reglab/statecodes huggingface dataset:
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › OPIOIDS FOR NONCANCER PAIN › Section 296-20-03085 - Addiction treatment

Current through Register Vol. 24-14, July 15, 2024
The department or self-insurer may authorize payment for
				  addiction management through a licensed chemical dependency treatment center
				  for up to six months as an aid to recovery if the following conditions are
				  met:
. The worker has failed steps 1 and 2 taper (see WAC
				  296-20-03030 for the definition
				  of step 1 and 2 taper); and
. The worker is diagnosed with opioid use disorder and this
				  condition is identified as a barrier to recovery; and
. The provider has documented how time-limited treatment of
				  this condition will allow significantly improved work capacity and/or the
				  ability to progress in vocational retraining; and
. The provider has submitted a time-limited treatment
				  plan.
Payment for addiction treatment is limited to six months per
				  worker.
Statutory Authority:
					 RCW
					 51.04.020 and
					 51.04.030. 13-12-024, §
					 296-20-03085, filed 5/28/13, effective
					 7/1/13.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › OPIOIDS FOR NONCANCER PAIN › Section 296-20-035 - Treatment in cases that remain open beyond sixty days

Current through Register Vol. 24-14, July 15, 2024
Conditions requiring treatment beyond sixty days are
				  indicative of a major industrial condition or complication by other conditions.
				  Except in cases of severe and extensive injuries, i.e., quadriplegia,
				  paraplegia, multiple fractures, etc., when the worker requires treatment beyond
				  sixty days following injury, a complete examination is necessary to determine
				  and/or establish need for continued treatment and/or payment of time loss
				  compensation. This may be accomplished either by the attending doctor or a
				  consultation exam. In either case, a detailed exam report must be provided to
				  the department or self-insurer. Refer to chapter 296-20 WAC (including the
				  definition section) and department policy for the type of information that must
				  be included in these reports.
Statutory Authority:
					 RCW
					 51.04.020,
					 51.04.030 and 1993 c 159.
					 93-16-072, § 296-20-035, filed 8/1/93, effective 9/1/93. Statutory
					 Authority:
					 RCW
					  51.04.020(4) and 51.040.030
					 [51.04.030]. 87-08-004 (Order 87-09), § 296-20-035, filed 3/20/87.
					 Statutory Authority:
					 RCW
					  51.04.020(4) and
					 51.04.030. 86-06-032 (Order
					 86-19), § 296-20-035, filed 2/28/86, effective 4/1/86. Statutory
					 Authority:
					 RCW
					  51.04.020(4),
					 51.04.030, and
					 51.16.120(3).
					 81-24-041 (Order 81-28), § 296-20-035, filed 11/30/81, effective 1/1/82;
					 81-01-100 (Order 80-29), § 296-20-035, filed 12/23/80, effective 3/1/81;
					 Order 71-6, § 296-20-035, filed 6/1/71; Order 70-12, § 296-20-035,
					 filed 12/1/70, effective 1/1/71; Order 68-7, § 296-20-035, filed 11/27/68,
					 effective 1/1/69.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › OPIOIDS FOR NONCANCER PAIN › Section 296-20-045 - Consultation requirements

Current through Register Vol. 24-14, July 15, 2024
In the event of complication, controversy, or dispute over
				  the treatment aspects of any claim, the department or self-insurer will not
				  authorize treatment until the attending doctor has arranged a consultation with
				  a qualified doctor with experience and expertise on the subject, and the
				  department or self-insurer has received notification of the findings and
				  recommendations of the consultant.
This consultation must be arranged in accordance with WAC
				  296-20-051.
Consultations are also required in the following
				  situations:
(1) All nonemergent major
				surgery on a patient with serious medical, emotional or social problems which
				are likely to complicate recovery.
(2) All procedures of a controversial nature
				or type not in common use for the specific condition.
(3) Surgical cases where there are
				complications or unfavorable circumstances such as age, preexisting conditions
				or interference with occupational requirements, etc.
(4) If the attending doctor, the department,
				self-insurer, or authorized department representative requests a
				consultation.
(5) Conservative
				care, (e.g., nonsurgical cases) extending past one hundred twenty days
				following initial visit. Such consultation may be with a chiropractic or a
				medical or osteopathic consultant.
Statutory Authority:
					 RCW
					 51.04.020(4) and
					 51.04.030. 90-04-057, §
					 296-20-045, filed 2/2/90, effective 3/5/90. Statutory Authority:
					 RCW
					  51.04.020(4),
					 51.04.030, and
					 51.16.120(3).
					 81-01-100 (Order 80-29), § 296-20-045, filed 12/23/80, effective 3/1/81.
					 Statutory Authority:
					 RCW
					  51.04.030 and
					 51.16.035. 79-12-086 (Order
					 79-18), § 296-20-045, filed 11/30/79, effective 1/1/80; Order 71-6, §
					 296-20-045, filed 6/1/71; Order 70-12, § 296-20-045, filed 12/1/70,
					 effective 1/1/71; Order 68-7, § 296-20-045, filed 11/27/68, effective
					 1/1/69.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › OPIOIDS FOR NONCANCER PAIN › Section 296-20-051 - Consultations

