Workers' comp./PTs & OTs

AN ACT Relating to including physical and occupational therapists 1
as attending providers for workers' compensation; amending RCW 2
51.08.200, 51.28.010, 51.28.010, 51.28.020, 51.28.020, 51.36.010, and 3
51.36.010; providing an effective date; and providing an expiration 4
date. 5
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:6
Sec. 1. RCW 51.08.200 and 2023 c 171 s 2 are each amended to 7
read as follows: 8
"Attending provider" means a person who is a member of the health 9
care provider network established under RCW 51.36.010, is treating 10
injured workers within the person's scope of practice, and is 11
licensed under Title 18 RCW in one of the following professions: 12
Physicians, chapter 18.71 RCW; osteopathy, chapter 18.57 RCW; 13
chiropractic, chapter 18.25 RCW; naturopathy, chapter 18.36A RCW; 14
podiatric medicine and surgery, chapter 18.22 RCW; dentistry, chapter 15
18.32 RCW; optometry, chapter 18.53 RCW; occupational therapy, 16
chapter 18.59 RCW; physical therapy, chapter 18.74 RCW; in the case 17
of claims solely for mental health conditions, psychology, chapter 18
18.83 RCW; physician assistants, chapter 18.71A RCW; and licensed 19
advanced registered nurse practitioners, chapter 18.79 RCW.20
S-3465.2
SENATE BILL 6152
State of Washington 69th Legislature 2026 Regular Session
By Senators Harris, Chapman, Conway, Frame, Hasegawa, Orwall,
Saldaña, Stanford, and Warnick
Read first time 01/15/26. Referred to Committee on Labor & Commerce.
p. 1 SB 6152
Sec. 2. RCW 51.28.010 and 2023 c 171 s 3 are each amended to 1
read as follows: 2
(1) Whenever any accident occurs to any worker it shall be the 3
duty of such worker or someone in his or her behalf to forthwith 4
report such accident to his or her employer, superintendent, or 5
supervisor in charge of the work, and of the employer to at once 6
report such accident and the injury resulting therefrom to the 7
department pursuant to RCW 51.28.025 where the worker has received 8
treatment from a physician, osteopathic physician, chiropractor, 9
naturopath, podiatric physician, optometrist, dentist, licensed 10
advanced registered nurse practitioner, physician assistant, 11
occupational therapist, physical therapist, or psychologist in claims 12
solely for mental health conditions, has been hospitalized, disabled 13
from work, or has died as the apparent result of such accident and 14
injury. 15
(2) Upon receipt of such notice of accident, the department shall 16
immediately forward to the worker or his or her beneficiaries or 17
dependents notification, in nontechnical language, of their rights 18
under this title. The notice must specify the worker's right to 19
receive health services from a provider of the worker's choice under 20
RCW 51.36.010(2)(a), including chiropractic services under RCW 21
51.36.015, and must list the types of providers authorized to provide 22
these services. 23
(3) Employers shall not engage in claim suppression.24
(4) For the purposes of this section, "claim suppression" means 25
intentionally: 26
(a) Inducing employees to fail to report injuries;27
(b) Inducing employees to treat injuries in the course of 28
employment as off-the-job injuries; or 29
(c) Acting otherwise to suppress legitimate industrial insurance 30
claims. 31
(5) In determining whether an employer has engaged in claim 32
suppression, the department shall consider the employer's history of 33
compliance with industrial insurance reporting requirements, and 34
whether the employer has discouraged employees from reporting 35
injuries or filing claims. The department has the burden of proving 36
claim suppression by a preponderance of the evidence.37
(6) Claim suppression does not include bona fide workplace safety 38
and accident prevention programs or an employer's provision at the 39
worksite of first aid as defined by the department. The department 40
p. 2 SB 6152
shall adopt rules defining bona fide workplace safety and accident 1
prevention programs and defining first aid. 2
Sec. 3. RCW 51.28.010 and 2025 c 58 s 5113 are each amended to 3
read as follows: 4
(1) Whenever any accident occurs to any worker it shall be the 5
duty of such worker or someone in his or her behalf to forthwith 6
report such accident to his or her employer, superintendent, or 7
supervisor in charge of the work, and of the employer to at once 8
report such accident and the injury resulting therefrom to the 9
department pursuant to RCW 51.28.025 where the worker has received 10
treatment from a physician, osteopathic physician, chiropractor, 11
naturopath, podiatric physician, optometrist, dentist, licensed 12
advanced practice registered nurse, physician assistant, occupational 13
therapist, physical therapist, or psychologist in claims solely for 14
mental health conditions, has been hospitalized, disabled from work, 15
or has died as the apparent result of such accident and injury.16
(2) Upon receipt of such notice of accident, the department shall 17
immediately forward to the worker or his or her beneficiaries or 18
dependents notification, in nontechnical language, of their rights 19
under this title. The notice must specify the worker's right to 20
receive health services from a provider of the worker's choice under 21
RCW 51.36.010(2)(a), including chiropractic services under RCW 22
