Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › OPIOIDS FOR NONCANCER PAIN › Section 296-20-1102 - Special equipment rental and purchase prosthetic and orthotics equipment

Current through Register Vol. 24-14, July 15, 2024
The department or self-insurer will authorize and pay rental
				  fee for equipment or devices if the need for the equipment will be for a short
				  period of treatment during the acute phase of condition. Rental extending
				  beyond sixty days requires prior authorization. If the equipment will be needed
				  on long term basis, the department or self-insurer will consider purchase of
				  the equipment or device. The department's or self-insurer's decision to rent or
				  purchase an item of medical equipment will be based on a comparison of the
				  projected rental costs of the item with its purchase price. An authorized
				  representative of the department or self-insurer will decide whether to rent or
				  purchase certain items, provided they are appropriate and medically necessary
				  for treatment of the worker's accepted industrial condition. Decisions to rent
				  or purchase items will be based on the following information:
(1) Purchase price of the item.
(2) Monthly rental fee.
(3) The prescribing doctor's estimate of how
				long the item will be needed.
The prescribing doctor must obtain prior authorization from
				  the department or self-insurer, for rental or purchase of special equipment or
				  devices. Also, all equipment (rentals and purchases), prosthetics, and
				  orthotics must be billed using the appropriate codes, and billing forms, as
				  determined by the medical aid rules and fee schedules.
The department or self-insurer will authorize and pay for
				  prosthetics and orthotics as needed by the worker and substantiated by
				  attending doctor. If such items are furnished by the attending doctor, the
				  department or self-insurer will reimburse the doctor his cost for the item. See
				  chapter 296-20 WAC (including WAC
				  296-20-124)  and the fee
				  schedules for information regarding replacement of such items on closed
				  claims.
The department or self-insurer will repair or replace
				  originally provided damaged, broken, or worn-out prosthetics, orthotics, or
				  special equipment devices upon documentation and substantiation from the
				  attending doctor.
Provision of such equipment requires prior
				  authorization.
THE GRAVITY GUIDING SYSTEM, GRAVITY LUMBAR REDUCTION DEVICE,
				  BACKSWING AND OTHER INVERSION TRACTION EQUIPMENT MAY ONLY BE USED IN A
				  SUPERVISED SETTING. RENTAL OR PURCHASE FOR HOME USE WILL NOT BE ALLOWED NOR
				  PAID BY THE DEPARTMENT OR SELF-INSURER.
EQUIPMENT NOT REQUIRING PRIOR AUTHORIZATION INCLUDES
				  CRUTCHES, CERVICAL COLLARS, LUMBAR AND RIB BELTS, AND OTHER COMMONLY USED
				  ORTHOTICS OF MINIMAL COST.
PERSONAL APPLIANCES SUCH AS VIBRATORS, HEATING PADS, HOME
				  FURNISHINGS, HOT TUBS, WATERBEDS, EXERCISE BIKES, EXERCISE EQUIPMENT,
				  JACUZZIES, PILLOWS, CASSETTE TAPES, EDUCATIONAL MATERIALS OR BOOKS, AND OTHER
				  SIMILAR ITEMS WILL NOT BE AUTHORIZED OR PAID.
In no case will the department or self-insurer pay for rental
				  fees once the purchase price of the rented item has been reached with the
				  exception of oxygen equipment. The department or self-insurer may pay for
				  rental fees of oxygen equipment beyond its purchase price.
Statutory Authority:
					 RCW
					 51.04.020 and
					 51.04.030. 05-23-143, §
					 296-20-1102, filed 11/22/05, effective 1/3/06. Statutory Authority:
					 RCW
					  51.04.020,
					 51.04.030 and 1993 c 159.
					 93-16-072, § 296-20-1102, filed 8/1/93, effective 9/1/93. Statutory
					 Authority:
					 RCW
					  51.04.020(4) and
					 51.04.030. 87-22-052 (Order
					 87-22), § 296-20-1102, filed 11/2/87; 86-06-032 (Order 86-19), §
					 296-20-1102, filed 2/28/86, effective 4/1/86; 83-16-066 (Order 83-23), §
					 296-20-1102, filed 8/2/83. Statutory Authority:
					 RCW
					  51.04.020(4),
					 51.04.030, and
					 51.16.120(3).
					 81-24-041 (Order 81-28), § 296-20-1102, filed 11/30/81, effective 1/1/82;
					 81-01-100 (Order 80-29), § 296-20-1102, filed 12/23/80, effective
					 3/1/81.