AN ACT
Relating to extending deadlines for studies of medical benefits for injured
workers under a consolidated health care system; and amending RCW 43.72.850 and
43.72.860.
BE IT ENACTED BY THE LEGISLATURE
OF THE STATE OF WASHINGTON:
Sec.
1. RCW
43.72.850 and 1993 c 492 s 485 are each amended to read as follows:
On or
before January 1, 1995, and January 1, 1996, the health services
commission, in coordination with the department of labor and industries and the
workers' compensation advisory committee, shall study and make an interim
report, and on or before January 1, ((1996)) 1997, a final
report, to the governor and appropriate committees of the legislature on the
provision of medical benefits for injured workers under a consolidated health
care system. The study shall include a review of options and recommendations
for modifying the industrial insurance system to provide medical services for
injured workers in a more cost-effective manner under a consolidated system,
and may include consideration of the purchase of industrial insurance medical
benefits through the health care authority or the inclusion of industrial
insurance medical benefits in the services offered by certified health plans or
other appropriate options. The commission should also give consideration to at
least the following issues: The use of managed care and the effect of managed
care options on the injured workers' choice of health services provider; the
potential cost savings or other impacts of various consolidation options; the
benefit structure required under industrial insurance; the potential for consolidation
to meet or exceed existing medical cost management of the medical aid fund; the
impact of separating the medical management of claims from the disability
management of claims; the relationship between return-to-work efforts, medical
services, and disability prevention; the relationship between medical services
and rehabilitation services; and the effects of the quasi-judicial system that
determines industrial insurance rights and obligations. In addition, the final
report shall include a proposed plan and timeline for including the medical
benefits of the industrial insurance system in the services offered by
certified health plans. The proposed plan shall assure that:
(1)
The plan shall not take effect until at least ninety-seven percent of state residents
have access to the uniform benefits package as required in chapter 492, Laws of
1993;
(2)
The uniform benefits package of the certified health plan will provide benefits
for injured workers that are at least equivalent to the medical benefits provided
to injured workers under Title 51 RCW as determined by the department of labor
and industries as of the effective date of the plan, including payments for
services that are ancillary to industrial insurance medical benefits, such as
but not limited to medical examinations for permanent disabilities;
(3)
Other nonmedical benefits required to be provided under Title 51 RCW, such as
but not limited to total or partial disability benefits or vocational
rehabilitation benefits, are not affected;
(4)
Employers who do not choose to become certified health plans under chapter 492,
Laws of 1993, will continue to be required to provide industrial insurance
medical benefits under Title 51 RCW;
(5)
Employees participating in the plan shall not be required to pay deductibles,
copayments, or other point of service charges for services related to
industrial insurance injuries or diseases, such costs to be paid by the
department of labor and industries or self-insured employer, as applicable;
(6)
The plan includes a mechanism to return to workers and employers, in equal
shares, any savings that are realized in the costs of medical services for
injured workers, as identified by the department of labor and industries;
(7)
The majority of the employer's employees or, if the employees are represented
for collective bargaining purposes, the exclusive bargaining representative
voluntarily agree to the employer's participation in the plan.
Sec.
2. RCW
43.72.860 and 1993 c 492 s 486 are each amended to read as follows:
(1)
The department of labor and industries, in consultation with the workers'
compensation advisory committee, may conduct pilot projects to purchase medical
services for injured workers through managed care arrangements. The projects
shall assess the effects of managed care on the cost and quality of, and
employer and employee satisfaction with, medical services provided to injured
workers.
(2)
The pilot projects may be limited to specific employers. The implementation of
a pilot project shall be conditioned upon a participating employer and a
majority of its employees, or, if the employees are represented for collective
bargaining purposes, the exclusive bargaining representative, voluntarily
agreeing to the terms of the pilot. Unless the project is terminated by the
department, both the employer and employees are bound by the project agreements
for the duration of the project.
(3)
Solely for the purpose and duration of a pilot project, the specific
requirements of Title 51 RCW that are identified by the department as otherwise
prohibiting implementation of the pilot project shall not apply to the
participating employers and employees to the extent necessary for conducting
the project. Managed care arrangements for the pilot projects may include the
designation of doctors responsible for the care delivered to injured workers
participating in the projects.
(4)
The projects shall conclude no later than January 1, 1997. The department
shall make an interim report on the projects to the governor and appropriate
committees of the legislature on or before October 1, 1996. The department
shall present the final results of the pilot projects and any final
recommendations related to the projects to the governor and appropriate committees
of the legislature on or before ((October 1, 1996)) April 1, 1997.
