WSR 15-09-119

PREPROPOSAL STATEMENT OF INQUIRY

[Filed April 21, 2015, 10:01 a.m.]

Subject of Possible Rule Making: WAC 296-20-125 Billing procedures, 296-20-01002 Definitions, 296-20-025 Initiating treatment and submitting a claim for benefits, 296-20-03001 Treatment requiring authorization, and 296-20-06101 What reports are health care providers required to submit to the insurer?

Statutes Authorizing the Agency to Adopt Rules on this Subject: RCW 51.04.020, 51.04.030, and 51.36.080.

Reasons Why Rules on this Subject may be Needed and What They Might Accomplish: The rule changes are needed to ensure the agency is current in its use of the federally adopted diagnosis code set. Though the department of labor and industries (L&I) is not required to make these changes, the agency is doing so to decrease administrative burden on the provider community if and when the federal government adopts a new code set. If L&I does not make the change, providers would need to maintain dual billing systems to accommodate the outdated L&I billing model while they adhere to the federally adopted, industry standard code set used by other payers.

Other Federal and State Agencies that Regulate this Subject and the Process Coordinating the Rule with These Agencies: Washington workers' compensation is governed by Title 51 RCW, Washington's Industrial Insurance Act. No other state or federal agencies are responsible for interpreting and enforcing the provisions of this act.

Process for Developing New Rule: This process was developed by L&I staff to ensure the agency is current in its use of the federally adopted diagnosis code set.

Interested parties can participate in the decision to adopt the new rule and formulation of the proposed rule before publication by contacting L&I, Health Services Analysis, Emily Stinson or Robert Mayer, phone (360) 902-5974 or (360) 902-5021, fax (360) 902-4249, e-mail them235@Lni.wa.gov or mayr235@lni.wa.gov.

April 21, 2015

Joel Sacks

Director