Workers' comp. medical care

AN ACT Relating to access to medical care in workers' 1
compensation; amending RCW 51.36.010, 51.36.010, and 51.32.160; 2
creating a new section; providing effective dates; and providing an 3
expiration date. 4
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:5
Sec. 1. RCW 51.36.010 and 2023 c 171 s 9 are each amended to 6
read as follows: 7
(1)(a) The legislature finds that high quality medical treatment 8
and adherence to occupational health best practices can prevent 9
disability and reduce loss of family income for workers, and lower 10
labor and insurance costs for employers. Injured workers deserve high 11
quality medical care in accordance with current health care best 12
practices. To this end, the department shall establish minimum 13
standards for providers who treat workers from both state fund and 14
self-insured employers. The department shall establish a health care 15
provider network to treat injured workers, and shall accept providers 16
into the network who meet those minimum standards. The department 17
shall convene an advisory group made up of representatives from or 18
designees of the workers' compensation advisory committee and the 19
industrial insurance medical and chiropractic advisory committees to 20
consider and advise the department related to implementation of this 21
S-3521.1
SENATE BILL 5847
State of Washington 69th Legislature 2026 Regular Session
By Senators Saldaña, Harris, Alvarado, Trudeau, Bateman, Conway,
Hasegawa, Lovelett, Nobles, Orwall, Riccelli, Shewmake, Stanford,
Valdez, and C. Wilson
Prefiled 12/08/25. Read first time 01/12/26. Referred to Committee
on Labor & Commerce.
p. 1 SB 5847
section, including development of best practices treatment guidelines 1
for providers in the network. The department shall also seek the 2
input of various health care provider groups and associations 3
concerning the network's implementation. 4
(b) Network providers must ((be required to )), when medically 5
appropriate as determined by the provider, follow the department's 6
evidence-based coverage decisions and treatment guidelines, policies, 7
and must ((be expected to)), when medically appropriate as determined 8
by the provider, follow other national treatment guidelines 9
appropriate for their patient. 10
(c) The department, in collaboration with the advisory group, 11
shall also establish additional best practice standards for providers 12
to qualify for a second tier within the network, based on 13
demonstrated use of occupational health best practices. This second 14
tier is separate from and in addition to the centers for occupational 15
health and education established under subsection (5) of this 16
section. 17
(2)(a)(i) Upon the occurrence of any injury to a worker entitled 18
to compensation under the provisions of this title, ((he or she)) the 19
worker shall receive proper and necessary medical and surgical 20
services at the hands of a physician, osteopathic physician, 21
chiropractor, naturopath, podiatric physician, optometrist, dentist, 22
licensed advanced registered nurse practitioner, physician assistant, 23
or psychologist in claims solely for mental health conditions, of 24
((his or her )) the worker's own choice, if conveniently located, 25
except as provided in (b) of this subsection, and proper and 26
necessary hospital care and services during the period of ((his or 27
her)) the worker's disability from such injury. 28
(ii) Upon notice of an injury, an employer must inform the 29
injured worker that the worker has a right to seek medical treatment 30
with a provider of the worker's own choice. An employer is prohibited 31
from requiring, or in any way inducing, an injured worker to seek 32
medical treatment from a specific provider or clinic. The department 33
shall investigate any allegation that an employer attempted to 34
require or induce an injured worker to seek treatment from a specific 35
provider or clinic. Any violation of this subsection (2)(a)(ii) by a 36
self-insured employer is a per se violation of RCW 51.14.180. Any 37
violation by other employers of this subsection (2)(a)(ii) subjects 38
the employer to a penalty pursuant to RCW 51.28.025(2).39
p. 2 SB 5847
(b) ((Once)) Except as provided in (g) of this subsection, once 1
the provider network is established in the worker's geographic area, 2
an injured worker may receive care from a nonnetwork provider only 3
for an initial office or emergency room visit. However, the 4
department or self-insurer may limit reimbursement to the 5
department's standard fee for the services. The provider must comply 6
with all applicable billing policies and must accept the department's 7
fee schedule as payment in full. 8
(c) The department, in collaboration with the advisory group, 9
shall adopt policies for the development, credentialing, 10
accreditation, and continued oversight of a network of health care 11
providers approved to treat injured workers. Health care providers 12