51.36.015, and must list the types of providers authorized to provide 23
these services. 24
(3) Employers shall not engage in claim suppression.25
(4) For the purposes of this section, "claim suppression" means 26
intentionally: 27
(a) Inducing employees to fail to report injuries;28
(b) Inducing employees to treat injuries in the course of 29
employment as off-the-job injuries; or 30
(c) Acting otherwise to suppress legitimate industrial insurance 31
claims. 32
(5) In determining whether an employer has engaged in claim 33
suppression, the department shall consider the employer's history of 34
compliance with industrial insurance reporting requirements, and 35
whether the employer has discouraged employees from reporting 36
injuries or filing claims. The department has the burden of proving 37
claim suppression by a preponderance of the evidence.38
p. 3 SB 6152
(6) Claim suppression does not include bona fide workplace safety 1
and accident prevention programs or an employer's provision at the 2
worksite of first aid as defined by the department. The department 3
shall adopt rules defining bona fide workplace safety and accident 4
prevention programs and defining first aid. 5
Sec. 4. RCW 51.28.020 and 2023 c 171 s 4 are each amended to 6
read as follows: 7
(1)(a) Where a worker is entitled to compensation under this 8
title he or she shall file with the department or his or her self-9
insured employer, as the case may be, his or her application for 10
such, together with the certificate of the physician, osteopathic 11
physician, chiropractor, naturopath, podiatric physician, 12
optometrist, dentist, licensed advanced registered nurse 13
practitioner, physician assistant, occupational therapist, physical 14
therapist, or psychologist in claims solely for mental health 15
conditions, who attended him or her. An application form developed by 16
the department shall include a notice specifying the worker's right 17
to receive health services from a provider of the worker's choice 18
under RCW 51.36.010(2)(a), and listing the types of providers 19
authorized to provide these services. 20
(b) The physician, osteopathic physician, chiropractor, 21
naturopath, podiatric physician, optometrist, dentist, licensed 22
advanced registered nurse practitioner, physician assistant, 23
occupational therapist, physical therapist, or psychologist in claims 24
solely for mental health conditions, who attended the injured worker 25
shall inform the injured worker of his or her rights under this title 26
and lend all necessary assistance in making this application for 27
compensation and such proof of other matters as required by the rules 28
of the department without charge to the worker. The department shall 29
provide a manual which outlines the procedures to be followed in 30
applications for compensation involving occupational diseases, and 31
which describes claimants' rights and responsibilities related to 32
occupational disease claims. 33
(2) If the application required by this section is:34
(a) Made to the department and the employer has not received a 35
copy of the application, the department shall immediately send a copy 36
of the application to the employer; or 37
(b) Made to a self-insured employer, the employer shall forthwith 38
send a copy of the application to the department. 39
p. 4 SB 6152
(3) The application required by this section may be transmitted 1
to the department electronically. 2
Sec. 5. RCW 51.28.020 and 2025 c 58 s 5114 are each amended to 3
read as follows: 4
(1)(a) Where a worker is entitled to compensation under this 5
title he or she shall file with the department or his or her self-6
insured employer, as the case may be, his or her application for 7
such, together with the certificate of the physician, osteopathic 8
physician, chiropractor, naturopath, podiatric physician, 9
optometrist, dentist, licensed advanced practice registered nurse, 10
physician assistant, occupational therapist, physical therapist, or 11
psychologist in claims solely for mental health conditions, who 12
attended him or her. An application form developed by the department 13
shall include a notice specifying the worker's right to receive 14
health services from a provider of the worker's choice under RCW 15
51.36.010(2)(a), and listing the types of providers authorized to 16
provide these services. 17
(b) The physician, osteopathic physician, chiropractor, 18
naturopath, podiatric physician, optometrist, dentist, licensed 19
advanced practice registered nurse, physician assistant, occupational 20
therapist, physical therapist, or psychologist in claims solely for 21
mental health conditions, who attended the injured worker shall 22
inform the injured worker of his or her rights under this title and 23
lend all necessary assistance in making this application for 24
compensation and such proof of other matters as required by the rules 25
of the department without charge to the worker. The department shall 26
provide a manual which outlines the procedures to be followed in 27
applications for compensation involving occupational diseases, and 28
which describes claimants' rights and responsibilities related to 29
occupational disease claims. 30
(2) If the application required by this section is:31
(a) Made to the department and the employer has not received a 32
copy of the application, the department shall immediately send a copy 33