Current through Register Vol. 24-14, July 15, 2024
In cases presenting diagnostic or therapeutic problems to the
				  attending doctor, consultation with a specialist will be allowed without prior
				  authorization. The consultant must submit his findings and recommendations
				  immediately to the attending doctor and the department or self-insurer. Refer
				  to chapter 296-20 WAC and department policy for reporting requirements.
Whenever possible, the referring doctor should make his
				  x-rays and records available to the consultant to avoid unnecessary
				  duplication. The department's consultation referral form may be used to convey
				  information to the consultant. Consultants may proceed with indicated and
				  reasonable x rays or laboratory work and reasonable diagnostic studies as
				  permitted within their scope of practice.
Consultations will be held with a specialist within a
				  reasonable geographic area. Whenever possible, consultation should be made with
				  a doctor outside the referring doctor's office or partnership.
The attending doctor will not arrange a consultation if he
				  has received notification that a special or commission examination is being
				  arranged by the department or self-insurer. If he has had recent consultation
				  and is notified that the department or self-insurer is arranging an
				  examination, he must immediately advise the department or self-insurer of the
				  consultation.
The consultation fee will be paid only if a consultation
				  report is complete and contains all pathological findings as well as all
				  pertinent negative or normal findings. The report must be received in the
				  department within fifteen days from the date of the consultation. No fee is
				  paid to the consultant if the worker fails the appointment.
The consultant may not order, prescribe, or provide treatment
				  without the approval of the attending doctor and the injured worker. No
				  transfer will be made to the consultant without the prior approval of the
				  attending doctor and the injured worker.
Consultation services will not be reimbursed for workers who
				  are currently, or have been under the physician's care within the last three
				  years. Such services should be billed as follow up visits, as listed in the fee
				  schedules.
Statutory Authority:
					 RCW
					 51.04.020,
					 51.04.030 and 1993 c 159.
					 93-16-072, § 296-20-051, filed 8/1/93, effective 9/1/93. Statutory
					 Authority:
					 RCW
					  51.04.020(4) and
					 51.04.030. 86-06-032 (Order
					 86-19), § 296-20-051, 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), § 296-20-051, filed 12/23/80, effective 3/1/81;
					 Order 71-6, § 296-20-051, filed 6/1/71; Order 70-12, § 296-20-051,
					 filed 12/1/70, effective 1/1/71. Formerly WAC
					 296-20-070.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › OPIOIDS FOR NONCANCER PAIN › Section 296-20-055 - Limitation of treatment and temporary treatment of unrelated conditions when retarding recovery

Current through Register Vol. 24-14, July 15, 2024
Conditions preexisting the injury or occupational disease are
				  not the responsibility of the department. When an unrelated condition is being
				  treated concurrently with the industrial condition, the attending doctor must
				  notify the department or self-insurer immediately and submit the
				  following:
(1) Diagnosis and/or nature
				of unrelated condition.
(2)
				Treatment being rendered.
(3) The
				effect, if any, on industrial condition.
Temporary treatment of an unrelated condition may be allowed,
				  upon prior approval by the department or self-insurer, provided these
				  conditions directly retard recovery of the accepted condition. The department
				  or self-insurer will not approve or pay for treatment for a known preexisting
				  unrelated condition for which the claimant was receiving treatment prior to his
				  industrial injury or occupational disease, which is not retarding recovery of
				  his industrial condition.
A thorough explanation of how the unrelated condition is
				  affecting the industrial condition must be included with the request for
				  authorization.
The department or self-insurer will not pay for treatment of
				  an unrelated condition when it no longer exerts any influence upon the accepted
				  industrial condition. When treatment of an unrelated condition is being
				  rendered, reports must be submitted monthly outlining the effect of treatment
				  on both the unrelated and the accepted industrial conditions.
The department or self-insurer will not pay for
				  treatment for unrelated conditions unless specifically authorized.
This
				  includes prescription of drugs and medicines.
Statutory Authority:
					 RCW
					 51.04.020(4),
					 51.04.030, and
					 51.16.120(3).
					 81-01-100 (Order 80-29), § 296-20-055, filed 12/23/80, effective 3/1/81;
					 Order 71-6, § 296-20-055, filed 6/1/71; Order 70-12, § 296-20-055,
					 filed 12/1/70, effective 1/1/71; Order 68-7, § 296-20-055, filed 11/27/68,
					 effective 1/1/69.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › OPIOIDS FOR NONCANCER PAIN › Section 296-20-071 - Concurrent treatment