shall apply to the network by completing the department's provider 13
application which shall have the force of a contract with the 14
department to treat injured workers. The advisory group shall 15
recommend minimum network standards for the department to approve a 16
provider's application, to remove a provider from the network, or to 17
require peer review such as, but not limited to: 18
(i) Current malpractice insurance coverage exceeding a dollar 19
amount threshold, number, or seriousness of malpractice suits over a 20
specific time frame; 21
(ii) Previous malpractice judgments or settlements that do not 22
exceed a dollar amount threshold recommended by the advisory group, 23
or a specific number or seriousness of malpractice suits over a 24
specific time frame; 25
(iii) No licensing or disciplinary action in any jurisdiction or 26
loss of treating or admitting privileges by any board, commission, 27
agency, public or private health care payer, or hospital;28
(iv) For some specialties such as surgeons, privileges in at 29
least one hospital; 30
(v) Whether the provider has been credentialed by another health 31
plan that follows national quality assurance guidelines; and32
(vi) Alternative criteria for providers that are not credentialed 33
by another health plan. 34
The department shall develop alternative criteria for providers 35
that are not credentialed by another health plan or as needed to 36
address access to care concerns in certain regions.37
(d) Network provider contracts will automatically renew at the 38
end of the contract period unless the department provides written 39
notice of changes in contract provisions or the department or 40
p. 3 SB 5847
provider provides written notice of contract termination. The 1
industrial insurance medical advisory committee shall develop 2
criteria for removal of a provider from the network to be presented 3
to the department and advisory group for consideration in the 4
development of contract terms. 5
(e) In order to monitor quality of care and assure efficient 6
management of the provider network, the department shall establish 7
additional criteria and terms for network participation including, 8
but not limited to, requiring compliance with administrative and 9
billing policies. 10
(f) The advisory group shall recommend best practices standards 11
to the department to use in determining second tier network 12
providers. The department shall develop and implement financial and 13
nonfinancial incentives for network providers who qualify for the 14
second tier. The department is authorized to certify and decertify 15
second tier providers. 16
(g) If a worker is unable to find a provider in the medical 17
provider network who is willing to treat the worker within 15 miles 18
of the worker's home, the worker may provide notice of this fact to 19
the department or self-insured employer. Within seven calendar days 20
of receiving such notice, the department or self-insured employer 21
shall send the worker a declaration developed by the department to 22
sign certifying this fact. Upon signing and returning the 23
declaration, or if the department or self-insured employer fails to 24
send the declaration within seven calendar days, the worker may seek 25
treatment from a nonnetwork provider if the provider agrees to be 26
paid in accordance with the department's fee schedule. The department 27
or self-insured employer shall pay for such proper and necessary 28
treatment.29
(3)(a) The department shall work with self-insurers and the 30
department utilization review provider to implement utilization 31
review for the self-insured community to ensure consistent quality, 32
cost-effective care for all injured workers and employers, and to 33
reduce administrative burden for providers. 34
(b) Any utilization review must be completed within 10 business 35
days of the date the department received a request for approval of 36
treatment on behalf of an injured worker or the treatment must be 37
authorized.38
(4)(a) The department for state fund claims shall pay, in 39
accordance with the department's fee schedule, for any alleged injury 40
p. 4 SB 5847
for which a worker files a claim, any initial prescription drugs 1
provided in relation to that initial visit, without regard to whether 2
the worker's claim for benefits is allowed. 3
(b) In all accepted claims, treatment shall be limited in point 4
of duration as follows: 5
(i) In the case of permanent partial disability, not to extend 6
beyond the date when compensation shall be awarded ((him or her)) the 7
worker, except when the worker returned to work before permanent 8
partial disability award is made, in such case not to extend beyond 9
the time when monthly allowances to ((him or her )) the worker shall 10
cease((; in)).11
(ii) In the case of temporary disability not to extend beyond the 12
time when monthly allowances to ((him or her )) the worker shall 13
cease: PROVIDED, That after any injured worker has returned to ((his 14
