STATE ACTIVITIES:
August 2019 VIEW PUBLICATION →
REGULATORY ACTIVITY:
- The Washington State Department of Labor & Industries has adopted a new Health Technology Clinical Committee coverage determination regarding SI joint fusion. Effective September 1, 2019, SI joint fusion for chronic sacroiliac joint pain related to degenerative sacroilitis and/or sacroiliac joint disruption is not a covered benefit. For additional information, go to http://www.lni.wa.gov/ClaimsIns/Providers/TreatingPatients/ByCondition/SacroiliacJointFusion.asp?utm_medium=email&utm_source=govdelivery.
- The Washington State Department of Labor & Industries has adopted a new Health Technology Clinical Committee coverage determination regarding peripheral nerve ablation. Effective September 1, 2019, peripheral nerve ablation for limb pain is not a covered benefit. For additional information, go to http://www.lni.wa.gov/ClaimsIns/Providers/TreatingPatients/ByCondition/PeripheralNerveAblationforLimbPain.asp?utm_medium=email&utm_source=govdelivery.
- The rulemaking adopts an amendment in chapter 296-14 WAC, Industrial insurance. Specifically, this rulemaking amends WAC 296-14-400, Re-openings for benefits, due to the State of Washington Court of Appeals decision Ronald V. Ma'ae v. State of Washington Dept of Labor And Industries, 2019 WL 1492822 that found the department cannot prohibit non-MPN providers from submitting re-opening applications. This rule amendment allows L&I to be in compliance with the Ma’ae decision and is effective upon filing per RCW 34.05.380(3) (a). The changes were adopted 7/23/2019 and became effective on 7/23/2019. To view is notice, go to http://www.lni.wa.gov/LawRule/WhatsNew/Proposed/default.asp?RuleID=371.
LEGISLATIVE ACTIONS:
- House Bill 1909
The enacted legislation provides that if an employer or employer's authorized representative reveals information in an injured worker's claim file regarding a mental health condition or treatment to any person other than an authorized representative, the employer is subject to a civil penalty of one thousand dollars for each occurrence. Requires the department of labor and industries to ensure that employers and workers are notified of their rights and responsibilities regarding claim files. Effective Date July 28, 2019.
July 2019 VIEW PUBLICATION →
REGULATORY ACTIVITY:
- Posted notice of an expedited rulemaking. The purpose of this expedited rulemaking is to amend WAC 296-14-400, Re-openings for benefits, to remove the requirement that applications to re-open a workers’ compensation claim must be submitted by a provider in the department’s Medical Provider Network (MPN) as a result of the State of Washington Court of Appeals decision (Ronald V. Ma'ae v. State of WA Dept of Labor And Industries, 2019 WL 1492822) that found the department cannot prohibit non-MPN providers from submitting re-opening applications. This rule amendment allows the department to be in compliance with the Court of Appeals decision. The department proposes removing the following language from WAC 296-14-400: For services or provider types where the department has established a provider network, beginning January 1, 2013, medical treatment and documentation for reopening applications must be completed by network providers. To view this notice, go to http://www.lni.wa.gov/LawRule/WhatsNew/Proposed/default.asp?RuleID=371. Comments are due by July 22, 2019.
- The Department of Labor & Industries payment policies and fee schedules for 2019 are now available online, and they are effective July 1st. For additional information, go to https://www.lni.wa.gov/ClaimsIns/Providers/Billing/FeeSched/2019/default.asp?utm_medium=email&utm_source=govdelivery.
- Posted notice of effective date of self-insurance rules and regulation Chapter 296-15 which was adopted December 18, 2018 and became effective July 1, 2019. A copy of the order adopting the rule and the rule language can be viewed at http://www.lni.wa.gov/LawRule/WhatsNew/Proposed/default.asp?RuleID=263.
- Posted notice of proposed rulemaking regarding vocational rehabilitation (Chapter 296-19A WAC). The purpose of this rulemaking is to support the department’s vocational recovery effort by:
- Ensuring expectations of vocational providers are better aligned with the return-to-work language in RCW 51.32.095;
- Addressing minimum requirements for vocational providers/firms; and
- Outlining when and to what degree vocational providers may be subject to corrective action or sanctions.
To view the notice of proposed rulemaking, go to http://www.lni.wa.gov/LawRule/WhatsNew/Proposed/default.asp?RuleID=267.