of the application to the employer; or 34
(b) Made to a self-insured employer, the employer shall forthwith 35
send a copy of the application to the department. 36
(3) The application required by this section may be transmitted 37
to the department electronically. 38
p. 5 SB 6152
Sec. 6. RCW 51.36.010 and 2023 c 171 s 9 are each amended to 1
read as follows: 2
(1) The legislature finds that high quality medical treatment and 3
adherence to occupational health best practices can prevent 4
disability and reduce loss of family income for workers, and lower 5
labor and insurance costs for employers. Injured workers deserve high 6
quality medical care in accordance with current health care best 7
practices. To this end, the department shall establish minimum 8
standards for providers who treat workers from both state fund and 9
self-insured employers. The department shall establish a health care 10
provider network to treat injured workers, and shall accept providers 11
into the network who meet those minimum standards. The department 12
shall convene an advisory group made up of representatives from or 13
designees of the workers' compensation advisory committee and the 14
industrial insurance medical and chiropractic advisory committees to 15
consider and advise the department related to implementation of this 16
section, including development of best practices treatment guidelines 17
for providers in the network. The department shall also seek the 18
input of various health care provider groups and associations 19
concerning the network's implementation. Network providers must be 20
required to follow the department's evidence-based coverage decisions 21
and treatment guidelines, policies, and must be expected to follow 22
other national treatment guidelines appropriate for their patient. 23
The department, in collaboration with the advisory group, shall also 24
establish additional best practice standards for providers to qualify 25
for a second tier within the network, based on demonstrated use of 26
occupational health best practices. This second tier is separate from 27
and in addition to the centers for occupational health and education 28
established under subsection (5) of this section. 29
(2)(a) Upon the occurrence of any injury to a worker entitled to 30
compensation under the provisions of this title, he or she shall 31
receive proper and necessary medical and surgical services at the 32
hands of a physician, osteopathic physician, chiropractor, 33
naturopath, podiatric physician, optometrist, dentist, licensed 34
advanced registered nurse practitioner, physician assistant, 35
occupational therapist, physical therapist, or psychologist in claims 36
solely for mental health conditions, of his or her own choice, if 37
conveniently located, except as provided in (b) of this subsection, 38
and proper and necessary hospital care and services during the period 39
of his or her disability from such injury. 40
p. 6 SB 6152
(b) Once the provider network is established in the worker's 1
geographic area, an injured worker may receive care from a nonnetwork 2
provider only for an initial office or emergency room visit. However, 3
the department or self-insurer may limit reimbursement to the 4
department's standard fee for the services. The provider must comply 5
with all applicable billing policies and must accept the department's 6
fee schedule as payment in full. 7
(c) The department, in collaboration with the advisory group, 8
shall adopt policies for the development, credentialing, 9
accreditation, and continued oversight of a network of health care 10
providers approved to treat injured workers. Health care providers 11
shall apply to the network by completing the department's provider 12
application which shall have the force of a contract with the 13
department to treat injured workers. The advisory group shall 14
recommend minimum network standards for the department to approve a 15
provider's application, to remove a provider from the network, or to 16
require peer review such as, but not limited to: 17
(i) Current malpractice insurance coverage exceeding a dollar 18
amount threshold, number, or seriousness of malpractice suits over a 19
specific time frame; 20
(ii) Previous malpractice judgments or settlements that do not 21
exceed a dollar amount threshold recommended by the advisory group, 22
or a specific number or seriousness of malpractice suits over a 23
specific time frame; 24
(iii) No licensing or disciplinary action in any jurisdiction or 25
loss of treating or admitting privileges by any board, commission, 26
agency, public or private health care payer, or hospital;27
(iv) For some specialties such as surgeons, privileges in at 28
least one hospital; 29
(v) Whether the provider has been credentialed by another health 30
plan that follows national quality assurance guidelines; and31
(vi) Alternative criteria for providers that are not credentialed 32
by another health plan. 33
The department shall develop alternative criteria for providers 34
that are not credentialed by another health plan or as needed to 35
address access to care concerns in certain regions.36
(d) Network provider contracts will automatically renew at the 37
end of the contract period unless the department provides written 38
