WSR 97-19-090

PROPOSED RULES

DEPARTMENT OF

LABOR AND INDUSTRIES

[Filed September 17, 1997, 10:32 a.m.]

Original Notice.

Preproposal statement of inquiry was filed as WSR 97-02-096.

Title of Rule: Chiropractic office visits, special services and general instructions.

Purpose: Repeal WAC 296-23-190 and 296-23-210, update the department's fee schedule for chiropractic services.

Statutory Authority for Adoption: RCW 51.04.020, 51.04.030, 51.36.080, and 51.36.110.

Statute Being Implemented: RCW 51.04.020, 51.04.030, 51.36.080, and 51.36.110.

Summary: (1) Repeal WAC 296-23-190 General instructions--Chiropractic, information in WAC 296-23-190 duplicates information contained in chapter 296-20 WAC, General instructions.

(2) Repeal WAC 296-23-210 Chiropractic office visits and special services, the office visit definitions contained in this WAC are not consistent with the definitions contained in current procedural terminology (CPT).

Reasons Supporting Proposal: This proposal eliminates duplications in rule and maintains the Department of Labor and Industries' responsibility to update its fee schedule and payment rates for chiropractic services.

Name of Agency Personnel Responsible for Drafting: Diane Reus, Tumwater, (360) 902-5021; Implementation and Enforcement: Gary Moore, Director, Tumwater, (360) 902-4200.

Name of Proponent: Diane Reus, Medical Program Specialist, Health Services Analysis, Department of Labor and Industries, governmental.

Rule is not necessitated by federal law, federal or state court decision.

Explanation of Rule, its Purpose, and Anticipated Effects: Repealing WAC 296-23-190 reduces duplication in department rules. Repealing WAC 296-23-210 deletes office visit definitions that are inconsistent with the definitions contained in current procedural terminology (CPT).

The proposed chiropractic fee schedule changes allow chiropractors to use a limited range of evaluation and management codes for new and established patients and consultations. The department has developed new complexity based [on] the Department of Labor and Industries local codes for manipulation services. The policy objectives for changes to the chiropractic fee schedule changes include:

Improving consistency of chiropractic reimbursement methods and policies with other payers,

Maintaining the Department of Labor and Industries' responsibility to prudently manage payments for chiropractic services,

Improving the equity of provider reimbursement,

Reducing administrative complexity for chiropractors and the department, and

Maintaining access to quality chiropractic care for eligible workers.

Proposal Changes the Following Existing Rules: This proposal: (1) Repeals WAC 296-23-190. WAC 296-23-190 duplicates information contained in chapter 296-20 WAC, General instructions.

(2) Repeals WAC 296-23-210. The department proposes to transition chiropractors to a range of codes in the resource based relative value scale (RBRVS) fee schedule for evaluation and management services. This allows chiropractors to bill and be paid for evaluation and management services using similar codes (3 levels) and descriptions as other attending physicians. The current office visit definitions contained in WAC are being repealed because they are not consistent with the evaluation and management office visit descriptions contained in current procedural terminology (CPT).

No small business economic impact statement has been prepared under chapter 19.85 RCW. The Regulatory Fairness Act, chapter 19.85 RCW, requires that a small business economic impact statement be prepared if a proposed rule has the potential of placing a proportionally higher economic impact on small businesses. Since the proposed amendments will result in an increase in payments to chiropractors, the department is not required to prepare a small business impact.

RCW 34.05.328 does not apply to this rule adoption. The proposed changes are not a significant change to existing department policy. The department is required to periodically change and make available a fee schedule of the maximum charges to be made by any physician, surgeon, chiropractor, hospital or other health care provider.

Hearing Location: Department of Labor and Industries, Auditorium, 7273 Linderson Way S.W., Tumwater, WA 98502, on October 21, 1997, at 9 a.m.

Assistance for Persons with Disabilities: Contact Diane Reus at (360) 902-5021, by October 14, 1997.

Submit Written Comments to: Diane Reus, FAX (360) 902-4249, by October 31, 1997.

Date of Intended Adoption: November 26, 1997.

September 16, 1997

Gary Moore

Director

REPEALER

The following sections of the Washington Administrative Code are repealed:

WAC 296-23-190 General instructions--Chiropractic.