or her )) the worker's work ((his or her )), the worker's medical and 15
surgical treatment may be continued if, and so long as, such 16
continuation is deemed necessary by the supervisor of industrial 17
insurance to be necessary to ((his or her )) the worker's more 18
complete recovery((; in)).19
(iii) In the case of a permanent total disability not to extend 20
beyond the date on which a lump sum settlement is made with ((him or 21
her or he or she )) the worker, or the worker is placed upon the 22
permanent pension roll: PROVIDED, HOWEVER, That the supervisor of 23
industrial insurance, solely in ((his or her )) the supervisor's 24
discretion, in all cases of permanent partial disability or permanent 25
total disability , may authorize continued medical and surgical 26
treatment for conditions previously accepted by the department when 27
such medical and surgical treatment is deemed necessary by the 28
supervisor of industrial insurance to protect such worker's life or 29
provide for the administration of medical and therapeutic measures 30
including payment of prescription medications, but not including 31
those controlled substances currently scheduled by the pharmacy 32
quality assurance commission as Schedule I, II, III, or IV substances 33
under chapter 69.50 RCW, which are necessary to alleviate continuing 34
pain which results from the industrial injury. ((In order to 35
authorize such continued treatment the written order of the 36
supervisor of industrial insurance issued in advance of the 37
continuation shall be necessary.))38
(iv) Provided, that where cancer is an accepted diagnosis, the 39
department or self-insured employer, as the case may be, shall 40
p. 5 SB 5847
continue to pay for monitoring of the diagnosis at a frequency 1
recommended by the worker's treating oncologist. The monitoring must 2
include all necessary diagnostic studies and associated medical 3
consultations. 4
(c) The supervisor of industrial insurance, the supervisor's 5
designee, or a self-insurer, in ((his or her)) their sole discretion, 6
may authorize inoculation or other immunological treatment in cases 7
in which a work-related activity has resulted in probable exposure of 8
the worker to a potential infectious occupational disease. 9
Authorization of such treatment does not bind the department or self-10
insurer in any adjudication of a claim by the same worker or the 11
worker's beneficiary for an occupational disease. 12
(d) Nothing in this section prevents a worker from reopening the 13
worker's claim pursuant to RCW 51.32.160.14
(5)(a) The legislature finds that the department and its business 15
and labor partners have collaborated in establishing centers for 16
occupational health and education to promote best practices and 17
prevent preventable disability by focusing additional provider-based 18
resources during the first twelve weeks following an injury. The 19
centers for occupational health and education represent innovative 20
accountable care systems in an early stage of development consistent 21
with national health care reform efforts. Many Washington workers do 22
not yet have access to these innovative health care delivery models.23
(b) To expand evidence-based occupational health best practices, 24
the department shall establish additional centers for occupational 25
health and education, with the goal of extending access to at least 26
fifty percent of injured and ill workers by December 2013 and to all 27
injured workers by December 2015. The department shall also develop 28
additional best practices and incentives that span the entire period 29
of recovery, not only the first twelve weeks. 30
(c) The department shall certify and decertify centers for 31
occupational health and education based on criteria including 32
institutional leadership and geographic areas covered by the center 33
for occupational health and education, occupational health leadership 34
and education, mix of participating health care providers necessary 35
to address the anticipated needs of injured workers, health services 36
coordination to deliver occupational health best practices, 37
indicators to measure the success of the center for occupational 38
health and education, and agreement that the center's providers 39
p. 6 SB 5847
shall, if feasible, treat certain injured workers if referred by the 1
department or a self-insurer. 2
(d) Health care delivery organizations may apply to the 3
department for certification as a center for occupational health and 4
education. These may include, but are not limited to, hospitals and 5
affiliated clinics and providers, multispecialty clinics, health 6
maintenance organizations, and organized systems of network 7
physicians. 8
(e) The centers for occupational health and education shall 9
implement benchmark quality indicators of occupational health best 10
practices for individual providers, developed in collaboration with 11
the department. A center for occupational health and education shall 12