notice of changes in contract provisions or the department or 39
provider provides written notice of contract termination. The 40
p. 7 SB 6152
industrial insurance medical advisory committee shall develop 1
criteria for removal of a provider from the network to be presented 2
to the department and advisory group for consideration in the 3
development of contract terms. 4
(e) In order to monitor quality of care and assure efficient 5
management of the provider network, the department shall establish 6
additional criteria and terms for network participation including, 7
but not limited to, requiring compliance with administrative and 8
billing policies. 9
(f) The advisory group shall recommend best practices standards 10
to the department to use in determining second tier network 11
providers. The department shall develop and implement financial and 12
nonfinancial incentives for network providers who qualify for the 13
second tier. The department is authorized to certify and decertify 14
second tier providers. 15
(3) The department shall work with self-insurers and the 16
department utilization review provider to implement utilization 17
review for the self-insured community to ensure consistent quality, 18
cost-effective care for all injured workers and employers, and to 19
reduce administrative burden for providers. 20
(4) The department for state fund claims shall pay, in accordance 21
with the department's fee schedule, for any alleged injury for which 22
a worker files a claim, any initial prescription drugs provided in 23
relation to that initial visit, without regard to whether the 24
worker's claim for benefits is allowed. In all accepted claims, 25
treatment shall be limited in point of duration as follows:26
In the case of permanent partial disability, not to extend beyond 27
the date when compensation shall be awarded him or her, except when 28
the worker returned to work before permanent partial disability award 29
is made, in such case not to extend beyond the time when monthly 30
allowances to him or her shall cease; in case of temporary disability 31
not to extend beyond the time when monthly allowances to him or her 32
shall cease: PROVIDED, That after any injured worker has returned to 33
his or her work his or her medical and surgical treatment may be 34
continued if, and so long as, such continuation is deemed necessary 35
by the supervisor of industrial insurance to be necessary to his or 36
her more complete recovery; in case of a permanent total disability 37
not to extend beyond the date on which a lump sum settlement is made 38
with him or her or he or she is placed upon the permanent pension 39
roll: PROVIDED, HOWEVER, That the supervisor of industrial insurance, 40
p. 8 SB 6152
solely in his or her discretion, may authorize continued medical and 1
surgical treatment for conditions previously accepted by the 2
department when such medical and surgical treatment is deemed 3
necessary by the supervisor of industrial insurance to protect such 4
worker's life or provide for the administration of medical and 5
therapeutic measures including payment of prescription medications, 6
but not including those controlled substances currently scheduled by 7
the pharmacy quality assurance commission as Schedule I, II, III, or 8
IV substances under chapter 69.50 RCW, which are necessary to 9
alleviate continuing pain which results from the industrial injury. 10
In order to authorize such continued treatment the written order of 11
the supervisor of industrial insurance issued in advance of the 12
continuation shall be necessary. 13
The supervisor of industrial insurance, the supervisor's 14
designee, or a self-insurer, in his or her sole discretion, may 15
authorize inoculation or other immunological treatment in cases in 16
which a work-related activity has resulted in probable exposure of 17
the worker to a potential infectious occupational disease. 18
Authorization of such treatment does not bind the department or self-19
insurer in any adjudication of a claim by the same worker or the 20
worker's beneficiary for an occupational disease. 21
(5)(a) The legislature finds that the department and its business 22
and labor partners have collaborated in establishing centers for 23
occupational health and education to promote best practices and 24
prevent preventable disability by focusing additional provider-based 25
resources during the first twelve weeks following an injury. The 26
centers for occupational health and education represent innovative 27
accountable care systems in an early stage of development consistent 28
with national health care reform efforts. Many Washington workers do 29
not yet have access to these innovative health care delivery models.30
(b) To expand evidence-based occupational health best practices, 31
the department shall establish additional centers for occupational 32
health and education, with the goal of extending access to at least 33
fifty percent of injured and ill workers by December 2013 and to all 34
injured workers by December 2015. The department shall also develop 35
additional best practices and incentives that span the entire period 36
of recovery, not only the first twelve weeks. 37
(c) The department shall certify and decertify centers for 38
occupational health and education based on criteria including 39
institutional leadership and geographic areas covered by the center 40