Current through Register Vol. 24-14, July 15, 2024
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 provider, who will be
				  responsible for 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,
					 51.04.030. 09-14-104, §
					 296-20-071, filed 6/30/09, effective 7/31/09. 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.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › OPIOIDS FOR NONCANCER PAIN › Section 296-20-075 - Hospitalization

Current through Register Vol. 24-14, July 15, 2024
(1) Hospitalization
				will be paid for proper and necessary medical treatment of the accepted
				condition(s). The department may develop and implement utilization management
				criteria which will be used to review inpatient hospital admissions.
				Reimbursement for hospitalization is limited to proper and necessary care for
				an accepted condition. Failure to comply with these criteria may result in
				delayed or reduced reimbursement to the provider as allowed under chapter 51.48
				RCW. Ward or semi-private accommodations will be paid, unless the worker's
				condition requires special care.
(2) Discharge from the hospital shall be at
				the earliest date possible consistent with proper health care. If additional
				treatment is needed, discharge planning must include referral to a network
				provider. If transfer to a convalescent center or nursing home is indicated,
				prior arrangements should be made with the department or self-insurer. See WAC
				296-20-091 for further
				information. The department may designate those diagnostic and surgical
				procedures which will be reimbursed only if performed in an outpatient setting.
				When procedures so designated must be performed in an inpatient setting for
				reasons of medical necessity, prior authorization must be obtained.
Statutory Authority:
					 RCW
					 51.36.010,
					 51.04.020, and
					 51.04.030. 12-06-066, §
					 296-20-075, filed 3/6/12, effective 4/6/12. Statutory Authority:
					 RCW
					  51.04.020(4) and
					 51.04.030. 90-04-057, §
					 296-20-075, filed 2/2/90, effective 3/5/90; 87-24-050 (Order 87-23), §
					 296-20-075, filed 11/30/87, effective 1/1/88; 86-20-074 (Order 86-36), §
					 296-20-075, filed 10/1/86, effective 11/1/86; 86-06-032 (Order 86-19), §
					 296-20-075, 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), § 296-20-075, filed 12/23/80, effective 3/1/81;
					 Order 71-6, § 296-20-075, filed 6/1/71; Order 70-12, § 296-20-075,
					 filed 12/1/70, effective 1/1/71; Order 68-7, § 296-20-075, filed 11/27/68,
					 effective 1/1/69.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › OPIOIDS FOR NONCANCER PAIN › Section 296-20-081 - Unrelated concurrent nonemergent surgery

Current through Register Vol. 24-14, July 15, 2024
Elective surgery for an unrelated condition is not normally
				  permitted during hospitalization for an industrial condition. Under some
				  circumstances unrelated elective surgery may be permitted through prior
				  agreement and approval by the department provided the unrelated surgery is not
				  more extensive than the procedure for the industrial condition. The requesting
				  doctor must submit a written request and identify which services are needed due
				  to the industrial injury and which are needed due to unrelated conditions,
				  along with an estimate of what effect, if any, the unrelated surgery will have
				  on the accepted conditions and recovery time from surgery.
Statutory Authority:
					 RCW
					 51.04.020(4),
					 51.04.030, and
					 51.16.120(3).
					 81-01-100 (Order 80-29), § 296-20-081, filed 12/23/80, effective 3/1/81;
					 Order 70-12, § 296-20-081, filed 12/1/70, effective 1/1/71. Formerly WAC
					 296-20-095.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › OPIOIDS FOR NONCANCER PAIN › Section 296-20-091 - Home nursing

Current through Register Vol. 24-14, July 15, 2024
A worker temporarily totally disabled or permanently totally
				  disabled may either temporarily or permanently require home nursing care. A
				  physician's request and prior department authorization are required for home
				  nursing care.
Home health, hospice, and home care agency providers shall be
				  licensed.
Statutory Authority:
					 RCW
					 51.04.020,
					 51.04.030,
					 51.32.060,
					 51.32.072, and
					 7.68.070. 01-18-041, §
					 296-20-091, filed 8/29/01, effective 10/1/01. Statutory Authority:
					 RCW
					  51.04.020(4) and
					 51.04.030. 92-05-041, §
					 296-20-091, filed 2/13/92, effective 3/15/92. Statutory Authority:
					 RCW
					  51.04.020(4),
					 51.04.030, and
					 51.16.120(3).
					 81-01-100 (Order 80-29), § 296-20-091, filed 12/23/80, effective 3/1/81;
					 Order 71-6, § 296-20-091, filed 6/1/71; Order 70-12, § 296-20-091,
					 filed 12/1/70, effective 1/1/71. Formerly WAC
					 296-20-080.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › OPIOIDS FOR NONCANCER PAIN › Section 296-20-097 - Reopenings

