WSR 09-14-104




[ Filed June 30, 2009, 12:41 p.m. , effective July 31, 2009 ]

Effective Date of Rule: July 31, 2009.

Purpose: This rule is being adopted in response to a petition for a rule change. The amended rule will allow psychiatric ARNPs to provide psychiatric services to injured workers. Currently only psychiatrists and psychologists can provide psychiatric services to injured workers. The amended rule will also clarify that concurrent care providers, like psychiatrists and psychiatric ARNPs, can prescribe medication while providing concurrent care.

Citation of Existing Rules Affected by this Order: Amending WAC 296-20-071, 296-21-270, and 293-23-241.

Statutory Authority for Adoption: RCW 51.04.020, 51.04.030.

Adopted under notice filed as WSR 09-08-104 on March 31, 2009.

Changes Other than Editing from Proposed to Adopted Version: In WAC 296-20-071, language is added to make it clearer that a concurrent care provider can prescribe medications for the worker. This is a nonsubstantive change from language proposed in the CR-102. In WAC 296-21-270, language is added to clarify that psychologists treating injured workers must be clinical PhD psychologists. This is not a change in department policy. The title of WAC 296-23-241 is changed to make it simpler and to allow the inclusion of psychiatric ARNPs, who are not usually the attending provider. This is a nonsubstantive change.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 1, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 2, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 3, Repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 3, Repealed 0.

Date Adopted: June 30, 2009.

Judy Schurke



AMENDATORY SECTION(Amending Order 86-19, filed 2/28/86, effective 4/1/86)

WAC 296-20-071   Concurrent treatment.   In some cases, treatment by more than one practitioner may be allowed. The department or self-insurer will consider concurrent treatment when the accepted conditions resulting from the injury involve more than one system and/or require specialty or multidisciplinary care.

When requesting consideration for concurrent treatment, the attending doctor must provide the department or self-insurer with the following:

The name, address, discipline, and specialty of all other practitioners assisting in the treatment of the injured worker and an outline of their responsibility in the case and an estimate of the length of the period of concurrent care.

When concurrent treatment is allowed, the department or self-insurer will recognize one primary attending ((doctor)) provider, who will be responsible for ((prescribing all medications;)) directing the over-all treatment program((;)), including monitoring or prescribing medications when appropriate, providing copies of all reports and other data received from the involved practitioners and, in time loss cases, providing adequate certification evidence of the worker's inability to work. The department or self-insurer may allow a concurrent care provider to prescribe medications. In such cases, the concurrent care provider is required to send the attending provider and the department or self-insurer all required reports, including a report of the medications prescribed.

The department or self-insurer will approve concurrent care on a case-by-case basis. Consideration will be given to all factors in the case including availability of providers in the worker's geographic location.

[Statutory Authority: RCW 51.04.020(4) and 51.04.030. 86-06-032 (Order 86-19), 296-20-071, filed 2/28/86, effective 4/1/86. Statutory Authority: RCW 51.04.020(4), 51.04.030, and 51.16.120(3). 81-01-100 (Order 80-29), 296-20-071, filed 12/23/80, effective 3/1/81; Order 75-39, 296-20-071, filed 11/28/75, effective 1/1/76; Order 70-12, 296-20-071, filed 12/1/70, effective 1/1/71. Formerly WAC 296-20-060.]


AMENDATORY SECTION(Amending WSR 93-16-072, filed 8/1/93, effective 9/1/93)

WAC 296-21-270   Psychiatric services.   The following rule((s)) supplements information contained in the fee schedules regarding coverage and reimbursement for psychiatric services.

Treatment of mental conditions to workers is to be goal directed, time limited, intensive, and limited to conditions caused or aggravated by the industrial condition. Psychiatric services to workers are limited to those provided by psychiatrists ((and licensed)), clinical PhD psychologists, and psychiatric advanced registered nurse practitioners and according to department policy. Psychiatrists and psychiatric advanced registered nurse practitioners may prescribe medications while providing concurrent care. For purposes of this rule, the term "psychiatric" refers to treatment by psychologists ((as well as)), psychiatric advanced registered nurse practitioners, and psychiatrists.

Initial evaluation, and subsequent treatment must be authorized by department staff, as outlined by department policy. The report of initial evaluation, including test results, and treatment plan are to be sent to the worker's attending provider, as well as to the department or self-insurer. A copy of sixty-day narrative reports are to be sent to the department ((is also to be sent)) or self-insurer and to the attending provider.

All providers are bound by the medical aid rules in chapter 296-20 WAC. Reporting requirements are defined in chapter 296-20 WAC. In addition, the following are required: Testing results with scores, scales, and profiles; report of raw data sufficient to allow reassessment by a panel or independent medical examiner. Use of the current Diagnostic and Statistical Manual of the American Psychiatric Association axis format in the initial evaluation and sixty-day narrative reports, and explanation of the numerical scales are required.

A report to the department will contain, at least, the following elements:

Subjective complaints;

Objective observations;

Assessment of the worker's condition and goals accomplished; and

Plan of care.

The codes, reimbursement levels, and other policies for psychiatric services are listed in the fee schedules.

[Statutory Authority: RCW 51.04.020, 51.04.030 and 1993 c 159. 93-16-072, 296-21-270, filed 8/1/93, effective 9/1/93.]


AMENDATORY SECTION(Amending WSR 08-04-094, filed 2/5/08, effective 2/22/08)

WAC 296-23-241   ((Can)) Advanced registered nurse practitioners ((independently perform the functions of an attending provider?)).   (1) Advanced registered nurse practitioners (ARNPs) may independently perform the functions of an attending provider under the Industrial Insurance Act, with the exception of rating permanent impairment. These functions are referenced in the medical aid rules as those of an attending or treating provider, and include, but are not limited to:

Completing and signing the report of accident or provider's initial report, where applicable;

Certifying time-loss compensation;

Completing and submitting all required or requested reports;

Referring workers for consultations;

Performing consultations;

Facilitating early return to work offered by and performed for the employer(s) of record;

Doing all that is possible to expedite the vocational process, including making an estimate of the worker's physical or mental capacities that affect the worker's employability.

(2) Psychiatric advanced registered nurse practitioners can provide psychiatric services as defined in WAC 296-21-270.

(3) ARNPs can state whether a worker has permanent impairment, such as on the department's activity prescription form (APF). ARNPs cannot rate permanent impairment or perform independent medical examinations (IMEs).

(((2) Advanced registered nurse practitioners cannot:

Rate permanent impairment; or

Perform independent medical examinations (IMEs).))

[Statutory Authority: 2007 c 275, RCW 51.04.020 and 51.04.030. 08-04-094, 296-23-241, filed 2/5/08, effective 2/22/08. Statutory Authority: 2004 c 65 and 2004 c 163. 04-22-085, 296-23-241, filed 11/2/04, effective 12/15/04.]

Washington State Code Reviser's Office