p. 9 SB 6152
for occupational health and education, occupational health leadership 1
and education, mix of participating health care providers necessary 2
to address the anticipated needs of injured workers, health services 3
coordination to deliver occupational health best practices, 4
indicators to measure the success of the center for occupational 5
health and education, and agreement that the center's providers 6
shall, if feasible, treat certain injured workers if referred by the 7
department or a self-insurer. 8
(d) Health care delivery organizations may apply to the 9
department for certification as a center for occupational health and 10
education. These may include, but are not limited to, hospitals and 11
affiliated clinics and providers, multispecialty clinics, health 12
maintenance organizations, and organized systems of network 13
physicians. 14
(e) The centers for occupational health and education shall 15
implement benchmark quality indicators of occupational health best 16
practices for individual providers, developed in collaboration with 17
the department. A center for occupational health and education shall 18
remove individual providers who do not consistently meet these 19
quality benchmarks. 20
(f) The department shall develop and implement financial and 21
nonfinancial incentives for center for occupational health and 22
education providers that are based on progressive and measurable 23
gains in occupational health best practices, and that are applicable 24
throughout the duration of an injured or ill worker's episode of 25
care. 26
(g) The department shall develop electronic methods of tracking 27
evidence-based quality measures to identify and improve outcomes for 28
injured workers at risk of developing prolonged disability. In 29
addition, these methods must be used to provide systematic feedback 30
to physicians regarding quality of care, to conduct appropriate 31
objective evaluation of progress in the centers for occupational 32
health and education, and to allow efficient coordination of 33
services. 34
(6) If a provider fails to meet the minimum network standards 35
established in subsection (2) of this section, the department is 36
authorized to remove the provider from the network or take other 37
appropriate action regarding a provider's participation. The 38
department may also require remedial steps as a condition for a 39
provider to participate in the network. The department, with input 40
p. 10 SB 6152
from the advisory group, shall establish waiting periods that may be 1
imposed before a provider who has been denied or removed from the 2
network may reapply. 3
(7) The department may permanently remove a provider from the 4
network or take other appropriate action when the provider exhibits a 5
pattern of conduct of low quality care that exposes patients to risk 6
of physical or psychiatric harm or death. Patterns that qualify as 7
risk of harm include, but are not limited to, poor health care 8
outcomes evidenced by increased, chronic, or prolonged pain or 9
decreased function due to treatments that have not been shown to be 10
curative, safe, or effective or for which it has been shown that the 11
risks of harm exceed the benefits that can be reasonably expected 12
based on peer-reviewed opinion. 13
(8) The department may not remove a health care provider from the 14
network for an isolated instance of poor health and recovery outcomes 15
due to treatment by the provider. 16
(9) When the department terminates a provider from the network, 17
the department or self-insurer shall assist an injured worker 18
currently under the provider's care in identifying a new network 19
provider or providers from whom the worker can select an attending or 20
treating provider. In such a case, the department or self-insurer 21
shall notify the injured worker that he or she must choose a new 22
attending or treating provider. 23
(10) The department may adopt rules related to this section.24
(((11) The department shall report to the workers' compensation 25
advisory committee and to the appropriate committees of the 26
legislature on each December 1st, beginning in 2012 and ending in 27
2016, on the implementation of the provider network and expansion of 28
the centers for occupational health and education. The reports must 29
include a summary of actions taken, progress toward long-term goals, 30
outcomes of key initiatives, access to care issues, results of 31
disputes or controversies related to new provisions, and whether any 32
changes are needed to further improve the occupational health best 33
practices care of injured workers.))34
Sec. 7. RCW 51.36.010 and 2025 c 58 s 5117 are each amended to 35
read as follows: 36
(1) The legislature finds that high quality medical treatment and 37
adherence to occupational health best practices can prevent 38
disability and reduce loss of family income for workers, and lower 39
p. 11 SB 6152
labor and insurance costs for employers. Injured workers deserve high 1
quality medical care in accordance with current health care best 2
practices. To this end, the department shall establish minimum 3
standards for providers who treat workers from both state fund and 4
self-insured employers. The department shall establish a health care 5
provider network to treat injured workers, and shall accept providers 6
