REGULATORY ACTIVITY:

• The state has posted notice of amendments to rule 296-20 Prescription Drug Program and Interchangeable Biologics. The purpose of this rulemaking is to update Chapter 296-20 WAC, Medical Aid Rules. This rulemaking will amend rules that are now inconsistent with Engrossed Senate Bill 5935 (Chapter 242, Laws of 2015), a new law related to interchangeable biologics, and new rule language from the Washington State Health Care Authority (HCA) related to the Washington State Prescription Drug Program (PDP). The proposed language will also incorporate by reference the provisions of the therapeutic interchange in HCA’s WAC 182-50-200. The proposed rule language will accomplish the following: - WAC 296-20-03011 will be amended to include new content regarding “interchangeable biologics” that is explicitly and specifically dictated by ESB 5935, now codified in statute in RCW 69.41.110. - Definitions in WAC 296-20-01002 will be amended to be consistent with recently amended definitions by the HCA regarding Washington State’s PDP. HCA definitions will be adopted without material change. - Language in WAC 296-20-03011 also will incorporate by reference the HCA’s rules for therapeutic alternatives and the therapeutic interchange. This will allow the department’s rules on this program to be consistent with HCA language now and for future HCA amendments.
• Washington Division: Insurance Services (Retrospective Rating)
  Topic: Proposal (CR-102) - Retro Rules Update
  Brief Description: The purpose of this rulemaking is to implement changes to the rules governing the Retrospective Rating Program as a result of updated studies, specifically those regarding hazard groups assignments and Retro plan tables. When changes to the rules governing the Retrospective Rating program were implemented in 2011, the Department committed to repeating the studies that created these rules. Updating the hazard groups and Retro plan tables continues to improve fairness in the distribution of refunds among the participants in the Retro program. It is anticipated that these changes will take effect with July 1, 2017 enrollment.
• Washington Coverage Determination Artificial Disc Replacement (ADR)* - Re-review
  • * Artificial Disc Replacement is the same as Total Disc Arthroplasty (TDA)
  • Artificial disc replacement is a potential alternative procedure to cervical fusion in patients with radiculopathy and/or myelopathy secondary to degenerative disc disease. The most recent evidence, however, does not favor ADR as a treatment for lumbar degenerative disc disease.
  • Coverage decisions: Lumbar ADR and Cervical ADR (Effective date: June 1, 2017)
  • Washington Coverage Determination Pharmacogenomic Testing
  • Pharmacogenomic testing is also known as drug-gene testing or pharmacogenetic testing.  It looks for changes or variants in a person’s genes that may determine whether a medication could be an effective treatment for them or whether they could have side effects to a specific medication.
  • Coverage Decision: Not Covered (Effective date: July 1, 2017)
  • Psychiatric conditions: The Health Technology Clinical Committee (HTCC) has determined that pharmacogenomic testing for depression, mood disorders, psychosis, anxiety, attention deficit/hyperactive disorder (ADHD) and substance use disorder is not a covered benefit.
• The HTCC reviewed the evidence on pharmacogenomic testing for the selected conditions in January 2017, and found the technology unproven for safety, efficacy and cost-effectiveness based on the quality of available evidence. The decision was finalized in March 2017. Complete information on this HTCC determination is available here: http://www.hca.wa.gov/about-hca/health-technology-assessment/health-technology-reviews.
• In adopting this HTCC coverage determination, the Department has concluded that the determination does not conflict with any state statute. Any coverage for investigational treatment would be considered per WAC 296-20-02850.  Any coverage for health technologies that have a FDA Humanitarian Device Exemption status would be considered per RCW 14.120 (1) (b)
• Other conditions: L&I does not cover pharmacogenomic testing for any other conditions.

LEGISLATIVE ACTIONS:

• House Bill 1755
  The enacted legislation requires the department of labor and industries to, for a state fund claim, provide reasonable ongoing notice to the employer of the status of compromise or settlement negotiations between the injured worker or beneficiary and the department.  Effective Date July 23, 2017 .

