Rule Updates

Rules Under Development

Medical Aid Rules

Chapter 296-20, WAC

All updates for this rule:

Medical Aid Rules Update (WAC 296-20-135, WAC 296-23-220, WAC 296-23-230)

The purpose of this rulemaking is to update the Medical Aid Rules rates. The affected rules describe elements used in the process of updating the maximum allowable payments for most professional health care services. These elements are set in rule in order to follow the established methodologies of the department and maintain consistency with the Health Care Authority and Medicaid Purchasing Administration. Specifically, the proposed rule changes will do the following: 1. WAC 296-20-135: Update the conversion factors used by the department for calculating reimbursement rates for most professional health care and anesthesia services. The conversion factors will be updated to correspond to changes in the medical procedure codes, the relative value units, and anesthesia base units. These changes will enable the department to continue a reimbursement methodology consistent with other state agencies. Cost-of-living increases may be incorporated into the changes in the conversion factors. 2. WAC 296-23-220 and 230: Update the maximum daily reimbursement level for physical and occupational therapy services so the department may, if necessary, give cost-of-living increases to affected providers.839.

12/18/2018

PDF: Preproposal (CR-101)

Hearing Aid Replacement (WAC 296-20-1101)

This rulemaking amends WAC 296-20-1101, Hearing aids and masking devices, allowing the replacement of hearing aids upon request five years after the issue date of the current hearing aids. The rule language was developed through the recommendations and consensus of a department initiated and led workgroup of expert and interested parties. The changes were adopted 4/2/2019 and became effective on 5/15/2019.822.

5/15/2019

Rule Changes Effective

4/2/2019

PDF: Adoption (Rule-Making Order CR-103)

PDF: Adopted Rule Language

PDF: Response to Public Comments (CES)

2/28/2019

Public Hearing

2/28/2019

Comments Due

1/22/2019

PDF: Proposed Rulemaking (CR 102)

PDF: Proposed Rule Language

2/6/2018

PDF: Preproposal (CR-101)

Medical Aid Rules Update (WAC 296-20-135, WAC 296-23-220, WAC 296-23-230)

This rulemaking adopts amendments that update the Medical Aid Rules rates by updating conversion factors provided in WAC 296-20-135 Conversion Factors, and maximum daily fees provided in WAC 296-23-220 Physical Therapy Rules and WAC 296-23-230 Occupational Therapy Rules for certain professional health care services for injured workers. These amendments are necessary to maintain current overall fees for health care services, which are published annually in the Medical Aid Rules and Fee Schedules. These amendments increase the resource based relative value scale (RBRVS), anesthesia conversion factors and the maximum daily caps to be consistent with the changes for other professional fees resulting from increases in the relative value units published by the Centers for Medicare and Medicaid Services. The changes were adopted 5/1/2018 and became effective on 7/1/2018.817.

7/1/2018

Rule Changes Effective

5/1/2018

PDF: Adoption (Rule-Making Order CR-103)

PDF: Adopted Rule Language

3/28/2018

Public Hearing

3/28/2018

Comments Due

2/6/2018

PDF: Proposed Rulemaking (CR 102)

PDF: Proposed Rule Language

12/19/2017

PDF: Preproposal (CR-101)

Prescription Drug Program & Interchangeable Biologics (Chapter 296-20 WAC, Medical Aid Rules)

The purpose of this rulemaking is to update Chapter 296-20 WAC, Medical Aid Rules. The adopted rule language creates the following changes: - WAC 296-20-03011 is amended to include new content regarding ďinterchangeable biologicsĒ that is explicitly and specifically dictated by RCW 69.41.110; - Definitions in WAC 296-20-01002 are amended to be consistent with recently amended definitions of the Washington State Health Care Authority (HCA) regarding Washington Stateís Prescription Drug Program. HCA definitions have been adopted without material change; and - Language in WAC 296-20-03011 also incorporates by reference HCAís rules for therapeutic alternatives and the therapeutic interchange. This will allow the departmentís rules to be consistent with HCA language. The changes were adopted 8/1/2017 and became effective on 9/1/2017.790.

9/1/2017

Rule Changes Effective

8/1/2017

PDF: Adoption (Rule-Making Order CR-103)

PDF: Adopted Rule Language

5/15/2017

Public Hearing

5/15/2017

Comments Due

3/29/2017

PDF: Proposed Rulemaking (CR 102)

PDF: Proposed Rule Language

1/31/2017

PDF: Preproposal (CR-101)

Medical Aid Rules Update (WAC 296-20-135, WAC 296-23-220, WAC 296-23-230)

This rulemaking adopts amendments to update the Medical Aid Rules rates. Conversion factors provided in WAC 296-20-135 and maximum daily fees provided in WAC 296-23-220 and WAC 296-23-230 for certain professional health care services for injured workers are updated. Rule changes are necessary to maintain current overall fees for health care services, which are published annually in the Medical Aid Rules and Fee Schedules. These rules increase the resource based relative value scale (RBRVS), anesthesia conversion factors and the maximum daily caps to be consistent with the changes for other professional fees resulting from increases in the relative value units published by the Centers for Medicare and Medicaid Services. The changes were adopted 5/2/2017 and became effective on 7/1/2017.786.

7/1/2017

Rule Changes Effective

5/2/2017

PDF: Adoption (Rule-Making Order CR-103)

PDF: Adopted Rule Language

3/29/2017

Public Hearing

3/29/2017

Comments Due

2/14/2017

PDF: Proposed Rulemaking (CR 102)

PDF: Proposed Rule Language

12/20/2016

PDF: Preproposal (CR-101)

Lumbar Fusion and Structured Intensive Multidisciplinary Program (SIMP) (Chapter 296-20 WAC - Medical Aid Rules)

The purpose of this rulemaking is to repeal the Structured Intensive Multidisciplinary Program (SIMP) rules, WACs 296-20-12055 through 296-20-12095, thereby bringing the Departmentís rules into compliance with a recent coverage determination by the Washington State Health Technology Clinical Committee (HTCC). The HTCC made a determination that lumbar fusion for uncomplicated degenerative disc disease (UDDD) is no longer a covered procedure. Before this non-coverage determination was made, a previous HTCC determination required lumbar fusion candidates with UDDD to attend a SIMP prior to having surgery. This previous coverage determination is contained within the SIMP rules and is now inconsistent with this new HTCC non coverage determination. The Departmentís payment policies, the lumbar fusion surgical guideline and a medical coverage decision have already been amended effective March 7, 2016 in response to the HTCC lumbar fusion for UDDD non-coverage determination. SIMP program requirements are currently also contained within the Departmentís fee schedulesí payment policies and, other than removing the lumbar fusion for UDDD requirement, will remain in effect when the SIMP rules are repealed. The changes were adopted 11/1/2016 and became effective on 12/2/2016.762.

12/2/2016

Rule Changes Effective

11/1/2016

PDF: Adoption (Rule-Making Order CR-103)

PDF: Adopted Rule Language

8/26/2016

Public Hearing

8/26/2016

Comments Due

7/19/2016

PDF: Proposed Rulemaking (CR 102)

PDF: Proposed Rule Language

5/3/2016

PDF: Preproposal (CR-101)

End of main content, page footer follows.

Access Washington official state portal

   © Washington State Dept. of Labor & Industries. Use of this site is subject to the laws of the state of Washington.

Help us improve