended 1, Repealed 1.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 1, Repealed 1.
Number of Sections Adopted using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 1.
Date Adopted: May 1, 2018.
Joel Sacks
Director
AMENDATORY SECTION (Amending WSR 11-22-054, filed 10/31/11, effective 12/1/11)
WAC 296-30-090 What are the maximum allowable fees?
(1) Maximum allowable fees for medical and mental health services((, that are not hospital inpatient or outpatient services, are a percentage of those fees)) are published in the medical aid rules and fee schedules((,)) and the crime victims' compensation program mental health fee schedule and billing guidelines less any available benefits of public or private insurance.
(2) The percent of allowed charges for authorized hospital inpatient and outpatient services billed by revenue codes are those rates established by the department. ((If the maximum allowable fees for hospital inpatient or outpatient services is lower than the maximum allowable fees for those procedures established under Title 74 RCW for the ratio of costs to charges (RCC) rate, the department will use the RCC rate as the percent of allowed charges for hospital inpatient and outpatient services, regardless of whether the hospital is diagnosis related group (DRG) exempt.))
(3) If sufficient funding is not provided to continue payments equal to the medical aid rules and fee schedules and the crime victims' compensation program mental health fee schedule and billing guidelines, payments will be reduced based on caseload estimates and available funding. The reduced payments will not be less than seventy percent of payments provided under the fee schedules.
(4) If an unforeseeable catastrophic event results in insufficient funding to continue payments equal to the medical aid rules and fee schedules and the crime victims' compensation program mental health fee schedule and billing guidelines, payments will be reduced to not less than seventy percent of payments provided under the fee schedules to the extent the reduction in payments is necessary to fund benefits.
REPEALER
The following section of the Washington Administrative Code is repealed:
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