What are treatment and diagnostic guidelines and how are they related to medical coverage decisions?
(1) Treatment and diagnostic guidelines are developed by the department for the diagnosis or treatment of accepted conditions. These guidelines are developed to give providers a range of the many treatment or diagnostic options available for a particular medical condition. Treatment and diagnostic guidelines are a combination of the best available scientific evidence and a consensus of expert opinion.
(2) The department may develop treatment or diagnostic guidelines to improve outcomes for workers receiving covered health services. As appropriate to the subject matter, the department may develop these guidelines in collaboration with the following committees:
• The industrial insurance medical advisory committee;
• The industrial insurance chiropractic advisory committee.
• The Washington state pharmacy and therapeutics committee.
• The Washington state health technology assessment clinical committee.
(3) In the process of implementing these guidelines, the department may find it necessary to make a formal medical coverage decision on one or more of the treatment or diagnostic options. The department, not the advisory committees, is responsible for implementing treatment guidelines and for making coverage decisions that result from such implementation.
(4) Network providers are required to follow the department's evidence-based coverage decisions, treatment guidelines, and policies.
[Statutory Authority: RCW 51.36.010
, and 51.04.030
. WSR 12-23-020, § 296-20-02705, filed 11/13/12, effective 12/14/12. Statutory Authority: 2007 c 282, RCW 51.04.02 [51.04.020], 51.04.030
. WSR 08-02-020, § 296-20-02705, filed 12/21/07, effective 1/21/08. Statutory Authority: RCW 51.04.020
. WSR 04-08-040, § 296-20-02705, filed 3/30/04, effective 5/1/04. Statutory Authority: RCW 51.04.020
. WSR 00-01-037, § 296-20-02705, filed 12/7/99, effective 1/8/00.]