1410-S AMH LISK CORD 6

SHB 1410 ‑ H AMDS 573 WITHDRAWN 3/24/95

By Representative Lisk

On page 36, after line 30, insert the following:

"(5) $61,107 of the accident account--state appropriation and $129,602 of the medical aid account--state appropriation are provided solely to implement an integrated statewide on-line adjudication system for pharmacy providers that includes prospective drug utilization. The amount appropriated in this section shall only be expended to administer an adjudication system that is implemented by means of contracts that are competitively bid. Until this service is implemented, the fee schedule for industrial insurance pharmacy services in effect on January 1, 1995, may not be reduced."

On page 107, after line 24, insert the following:

"Sec. 912. RCW 51.04.030 and 1994 c 164 ' 25 are each amended to read as follows:

(1) The director shall supervise the providing of prompt and efficient care and treatment, including care provided by physician assistants governed by the provisions of chapters 18.57A and 18.71A RCW, acting under a supervising physician, and including chiropractic care, 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 adopt 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.

(2)(a) Subject to (b) of this subsection, the director shall, in consultation with interested persons, establish and, in his or her discretion, periodically change as may be necessary, and make available a fee schedule of the maximum charges to be made by any physician, surgeon, chiropractor, 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. The department shall coordinate with other state purchasers of health care services to establish as much consistency and uniformity in billing and coding practices as possible, taking into account the unique requirements and differences between programs. No service covered under this title shall be charged or paid at a rate or rates exceeding those specified in such fee schedule, and no contract providing for greater fees shall be valid as to the excess. The establishment of such a schedule, exclusive of conversion factors, does not constitute "agency action" as used in RCW 34.05.010(3), nor does such a fee schedule constitute a "rule" as used in RCW 34.05.010(15).

(b) The pharmacy services fee schedule established under this section and in effect on January 1, 1995, may not be reduced during the fiscal biennium ending June 30, 1997, until the department implements an integrated statewide on-line adjudication system for pharmacy providers.

(3) 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 adopted rules, regulations, established fee schedules, 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, regulations, or the established fee schedules and rules and regulations adopted under it."

Renumber the sections consecutively, correct internal references accordingly, and correct the title.