Current through Register Vol. 24-14, July 15, 2024
When a claim has been closed by the department or
				  self-insurer by written order and notice for 60 days, submission of a formal
				  "application to reopen claim due to worsening of condition" form # F242-079-000
				  is preferred. The department or self-insurer is responsible for customary
				  charges for examinations, diagnostic studies, and determining whether or not
				  time-loss is payable regardless of the final action taken on the reopening
				  application. Reopening applications should be submitted immediately. When
				  reopening is granted, the department or self-insurer can pay time loss and
				  treatment benefits only for a period not to exceed 60 days
prior
to date the application is received by the department or
				  self-insurer. The 60 days may be extended up to 120 days consistent with
				  RCW
				   51.28.040. Necessary treatment should not be
				  deferred pending a department or self-insurer adjudication decision. However,
				  should reopening be denied treatment costs become the financial responsibility
				  of the worker.
Statutory Authority:
					 RCW
					  51.04.020,
					 51.04.030, and
					 Title
					 51 RCW. 08-24-047, §
					 296-20-097, filed 11/25/08, effective 12/26/08. Statutory Authority:
					 RCW
					  51.32.190 and
					 51.32.210. 90-22-054, §
					 296-20-097, filed 11/5/90, effective 12/6/90. Statutory Authority:
					 RCW
					  51.04.020(4),
					 51.04.030, and
					 51.16.120(3).
					 81-24-041 (Order 81-28), § 296-20-097, filed 11/30/81, effective 1/1/82;
					 81-01-100 (Order 80-29), § 296-20-097, filed 12/23/80, effective 3/1/81;
					 Order 71-6, § 296-20-097, filed 6/1/71; Order 70-12, § 296-20-095
					 (codified as WAC
					 296-20-097), filed 12/1/70,
					 effective 1/1/71. Formerly WAC
					 296-20-090.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › OPIOIDS FOR NONCANCER PAIN › Section 296-20-09701 - Request for reconsideration

Current through Register Vol. 24-14, July 15, 2024
On occasion, a claim may be closed prematurely or in error or
				  other adjudication action may be taken, which may seem inappropriate to the
				  doctor or injured worker. When this occurs the attending doctor should submit
				  immediately in writing his request for reconsideration of the adjudication
				  action, supported by an outline of:
(1) The claimant's current
				condition.
(2) The treatment
				program being received.
(3) The
				prognosis of when stabilization will occur.
All requests for reconsideration must be received by the
				  department or self-insurer within sixty days from date of the order and notice
				  of closure. Request for reconsideration of other department or self-insurer
				  orders or actions must be made in writing by either the doctor or the injured
				  worker within sixty days of the date of the action or order.
Statutory Authority:
					 RCW
					 51.04.020(4),
					 51.04.030, and
					 51.16.120(3).
					 81-01-100 (Order 80-29), § 296-20-09701, filed 12/23/80, effective
					 3/1/81.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › OPIOIDS FOR NONCANCER PAIN › Section 296-20-100 - Eye glasses and refractions

Current through Register Vol. 24-14, July 15, 2024
The department or self-insurer will be responsible one time
				  for replacement of glasses or contact lenses only to the extent of the cost of
				  restoring damaged item to its condition at the time of the accident. This
				  benefit applies only if the worker was wearing the glasses or contact lens when
				  the industrial accident occurred.
If glasses are repairable and a worker determines that he/she
				  prefers a replacement, the department or self-insurer is responsible only for
				  the cost of the repairs and the worker is responsible for the difference
				  between repair and replacement costs.
Refraction to replace a broken or lost lens is only payable
				  when it is substantiated that the prescription was not available from the
				  broken lens or any other source. If the prescription is available, and the
				  patient needs a new refraction, he is responsible for the costs of such
				  exam.
If a refractive error is the result of the industrial injury
				  or occupational disease condition, refraction and glasses or contact lenses
				  will be authorized and paid by the department or self-insurer.
When broken or lost glasses or contact lenses are the only
				  injury or condition suffered, the doctor's portion of the report of accident
				  can be completed by an optometrist or other vendor furnishing the replacement.
				  A report of accident must be received by the department or self-insurer in
				  order to adjudicate the claim.
Statutory Authority:
					 RCW
					 51.04.020(4) and
					 51.04.030. 86-06-032 (Order
					 86-19), § 296-20-100, 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), § 296-20-100, filed 12/23/80, effective 3/1/81;
					 Order 71-6, § 296-20-100, filed 6/1/71; Order 70-12, § 296-20-100,
					 filed 12/1/70, effective 1/1/71; Order 68-7, § 296-20-100, filed 11/27/68,
					 effective 1/1/69.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › OPIOIDS FOR NONCANCER PAIN › Section 296-20-110 - Dental

