AN ACT Relating to fee schedules for industrial
insurance medical aid; and amending RCW 51.04.030, 51.36.080, and 51.36.085.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF
WASHINGTON:
Sec. 1.
RCW 51.04.030 and 1989 c 189 s 1 are each amended to read as follows:
The director shall, through the division of
industrial insurance, supervise the providing of prompt and efficient care and
treatment, including care provided by physician((s')) assistants
governed by the provisions of chapters 18.57A and 18.71A RCW, acting under a
supervising physician to workers injured during the course of their employment
at the least cost consistent with promptness and efficiency, without
discrimination or favoritism, and with as great uniformity as the various and
diverse surrounding circumstances and locations of industries will permit and
to that end shall, from time to time, establish and promulgate and supervise
the administration of printed forms, rules, regulations, and practices for the
furnishing of such care and treatment: PROVIDED, That, the department may
recommend to an injured worker particular health care services and providers
where specialized treatment is indicated or where cost effective payment levels
or rates are obtained by the department: AND PROVIDED FURTHER, That the
department may enter into contracts for goods and services including, but not
limited to, durable medical equipment so long as state-wide access to quality
service is maintained for injured workers.
The director shall ((make)), in
consultation with interested persons, establish and, ((from time to
time,)) in his or her discretion, periodically change as may be necessary,
and ((promulgate)) make available a fee ((bill)) schedule
of the maximum charges to be made by any physician, surgeon, hospital, druggist,
physicians' assistants as defined in chapters 18.57A and 18.71A RCW, acting
under a supervising physician or other agency or person rendering services to
injured workers. The department shall coordinate with other state
purchasers of health care services to establish as much consistency and
uniformity in billing and coding practices as possible, taking into account the
unique requirements and differences between programs. No service covered
under this title shall be charged or paid at a rate or rates exceeding those
specified in such fee ((bill)) schedule, and no contract
providing for greater fees shall be valid as to the excess. The
establishment of such a schedule, exclusive of conversion factors, does not
constitute "agency action" as used in RCW 34.05.010(3), nor does such
a fee schedule constitute a "rule" as used in RCW 34.05.010(15).
The director or self-insurer, as the case may
be, shall make a record of the commencement of every disability and the
termination thereof and, when bills are rendered for the care and treatment of
injured workers, shall approve and pay those which conform to the promulgated
rules, regulations, established fee schedules, and practices of the
director and may reject any bill or item thereof incurred in violation of the
principles laid down in this section or the rules ((and)),
regulations, or the established fee schedules and rules and regulations
promulgated under it.
Sec. 2.
RCW 51.36.080 and 1987 c 470 s 1 are each amended to read as follows:
(1) All fees and medical charges under this
title shall conform to ((regulations promulgated)) the fee schedule
established by the director and shall be paid within sixty days of receipt
by the department of a proper billing in the form prescribed by department rule
or sixty days after the claim is allowed by final order or judgment, if an
otherwise proper billing is received by the department prior to final
adjudication of claim allowance. The department shall pay interest at the rate
of one percent per month, but at least one dollar per month, whenever the
payment period exceeds the applicable sixty-day period on all proper fees and
medical charges.
Beginning in fiscal year 1987, interest
payments under this subsection may be paid only from funds appropriated to the
department for administrative purposes. A record of payments made under this
subsection shall be submitted twice yearly to the commerce and labor committees
of the senate and the house of representatives and to the ways and means
committees of the senate and the house of representatives.
Nothing in this section may be construed to
require the payment of interest on any billing, fee, or charge if the
industrial insurance claim on which the billing, fee, or charge is predicated
is ultimately rejected or the billing, fee, or charge is otherwise not
allowable.
In establishing fees for medical and other
health care services, the director shall consider the director's duty to
purchase health care in a prudent, cost-effective manner without unduly
restricting access to necessary care by persons entitled to the care. With
respect to workers admitted as hospital inpatients on or after July 1, 1987,
the director shall pay for inpatient hospital services on the basis of
diagnosis-related groups, contracting for services, or other prudent,
cost-effective payment method, which the director shall establish by rules
adopted in accordance with chapter 34.05 RCW.
(2) The director may establish procedures for
selectively or randomly auditing the accuracy of fees and medical billings
submitted to the department under this title.
Sec. 3.
RCW 51.36.085 and 1987 c 316 s 4 are each amended to read as follows:
All fees and medical charges under this title
shall conform to regulations promulgated, and the fee schedule established
by the director and shall be paid within sixty days of receipt by the
self-insured of a proper billing in the form prescribed by department rule or
sixty days after the claim is allowed by final order or judgment, if an
otherwise proper billing is received by the self-insured prior to final
adjudication of claim allowance. The self-insured shall pay interest at the
rate of one percent per month, but at least one dollar per month, whenever the
payment period exceeds the applicable sixty-day period on all proper fees and
medical charges.
