LABOR AND INDUSTRIES
[Filed August 20, 2019, 10:14 a.m., effective January 1, 2020]
Effective Date of Rule: January 1, 2020.
Purpose: The department is adopting one new rule. This rule making involves significant legislative changes. The goals of the new rule are to create standardized medical bill reporting expectations for self-insured employers, to support the collection of quality data, and to create a reporting exemption for qualifying employers.
This rule making will ensure:
|•||Self-insured employers are required to report medical bills through the medical bill electronic data interchange.|
|•||Self-insured employers are required to report bills accurately and timely.|
|•||Under limited circumstances, self-insured employers can be provided an exception, which means that they are exempt from reporting.|
Standardized reporting will build data integrity, improve industry benchmarking, and inform and support policy conversations and decisions.
Citation of Rules Affected by this Order: New WAC 296-15-232.
Adopted under notice filed as WSR 19-12-087 on June 4, 2019.
A final cost-benefit analysis is available by contacting K. C. Wilkerson, P.O. Box 44890, Olympia, WA 98504-4890, phone 360-902-6851, fax 360-902-6977, email kc.wilkerson@Lni.wa.gov, web site http://www.Lni.wa.gov/LawRule.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at the Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's own Initiative: New 1, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 1, Amended 0, Repealed 0.
Number of Sections Adopted using Negotiated Rule Making: New 1, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 0, Repealed 0.
Date Adopted: August 20, 2019.
WAC 296-15-232Self-insurance medical bill electronic data interchange.
(1) Self-insurers are required to report medical bills incurred from their workers' compensation claims according to department guidelines.
(a) All bills associated with qualifying claims must be reported, and the department will establish a minimum threshold percentage for reporting of bill to claims to monitor compliance.
(b) Qualifying claims include claims for which:
(i) The date of injury (DOI) was on or after January 1, 2020.
(ii) The claim was initiated during a time that the employer was self-insured, and the liability for that claim remains with the employer.
(2) Self-insurers must submit complete and accurate reports based on standards set forth by the International Association of Industrial Accident Boards and Commissions (IAIABC).
(a) The department will systematically monitor report data for quality and timeliness, and establish objective performance standards based on the overall reporting of data.
(b) The department will establish a maximum threshold percentage for errors or untimely submittals.
(c) The department will provide notification to submitters if performance measures are below the standard set by the department.
(d) Submitters will have thirty days from the date of notification to make corrections to errors and resubmit, or request an extension in writing to the department.
(e) The department will review errors that remain uncorrected after thirty days. Uncorrected errors may result in training, audit, rule violation penalties, and/or a corrective action process.
(3) New self-insurers may apply for an exemption to reporting medical bills with their application for certification as a self-insured employer.
(a) To qualify for the exemption, the employer must have had one or fewer claims filed in the state of Washington in the last three years, and the employer must have fewer than five employees in the state.
(b) The department may deny any request for exemption.
(c) Authority to grant or deny exemptions belongs to the supervisor of industrial insurance, or designee.
(d) If granted, the exemption expires after three years. The employer may apply for another exemption at that time.