Current through Register Vol. 24-14, July 15, 2024
Only dentists, oral surgeons or dental specialists licensed
				  in the state in which they practice are eligible to treat workers entitled to
				  benefits under the industrial insurance law.
If only a dental injury is involved, the doctor's portion of
				  the report of accident must be completed by the dentist to whom the worker
				  first reports. See WAC
				  296-20-025 for further
				  information.
If the accident report has been submitted by another doctor,
				  the dentist's report should be made by letter. In addition to the information
				  required under WAC
				  296-20-025, the dentist should
				  outline the extent of the dental injury and the treatment program necessary to
				  repair damage due to the injury. Dental X rays should be retained by the
				  attending dentist for a period of not less than ten years. The department or
				  self-insurer does not require submission of the actual films except upon
				  specific request.
The department or self-insurer is responsible only for repair
				  or replacement of teeth injured or dentures broken as a result of an industrial
				  accident. Any dental work needed due to underlying conditions unrelated to the
				  industrial injury is the responsibility of the worker. It is the responsibility
				  of the dentist to advise the worker accordingly.
In cases presenting complication, controversy, or diagnostic
				  or therapeutic problems, consultation by another dentist may be requested to
				  support authorization for restorative repairs.
Bills covering the cost of dentures should be submitted for
				  the denture only and should not include the cost for subsequent relining. If
				  relining becomes necessary, authorization for relining must be obtained in
				  advance from the department or self-insurer.
Bills must be submitted to the department or self-insurer
				  within one year from the date the service is rendered. Bills must itemize the
				  service rendered, including the current HCPCS Level II codes, the materials
				  used and the injured tooth number(s). See WAC
				  296-20-125 and department policy
				  for further billing rules.
Statutory Authority:
					 RCW
					 51.04.020,
					 51.04.030 and 1993 c 159.
					 94-14-044, § 296-20-110, filed 6/29/94, effective 7/30/94; 93-16-072,
					 § 296-20-110, filed 8/1/93, effective 9/1/93. Statutory Authority:
					 RCW
					  51.04.020(4) and
					 51.04.030. 86-06-032 (Order
					 86-19), § 296-20-110, 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), § 296-20-110, filed 12/23/80, effective 3/1/81;
					 Order 70-12, § 296-20-110, filed 12/1/70, effective 1/1/71; Order 68-7,
					 § 296-20-110, filed 11/27/68, effective
					 1/1/69.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › OPIOIDS FOR NONCANCER PAIN › Section 296-20-1101 - Hearing aids and masking devices

Current through Register Vol. 24-14, July 15, 2024
The department or self-insurer is responsible for replacement
				  or repair of hearing aids damaged or lost due to an industrial accident only to
				  the extent of restoring the damaged item to its condition at time of the
				  accident. If the hearing aid is repairable and the worker determines he prefers
				  replacement, the department or self-insurer is responsible only to the extent
				  of the cost to repair the original and the worker is responsible for the
				  difference between repair and replacement costs.
When the department or self-insurer has accepted a hearing
				  loss condition either as a result of industrial injury or occupational
				  exposure, the department or self-insurer will furnish a hearing aid (hearing
				  aids when bilateral loss is present) when prescribed or recommended by a
				  physician.
The department or self-insurer will bear the cost of :
(1) Repairs due to normal wear;
(2) Replacement due to normal wear;
(3) Replacement upon request five years after
				the issue date of the current hearing aid; and
(4) Battery replacement for the life of the
				hearing aid.
If the worker has been issued a linear analog hearing aid and
				  it becomes inoperable or if the worker is unable to hear, the department or
				  self-insurer will replace the linear analog hearing aid with a nonlinear
				  digital or nonlinear analog hearing aid in accordance with existing medical aid
				  rules and fee schedules and at no cost to the worker even if the linear analog
				  hearing aid is repairable.
In cases of accepted tinnitus, the department or self-insurer
				  may provide masking devices under the same provisions as outlined for hearing
				  aids due to hearing loss.
Provision of masking devices and hearing aids require prior
				  authorization.
Statutory Authority:
					 RCW
					  51.04.020,
					 51.36.080,
					 7.68.030,
					 7.68.080. 08-05-093, §
					 296-20-1101, filed 2/15/08, effective 3/22/08. Statutory Authority:
					 RCW
					  51.04.020(4),
					 51.04.030, and
					 51.16.120(3).
					 81-01-100 (Order 80-29), § 296-20-1101, filed 12/23/80, effective
					 3/1/81.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › OPIOIDS FOR NONCANCER PAIN › Section 296-20-1103 - Travel expense

Current through Register Vol. 24-14, July 15, 2024
(1) The department
				or self-insurer will reimburse travel expense incurred by workers for :
(a) Examinations at department's or
				self-insurer's request;
(b)
				Approved vocational retraining or vocational services at department's or
				self-insurer's request;
(c) Fitting
				of prosthetic device;
(d) Upon
prior authorization
for treatment when worker must travel more
				than fifteen miles one-way from the worker's home to the nearest point of
				adequate treatment . Travel expense
is not
payable when
				adequate treatment is available within fifteen miles of injured worker's home,
				yet the injured worker prefers to report to an attending provider outside the
				worker's home area.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › OPIOIDS FOR NONCANCER PAIN › Section 296-20-120 - Procedures not listed in this schedule

