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296-20-01002  <<  296-20-01010 >>   296-20-01020

WAC 296-20-01010

Agency filings affecting this section

Scope of health care provider network.

(1) The rules establish the development, enrollment, and oversight of a network of health care providers approved to treat injured workers. The health care provider network rules apply to care for workers covered by Washington state fund and self-insured employers.
(2) As of January 1, 2013, the following types of health care providers (hereafter providers) must be enrolled in the network with an approved provider agreement to provide and be reimbursed for care to injured workers in Washington state beyond the initial office or emergency room visit:
(a) Medical physicians and surgeons;
(b) Osteopathic physicians and surgeons;
(c) Chiropractic physicians;
(d) Naturopathic physicians;
(e) Podiatric physicians and surgeons;
(f) Dentists;
(g) Optometrists;
(h) Advanced registered nurse practitioners; and
(i) Physician assistants.
(3) The requirement in subsection (2) of this section does not apply to providers who practice exclusively in acute care hospitals or within inpatient settings in the following specialties:
(a) Pathologists;
(b) Consulting radiologists working within a hospital radiology department;
(c) Anesthesiologists or certified registered nurse anesthetists (CRNAs) except anesthesiologists and CRNAs with pain management practices in either hospital-based or ambulatory care settings;
(d) Emergency room providers; or
(e) Hospitalists.
(4) The department may phase implementation of the network to ensure access within all geographic areas. The director of the department shall determine, at his/her discretion, whether to establish or expand the network, after consideration of at least the following:
• The percent of injured workers statewide who have access to at least five primary care providers within fifteen miles, compared to a baseline established within the previous twelve months;
• The percent of injured workers by county who have access to at least five primary care providers within fifteen miles, compared to a baseline established within the previous twelve months; and
• The availability within the network of a broad variety of specialists necessary to treat injured workers.
The department may expand the health care provider network scope to include additional providers not listed in subsection (2) of this section, listed in subsection (3) of this section, and to out-of-state providers. For providers outside the scope of the health care provider network rule, the department and self-insured employers may reimburse for treatment beyond the initial office or emergency room visit.
[Statutory Authority: RCW 51.36.010, 51.04.020, and 51.04.030. WSR 12-23-020, § 296-20-01010, filed 11/13/12, effective 12/14/12; WSR 12-02-058, § 296-20-01010, filed 1/3/12, effective 2/3/12.]