remove individual providers who do not consistently meet these 13
quality benchmarks. 14
(f) The department shall develop and implement financial and 15
nonfinancial incentives for center for occupational health and 16
education providers that are based on progressive and measurable 17
gains in occupational health best practices, and that are applicable 18
throughout the duration of an injured or ill worker's episode of 19
care. 20
(g) The department shall develop electronic methods of tracking 21
evidence-based quality measures to identify and improve outcomes for 22
injured workers at risk of developing prolonged disability. In 23
addition, these methods must be used to provide systematic feedback 24
to physicians regarding quality of care, to conduct appropriate 25
objective evaluation of progress in the centers for occupational 26
health and education, and to allow efficient coordination of 27
services. 28
(6)(a) If a provider fails to meet the minimum network standards 29
established in subsection (2) of this section, the department is 30
authorized to remove the provider from the network or take other 31
appropriate action regarding a provider's participation. The 32
department may also require remedial steps as a condition for a 33
provider to participate in the network. The department, with input 34
from the advisory group, shall establish waiting periods that may be 35
imposed before a provider who has been denied or removed from the 36
network may reapply. 37
(((7))) (b) The department may permanently remove a provider from 38
the network or take other appropriate action when the provider 39
exhibits a pattern of conduct of low quality care that exposes 40
p. 7 SB 5847
patients to risk of physical or psychiatric harm or death. Patterns 1
that qualify as risk of harm include, but are not limited to, poor 2
health care outcomes evidenced by increased, chronic, or prolonged 3
pain or decreased function due to treatments that have not been shown 4
to be curative, safe, or effective or for which it has been shown 5
that the risks of harm exceed the benefits that can be reasonably 6
expected based on peer-reviewed opinion. 7
(((8))) (c) The department may not remove a health care provider 8
from the network for an isolated instance of poor health and recovery 9
outcomes due to treatment by the provider. 10
(((9))) (d) When the department terminates a provider from the 11
network, the department or self-insurer shall assist an injured 12
worker currently under the provider's care in identifying a new 13
network provider or providers from whom the worker can select an 14
attending or treating provider. In such a case, the department or 15
self-insurer shall notify the injured worker that ((he or she )) the 16
worker must choose a new attending or treating provider.17
(((10))) (e) Any action taken by the department to remove a 18
provider or terminate a provider from the network must be done in 19
writing. The provider may appeal such action to the board of 20
industrial insurance appeals pursuant to chapter 51.52 RCW.21
(7) The department may adopt rules related to this section.22
(((11) The department shall report to the workers' compensation 23
advisory committee and to the appropriate committees of the 24
legislature on each December 1st, beginning in 2012 and ending in 25
2016, on the implementation of the provider network and expansion of 26
the centers for occupational health and education. The reports must 27
include a summary of actions taken, progress toward long-term goals, 28
outcomes of key initiatives, access to care issues, results of 29
disputes or controversies related to new provisions, and whether any 30
changes are needed to further improve the occupational health best 31
practices care of injured workers.))32
Sec. 2. RCW 51.36.010 and 2025 c 58 s 5117 are each amended to 33
read as follows: 34
(1)(a) The legislature finds that high quality medical treatment 35
and adherence to occupational health best practices can prevent 36
disability and reduce loss of family income for workers, and lower 37
labor and insurance costs for employers. Injured workers deserve high 38
quality medical care in accordance with current health care best 39
p. 8 SB 5847
practices. To this end, the department shall establish minimum 1
standards for providers who treat workers from both state fund and 2
self-insured employers. The department shall establish a health care 3
provider network to treat injured workers, and shall accept providers 4
into the network who meet those minimum standards. The department 5
shall convene an advisory group made up of representatives from or 6
designees of the workers' compensation advisory committee and the 7
industrial insurance medical and chiropractic advisory committees to 8
consider and advise the department related to implementation of this 9
section, including development of best practices treatment guidelines 10
for providers in the network. The department shall also seek the 11