- Posted notice of proposed rule amendment: WAC 296-14-400 Re-openings for benefits, this rule explains the requirements for reopening a workers' compensation claim that has been previously closed. The purpose of the proposal is to amend WAC 296-14-400 Re-openings for benefits, to remove the requirement that applications to reopen a workers' compensation claim must be submitted by a provider in the department's medical provider network (MPN) as a result of the state of Washington court of appeals decision (Ronald V. Ma'ae v. State of WA Dept of Labor And Industries, 2019 WL 1492822) that found the department cannot prohibit non-MPN providers from submitting reopening applications. This rule amendment allows the department to be in compliance with the court of appeals decision. The department proposes removing the following language from WAC 296-14-400: For services or provider types where the department has established a provider network, beginning January 1, 2013, medical treatment and documentation for reopening applications must be completed by network providers. Reasons Supporting Proposal: In 2012, the department amended its rules related to what services for injured workers may be provided by a nonnetwork provider in order to align with the statewide MPN established under RCW 51.36.010, as amended by SSB 5801, chapter 6, Laws of 2011. Recently, the Washington state court of appeals ruled that the requirement in WAC 296-14-400 that a worker submit medical documentation from only a network doctor to reopen a claim for aggravation was outside the statutory authority. Ronald V. Ma'ae v. State of WA Dept of Labor and Industries, 2019 WL 1492822. The court held the amendment to WAC 296-14-400 to be invalid, and the language of the rule must now be amended to be in compliance with the court's decision. To view the proposed rule, go to http://lawfilesext.leg.wa.gov/law/wsr/2019/11/19-11-110.htm
June 2019 VIEW PUBLICATION →
REGULATORY ACTIVITY:
- The Department of Labor & Industries pays for interpreters during medical or vocational services to workers or crime victims, on all opened and allowed claims.
- L&I used pilot rulemaking to determine how best to incorporate acupuncture into Washington’s workers’ compensation program. The purpose of this rulemaking is to allow the department and self-insurers to pay for acupuncture as specified in new section WAC 296-23-238. The related Acupuncture medical coverage decision’s approved conditions will remain only “low back pain related to an accepted condition on an open claim.” Other conditions may be considered at a later date based on L&I’s review of available scientific and clinical evidence. The last day of the pilot will be May 31, 2019 and the CR-103 will be effective June 1, 2019. This will mean that there is no gap in services. Prior to June 1, 2019 only pilot participants can use acupuncture to treat injured workers. Pilot participants can continue to treat at the June 1, 2019 overall start date without submitting any new documentation to the department. Other non-pilot L&I providers that have acupuncture within the scope of their licensure can begin using acupuncture to treat injured workers on June 1, 2019. Providers that are new to treating injured workers will need to apply for a provider number to be paid for their services. If they meet eligibility criteria, L&I will assign them a provider number and they can then treat on or after June 1, 2019 based on when they have an L&I provider number. L&I adopted the language as proposed in the CR-102 with minor clarifying changes. The CR-103, the Concise Explanatory Statement and the final rule language can be viewed at https://www.lni.wa.gov/ClaimsIns/Providers/TreatingPatients/ByCondition/Acupuncture.asp?utm_medium=email&utm_source=govdelivery. To view a copy of the adopted rule, go to http://www.lni.wa.gov/LawRule/WhatsNew/Proposed/default.asp?RuleID=434. The rule becomes effective June 1, 2019.
- The Department of Labor & Industries will continue utilizing the fees from July 2019 to June 2020 that were established in 2018. Following our annual review (per WAC 296-20-132), we have determined there will be no change to our fee schedule. L&I payment policies will update on July 1. Visit L&I’s website for fees: lni.wa.gov/FeeSchedules .
LEGISLATIVE ACTIONS:
- House Bill 1490
The enacted legislation modifies the presumption of occupational disease for industrial insurance established for cancer to apply to certain Hanford site workers who have cancer that develops or manifests itself and who were not given a qualifying medical examination because an exam was not required. The presumption established for cancer is amended to also apply to any active or former USDOE Hanford site worker who has cancer that develops or manifests itself and who was not given a qualifying medical examination because a qualifying medical examination was not required. Effective Date July 28, 2019.
- House Bill 1913
The enacted legislation makes the occupational disease presumptions for firefighters applicable to certain emergency medical technicians and public employee fire investigators and adds additional cancers to the cancer occupational disease presumption. It creates an occupational disease presumption for heart problems and infectious diseases for law enforcement officers. Requires the Director of the Department of Labor and Industries to create an advisory committee on occupational disease presumptions, made up of specified scientists. Effective Date July 28, 2019.
