WSR 16-10-085
[Filed May 3, 2016, 11:10 a.m.]
Subject of Possible Rule Making: Chapter 296-20 WAC, Medical aid rules.
Statutes Authorizing the Agency to Adopt Rules on this Subject: RCW 70.14.120, 51.04.020, and 51.04.030.
Reasons Why Rules on this Subject may be Needed and What They Might Accomplish: Department of labor and industries' (L&I) current rules related to structured intensive multidisciplinary programs (SIMP) for chronic, noncancer pain (WAC 296-20-12055 through 296-20-12095) need to be changed. They are now inconsistent with the recent coverage decision made by the Washington state health technology clinical committee (HTCC) that lumbar fusion for uncomplicated degenerative disc disease (DDD) is not a covered procedure. In addition to this rule change, L&I will be reviewing the best available scientific evidence on the treatment of chronic pain, and will work with clinicians to develop and implement policies regarding new medical coverage decisions, medical treatment guidelines, and/or payment policies about chronic pain management. Program requirements are also contained in the fee schedule. Removing SIMP program requirements from rule will permit L&I to be flexible and efficient when making these changes.
Other Federal and State Agencies that Regulate this Subject and the Process Coordinating the Rule with These Agencies: HTCC made the coverage determination using an open and transparent process after considering the best available scientific evidence, agency utilization data, and public testimony regarding the safety, efficacy and cost-effectiveness of lumbar fusions for uncomplicated DDD. The HTCC made its final coverage determination January 15, 2016. Pursuant to RCW 70.14.120, participating agencies, which includes L&I, must comply with a determination of the HTCC.
Process for Developing New Rule: This rule-making process is being developed partly in response to a final HTCC determination and in compliance with RCW 70.14.120. Rule changes will be developed in consultation with L&I's major stakeholders and other interested parties. Major stakeholder groups include, but are not limited to:
The industrial insurance medical advisory committee (IIMAC),
Advisory committee on healthcare innovation and evaluation (ACHIEV), and
SIMP providers.
Interested parties can participate in the decision to adopt the new rule and formulation of the proposed rule before publication by contacting Jami Lifka, Department of Labor and Industries, Office of the Medical Director, P.O. Box 44321, Olympia, WA 98504-4321, fax (360) 902-6315, phone (360) 902-4941, e-mail
May 3, 2016
Joel Sacks