input of various health care provider groups and associations 12
concerning the network's implementation. 13
(b) Network providers must ((be required to )), when medically 14
appropriate as determined by the provider, follow the department's 15
evidence-based coverage decisions and treatment guidelines, policies, 16
and must ((be expected to)), when medically appropriate as determined 17
by the provider, follow other national treatment guidelines 18
appropriate for their patient. 19
(c) The department, in collaboration with the advisory group, 20
shall also establish additional best practice standards for providers 21
to qualify for a second tier within the network, based on 22
demonstrated use of occupational health best practices. This second 23
tier is separate from and in addition to the centers for occupational 24
health and education established under subsection (5) of this 25
section. 26
(2)(a)(i) Upon the occurrence of any injury to a worker entitled 27
to compensation under the provisions of this title, ((he or she)) the 28
worker shall receive proper and necessary medical and surgical 29
services at the hands of a physician, osteopathic physician, 30
chiropractor, naturopath, podiatric physician, optometrist, dentist, 31
licensed advanced practice registered nurse, physician assistant, or 32
psychologist in claims solely for mental health conditions, of ((his 33
or her)) the worker's own choice, if conveniently located, except as 34
provided in (b) of this subsection, and proper and necessary hospital 35
care and services during the period of ((his or her )) the worker's 36
disability from such injury. 37
(ii) Upon notice of an injury, an employer must inform the 38
injured worker that the worker has a right to seek medical treatment 39
with a provider of the worker's own choice. An employer is prohibited 40
p. 9 SB 5847
from requiring, or in any way inducing, an injured worker to seek 1
medical treatment from a specific provider or clinic. The department 2
shall investigate any allegation that an employer attempted to 3
require or induce an injured worker to seek treatment from a specific 4
provider or clinic. Any violation of this subsection (2)(a)(ii) by a 5
self-insured employer is a per se violation of RCW 51.14.180. Any 6
violation by other employers of this subsection (2)(a)(ii) subjects 7
the employer to a penalty pursuant to RCW 51.28.025(2).8
(b) ((Once)) Except as provided in (g) of this subsection, once 9
the provider network is established in the worker's geographic area, 10
an injured worker may receive care from a nonnetwork provider only 11
for an initial office or emergency room visit. However, the 12
department or self-insurer may limit reimbursement to the 13
department's standard fee for the services. The provider must comply 14
with all applicable billing policies and must accept the department's 15
fee schedule as payment in full. 16
(c) The department, in collaboration with the advisory group, 17
shall adopt policies for the development, credentialing, 18
accreditation, and continued oversight of a network of health care 19
providers approved to treat injured workers. Health care providers 20
shall apply to the network by completing the department's provider 21
application which shall have the force of a contract with the 22
department to treat injured workers. The advisory group shall 23
recommend minimum network standards for the department to approve a 24
provider's application, to remove a provider from the network, or to 25
require peer review such as, but not limited to: 26
(i) Current malpractice insurance coverage exceeding a dollar 27
amount threshold, number, or seriousness of malpractice suits over a 28
specific time frame; 29
(ii) Previous malpractice judgments or settlements that do not 30
exceed a dollar amount threshold recommended by the advisory group, 31
or a specific number or seriousness of malpractice suits over a 32
specific time frame; 33
(iii) No licensing or disciplinary action in any jurisdiction or 34
loss of treating or admitting privileges by any board, commission, 35
agency, public or private health care payer, or hospital;36
(iv) For some specialties such as surgeons, privileges in at 37
least one hospital; 38
(v) Whether the provider has been credentialed by another health 39
plan that follows national quality assurance guidelines; and40
p. 10 SB 5847
(vi) Alternative criteria for providers that are not credentialed 1
by another health plan. 2
The department shall develop alternative criteria for providers 3
that are not credentialed by another health plan or as needed to 4
address access to care concerns in certain regions.5
(d) Network provider contracts will automatically renew at the 6
end of the contract period unless the department provides written 7
notice of changes in contract provisions or the department or 8
provider provides written notice of contract termination. The 9
industrial insurance medical advisory committee shall develop 10
