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.
