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Medical Aid Rules - WAC 296-20

Medical Aid Rules

WAC Sections

296-20-010 General information
296-20-0100 Chiropractic advisory committee
296-20-01001 Medical advisory industrial insurance committee
296-20-01002 Definitions
296-20-015 Who may treat
296-20-01501 Physician's assistant rules
296-20-01505 Provider types and services not covered
296-20-020 Acceptance of rules and fees
296-20-02005 Keeping of records
296-20-02010 Review of health services providers
296-20-02015 Interest on excess payments
296-20-022 Payment of out-of-state providers
296-20-023 Third party settlement -- Excess recoveries
296-20-024 Utilization management
296-20-025 Initial treatment and report of accident
296-20-02700 What is a medical coverage decision?
296-20-02701 Who makes medical coverage decisions?
296-20-02702 Who uses medical coverage decisions?
296-20-02703 How can I determine if a specific health care service or supply is the subject of a medical coverage decision?
296-20-02704 What criteria does the director or director's designee use to make medical coverage decisions?
296-20-02705 What are treatment and diagnostic guidelines and how are they related to medical coverage decisions?
296-20-02850 When may the department cover controversial, obsolete, investigational or experimental treatment?

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296-20-030 Treatment not requiring authorization for accepted conditions
296-20-03001 Treatment requiring authorization
296-20-03002 Treatment not authorized
296-20-03004 Chemonucleolysis
296-20-03005 Inoculation or immunological treatment for exposure to infectious occupational disease
296-20-03010 What are the general principles the department uses to determine coverage on drugs and medications?
296-20-03011 What general limitations are in place for medications?
296-20-03012 Where can I find the department's outpatient drug and medication coverage decisions?
296-20-03013 Will the department or self-insurer pay for a denied outpatient drug in special circumstances?
296-20-03014 Which drugs have specific limitations?
296-20-03015 What steps may the department or self-insurer take when concerned about the amount or appropriateness of drugs and medications prescribed to the injured worker?
296-20-03016 Is detoxification and/or chemical dependency treatment covered?
296-20-03017 What information is needed for prescriptions and the physician's record?
296-20-03018 What inpatient drugs are covered?
296-20-03019 Under what conditions will the department or self-insurer pay for oral opioid treatment for chronic, noncancer pain?
296-20-03020 What are the authorization requirements for treatment of chronic, noncancer pain with opioids?
296-20-03021 What documentation is required to be submitted for continued coverage of opioids to treat chronic, noncancer pain?
296-20-03022 How long will the department or self-insurer continue to pay for opioids to treat chronic, noncancer pain?
296-20-03023 When may the department or self-insurer deny payment of opioid medications used to treat chronic, noncancer pain?
296-20-03024 Will the department or self-insurer pay for nonopioid medications for the treatment of chronic, noncancer pain?
296-20-035 Treatment in cases that remain open beyond sixty days
296-20-045 Consultation requirements

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296-20-051 Consultations
296-20-055 Limitation of treatment and temporary treatment of unrelated conditions when retarding recovery
296-20-06101 What reports are health care providers required to submit to the insurer?
296-20-065 Transfer of doctors
296-20-071 Concurrent treatment
296-20-075 Hospitalization
296-20-081 Unrelated concurrent nonemergent surgery
296-20-091 Home nursing
296-20-097 Reopenings
296-20-09701 Request for reconsideration
296-20-100 Eye glasses and refractions
296-20-110 Dental
296-20-1101 Hearing aids and masking devices
296-20-1102 Special equipment rental and purchase prosthetic and orthotics equipment
296-20-1103 Travel expense
296-20-120 Procedures not listed in this schedule
296-20-12050 Special programs
296-20-12055 Structured intensive multidisciplinary program (SIMP) for chronic noncancer pain
296-20-12060 SIMP requirements for lumbar fusion and artificial disc replacement candidates.
296-20-12065 SIMP definitions.
296-20-12070 SIMP evaluation phase.
296-20-12075 SIMP treatment phase.
296-20-12080 SIMP follow up phase.
296-20-12085 Requirements the SIMP provider must meet.
296-20-12090 Requirements the worker must meet for a SIMP.
296-20-12095 SIMP referral and prior authorization requirements.
296-20-121 X-rays
296-20-124 Rejected and closed claims
296-20-12401 Provider application process
296-20-125 Billing procedures
296-20-12501 Physician assistant billing procedure
296-20-132 Determination of conversion factor adjustments
296-20-135 Conversion factors
296-20-170 Pharmacy -- Acceptance of rules and fees
296-20-17001 Allowance and payment for medication
296-20-17002 Billing
296-20-17004 Billing and payment for initial prescription drugs.
296-20-19000 What is a permanent partial disability award?