criteria for removal of a provider from the network to be presented 11
to the department and advisory group for consideration in the 12
development of contract terms. 13
(e) In order to monitor quality of care and assure efficient 14
management of the provider network, the department shall establish 15
additional criteria and terms for network participation including, 16
but not limited to, requiring compliance with administrative and 17
billing policies. 18
(f) The advisory group shall recommend best practices standards 19
to the department to use in determining second tier network 20
providers. The department shall develop and implement financial and 21
nonfinancial incentives for network providers who qualify for the 22
second tier. The department is authorized to certify and decertify 23
second tier providers. 24
(g) If a worker is unable to find a provider in the medical 25
provider network who is willing to treat the worker within 15 miles 26
of the worker's home, the worker may provide notice of this fact to 27
the department or self-insured employer. Within seven calendar days 28
of receiving such notice, the department or self-insured employer 29
shall send the worker a declaration developed by the department to 30
sign certifying this fact. Upon signing and returning the 31
declaration, or if the department or self-insured employer fails to 32
send the declaration within seven calendar days, the worker may seek 33
treatment from a nonnetwork provider if the provider agrees to be 34
paid in accordance with the department's fee schedule. The department 35
or self-insured employer shall pay for such proper and necessary 36
treatment.37
(3)(a) The department shall work with self-insurers and the 38
department utilization review provider to implement utilization 39
review for the self-insured community to ensure consistent quality, 40
p. 11 SB 5847
cost-effective care for all injured workers and employers, and to 1
reduce administrative burden for providers. 2
(b) Any utilization review must be completed within 10 business 3
days of the date the department received a request for approval of 4
treatment on behalf of an injured worker or the treatment must be 5
authorized.6
(4)(a) The department for state fund claims shall pay, in 7
accordance with the department's fee schedule, for any alleged injury 8
for which a worker files a claim, any initial prescription drugs 9
provided in relation to that initial visit, without regard to whether 10
the worker's claim for benefits is allowed. 11
(b) In all accepted claims, treatment shall be limited in point 12
of duration as follows: 13
(i) In the case of permanent partial disability, not to extend 14
beyond the date when compensation shall be awarded ((him or her)) the 15
worker, except when the worker returned to work before permanent 16
partial disability award is made, in such case not to extend beyond 17
the time when monthly allowances to ((him or her )) the worker shall 18
cease((; in)).19
(ii) In the case of temporary disability not to extend beyond the 20
time when monthly allowances to ((him or her )) the worker shall 21
cease: PROVIDED, That after any injured worker has returned to ((his 22
or her )) the worker's work ((his or her )), the worker's medical and 23
surgical treatment may be continued if, and so long as, such 24
continuation is deemed necessary by the supervisor of industrial 25
insurance to be necessary to ((his or her )) the worker's more 26
complete recovery((; in)).27
(iii) In the case of a permanent total disability not to extend 28
beyond the date on which a lump sum settlement is made with ((him or 29
her or he or she )) the worker, or the worker is placed upon the 30
permanent pension roll: PROVIDED, HOWEVER, That the supervisor of 31
industrial insurance, solely in ((his or her )) the supervisor's 32
discretion, in all cases of permanent partial disability or permanent 33
total disability , may authorize continued medical and surgical 34
treatment for conditions previously accepted by the department when 35
such medical and surgical treatment is deemed necessary by the 36
supervisor of industrial insurance to protect such worker's life or 37
provide for the administration of medical and therapeutic measures 38
including payment of prescription medications, but not including 39
those controlled substances currently scheduled by the pharmacy 40
p. 12 SB 5847
quality assurance commission as Schedule I, II, III, or IV substances 1
under chapter 69.50 RCW, which are necessary to alleviate continuing 2
pain which results from the industrial injury. ((In order to 3
authorize such continued treatment the written order of the 4
supervisor of industrial insurance issued in advance of the 5
continuation shall be necessary.))6
(iv) Provided, that where cancer is an accepted diagnosis, the 7
department or self-insured employer, as the case may be, shall 8
continue to pay for monitoring of the diagnosis at a frequency 9
