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SUBSTITUTE
HOUSE BILL 2822
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Passed
Legislature - 1998 Regular Session
State of Washington 55th
Legislature 1998 Regular Session
By
Read first time 02/05/98.
Referred to Committee on .
Exempting
agency medical coverage decisions by labor and industries from rule-making
provisions.
AN
ACT Relating to exempting department of labor and industries' medical coverage
decisions from rule-making requirements; and amending RCW 51.04.030.
BE IT ENACTED BY THE
LEGISLATURE OF THE STATE OF WASHINGTON:
Sec.
1. RCW
51.04.030 and 1997 c 325 s 2 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 medical coverage decisions of the department do not constitute a
"rule" as used in RCW 34.05.010(16), nor are such decisions subject
to the rule-making provisions of chapter 34.05 RCW except that criteria for
establishing medical coverage decisions shall be adopted by rule after
consultation with the workers' compensation advisory committee established in
RCW 51.04.110: PROVIDED FURTHER, 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)
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, including services provided to injured
workers, whether aliens or other injured workers, who are not residing in the
United States at the time of receiving the services, 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)))
(16).
(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.