Current through Register Vol. 24-14, July 15, 2024
Procedures not specifically listed will be given values
				  comparable to those of the listed procedures of closest similarity. Refer to
				  chapter 296-20 WAC (including the definition section) and the fee schedules for
				  required billing documentation.
Statutory Authority:
					 RCW
					 51.04.020,
					 51.04.030 and 1993 c 159.
					 93-16-072, § 296-20-120, filed 8/1/93, effective 9/1/93. Statutory
					 Authority:
					 RCW
					  51.04.020(4),
					 51.04.030, and
					 51.16.120(3).
					 81-01-100 (Order 80-29), § 296-20-120, filed 12/23/80, effective 3/1/81;
					 Order 71-6, § 296-20-120, filed 6/1/71; Order 70-12, § 296-20-120,
					 filed 12/1/70, effective 1/1/71; Order 68-7, § 296-20-120, filed 11/27/68,
					 effective 1/1/69.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › OPIOIDS FOR NONCANCER PAIN › Section 296-20-12050 - Special programs

Current through Register Vol. 24-14, July 15, 2024
(1) The department
				or self-insurer may from time to time enter into special agreements for
				services provided by, or under the direction of, licensed providers authorized
				to bill the department. Special agreements are for services other than routine
				services covered under the fee schedule, and may include multidisciplinary or
				inter-disciplinary programs such as pain management, work hardening, and
				physical conditioning.
(2) The
				department shall establish payment rates for special agreements, and may
				establish outcome criteria, measures of effectiveness, minimum staffing levels,
				certification requirements, special reporting requirements and such other
				criteria as will ensure injured workers receive good quality and effective
				services at a prudent cost.
(3)
				Special agreements shall be purchased at the discretion of the department or
				self-insurer. The department may terminate special programs from the industrial
				insurance program upon thirty days notice to the provider.
Statutory Authority:
					 RCW
					 51.04.020(4) and
					 51.04.030. 87-24-050 (Order
					 87-23), § 296-20-12050, filed 11/30/87, effective
					 1/1/88.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › STRUCTURED INTENSIVE MULTIDISCIPLINARY PROGRAM (SIMP) FOR CHRONIC NONCANCER PAIN › Section 296-20-12055

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
					 RCW
					  70.14.120,
					 51.04.020,
					 51.04.030. 09-20-040, §
					 296-20-12055, filed 9/30/09, effective
					 11/1/09.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › STRUCTURED INTENSIVE MULTIDISCIPLINARY PROGRAM (SIMP) FOR CHRONIC NONCANCER PAIN › Section 296-20-12060

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
					 RCW
					  70.14.120,
					 51.04.020,
					 51.04.030. 09-20-040, §
					 296-20-12060, filed 9/30/09, effective
					 11/1/09.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › STRUCTURED INTENSIVE MULTIDISCIPLINARY PROGRAM (SIMP) FOR CHRONIC NONCANCER PAIN › Section 296-20-12065

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
					 RCW
					  70.14.120,
					 51.04.020,
					 51.04.030. 09-20-040, §
					 296-20-12065, filed 9/30/09, effective
					 11/1/09.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › STRUCTURED INTENSIVE MULTIDISCIPLINARY PROGRAM (SIMP) FOR CHRONIC NONCANCER PAIN › Section 296-20-12070

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
					 RCW
					  70.14.120,
					 51.04.020,
					 51.04.030. 09-20-040, §
					 296-20-12070, filed 9/30/09, effective
					 11/1/09.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › STRUCTURED INTENSIVE MULTIDISCIPLINARY PROGRAM (SIMP) FOR CHRONIC NONCANCER PAIN › Section 296-20-12075

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
					 RCW
					  70.14.120,
					 51.04.020,
					 51.04.030. 09-20-040, §
					 296-20-12075, filed 9/30/09, effective
					 11/1/09.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › STRUCTURED INTENSIVE MULTIDISCIPLINARY PROGRAM (SIMP) FOR CHRONIC NONCANCER PAIN › Section 296-20-12080

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
					 RCW
					  70.14.120,
					 51.04.020,
					 51.04.030. 09-20-040, §
					 296-20-12080, filed 9/30/09, effective
					 11/1/09.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › STRUCTURED INTENSIVE MULTIDISCIPLINARY PROGRAM (SIMP) FOR CHRONIC NONCANCER PAIN › Section 296-20-12085

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
					 RCW
					  70.14.120,
					 51.04.020,
					 51.04.030. 09-20-040, §
					 296-20-12085, filed 9/30/09, effective
					 11/1/09.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › STRUCTURED INTENSIVE MULTIDISCIPLINARY PROGRAM (SIMP) FOR CHRONIC NONCANCER PAIN › Section 296-20-12090

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
					 RCW
					  70.14.120,
					 51.04.020,
					 51.04.030. 09-20-040, §
					 296-20-12090, filed 9/30/09, effective
					 11/1/09.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › STRUCTURED INTENSIVE MULTIDISCIPLINARY PROGRAM (SIMP) FOR CHRONIC NONCANCER PAIN › Section 296-20-12095