FEE SCHEDULE NEWS:

• The state has released and update to their fee schedule adding 16 new HCPCS codes/fees for Non- Facility and Facility effective April 1, 2017.  To view the payment and billing manual go to:
  http://www.lni.wa.gov/ClaimsIns/Providers/Billing/FeeSched/2016/policy2016.asp.  The next update to the fee schedule is expected to become effective July 1, 2017.

REGULATORY ACTIVITY:

• Washington has published proposed rule language for 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. This rulemaking will amend rules that are now inconsistent with Engrossed Senate Bill 5935 (Chapter 242, Laws of 2015), a new law related to interchangeable biologics, and new rule language from the Washington State Health Care Authority (HCA) related to the Washington State Prescription Drug Program (PDP). The proposed language will also incorporate by reference the provisions of the therapeutic interchange in HCA’s WAC 182-50-200. The proposed rule language will accomplish the following: - WAC 296-20-03011 will be amended to include new content regarding “interchangeable biologics” that is explicitly and specifically dictated by ESB 5935, now codified in statute in RCW 69.41.110. - Definitions in WAC 296-20-01002 will be amended to be consistent with recently amended definitions by the HCA regarding Washington State’s PDP. HCA definitions will be adopted without material change. - Language in WAC 296-20-03011 also will incorporate by reference the HCA’s rules for therapeutic alternatives and the therapeutic interchange. This will allow the department’s rules on this program to be consistent with HCA language now and for future HCA amendments.

REGULATORY ACTIVITY:

• The Department intends to review Chapter 296-20 WAC, Medical Aid Rules, for consistency with recent changes in other statues and state rules. Definitions need to be amended to be consistent with recently amended definitions of the Washington State Health Care Authority (HCA) regarding Washington State’s Prescription Drug Program (PDP). Language also should incorporate by reference to incorporate by reference HCA’s rules for therapeutic alternatives and the therapeutic interchange. This will allow the Departments’ rules on this program to be consistent with HCA language now and for future amendments. Existing rules will also be amended to include new content regarding “interchangeable biologics” that is explicitly and specifically dictated by statute (RCW 69.41.110).
• Changes to Rule Chapter 296-17A become effective April 1, 2017.
• L&I has adopted a Health Technology Clinical Committee (HTCC) coverage decision: Fecal Microbiota Transplantation (FMT).  The effective date is April 1, 2017. Preauthorization is required for self-insureds as well as state L and I claim. The conditions are:
  • Patients with Clostridium difficile infection who have failed an appropriate course of antibiotic therapy.
  • FMT is not covered for treatment of inflammatory bowel disease, such as ulcerative colitis or regional enteritis.
  • FMT is considered investigational for any other condition.

Labor and Industries, along with a workgroup from its Industrial Insurance Medical Advisory Committee, has expanded the current Carpal Tunnel Guideline to address computer use in the section on work-relatedness.  No changes were made to any other section.  Public comments on the work-relatedness section are being accepted through 3/14/2017.  The draft guideline will be presented, along with all public comments and responses, at the April 27th Industrial Insurance Medical Advisory Committee meeting. The Department of Labor and Industries (L&I) is proposing an update to the Washington Administrative Code that affects the Medical Aid Rules. The proposed change is scheduled to become effective July 1, 2017, and is summarized below.

• WAC section 296-20-135:
  • The amendment changes the conversion factor for services reimbursed under the Washington Resource Based Relative Value Scale (RBRVS) fee schedule from $61.52 to $63.25.
  • The amendment changes the conversion factor for services reimbursed under the anesthesia fee schedule from $3.41 to $3.44 per minute.
• WAC sections 296-23-220 and 296-23-230:
  • The amendments change the maximum daily reimbursement level for physical and occupational therapy services from $125.68 to $126.94.

