Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › OPIOIDS FOR NONCANCER PAIN › Section 296-20-065 - Transfer of providers

Current through Register Vol. 24-14, July 15, 2024
For services or provider types where the department has
				  established the provider network, the injured worker must select an attending
				  provider from the provider network for all care beyond the initial visit. If
				  the initial office or emergency room visit was completed with a nonnetwork
				  provider and additional treatment is needed, the worker must transfer care to a
				  network provider and promptly inform the department or self-insurer.
All transfers from one network provider to another must be
				  approved by the department or self-insurer. Normally transfers will be allowed
				  only after the worker has been under the care of the attending provider for
				  sufficient time for the provider to: Complete necessary diagnostic studies,
				  establish an appropriate treatment regimen, and evaluate the efficacy of the
				  therapeutic program.
Under
				  RCW
				   51.36.010 the worker is entitled to free
				  choice of treating provider. Except as provided under subsections (1) through
				  (7) of this section, no reasonable request for transfer to a network provider
				  will be denied. The worker must be advised when and why a transfer is
				  denied.
When a transfer is approved, the new attending provider must
				  be provided with a copy of the worker's treatment record by the previous
				  attending provider. X rays in the possession of the previous attending provider
				  must be immediately forwarded to the new attending provider for his or her
				  retention as long as the worker remains under his or her care. Copies of X rays
				  and other records may be provided in lieu of originals.
The department or self-insurer reserves the right to require
				  a worker to select another provider or specialist for treatment, under the
				  following conditions:
(1) When more
				conveniently located providers, qualified to provide the necessary treatment,
				are available.
(2) When the
				attending provider fails to cooperate in observance and compliance with the
				department rules.
(3) In time loss
				cases where reasonable progress towards return to work is not shown.
(4) Cases requiring specialized treatment,
				which the attending provider is not qualified to render, or is outside the
				scope of the attending provider's license to practice.
(5) Where the department or self-insurer
				finds a transfer of provider to be appropriate and has requested the worker to
				transfer in accordance with this rule, the department or self-insurer may
				select a new attending provider if the worker unreasonably refuses or delays in
				selecting another attending provider.
(6) In cases where the attending provider is
				not qualified to treat each of several accepted conditions. This does not
				preclude concurrent care where indicated. See WAC
				296-20-071.
(7) No transfer will be approved to a
				consultant or special examiner without the approval of the attending provider
				and the worker.
Transfers will be authorized for the foregoing reasons or
				  where the department or self-insurer in its discretion finds that a transfer is
				  in the best interest of returning the worker to a productive role in
				  society.
When a worker's care is transferred to another provider each
				  provider must submit a separate bill to the department or self-insurer for
				  their portion of the care. Payment will be made at rates determined by
				  department policy.
Statutory Authority:
					 RCW
					 51.36.010,
					 51.04.020, and
					 51.04.030. 12-06-066, §
					 296-20-065, filed 3/6/12, effective 4/6/12. Statutory Authority:
					 RCW
					  51.04.020,
					 51.04.030 and 1993 c 159.
					 93-16-072, § 296-20-065, 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), § 296-20-065, 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), § 296-20-065, filed 12/23/80, effective 3/1/81;
					 Order 77-27, § 296-20-065, filed 11/30/77, effective 1/1/78; Emergency
					 Order 77-26, § 296-20-065, filed 12/1/77; Emergency Order 77-16, §
					 296-20-065, filed 9/6/77; Order 75-39, § 296-20-065, filed 11/28/75,
					 effective 1/1/76; Order 74-7, § 296-20-065, filed 1/30/74; Order 71-6,
					 § 296-20-065, filed 6/1/71; Order 70-12, § 296-20-065, filed 12/1/70,
					 effective 1/1/71; Order 68-7, § 296-20-065, filed 11/27/68, effective
					 1/1/69.