| Rule Updates |  | |
 |
 |
 |
|||||
|
|||||||
 |
 |
||||||
Rules Under Development
Medical aid rules
Chapter 296-20, WAC
All updates for this rule:
296-20-12065, 296-20-12070, 296-20-12075, 296-20-12080, 296-20-12085, 296-20-12090, 296-20-12095, 296-20-12055, 296-20-12060
The purpose of this rule filing is to adopt new rules necessary to implement the lumbar fusion and artificial disc determinations made by the statutory HTCC committee. This rule will implement two HTCC coverage determinations. The determinations state that certain lumbar fusion and artificial intervertebral disc replacement surgeries are covered for the treatment of chronic pain due to uncomplicated degenerative disc disease. The principal condition of coverage is that a non-invasive, structured intensive multidisciplinary program for chronic, noncancer pain (SIMP) must be completed prior to the department or self-insurer authorizing a lumbar fusion or lumbar artificial disc replacement. Also, the department will delete language in WAC 296-20-03002 that says the Charite artificial disc is non-covered. Although the SIMP program is being established for lumbar surgery candidates, as defined in WAC 296-20-12065, the SIMP program is available for other workers with chronic, noncancer pain. The changes were adopted 9/30/2009 and became effective on 11/1/2009.
11/1/2009 9/30/2009 8/14/2009 Public Hearing
8/14/2009 Comments Due
6/30/2009 5/5/2009
The purpose of this rule making is to implement the Health Technology Clinical Committee coverage determination. The decision was that certain lumbar fusion candidates must first complete a structured intensive multidisciplinary pain program prior to the department or self-insurer authorizing lumbar fusion surgery.
12/2/2008
296-20-01002, 296-20-025, 296-20-03001, 296-20-09701
The purpose of this rulemaking is to consider general housekeeping changes regarding update definitions, initial treatment and report of accident, treatment requiring authorization and reopenings. The changes were adopted 11/25/2008 and became effective on 12/26/2008.
12/26/2008 11/25/2008 11/17/2008 Comments Due
9/16/2008
296-20-135, 296-23-220, 296-23-230
The purpose of the rule is to update the department’s payment rates for health care services by; Changing the conversion factor used to calculate payment levels for services payable through the Resource Based Relative Value Scale (RBRVS) fee schedule; Changing the conversion factor used to calculate payment for anesthesia services; Increasing the maximum daily payment for physical and occupational therapy. The changes were adopted 4/22/2008 and became effective on 7/1/2008.
7/1/2008 4/22/2008 4/2/2008 Comments Due
3/26/2008 Public Hearing
2/19/2008 12/18/2007
296-20-1101
This adopted revision will add language to the current rule regarding the current linear analog hearing aid replacement policy that became effective September 17, 2007. The purpose of this rulemaking is to ensure uniform compliance with the current linear analog hearing aid replacement policy. The changes were adopted 2/15/2008 and became effective on 3/22/2008.
3/22/2008 2/15/2008 12/18/2007 Comments Due
12/13/2007 Public Hearing
11/6/2007 9/18/2007
296-20-01501
House Bill 1722 (Chapter 263, Laws of 2007) which directs the department to accept the signature of a physician’s assistants on any certificate, card, form, or other documentation required by the department. A PA may not rate a worker’s permanent partial disability under RCW 51.32.055 The department must amend these rules to allow PAs signature on previously unaccepted forms. The changes were adopted 2/5/2008 and became effective on 2/22/2008.
2/22/2008 2/5/2008 1/10/2008 Public Hearing
12/4/2007 8/21/2007
WAC 296-20-01501
This emergency rulemaking is in response to House Bill 1722 (Chapter 263, Laws of 2007) which directs the department of Labor & Industries to accept the signature of the physician assistant on any certificate, card, form, or other documentation required by the department. This includes any form that the physician assistant’s supervising physician(s) may sign provided that it is within the physician assistant’s scope of practice and is consistent with the terms of the physician assistant’s practice arrangement plan. Effective July 1, 2007. The changes were adopted 10/26/2007 and became effective on 7/1/2007.
10/26/2007 7/1/2007
Rule changes are necessary to update our payment rates for health care services, which are published annually in the Medical Aid Rules and Fee Schedules.
5/1/2007 2/20/2007 12/19/2006
296-20-010 General Information & 296-20-125 Billing Procedures
The department is updating the WAC rules to change references to the current national hospital billing form (the U-92) to the new national hospital billing form (the UB-04). The department also wants to replace any reference to the national HCFA 1500 Health Insurance Claim Form with new form identifier CMS 1500 Health Insurance Claim Form.
4/3/2007 12/19/2006 10/17/2006
Treatment not authorized - Intrathecal Pump - Noncoverage
THIS PROPOSED RULEMAKING HAS BEEN WITHDRAWN AT THIS TIME. For more information, click here.
The proposal was to amend WAC 296-20-03002, Treatment not authorized, to explain that it will not provide coverage for intrathecal infusion pumps or medications that are prescribed for the administration via the intrathecal pump. Under the proposed rule it would be clear under what conditions the department will pay for intrathecal pumps. A worker with cancer or a spinal cord injury may be eligible for an intrathecal pump. Also hospitalized patients and those within 48 hours post surgery would be eligible. For safety reasons, under the proposed WAC, payment for permanent placement of the intrathecal infusion pumps would not be allowed for the treatment of chronic, non-cancer pain resulting from non-catastrophic injuries.
10/17/2006 6/20/2006
Definition of “proper and necessary"
To amend the definition of “proper and necessary” in WAC 296-20-01002 and to amend as necessary the criteria for making medical coverage decisions in WAC 296-20-02704.
11/12/2003