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
					 RCW
					  70.14.120,
					 51.04.020,
					 51.04.030. 09-20-040, §
					 296-20-12095, filed 9/30/09, effective
					 11/1/09.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › STRUCTURED INTENSIVE MULTIDISCIPLINARY PROGRAM (SIMP) FOR CHRONIC NONCANCER PAIN › Section 296-20-121 - X rays

Current through Register Vol. 24-14, July 15, 2024
Recognizing the greatest need for access to X rays lies with
				  the attending doctor, the department or self-insurer requires only submission
				  of X-ray findings and does not require submission of the actual films except
				  upon specific request when needed for purposes of permanent disability rating,
				  other administrative or legal decisions, or in litigation cases. The department
				  or self-insurer requires the attending doctor retain X rays for a period of not
				  less than ten years. In transfer cases, the X rays in the possession of the
				  current attending doctor must be made available to the new attending
				  doctor.
When requesting consultation, the attending doctor should
				  make any X rays in his possession available to the consultant.
When a special exam has been arranged for the worker by the
				  department or self-insurer, the worker's existing X rays should be provided to
				  the special examiner. The worker may carry such X rays to the exam.
When the doctor's office is closed because of death,
				  retirement or leaving the state, arrangements must be made with the department
				  or self-insurer regarding custody of X rays to insure availability on request.
				  When submitting billing for X-ray service, a copy of the X-ray findings is
				  required. No payment will be made for excessive or unnecessary X rays. No
				  payment will be made on closed or rejected claims, except under conditions
				  outlined in WAC
				  296-20-124.
Prior authorization is required for X rays subsequent to the
				  initial study. Repeat or serial radiology examinations may be performed only
				  upon adequate clinical justification to confirm changes in the condition(s)
				  accepted. The subjective complaints and the objective findings substantiating
				  the repeat study must be submitted by the practitioner in the request for
				  authorization to the department or self-insurer.
Statutory Authority:
					 RCW
					 51.04.020(4) and
					 51.04.030. 86-06-032 (Order
					 86-19), § 296-20-121, filed 2/28/86, effective 4/1/86. Statutory
					 Authority:
					 RCW
					  51.04.020(4),
					 51.04.030, and
					 51.16.120(3).
					 81-24-041 (Order 81-28), § 296-20-121, filed 11/30/81, effective 1/1/82;
					 81-01-100 (Order 80-29), § 296-20-121, filed 12/23/80, effective 3/1/81;
					 Order 77-27, § 296-20-121, filed 11/30/77, effective 1/1/78; Emergency
					 Order 77-26, § 296-20-121, filed 12/1/77; Emergency Order 77-16, §
					 296-20-121, filed 9/6/77; Order 74-39, § 296-20-121, filed 11/22/74,
					 effective 1/1/75; Order 74-7, § 296-20-121, filed
					 1/30/74.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › STRUCTURED INTENSIVE MULTIDISCIPLINARY PROGRAM (SIMP) FOR CHRONIC NONCANCER PAIN › Section 296-20-124 - Rejected and closed claims

Current through Register Vol. 24-14, July 15, 2024
(1) No
				payment will be made for treatment or medication on rejected claims except:
(a) Services which were carried out at the
				specific request of the department or the self-insurer; or
(b) Examination or diagnostic services which
				served as a basis for the adjudication decision; or
(c) Initial prescription drugs prescribed
				during the initial visit for state fund claims.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › BILLING › Section 296-20-12501 - Physician assistant billing procedure

Current through Register Vol. 24-14, July 15, 2024
Billing for physician assistant services will be paid at
				  ninety percent of the value listed in the fee schedules. Payment will be made
				  directly to the supervising physician.
(1) Bills must be itemized on department or
				self-insurer forms, as the case may be, specifying: The date, type of service
				and the charges for each service.
(2) The bill form must be completed in detail
				to include the claim number. All bills must be submitted under the physician
				assistant's account number. Bills will be accepted when signed by other than
				the practitioner rendering services. When bills are prepared by someone else,
				the responsibility for the completeness and accuracy of the description of
				services and charges rests with the supervising physician.
(3) For a bill to be considered for payment,
				it must be received in the department or by the self-insurer within one year
				from the date each specific treatment and/or service was rendered or performed.
				Whenever possible, bills should be submitted monthly.
(4) Bills cannot be paid for services
				rendered while a claim is closed.
(5) The department or self-insurer may deny
				payment of bills for services rendered in violation of the medical aid rules or
				department policy. Workers may not be billed for services rendered in violation
				of these rules.
Statutory Authority:
					 RCW
					 51.04.020. 03-21-069, § 296-20-12501,
					 filed 10/14/03, effective 12/1/03. Statutory Authority:
					 RCW
					  51.04.020,
					 51.04.030 and 1993 c 159.
					 93-16-072, § 296-20-12501, filed 8/1/93, effective 9/1/93. Statutory
					 Authority:
					 RCW
					  51.04.030 and
					 51.16.035. 79-12-086 (Order
					 79-18), § 296-20-12501, filed 11/30/79, effective
					 1/1/80.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › BILLING › Section 296-20-132 - Determination of conversion factor adjustments

