Chapter 296-20 WAC

Last Update: 5/1/18

MEDICAL AID RULES

WAC Sections

296-20-010General information.
296-20-0100Industrial insurance chiropractic advisory committee.
296-20-01001Industrial insurance medical advisory committee.
296-20-01002Definitions.
296-20-01010Scope of health care provider network.
296-20-01020Health care provider network enrollment.
296-20-01030Minimum health care provider network standards.
296-20-01040Health care provider network continuing requirements.
296-20-01050Health care provider network further review and denial.
296-20-01060Delegation of credentialing and recredentialing activities.
296-20-01070Waiting periods for reapplying to the network.
296-20-01080Management of the provider network.
296-20-01090Request for reconsideration of department decision.
296-20-01100Risk of harm.
296-20-015Who may treat.
296-20-01501Physician's assistant rules.
296-20-01505Provider types and services not covered.
296-20-020Acceptance of rules and fees.
296-20-02005Keeping of records.
296-20-02010Review of health services providers.
296-20-02015Interest on excess payments.
296-20-022Payment of out-of-state providers.
296-20-023Third party settlement—Excess recoveries.
296-20-024Utilization management.
296-20-025Initiating treatment and submitting a claim for benefits.
MEDICAL COVERAGE DECISIONS
296-20-02700What is a medical coverage decision?
296-20-02701Who makes medical coverage decisions?
296-20-02702Who uses medical coverage decisions?
296-20-02703How can I determine if a specific health care service or supply is the subject of a medical coverage decision?
296-20-02704What criteria does the director or director’s designee use to make medical coverage decisions?
296-20-02705What are treatment and diagnostic guidelines and how are they related to medical coverage decisions?
296-20-02850When may the department cover controversial, obsolete, investigational or experimental treatment?
TREATMENT AUTHORIZATION REQUIREMENTS
296-20-030Treatment not requiring authorization for accepted conditions.
296-20-03001Treatment requiring authorization.
296-20-03002Treatment not authorized.
296-20-03004Chemonucleolysis.
MEDICATION RULES
296-20-03005Inoculation or immunological treatment for exposure to infectious occupational disease.
296-20-03010What are the general principles the department uses to determine drug coverage?
296-20-03011What general limitations are in place for drugs?
296-20-03012Where can I find the department's outpatient drug coverage decisions?
296-20-03013Will the department or self-insurer pay for a denied outpatient drug in special circumstances?
296-20-03014Which drugs have specific limitations?
296-20-03015What steps may the department or self-insurer take when concerned about the amount or appropriateness of drugs prescribed for the injured worker?
296-20-03017What information is needed for prescriptions and the physician’s record?
296-20-03018What inpatient drugs are covered?
OPIOIDS FOR NONCANCER PAIN
296-20-03030Definitions associated with opioid authorization and payment.
296-20-03035Checking the prescription monitoring program database.
296-20-03040Administering urine drug testing.
296-20-03045Tracking function and pain.
296-20-03050Preinjury opioid use.
296-20-03055Opioid authorization requirement for the acute phase (0-6 weeks).
296-20-03056Opioid authorization requirement for the subacute phase (6-12 weeks).
296-20-03057Opioid authorization requirement for the chronic phase (˃ 12 weeks).
296-20-03058Opioid authorization requirement for ongoing chronic opioid therapy.
296-20-03059Opioid authorization requirement for catastrophic injuries.
296-20-03060Episodic care for pain.
296-20-03065Managing surgical pain in workers on opioid therapy.
296-20-03070When opioid prescribing is not proper and necessary care.
296-20-03075When to discontinue opioids.
296-20-03080Weaning or detoxification.
296-20-03085Addiction treatment.
296-20-035Treatment in cases that remain open beyond sixty days.
296-20-045Consultation requirements.
296-20-051Consultations.
296-20-055Limitation of treatment and temporary treatment of unrelated conditions when retarding recovery.
296-20-06101What reports are health care providers required to submit to the insurer?
296-20-065Transfer of providers.
296-20-071Concurrent treatment.
296-20-075Hospitalization.
296-20-081Unrelated concurrent nonemergent surgery.
296-20-091Home nursing.
296-20-097Reopenings.
296-20-09701Request for reconsideration.
296-20-100Eye glasses and refractions.
296-20-110Dental.
296-20-1101Hearing aids and masking devices.
296-20-1102Special equipment rental and purchase prosthetic and orthotics equipment.
296-20-1103Travel expense.
296-20-120Procedures not listed in this schedule.