recommended by the worker's treating oncologist. The monitoring must 10
include all necessary diagnostic studies and associated medical 11
consultations.12
(c) The supervisor of industrial insurance, the supervisor's 13
designee, or a self-insurer, in ((his or her)) their sole discretion, 14
may authorize inoculation or other immunological treatment in cases 15
in which a work-related activity has resulted in probable exposure of 16
the worker to a potential infectious occupational disease. 17
Authorization of such treatment does not bind the department or self-18
insurer in any adjudication of a claim by the same worker or the 19
worker's beneficiary for an occupational disease. 20
(d) Nothing in this section prevents a worker from reopening the 21
worker's claim pursuant to RCW 51.32.160.22
(5)(a) The legislature finds that the department and its business 23
and labor partners have collaborated in establishing centers for 24
occupational health and education to promote best practices and 25
prevent preventable disability by focusing additional provider-based 26
resources during the first twelve weeks following an injury. The 27
centers for occupational health and education represent innovative 28
accountable care systems in an early stage of development consistent 29
with national health care reform efforts. Many Washington workers do 30
not yet have access to these innovative health care delivery models.31
(b) To expand evidence-based occupational health best practices, 32
the department shall establish additional centers for occupational 33
health and education, with the goal of extending access to at least 34
fifty percent of injured and ill workers by December 2013 and to all 35
injured workers by December 2015. The department shall also develop 36
additional best practices and incentives that span the entire period 37
of recovery, not only the first twelve weeks. 38
(c) The department shall certify and decertify centers for 39
occupational health and education based on criteria including 40
p. 13 SB 5847
institutional leadership and geographic areas covered by the center 1
for occupational health and education, occupational health leadership 2
and education, mix of participating health care providers necessary 3
to address the anticipated needs of injured workers, health services 4
coordination to deliver occupational health best practices, 5
indicators to measure the success of the center for occupational 6
health and education, and agreement that the center's providers 7
shall, if feasible, treat certain injured workers if referred by the 8
department or a self-insurer. 9
(d) Health care delivery organizations may apply to the 10
department for certification as a center for occupational health and 11
education. These may include, but are not limited to, hospitals and 12
affiliated clinics and providers, multispecialty clinics, health 13
maintenance organizations, and organized systems of network 14
physicians. 15
(e) The centers for occupational health and education shall 16
implement benchmark quality indicators of occupational health best 17
practices for individual providers, developed in collaboration with 18
the department. A center for occupational health and education shall 19
remove individual providers who do not consistently meet these 20
quality benchmarks. 21
(f) The department shall develop and implement financial and 22
nonfinancial incentives for center for occupational health and 23
education providers that are based on progressive and measurable 24
gains in occupational health best practices, and that are applicable 25
throughout the duration of an injured or ill worker's episode of 26
care. 27
(g) The department shall develop electronic methods of tracking 28
evidence-based quality measures to identify and improve outcomes for 29
injured workers at risk of developing prolonged disability. In 30
addition, these methods must be used to provide systematic feedback 31
to physicians regarding quality of care, to conduct appropriate 32
objective evaluation of progress in the centers for occupational 33
health and education, and to allow efficient coordination of 34
services. 35
(6)(a) If a provider fails to meet the minimum network standards 36
established in subsection (2) of this section, the department is 37
authorized to remove the provider from the network or take other 38
appropriate action regarding a provider's participation. The 39
department may also require remedial steps as a condition for a 40
p. 14 SB 5847
provider to participate in the network. The department, with input 1
from the advisory group, shall establish waiting periods that may be 2
imposed before a provider who has been denied or removed from the 3
network may reapply. 4
(((7))) (b) The department may permanently remove a provider from 5
the network or take other appropriate action when the provider 6
exhibits a pattern of conduct of low quality care that exposes 7
patients to risk of physical or psychiatric harm or death. Patterns 8