- Senate Bill 5474
The enacted legislation establishes that in the event L&I makes an order communicating the closure of a claim of a self-insured employer, the self-insured employer may serve the order. The self-insured employer must use a separate, secure, and verifiable nonelectronic means of delivery. The self-insured employer must also include L&I's prescribed notice explaining the contents of the order and any protest or appeal rights. Effective Date July 28, 2019.
May 2019 VIEW PUBLICATION →
REGULATORY ACTIVITY:
- Legislation in 2018 (SSB 6245) required Labor & Industries to review its procurement process for interpreter services for injured workers and crime victims. After reviewing our options and gathering feedback from interpreters, providers, and workers, L&I has decided to contract with one or more scheduling organizations. This means we will be purchasing in-person spoken language interpreter services through a new scheduling system by September 2020. There are still more decisions to make, including the functions of the scheduling system. To help us answer these questions, we will be reaching out to interpreters, providers, and workers.
- Effective 4/25/2019, physical and occupational therapy students may assist on L&I claims. L&I has adopted a modified version of Medicare Part B’s policy on physical and occupational therapy students. L&I considers supervised students an extension of their supervising therapist. To view additional information, go to http://www.lni.wa.gov/ClaimsIns/Providers/Billing/FeeSched/2018/Updates2018.asp?utm_medium=email&utm_source=govdelivery.
- Washington is updating the state’s hearing aid replacement policy. 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 will be effective on 5/15/2019. To view the updated policy, go to http://www.lni.wa.gov/ClaimsIns/Rules/New/Proposed/default.asp?RuleID=268&utm_medium=email&utm_source=govdelivery.
- Published in the state register that May 15, 2019 is the effective date of a rule regarding the replacement of hearing aids request five years after the issue date of the current hearing aids. Rules affected are WAC 296-20-1101. To view this notice, go to http://lawfilesext.leg.wa.gov/law/wsr/2019/08/19-08-076.htm.
April 2019 VIEW PUBLICATION →
REGULATORY ACTIVITY:
- The Washington State Department of Labor & Industries announces changes to the Outpatient Drug Formulary and Selected Preferred Drug List effective April 1, 2019. The changes are available for review in the online Outpatient Drug Formulary and Selected Preferred Drug List PDF documents. To view the formulary, go to http://www.lni.wa.gov/ClaimsIns/Files/Providers/DrugFormulary.pdf?utm_medium=email&utm_source=govdelivery. To view the selected drug list, go to http://www.lni.wa.gov/ClaimsIns/Files/Providers/SelectedPDLforworkers.pdf?utm_medium=email&utm_source=govdelivery.
- Legislation in 2018 (SSB 6245) required Labor & Industries to review its procurement process for interpreter services for injured workers and crime victims. After reviewing the options and gathering feedback from interpreters, providers, and workers, L&I has decided to contract with one or more scheduling organizations. This means we will be purchasing in-person spoken language interpreter services through a new scheduling system by September 2020. There are still more decisions to make, including the functions of the scheduling system. To help us answer these questions, we will be reaching out to interpreters, providers, and workers.
February 2019 VIEW PUBLICATION →
REGULATORY ACTIVITY:
- Published rule proposal regarding Acupuncture (CR-102). The purpose of this proposed rulemaking is to allow the department and self-insurers to pay for acupuncture as specified in WAC 296-23-238. When this rule is effective, the Acupuncture medical coverage decision’s approved conditions will only list “low back pain related to an accepted condition on the claim.” Other conditions may be considered at a later date based on the best available scientific and clinical evidence. In addition, the proposed rules will allow Acupuncturists, including East Asian Medicine Practitioners (EAMPs), to treat injured workers. EAMPs have 15 different treatment modalities within their scope of practice (RCW 18.06.010). These proposed rule changes will only apply to acupuncture. A hearing on the proposed rule will be held on February 5, 2019 at 1:00 pm at L & I Headquarters 7273 Linderson Way SW, Room S118 in Tumwater WA. To view the notice and proposed rule, go to https://www.lni.wa.gov/LawRule/WhatsNew/Proposed/default.asp?RuleID=434.
January 2019 VIEW PUBLICATION →
FEE SCHEDULE NEWS:
- The Department of Labor & Industries has adopted new 2019 codes for the medical and ASC fee schedules effective January 1, 2019. A new fee schedule update is expected in July 2019.
