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Washington Administrative Code (WAC)

Chapter 20

Wash. Admin. Code ch. 296-20

Medical Aid Rules

LABOR AND INDUSTRIES, DEPARTMENT OF

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 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 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?296-20-030Treatment not requiring authorization for accepted conditions 296-20-03001Treatment requiring authorization 296-20-03002Treatment not authorized 296-20-03004Chemonucleolysis 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?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 60 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 department or self-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 296-20-121X-rays 296-20-124Rejected and closed claims 296-20-12401Application process for providers outside the scope of the provider network 296-20-125Billing procedures 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 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 providers, consultants or independent medical examination (IME) providers 296-20-2010General rules for impairment rating examinations by attending providers and consultants 296-20-2015What rating systems are used for determining an impairment rating conducted by the attending provider or a consultant?296-20-2025May a worker bring someone with them to an impairment rating examination conducted by the attending provider or a consultant?296-20-2030May the worker videotape or audiotape the impairment rating examination conducted by the attending provider 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