Current through Register Vol. 24-14, July 15, 2024
Adjustments to the conversion factors for providers and
				  services covered by the fee schedules and by department policy may occur
				  annually following prior public hearings.
Such adjustments will be based on the estimated
				  increase/decrease in the state's average wage for the current year and on other
				  factors as determined by department policy. The following calendar year's
				  estimate, of the average state wage will be adjusted to reflect the actual
				  increase/decrease in the state's average wage for the preceding year.
The total percentage change for any one calendar year for the
				  conversion factors may not exceed the total of the estimated increase/decrease
				  in the current year, plus or minus the actual adjustment for the preceding
				  calendar year.
Statutory Authority:
					 RCW
					 51.04.020(4) and
					 51.04.030. 96-10-086, §
					 296-20-132, filed 5/1/96, effective 7/1/96. Statutory Authority:
					 RCW
					  51.04.020,
					 51.04.030 and 1993 c 159.
					 93-16-072, § 296-20-132, filed 8/1/93, effective 9/1/93. Statutory
					 Authority:
					 RCW
					 51.04.020(4) and
					 51.04.030. 88-24-011 (Order
					 88-28), § 296-20-132, filed 12/1/88, effective 1/1/89; 82-24-050 (Order
					 82-39), § 296-20-132, filed 11/29/82, effective
					 1/1/84.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › BILLING › Section 296-20-170 - Pharmacy - Acceptance of rules and fees

Current through Register Vol. 24-14, July 15, 2024
(1) Acceptance and filling of a prescription
				for a worker entitled to benefits under the industrial insurance law,
				constitutes acceptance of the department's rules and fees.
(2) When there is questionable eligibility,
				(i.e., no claim number, prescription is for medication other than usually
				prescribed for industrial injury; or pharmacist has reason to believe claim is
				closed or rejected), the pharmacist may require the worker to pay for the
				prescription.
(a) The pharmacist must furnish
				the worker with a signed receipt and a nonnegotiable copy of the prescription
				including national drug code and quantity or a completed department pharmacy
				bill form signed in the appropriate areas verifying worker has paid for the
				prescribed item(s) in order for the worker to bill the department or
				self-insurer for reimbursement.
(b)
				The worker may not be charged more than the amount allowable by the department
				or self-insurer.
(c) The worker
				must submit such reimbursement request within one year of the date of service.
See WAC
				  296-20-020 for details on
				  providing a refund.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › BILLING › Section 296-20-17001 - Allowance and payment for medication

Current through Register Vol. 24-14, July 15, 2024
(1) The department or self-insurer will pay
				for medications or supplies dispensed for the treatment of conditions resulting
				from an industrial injury and/or conditions which are retarding the recovery
				from the industrial injury, for which the department or self-insurer has
				accepted temporary responsibility.
(2) Approved generic are to be substituted
				for brand name pharmaceuticals in all cases unless the worker's condition will
				not tolerate a generic preparation and the prescribing physician indicates no
				substitution is permitted. A list of approved generics and their base cost will
				be published periodically by the department.
(3) Items not normally paid include:
				Syringes, injectables, heating pads, vibrators, personal appliances, oral
				nutritional supplements, anorexiants, and medications normally prescribed for
				systemic conditions. These items may be authorized to certain individuals in
				unusual circumstances; prior approval from the department or self-insurer is
				mandatory.
(4) Rental or purchase
				of medical equipment must be prior authorized by the department or
				self-insurer.
(5) No payment will
				be made for medication dispensed after the date of the order and notice of
				claim closure or rejection or for conditions unrelated to the industrial injury
				or occupational disease except for initial prescription drugs prescribed during
				the initial visit for state fund claims.
Statutory Authority:
					 RCW
					 51.04.020,
					 51.04.030 and 2007 c 134.
					 08-02-021, § 296-20-17001, filed 12/21/07, effective 1/21/08. Statutory
					 Authority:
					 RCW
					  51.04.020(4) and
					 51.04.030. 86-06-032 (Order
					 86-19), § 296-20-17001, filed 2/28/86, effective 4/1/86; 83-24-016 (Order
					 83-35), § 296-20-17001, filed 11/30/83, effective 1/1/84. Statutory
					 Authority:
					 RCW
					  51.04.020(4),
					 51.04.030, and
					 51.16.120(3).
					 80-18-033 (Order 80-24), § 296-20-17001, filed 12/1/80, effective 1/1/81;
					 Order 76-34, § 296-20-17001, filed 11/24/76, effective
					 1/1/77.