REGULATORY ACTIVITY:
- Effective 01/01/2019, the payment policy for job modifications and pre-job modifications is being removed from Chapter 18: Modifications: Home, Job and Vehicle and can now be found in the updated Chapter 30: Vocational Services. Please see the PDF of Chapter 30 in this table. To view the information, go to https://lni.wa.gov/ClaimsIns/Providers/Billing/FeeSched/2018/Updates2018.asp?utm_medium=email&utm_source=govdelivery.
- The state adopted the Adjuster licensing special education criteria rule (R 2018-14) on November 29, 2018. The rule takes effect on January 1, 2019. The rule will create new, and amend existing, sections of WAC 284-17-123 to clarify the special education condition found in RCW 48.17.380(3)(d) for an adjuster license candidate. For more information, including the adopted rule (CR-103P) and the concise explanatory statement, go to https://www.insurance.wa.gov/adjuster-licensing-special-education-criteria-r-2018-14?utm_content=&utm_medium=email&utm_name=&utm_source=govdelivery&utm_term=.
- The Washington State Department of Labor & Industries announces changes to the Outpatient Drug Formulary and Selected Preferred Drug List effective January 1, 2019. The changes for the outpatient drug formulary are available at http://www.lni.wa.gov/ClaimsIns/Files/Providers/DrugFormulary.pdf?utm_medium=email&utm_source=govdelivery. The selected preferred drug list is available at http://www.lni.wa.gov/ClaimsIns/Files/Providers/SelectedPDLforworkers.pdf?utm_medium=email&utm_source=govdelivery.
- The Department of Labor & Industries has posted new CPT® and HCPCS codes effective January 1, 2019. Deleted codes effective December 31, 2018 are also posted. To view the updates, go to https://www.lni.wa.gov/ClaimsIns/Providers/Billing/FeeSched/2018/Updates2018.asp.
- Posted notice that the state is considering an increase to the RBRVS conversion factor, the anesthesia conversion factor, and the maximum daily caps for physical and occupational therapy for July 2019. To view a copy of the notice, go to https://www.lni.wa.gov/ClaimsIns/Rules/New/Proposed/default.asp?RuleID=268&utm_medium=email&utm_source=govdelivery.
October 2018 VIEW PUBLICATION →
REGULATORY ACTIVITY:
- The Washington State Department of Labor & Industries announces changes to the Outpatient Drug Formulary and Selected Preferred Drug List effective October 1, 2018. The changes are available for review in the online Outpatient Drug Formulary PDF document.
- Posted notice of proposed amendments to Workers' Compensation Self-Insurance Rules and regulations Chapter 296-15 WAC. The purpose of this proposal is to update Chapter 296-15 WAC, Workers’ Compensation Self-Insurance Rules and Regulations. The existing rules are outdated and lead to inefficient processes for workers, employers and the Department. The goals of the proposed rules are to create more focused intervention and adjudication for the Department, establish more efficient lines of communication for workers, and ensure greater certainty for employers. Also included in the rule changes are language clarifications, as well as a change to WAC 296-15-4316 that will bring it back into alignment with statute regarding the termination of time loss benefits when Option 2 is selected. To view the notice and proposed rule, go to http://www.lni.wa.gov/LawRule/WhatsNew/Proposed/default.asp?RuleID=263.
- Washington Coverage Decision: The Washington State Department of Labor & Industries has updated the coverage decision on pharmacogenomic testing according to a recent Health Technology Clinical Committee coverage determination. Effective November 1, 2018, pharmacogenomic testing for patients being treated with oral anticoagulants is not a covered benefit. For additional information, go to http://www.lni.wa.gov/ClaimsIns/Providers/TreatingPatients/ByCondition/Pharmacogenomic.asp?utm_medium=email&utm_source=govdelivery.
- Washington Coverage Decision: The Washington State Department of Labor & Industries has adopted a new Health Technology Clinical Committee coverage determination about surgery for lumbar radiculopathy/sciatica, effective November 1, 2018.
Lumbar radiculopathy is a clinical syndrome characterized by radiating leg pain, with or without motor weakness, and sensory disturbances in a myotomal or dermatomal distribution. The objective of treatment for radiculopathy is symptom relief through nonsurgical management, or surgical intervention to decompress the affected nerve. Coverage decision: Covered with conditions (Effective date: November 1, 2018). Authorization requirements
Is authorization required? | How do I get pre-authorization? |
Yes | L&I (State fund): request Utilization Review provided by Qualis For self-insured: Contact the employer or its third-party administrator. |
For additional information, go to http://www.lni.wa.gov/ClaimsIns/Providers/TreatingPatients/ByCondition/LumbarRadiculopathySciatica.asp?utm_medium=email&utm_source=govdelivery.
