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296-20-12075  <<  296-20-12080 >>   296-20-12085

WAC 296-20-12080

Agency filings affecting this section

SIMP follow-up phase.

(1) So long as the claim remains open, a follow-up phase may occur within six months after the treatment phase has concluded. This phase is not a substitute for and cannot serve as an extended treatment phase. The goals of the follow-up phase are to:
(a) Improve and reinforce the pain management gains made during the treatment phase;
(b) Help the worker integrate the knowledge and skills gained during the treatment phase into his or her job, daily activities, and family and community life;
(c) Evaluate the degree of improvement in the worker's condition at regular intervals and produce a written report describing the evaluation results;
(d) Address the goals listed in the return to work action plan if one was developed.
(2) Site of the follow-up phase. The activities of the follow-up phase may occur at the original multidisciplinary clinic (clinic-based) or at the worker's home, workplace, or health care provider office (community-based). This approach permits maximum flexibility for workers whose needs may range from intensive, focused follow-up care at the clinic to more independent episodes of care closer to home. It also enables workers to establish relationships with providers in their communities so they have increased access to health care resources.
(3) Face-to-face vs. nonface-to-face services: Follow-up services are payable as "face-to-face" and "nonface-to-face" services. Face-to-face services are when the provider interacts directly with the worker, the worker's family, employer, or other health care providers. Nonface-to-face services are when the SIMP provider uses the telephone or other electronic media to communicate with the worker, worker's family, employer, or other health care providers for the purpose of coordinating care in the worker's home community. Both are subject to the following limits:
(a) Face-to-face services: Up to twenty-four hours are allowed with a maximum of four hours per day.
(b) Nonface-to-face services: Up to forty hours are allowed.
(4) Reporting requirements.
(a) If a worker has been receiving follow-up services, a summary report must be submitted to the insurer that provides the following information:
• The worker's status, including whether the worker returned to work, how pain is being managed, medication use, whether the worker is getting services in his or her community, activity levels, and support systems;
• What was done during the follow-up phase;
• What resulted from the follow-up care; and
• Measures of pain and function using valid tests and instruments.
(b) This summary report must be submitted at the following intervals:
• For nonlumbar surgery candidates: At one and three months.
• For lumbar surgery candidates (regardless of whether they had lumbar surgery after successfully completing SIMP treatment): At one, three, and six months.
[Statutory Authority: RCW 70.14.120, 51.04.020, 51.04.030. WSR 09-20-040, § 296-20-12080, filed 9/30/09, effective 11/1/09.]