WSR 16-15-075
[Filed July 19, 2016, 10:39 a.m.]
Original Notice.
Preproposal statement of inquiry was filed as WSR 16-10-085.
Title of Rule and Other Identifying Information: Lumbar fusion and structured intensive multidisciplinary programs (SIMP) rule, department of labor and industries (L&I) is proposing to repeal the SIMP rules - WAC 296-20-12055 through 296-20-12095.
Hearing Location(s): L&I, Tumwater Headquarters Building, S119, 7273 Linderson Way S.W., Tumwater, WA 98501, on August 26, 2016, at 11:00 a.m.
Date of Intended Adoption: November 1, 2016.
Submit Written Comments to: Jami Lifka, P.O. Box 44321, Olympia, WA 98504-4321, e-mail, fax (360) 902-6315.
Written comments must be received no later than 5 p.m., August 26, 2016.
Assistance for Persons with Disabilities: Contact Jami Lifka by August 1, 2016, TTY 711 for (360) 902-4941 or directly to (360) 902-4941.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The purpose of this rule making is to bring L&I's rules into compliance with a recent coverage determination by the Washington state health technology clinical committee (HTCC). HTCC made a determination that lumbar fusion for uncomplicated degenerative disc disease (UDDD) is no longer a covered procedure. Before this noncoverage determination was made, a previous HTCC determination required lumbar fusion candidates with UDDD to attend a SIMP prior to having surgery. This previous coverage determination is contained within SIMP rules and is now inconsistent with this new HTCC noncoverage determination. L&I's payment policies, the lumbar fusion surgical guideline and a medical coverage decision have already been amended effective March 7, 2016, in response to HTCC lumbar fusion for UDDD noncoverage determination.
SIMP program requirements are currently also contained within the department's fee schedules' payment policies and, other than removing the lumbar fusion for UDDD requirement, will remain in effect when SIMP rules are repealed.
Reasons Supporting Proposal: 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 to assist injured workers heal and return to work. Repealing SIMP rules is the most effective and efficient way of removing SIMP requirement for lumbar fusion for UDDD from existing rules and will also allow L&I flexibility when making future changes in the management of chronic pain in general.
Statutory Authority for Adoption: RCW 70.14.120, 51.04.020, and 51.04.030.
Statute Being Implemented: RCW 70.14.120.
Rule is not necessitated by federal law, federal or state court decision.
Agency Comments or Recommendations, if any, as to Statutory Language, Implementation, Enforcement, and Fiscal Matters: Pursuant to RCW 70.14.120, participating agencies, including L&I, must comply with a determination of HTCC. HTCC made the lumbar fusion for UDDD noncoverage 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 UDDD. HTCC made its final coverage determination January 15, 2016.
Name of Proponent: L&I, governmental.
Name of Agency Personnel Responsible for Drafting: Jami Lifka, Office of the Medical Director, (360) 902-4941; Implementation: Leah Hole-Marshall, Medical Administrator, Office of the Medical Director, (360) 902-4996; and Enforcement: Vickie Kennedy, Assistant Director, Insurance Services, (360) 902-4997.
No small business economic impact statement has been prepared under chapter 19.85 RCW. A small business economic impact statement is not required. This rule making repeals existing requirements related to medical coverage decisions under RCW 51.04.030 and in part, the repeal is required by statute. Because this rule making repeals existing rules and adds no new requirements there are no compliance costs to be analyzed for a disproportionate impact on small businesses.
A cost-benefit analysis is not required under RCW 34.05.328. A cost-benefit analysis is not required because this rule making repeals existing rules and adds no new requirements.
July 19, 2016
Joel Sacks
The following sections of the Washington Administrative Code are repealed:
WAC 296-20-12055
Structured intensive multidisciplinary program (SIMP) for chronic noncancer pain.
WAC 296-20-12060
SIMP requirements for lumbar fusion and artificial disc replacement candidates.
WAC 296-20-12065
SIMP definitions.
WAC 296-20-12070
SIMP evaluation phase.
WAC 296-20-12075
SIMP treatment phase.
WAC 296-20-12080
SIMP follow-up phase.
WAC 296-20-12085
Requirements the SIMP provider must meet.
WAC 296-20-12090
Requirements the worker must meet for a SIMP.
WAC 296-20-12095
SIMP referral and prior authorization requirements.