LABOR AND INDUSTRIES
Effective Date of Rule: Immediately.
Purpose: Chapter 6, Laws of 2011, amended RCW 51.36.010 to direct the department of labor and industries (L&I) to establish a statewide medical provider network for treating injured and ill workers. The department adopted rules in 2012 so that, starting January 1, 2013, only network providers may treat injured workers beyond an initial visit. WAC 296-20-01020 allows providers to be provisionally enrolled while the department decides on their application, but only for sixty days. The emergency rule will allow providers who applied prior to January 1, 2013, to continue to treat injured workers until their application is approved, denied, or withdrawn; and it removes the sixty-day limit on provisional enrollment until expiration of the emergency rule or until the department takes further action to change the rule, whichever is first.
Citation of Existing Rules Affected by this Order: Amending WAC 296-20-01020.
Statutory Authority for Adoption: RCW 51.36.010, 51.04.020, and 51.04.030.
Under RCW 34.05.350 the agency for good cause finds that immediate adoption, amendment, or repeal of a rule is necessary for the preservation of the public health, safety, or general welfare, and that observing the time requirements of notice and opportunity to comment upon adoption of a permanent rule would be contrary to the public interest.
Reasons for this Finding: The number of applications from medical providers to join the L&I network has exceeded expectations. Nearly twelve thousand providers have been approved into the network, but there are more than five thousand additional applications waiting for final decision. Additional time is needed to review whether these providers meet network standards. Amending the current rule is necessary to avoid disrupting care for patients of providers whose applications were submitted prior to January 1 and are currently under review.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 1, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.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 1, Repealed 0.
Date Adopted: March 1, 2013.
AMENDATORY SECTION(Amending WSR 12-23-020, filed 11/13/12, effective 12/14/12)
WAC 296-20-01020 Health care provider network enrollment. (1) The department or its delegated entity will review the provider's application, supporting documents, and any other information requested or accessed by the department that is relevant to verifying the provider's application, clinical experience or ability to meet or maintain provider network requirements.
(2) The department will notify providers of incomplete applications, including when credentialing information obtained from other sources materially varies from information on the provider application. The provider may submit a supplement to the application with corrections or supporting documents to explain discrepancies within thirty days of the date of the notification from the department. Incomplete applications will be considered withdrawn within forty-five days of notification.
(3) The provider must produce adequate and timely information and timely attestation to support evaluation of the application. The provider must produce information and respond to department requests for information that will help resolve any questions regarding qualifications within the time frames specified in the application or by the department.
(4) The department's medical director or designee is authorized to approve, deny, or further review complete applications consistent with department rules and policies. Providers will be notified in writing of their approval or denial, or that their application is under further review within a reasonable period of time.
(5) Providers who meet the minimum provider network standards, have not been identified for further review, and are in compliance with department rules and policies, will be approved for enrollment into the network.
(6) Enrollment of a provider is effective no earlier than the date of the approved provider application. The department and self-insured employers will not pay for care provided to workers prior to application approval, regardless of whether the application is later approved or denied, except as provided in subsection (7) of this section.
(7) The department and self-insured employers may pay a provider without an approved application only when:
(a) The provider is outside the scope of the provider network per WAC 296-20-01010; or
(b) The provider is provisionally enrolled; or
(c) The provider applied prior to January 1, 2013, and the application is not yet approved, denied, or withdrawn.
(8)(a) A provider may be provisionally enrolled by the department after it obtains:
(i) Verification of a current, valid license to practice;
(ii) Verification of the past five years of malpractice claims or settlements from the malpractice carrier or the results of the National Practitioner Data Bank (NPDB) or Healthcare Integrity and Protection Data Bank (HIPDB) query; and
(iii) A current and signed application with attestation.
(c))) (b) A provider may only be provisionally enrolled
once (( and for no more than sixty calendar days)). Providers
who have previously participated in the network are not
eligible for provisional enrollment.
[Statutory Authority: RCW 51.36.010, 51.04.020, and 51.04.030. 12-23-020, § 296-20-01020, filed 11/13/12, effective 12/14/12; 12-02-058, § 296-20-01020, filed 1/3/12, effective 2/3/12.]