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296-20-19010 Are there different types of permanent partial disabilities?
296-20-19020 How is it determined which impairment rating system is to be used to rate specified and unspecified disabilities?
296-20-19030 To what extent is pain considered in an award for permanent partial disability?
296-20-200 General information for impairment rating examinations by attending doctors, consultants or independent medical examination (IME) providers.
296-20-2010 General rules for impairment rating examinations by attending doctors and consultants
296-20-2015 What rating systems are used for determining an impairment rating conducted by the attending doctor or a consultant?
296-20-2025 May a worker bring someone with them to an impairment rating examination conducted by the attending doctor or a consultant?
296-20-2030 May the worker videotape or audiotape the impairment rating examination conducted by the attending doctor or a consultant?
296-20-220 Special rules for evaluation of permanent bodily impairment
296-20-230 Cervical and cervico-dorsal impairments
296-20-240 Categories of permanent cervical and cervico-dorsal impairments
296-20-250 Impairments of the dorsal area
296-20-260 Categories of permanent dorsal area impairments
296-20-270 Dorso-lumbar and lumbosacral impairments
296-20-280 Categories of permanent dorso-lumbar and lumbosacral impairments
296-20-290 Impairments of the pelvis
296-20-300 Categories of permanent impairments of the pelvis
296-20-310 Convulsive neurological impairments
296-20-320 Categories of permanent convulsive neurological impairments
296-20-330 Impairments of mental health
296-20-340 Categories for evaluation of permanent impairments of mental health
296-20-350 Cardiac impairments
296-20-360 Categories of permanent cardiac impairments
296-20-370 Respiratory impairments
296-20-380 Categories of permanent respiratory impairments
296-20-385 Categories of persisting variable respiratory impairment with normal baseline spirometry
296-20-390 Air passage impairments
296-20-400 Categories of permanent air passage impairments
296-20-410 Nasal septum impairments
296-20-420 Categories of permanent air passage impairment due to nasal septum perforations

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296-20-430 Loss of taste and smell
296-20-440 Categories of permanent loss of taste and smell
296-20-450 Speech impairments
296-20-460 Categories of permanent speech impairments
296-20-470 Skin impairments
296-20-480 Categories of permanent skin impairments
296-20-490 Impairment of the upper digestive tract, stomach, esophagus or pancreas
296-20-500 Categories of permanent impairments of the upper digestive tract, stomach, esophagus or pancreas
296-20-510 Lower digestive tract impairments
296-20-520 Categories of permanent lower digestive tract impairments
296-20-530 Impairment of anal function
296-20-540 Categories of permanent impairments of anal function
296-20-550 Liver and biliary tract impairments
296-20-560 Categories of permanent liver and biliary tract impairments
296-20-570 Impairments of the spleen, loss of one kidney, and surgical removal of the bladder with urinary diversion
296-20-580 Categories of permanent impairment of the spleen, loss of one kidney, and surgical removal of bladder with urinary diversion
296-20-590 Impairment of upper urinary tract
296-20-600 Categories of permanent impairments of upper urinary tract
296-20-610 Additional permanent impairments of upper urinary tract due to surgical diversion
296-20-620 Categories of additional permanent impairments of upper urinary tract due to surgical diversion
296-20-630 Impairment of bladder function
296-20-640 Categories of permanent impairments of bladder function
296-20-650 Anatomical or functional loss of testes
296-20-660 Categories of permanent anatomical or functional loss of testes
296-20-670 Disability
296-20-680 Classification of disabilities in proportion to total bodily impairment
296-20-690 Permanent impairments of the cervico-dorsal (WAC 296-20-240) and lumbosacral regions (WAC 296-20-280) jointly

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