The public hearing relating to these changes will be held at the Department of Labor and Industries on Wednesday, March 29, 2017, at 9:00 AM. The L&I building is located at 7273 Linderson Way SW in Tumwater. To reach the site, take Interstate 5 to Exit 101 (Tumwater Boulevard), drive east on Tumwater Boulevard, turn left on Linderson Way and left into the L&I visitors' entrance. The hearing will be held in room S117.  Those who wish to comment on the proposed changes may testify at the public hearing or send written comments to: Emily Stinson Department of Labor and Industries Health Services Analysis PO Box 44322 Olympia, WA 98504-4322 Phone:  360-902-5974 FAX:  360-902-4249 E-mail:  Emily.Stinson@LNI.WA.GOV. Washington posted notice of final adoption of rule WAS 296-14 regarding the pension discount rate for 2017.   The adopted rule becomes effective on April 1, 2017. Pension Discount Rate 2017 (Chapter 296-14 WAC Industrial Insurance) This rulemaking amends WAC 296-14-8810 to reduce the current pension discount rate to 6.2 percent in 2017. The pension discount rate is the interest rate used to account for the time value of money when evaluating the present value of future pension payments. Currently, WAC 296-14-8810 sets the pension discount rate at 6.3 percent. This is the third gradual reduction in the pension discount rate. This reduction better aligns with return rates of long term bonds and more accurately states pension liabilities. The Department has worked with the Workers’ Compensation Advisory Committee (WCAC) to develop a plan for reducing the pension discount rate annually, through 2022, until it reaches 4.5 percent. The changes were adopted 2/14/2017 and will be effective on 4/1/2017.

FEE SCHEDULE NEWS:

• The state has adopted the new CPT and HCPCS codes with an effective date of January 1, 2017.  To view the payment and billing manual go to:
  http://www.lni.wa.gov/ClaimsIns/Providers/Billing/FeeSched/2016/policy2016.asp.

REGULATORY ACTIVITY:

• Washington has published notice and text of proposed rule regarding Pension Discount Rate 2017 (Chapter 296-14 WAC Industrial Insurance). The purpose of this rulemaking is to reduce the current pension discount rate to 6.2 percent in 2017. The pension discount rate is the interest rate used to account for the time value of money when evaluating the present value of future pension payments. Currently, WAC 296-14-8810 sets the pension discount rate at 6.3 percent. The department has worked with the Workers’ Compensation Advisory Committee (WCAC) to develop a plan for reducing the pension discount rate annually, through 2022, until it reaches 4.5 percent.
• Washington has posted notice of proposed amendment to the Medical aid 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 to follow the established methodologies of L&I 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.

LEGISLATIVE ACTIONS:

• House Bill 2730
  Requires a practitioner to use the prescription monitoring program established in chapter 70.225 RCW before initially prescribing a substance included in schedule II or III for the treatment of non-cancer-related chronic or intractable pain. Authorizes the department of health to provide data in the prescription monitoring program to: (1) Persons authorized to prescribe or dispense legend drugs for the purpose of providing medical or pharmaceutical care for their patients; and (2) A health care facility or entity for the purpose of providing medical or pharmaceutical care to the patients of the facility or entity; and (3) A health care provider group of five or more providers for purposes of providing medical or pharmaceutical care to the patients of the provider group.  Effective Date June 9, 2016.
• Senate Bill 6293
  Individual employers may provide medical aid benefits to: (1) student volunteers enrolled and participating in a program authorized by any public or private school, including institutions of higher education; and (2) “unpaid students” who are in school- sponsored, unpaid work-based learning.    Work-based learning includes cooperative education, clinical experiences, and internship programs.  An employer may annually elect to pay the L&I volunteer premiums and assessments for 100 hours of service for each volunteer, student volunteer and unpaid student, instead of tracking the actual number of hours of service for each volunteer.  An employer selecting this option must use the method for the entire calendar year.  Effective Date June 9, 2016.