that qualify as risk of harm include, but are not limited to, poor 9
health care outcomes evidenced by increased, chronic, or prolonged 10
pain or decreased function due to treatments that have not been shown 11
to be curative, safe, or effective or for which it has been shown 12
that the risks of harm exceed the benefits that can be reasonably 13
expected based on peer-reviewed opinion. 14
(((8))) (c) The department may not remove a health care provider 15
from the network for an isolated instance of poor health and recovery 16
outcomes due to treatment by the provider. 17
(((9))) (d) When the department terminates a provider from the 18
network, the department or self-insurer shall assist an injured 19
worker currently under the provider's care in identifying a new 20
network provider or providers from whom the worker can select an 21
attending or treating provider. In such a case, the department or 22
self-insurer shall notify the injured worker that ((he or she )) the 23
worker must choose a new attending or treating provider.24
(((10))) (e) Any action taken by the department to remove a 25
provider or terminate a provider from the network must be done in 26
writing. The provider may appeal such action to the board of 27
industrial insurance appeals pursuant to chapter 51.52 RCW.28
(7) The department may adopt rules related to this section.29
(((11) The department shall report to the workers' compensation 30
advisory committee and to the appropriate committees of the 31
legislature on each December 1st, beginning in 2012 and ending in 32
2016, on the implementation of the provider network and expansion of 33
the centers for occupational health and education. The reports must 34
include a summary of actions taken, progress toward long-term goals, 35
outcomes of key initiatives, access to care issues, results of 36
disputes or controversies related to new provisions, and whether any 37
changes are needed to further improve the occupational health best 38
practices care of injured workers.))39
p. 15 SB 5847
Sec. 3. RCW 51.32.160 and 1995 c 253 s 2 are each amended to 1
read as follows: 2
(1)(a) If aggravation, diminution, or termination of disability 3
takes place, the director may, upon the application of the 4
beneficiary, made within seven years from the date the first closing 5
order becomes final, or at any time upon his or her own motion, 6
readjust the rate of compensation in accordance with the rules in 7
this section provided for the same, or in a proper case terminate the 8
payment: PROVIDED, That the director may, upon application of the 9
worker made at any time, provide proper and necessary medical and 10
surgical services as authorized under RCW 51.36.010. The department 11
shall promptly mail a copy of the application to the employer at the 12
employer's last known address as shown by the records of the 13
department. 14
(b) "Closing order" as used in this section means an order based 15
on factors which include medical recommendation, advice, or 16
examination. "Closing order" includes orders issued awarding workers 17
permanent total disability compensation pursuant to RCW 51.32.060.18
(c) Applications for benefits where the claim has been closed 19
without medical recommendation, advice, or examination are not 20
subject to the seven year limitation of this section. The preceding 21
sentence shall not apply to any closing order issued prior to July 1, 22
1981. First closing orders issued between July 1, 1981, and July 1, 23
1985, shall, for the purposes of this section only, be deemed issued 24
on July 1, 1985. The time limitation of this section shall be ten 25
years in claims involving loss of vision or function of the eyes.26
(d) If an order denying an application to reopen filed on or 27
after July 1, 1988, is not issued within ninety days of receipt of 28
such application by the self-insured employer or the department, such 29
application shall be deemed granted. However, for good cause, the 30
department may extend the time for making the final determination on 31
the application for an additional sixty days. 32
(2) If a worker receiving a pension for total disability returns 33
to gainful employment for wages, the director may suspend or 34
terminate the rate of compensation established for the disability 35
without producing medical evidence that shows that a diminution of 36
the disability has occurred. 37
(3) No act done or ordered to be done by the director, or the 38
department prior to the signing and filing in the matter of a written 39
order for such readjustment shall be grounds for such readjustment.40
p. 16 SB 5847
NEW SECTION. Sec. 4. This act applies to all claims regardless 1
of the date of injury.2
NEW SECTION. Sec. 5. Section 1 of this act expires June 30, 3
2027.4
NEW SECTION. Sec. 6. Section 2 of this act takes effect June 5
30, 2027.6
NEW SECTION. Sec. 7. Except for section 2 of this act, this act 7
takes effect July 1, 2026.8
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p. 17 SB 5847