September 2018 VIEW PUBLICATION →
REGULATORY ACTIVITY:
- Pursuant to RCW 39.12.015, 39.12.020 and WAC 296-127-011, on August 1, 2018, the industrial statistician will determine and publish on the internet the statewide prevailing rates of wage. These rates become effective thirty days from publication on August 31, 2018. For more information on prevailing wage or a copy of the rates please visit our web site at www.lni.wa.gov/TradesLicensing/PrevailingWage/ or call 360-902-5335.
- Posted notice of a new rule regarding Presumptive PTSD Coverage (Chapter 296-14 WAC, WAC 296-14-300, 296-14-310). The purpose of this rulemaking is to consider amending WACs 296-14-300 and 296-14-310 and creating a new rule in chapter 296-14 WAC due to recently passed legislation. This legislation passed during the 2018 session (Chapter 264, Laws of 2018, Substitute Senate Bill 6214), resulted in updates to RCWs 51.08.142 and 51.32.185 and the addition of a new chapter to 51.08 RCW. The amended law provides a prima facie presumption for certain fire fighters, law enforcement officers, and emergency medical technicians covered under workers’ compensation. To view the rule, go to: http://www.lni.wa.gov/LawRule/WhatsNew/Proposed/default.asp.
- Published a new coverage decision regarding Therapeutic genicular nerve blocks for chronic knee pain. Coverage decision: Not Covered (Effective date: October 1, 2018). Genicular nerve block for treating chronic knee pain is not a covered benefit. The knee joint is innervated by the articular branches of several nerves including the femoral, common peroneal, saphenous, tibial and obturator nerves. These articular branches around the knee joint are known as genicular nerves. Genicular nerve block for treating chronic knee pain is controversial. The effectiveness of the procedure on relieving chronic knee pain is not established. The safety of repetitive anesthetic/steroid injections to the genicular nerves is unproven. To view the decision, go to http://www.lni.wa.gov/ClaimsIns/Providers/TreatingPatients/ByCondition/TherapeuticGenicularblock.asp?utm_medium=email&utm_source=govdelivery.
August 2018 VIEW PUBLICATION →
REGULATORY ACTIVITY:
- Subject of Possible Rule Making: Chapter 296-14 WAC, Industrial insurance, pension discount rates (PDR) for the state fund and self-insurance.
- Statutes Authorizing the Agency to Adopt Rules on this Subject: RCW 04.020, 51.44.070(1), 51.44.080, chapter 282, Laws of 2018 (SB 6393).
- Reasons Why Rules on this Subject may be needed and What They Might Accomplish: PDR is the interest rate used to account for the time value of money when evaluating the present value of future pension payments. The purpose of this rule making is to lower the PDR using different assumptions for annual investment returns for the reserve funds for self-insured and state fund pension claims, and to align with recent department requested legislation passed in the 2018 session allowing for the department to use different methods of calculating state fund and self-insured liabilities when determining the annuity values of a pension based on the rates of mortality, disability, remarriage, and interest.
- This rule making will consider reducing the pension discount rate to 4.5 percent for the state fund and to 6.0 percent for self-insurance.
- Other Federal and State Agencies that Regulate this Subject and the Process Coordinating the Rule with These Agencies: None.
- Process for Developing New Rule: Parties interested in these rules may contact the individual listed below. The public may also participate by commenting after amendments are proposed by providing written comments and/or testimony during the public hearing and comment process. Public hearings will be held after the proposal is filed.
- Interested parties can participate in the decision to adopt the new rule and formulation of the proposed rule before publication by contacting Suzy Campbell, Legal Services, P.O. Box 44250, Olympia, WA 98504-4250, phone 360-902-5003, fax 360-902-4960, TTY 360-902-4252, email campbell@lni.wa.gov.
- Secure Access Washington (SAW) is getting an upgrade Aug. 3; Many L&I customers use Secure Access Washington (SAW) to log into resources and services at L&I and other state agencies. This message is for L&I customers who access our web resources through SAW, so you know about a coming change to the site. If you’re a SAW user, you’ll notice a new look and feel on August 3. The site will work the same as always - it will just look different (see images below). You can continue to use the same username and password and will have the same access you had before the upgrade. The improved site will automatically adjust to your screen size, so it works better on phones and tablets, and a streamlined signup process makes it more user-friendly for new users. If you have questions or experience problems with the new site, contact https://support.secureaccess.wa.gov/sawuser/help/contact-support.
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