BILL REQ. #:  S-3935.1 

Read first time 01/20/2004.   Referred to Committee on Commerce & Trade.

     AN ACT Relating to the role of the department of labor and industries in regards to health care providers; amending RCW 51.36.110; adding a new section to chapter 51.52 RCW; and adding a new section to chapter 51.36 RCW.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION.  Sec. 1   A new section is added to chapter 51.52 RCW to read as follows:
     When a provider files with the board an appeal from an order terminating the provider's authority to provide services related to the treatment of industrially injured workers, the department may petition the board for an order immediately suspending the provider's eligibility to participate as a provider of services to industrially injured workers under this title pending the final disposition of the appeal by the board. The board shall grant the petition if it determines that there is good cause to believe that workers covered under this title may suffer serious physical or mental harm if the petition is not granted. The board shall expedite the hearing of the department's petition under this section.

Sec. 2   RCW 51.36.110 and 1994 c 154 s 312 are each amended to read as follows:
     (1) The director of the department of labor and industries or the director's authorized representative shall have the authority to:
     (((1))) (a) Conduct audits and investigations of providers of medical, chiropractic, dental, vocational, and other health services furnished to industrially injured workers pursuant to Title 51 RCW to determine whether providers are: (i) Complying with this title and the rules adopted under this title; (ii) engaging in overutilization; (iii) engaging in improper billing practices; and (iv) adhering to practice parameters and protocols of treatment established under this title. In the conduct of such audits or investigations, the director or the director's authorized representatives may examine all records, or portions thereof, including patient records, for which services were rendered by a health services provider and reimbursed by the department, notwithstanding the provisions of any other statute which may make or purport to make such records privileged or confidential: PROVIDED, That no original patient records shall be removed from the premises of the health services provider, and that the disclosure of any records or information obtained under authority of this section by the department of labor and industries is prohibited and constitutes a violation of RCW 42.52.050, unless such disclosure is directly connected to the official duties of the department: AND PROVIDED FURTHER, That the disclosure of patient information as required under this section shall not subject any physician or other health services provider to any liability for breach of any confidential relationships between the provider and the patient: AND PROVIDED FURTHER, That the director or the director's authorized representative shall destroy all copies of patient medical records in their possession upon completion of the audit, investigation, or proceedings;
     (((2))) (b) Approve or deny applications to participate as a provider of services furnished to industrially injured workers pursuant to Title 51 RCW; and
     (((3))) (c) Terminate or suspend eligibility to participate as a provider of services furnished to industrially injured workers pursuant to Title 51 RCW.
     (2)(a) If the department finds that a health services provider has improperly billed, overutilized, or failed to comply with rules adopted under this title, including but not limited to practice parameters and protocols established under this title, it must notify the provider of its findings and may determine that the health services provider may not receive payment from the department or self-insured employer, as the case may be, or may impose penalties as provided in RCW 51.48.080.
     (b) If a health services provider has received payment from the department or self-insured employer for services that were improperly billed, that constitute overutilization, or that were outside the practice parameters or protocols established under this title, the provider must repay those amounts to the department or self-insurer, as the case may be. The department may assess a penalty of up to five hundred dollars for each overpayment that is not refunded within thirty days after notification of overpayment by the department.
     (c) For the purposes of this subsection, "overutilization" means providing an inappropriate health service or level of service to an injured worker, including but not limited to providing treatment in excess of established practice parameters and protocols of treatment established under this title.

NEW SECTION.  Sec. 3   A new section is added to chapter 51.36 RCW to read as follows:
     The department shall monitor the quality and objectivity of written responses submitted to the department or self-insurers by attending or treating providers in response to reports of medical examinations that were ordered by the department or self-insurer under this section. At least annually, the department will report to the workers' compensation advisory committee on the quality and objectivity of these written responses.