AN ACT Relating to regulating medical treatment under the industrial insurance retrospective rating program; and amending RCW 51.04.030 and 51.32.110.

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

Sec. 1. Section 1, chapter 14, Laws of 1980 as last amended by section 1, chapter 189, Laws of 1989 and RCW 51.04.030 are each amended to read as follows:

The director shall, through the division of industrial insurance, supervise the providing of prompt and efficient care and treatment, including care provided by physicians' assistants governed by the provisions of chapters 18.57A and 18.71A RCW, acting under a supervising physician to workers injured during the course of their employment at the least cost consistent with promptness and efficiency, without discrimination or favoritism, and with as great uniformity as the various and diverse surrounding circumstances and locations of industries will permit and to that end shall, from time to time, establish and promulgate and supervise the administration of printed forms, rules, regulations, and practices for the furnishing of such care and treatment: PROVIDED, That, the department may recommend to an injured worker particular health care services and providers where specialized treatment is indicated or where cost effective payment levels or rates are obtained by the department: AND PROVIDED FURTHER, That the department may enter into contracts for goods and services including, but not limited to, durable medical equipment so long as state-wide access to quality service is maintained for injured workers.

The director shall make and, from time to time, change as may be, and promulgate a fee bill of the maximum charges to be made by any physician, surgeon, hospital, druggist, physicians' assistants as defined in chapters 18.57A and 18.71A RCW, acting under a supervising physician or other agency or person rendering services to injured workers. No service covered under this title shall be charged or paid at a rate or rates exceeding those specified in such fee bill, and no contract providing for greater fees shall be valid as to the excess.

The director or self-insurer, as the case may be, shall make a record of the commencement of every disability and the termination thereof and, when bills are rendered for the care and treatment of injured workers, shall approve and pay those which conform to the promulgated rules, regulations, and practices of the director and ((~~may~~)) shall reject any bill or item thereof incurred in violation of the principles laid down in this section or the rules and regulations promulgated under it.

Sec. 2. Section 11, chapter 14, Laws of 1980 and RCW 51.32.110 are each amended to read as follows:

Any worker entitled to receive any benefits or claiming such under this title shall, if requested by the department, retrospective rating program employer, or self-insurer, submit himself or herself for medical examination, at a time and from time to time, at a place reasonably convenient for the worker and as may be provided by the rules of the department. A medical examination requested by a retrospective rating program employer may only be conducted by a physician or physicians approved by the department. No worker entitled to benefits or claiming benefits under this title shall be required to submit to a medical examination for the same injury more than four times within any two calendar year period or more than twice within any four month period as a result of any combination of requests from the department or retrospective rating program employer, except as approved by a hearing tribunal, or a court. If the worker refuses to submit to medical examination, or obstructs the same, or, if any injured worker shall persist in unsanitary or injurious practices which tend to imperil or retard his or her recovery, or shall refuse to submit to such medical or surgical treatment as is reasonably essential to his or her recovery or refuse or obstruct evaluation or examination for the purpose of vocational rehabilitation or does not cooperate in reasonable efforts at such rehabilitation, the department or the self-insurer upon approval by the department, with notice to the worker ((~~may~~)) shall suspend any further action on any claim of such worker so long as such refusal, obstruction, noncooperation, or practice continues and reduce, suspend, or deny any compensation for such period: PROVIDED, That the department or the self-insurer shall not suspend any further action on any claim of a worker or reduce, suspend, or deny any compensation if a worker has good cause for refusing to submit to or to obstruct any examination, evaluation, treatment or practice requested by the department or required under this section. If the worker necessarily incurs traveling expenses in attending for examination pursuant to the request of the department, such traveling expenses shall be repaid to him or her out of the accident fund upon proper voucher and audit or shall be repaid by the self-insurer, as the case may be. If the retrospective rating program employer's accident fund account or self-insurer has been charged for medical examination, medical treatment, or vocational rehabilitation expenses when a worker has failed to appear for a scheduled medical examination or treatment, vocational rehabilitation examination, or training session, the department or self-insurer, upon approval of the department, with notice to the worker, shall withhold an amount equal to the expenses paid and charged against the account of a state fund employer from future disbursements to the worker and shall credit the medical aid account of the employer to the extent of prior unauthorized payment: PROVIDED, That at least one week prior to the scheduled examination, the worker has received written notice: (1) Of the date, time, and location of the examination, and (2) that any charges incurred for failure to appear will be deducted from future payments as a penalty for failure to appear without good cause: PROVIDED FURTHER, That the department or self-insurer shall not withhold future disbursements to the worker in an amount equal to expenses paid for failure to appear for a requested examination, evaluation, treatment, or training if a worker has good cause for failing to appear for any examination, evaluation, or treatment required under this section. The worker shall not have "failed to appear" for the purposes of this section if the worker arrives within fifteen minutes after the scheduled time and the examination is not begun within two hours of the scheduled time.

If the medical examination required by this section causes the worker to be absent from his or her work without pay he or she shall be paid for such time lost in accordance with the schedule of payments provided in RCW 51.32.090 as amended.