BP BHEAD INT S

AN ACT Relating to chiropractic care for industrial insurance; amending RCW 51.04.030 and 51.36.110; and adding a new chapter to Title 51 RCW.

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

NEW SECTION. Sec. 1. (1) Chiropractic care provided to an injured worker through the division of industrial insurance must be within the scope of practice under chapter 18.25 RCW and limited to the treatment of acute conditions.

(2) A chiropractor licensed to practice under chapter 18.25 RCW must be included among those health care providers authorized to recommend closure of claims and to examine injured workers to assist the department in determinations of permanent disability.

(3) If chiropractic care is provided to an injured worker under this title for a reason other than permanent disability determination, the chiropractor providing the care, either independently or in consultation with other chiropractors, shall determine the necessity and appropriateness of the care provided.

NEW SECTION. Sec. 2. A fee bill of maximum charges for chiropractic treatment established by the director under RCW 51.04.030 must be based on the usual and customary charges for those services.

NEW SECTION. Sec. 3. The department shall establish treatment and utilization standards for chiropractic treatment in consultation with representatives of the chiropractic profession. The standards must include the following:

(1) Standards designed to assure quality treatment and to maximize recovery from the work-related injury;

(2) Standards designed to contain costs, consistent with assured access to medically necessary treatment;

(3) Standards that require review of an injured worker's progress toward recovery after a stated number of chiropractic treatments. This initial review must be by a panel of chiropractors licensed to practice under chapter 18.25 RCW and appointed by the director or director's designee. If further chiropractic treatment is recommended by the panel and authorized by the department, the standard must require a second review after a stated number of treatments that must be conducted by one or more chiropractors, other than the attending chiropractor, and one or more physicians licensed to practice under chapter 18.71 RCW. The standard must determine the responsibilities of the second review panel.

NEW SECTION. Sec. 4. If conducting an audit and review of a chiropractor, as authorized under chapter 51.36 RCW, the director or director's authorized representative shall, to the extent practicable:

(1) Conduct treatment reviews during an active course of treatment rather than after treatment has concluded; and

(2) Utilize the chiropractic peer review committee and procedures established under chapter 18.26 RCW.

NEW SECTION. Sec. 5. The director shall appoint an assistant director for chiropractic treatment. The assistant director must be licensed under chapter 18.25 RCW. The assistant director shall:

(1) Serve as principal liaison between the department and the chiropractic profession;

(2) Provide chiropractic consultation to claims staff and other department staff as needed;

(3) Develop chiropractic treatment and utilization standards as set forth in section 4 of this act and propose changes to the standards as needed;

(4) Monitor current research and treatment developments within the chiropractic profession and the field of occupational health; and

(5) Perform other duties assigned by the director.

Sec. 6. RCW 51.04.030 and 1989 c 189 s 1 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, and including chiropractic care described under section 1 of this act, 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 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. 7. RCW 51.36.110 and 1986 c 200 s 2 are each amended to read as follows:

The director of the department of labor and industries or the director's authorized representative shall have the authority to:

(1) Conduct audits and investigations of providers of medical, dental, chiropractic, vocational, and other health services furnished to industrially injured workers pursuant to Title 51 RCW. In the conduct of such audits or investigations, the director or the director's authorized representatives ((~~may~~)) shall examine all pertinent records, or portions thereof, including patient records, and shall conduct interviews with the injured worker and claims staff who handled the claim, 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 42.22.040, 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) Deny or reduce payment or demand reimbursement or recoupment, with or without a penalty, of sums paid to providers for services billed in violation of medical aid rules or fees schedules. For amounts paid within the twelve calendar months immediately preceding the date of the demand, if the amounts paid are determined to be unnecessary care by due process, recoupment is not mandated until any appeals are concluded and final findings are issued. If payment to a provider has been induced by fraud the department may terminate or suspend eligibility to participate as a provider of services furnished to any workers covered under this title and RCW 51.32.240(4) applies;

(3) Approve or deny applications to participate as a provider of services furnished to industrially injured workers pursuant to Title 51 RCW; and

((~~(3)~~)) (4) Terminate or suspend eligibility to participate as a provider of services furnished to industrially injured workers pursuant to Title 51 RCW.

NEW SECTION. Sec. 8. Sections 1 through 5 of this act shall constitute a new chapter in Title 51 RCW.