296-20-12050Special programs.
STRUCTURED INTENSIVE MULTIDISCIPLINARY
PROGRAM (SIMP) FOR CHRONIC NONCANCER PAIN
296-20-121X-rays.
296-20-124Rejected and closed claims.
296-20-12401Application process for providers outside the scope of the provider network.
BILLING
296-20-125Billing procedures.
296-20-12501Physician assistant billing procedure.
296-20-132Determination of conversion factor adjustments.
296-20-135Conversion factors.
296-20-170Pharmacy—Acceptance of rules and fees.
296-20-17001Allowance and payment for medication.
296-20-17002Billing.
296-20-17004Billing and payment for initial prescription drugs.
IMPAIRMENT RATING
296-20-19000What is a permanent partial disability award?
296-20-19010Are there different types of permanent partial disabilities?
296-20-19020How is it determined which impairment rating system is to be used to rate specified and unspecified disabilities?
296-20-19030To what extent is pain considered in an award for permanent partial disability?
296-20-200General information for impairment rating examinations by attending doctors, consultants or independent medical examination (IME) providers.
296-20-2010General rules for impairment rating examinations by attending doctors and consultants.
296-20-2015What rating systems are used for determining an impairment rating conducted by the attending doctor or a consultant?
296-20-2025May a worker bring someone with them to an impairment rating examination conducted by the attending doctor or a consultant?
296-20-2030May the worker videotape or audiotape the impairment rating examination conducted by the attending doctor or a consultant?
296-20-220Special rules for evaluation of permanent bodily impairment.
296-20-230Cervical and cervico-dorsal impairments.
296-20-240Categories of permanent cervical and cervico-dorsal impairments.
296-20-250Impairments of the dorsal area.
296-20-260Categories of permanent dorsal area impairments.
296-20-270Dorso-lumbar and lumbosacral impairments.
296-20-280Categories of permanent dorso-lumbar and lumbosacral impairments.
296-20-290Impairments of the pelvis.
296-20-300Categories of permanent impairments of the pelvis.
296-20-310Convulsive neurological impairments.
296-20-320Categories of permanent convulsive neurological impairments.
296-20-330Impairments of mental health.
296-20-340Categories for evaluation of permanent impairments of mental health.
296-20-350Cardiac impairments.
296-20-360Categories of permanent cardiac impairments.
296-20-370Respiratory impairments.
296-20-380Categories of permanent respiratory impairments.
296-20-385Categories of persisting variable respiratory impairment with normal baseline spirometry.
296-20-390Air passage impairments.
296-20-400Categories of permanent air passage impairments.
296-20-410Nasal septum impairments.
296-20-420Categories of permanent air passage impairment due to nasal septum perforations.
296-20-430Loss of taste and smell.
296-20-440Categories of permanent loss of taste and smell.
296-20-450Speech impairments.
296-20-460Categories of permanent speech impairments.
296-20-470Skin impairments.
296-20-480Categories of permanent skin impairments.
296-20-490Impairment of the upper digestive tract, stomach, esophagus or pancreas.
296-20-500Categories of permanent impairments of the upper digestive tract, stomach, esophagus or pancreas.
296-20-510Lower digestive tract impairments.
296-20-520Categories of permanent lower digestive tract impairments.
296-20-530Impairment of anal function.
296-20-540Categories of permanent impairments of anal function.
296-20-550Liver and biliary tract impairments.
296-20-560Categories of permanent liver and biliary tract impairments.
296-20-570Impairments of the spleen, loss of one kidney, and surgical removal of the bladder with urinary diversion.
296-20-580Categories of permanent impairment of the spleen, loss of one kidney, and surgical removal of bladder with urinary diversion.
296-20-590Impairment of upper urinary tract.
296-20-600Categories of permanent impairments of upper urinary tract.
296-20-610Additional permanent impairments of upper urinary tract due to surgical diversion.
296-20-620Categories of additional permanent impairments of upper urinary tract due to surgical diversion.
296-20-630Impairment of bladder function.
296-20-640Categories of permanent impairments of bladder function.
296-20-650Anatomical or functional loss of testes.
296-20-660Categories of permanent anatomical or functional loss of testes.
296-20-670Disability.
296-20-680Classification of disabilities in proportion to total bodily impairment.
296-20-690Permanent impairments of the cervico-dorsal (WAC 296-20-240) and lumbosacral regions (WAC 296-20-280) jointly.
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