into the network who meet those minimum standards. The department 7
shall convene an advisory group made up of representatives from or 8
designees of the workers' compensation advisory committee and the 9
industrial insurance medical and chiropractic advisory committees to 10
consider and advise the department related to implementation of this 11
section, including development of best practices treatment guidelines 12
for providers in the network. The department shall also seek the 13
input of various health care provider groups and associations 14
concerning the network's implementation. Network providers must be 15
required to follow the department's evidence-based coverage decisions 16
and treatment guidelines, policies, and must be expected to follow 17
other national treatment guidelines appropriate for their patient. 18
The department, in collaboration with the advisory group, shall also 19
establish additional best practice standards for providers to qualify 20
for a second tier within the network, based on demonstrated use of 21
occupational health best practices. This second tier is separate from 22
and in addition to the centers for occupational health and education 23
established under subsection (5) of this section. 24
(2)(a) Upon the occurrence of any injury to a worker entitled to 25
compensation under the provisions of this title, he or she shall 26
receive proper and necessary medical and surgical services at the 27
hands of a physician, osteopathic physician, chiropractor, 28
naturopath, podiatric physician, optometrist, dentist, licensed 29
advanced practice registered nurse, physician assistant, occupational 30
therapist, physical therapist, or psychologist in claims solely for 31
mental health conditions, of his or her own choice, if conveniently 32
located, except as provided in (b) of this subsection, and proper and 33
necessary hospital care and services during the period of his or her 34
disability from such injury. 35
(b) Once the provider network is established in the worker's 36
geographic area, an injured worker may receive care from a nonnetwork 37
provider only for an initial office or emergency room visit. However, 38
the department or self-insurer may limit reimbursement to the 39
department's standard fee for the services. The provider must comply 40
p. 12 SB 6152
with all applicable billing policies and must accept the department's 1
fee schedule as payment in full. 2
(c) The department, in collaboration with the advisory group, 3
shall adopt policies for the development, credentialing, 4
accreditation, and continued oversight of a network of health care 5
providers approved to treat injured workers. Health care providers 6
shall apply to the network by completing the department's provider 7
application which shall have the force of a contract with the 8
department to treat injured workers. The advisory group shall 9
recommend minimum network standards for the department to approve a 10
provider's application, to remove a provider from the network, or to 11
require peer review such as, but not limited to: 12
(i) Current malpractice insurance coverage exceeding a dollar 13
amount threshold, number, or seriousness of malpractice suits over a 14
specific time frame; 15
(ii) Previous malpractice judgments or settlements that do not 16
exceed a dollar amount threshold recommended by the advisory group, 17
or a specific number or seriousness of malpractice suits over a 18
specific time frame; 19
(iii) No licensing or disciplinary action in any jurisdiction or 20
loss of treating or admitting privileges by any board, commission, 21
agency, public or private health care payer, or hospital;22
(iv) For some specialties such as surgeons, privileges in at 23
least one hospital; 24
(v) Whether the provider has been credentialed by another health 25
plan that follows national quality assurance guidelines; and26
(vi) Alternative criteria for providers that are not credentialed 27
by another health plan. 28
The department shall develop alternative criteria for providers 29
that are not credentialed by another health plan or as needed to 30
address access to care concerns in certain regions.31
(d) Network provider contracts will automatically renew at the 32
end of the contract period unless the department provides written 33
notice of changes in contract provisions or the department or 34
provider provides written notice of contract termination. The 35
industrial insurance medical advisory committee shall develop 36
criteria for removal of a provider from the network to be presented 37
to the department and advisory group for consideration in the 38
development of contract terms. 39
p. 13 SB 6152
(e) In order to monitor quality of care and assure efficient 1
management of the provider network, the department shall establish 2
additional criteria and terms for network participation including, 3
but not limited to, requiring compliance with administrative and 4
billing policies. 5
(f) The advisory group shall recommend best practices standards 6
to the department to use in determining second tier network 7
providers. The department shall develop and implement financial and 8
nonfinancial incentives for network providers who qualify for the 9
second tier. The department is authorized to certify and decertify 10
second tier providers. 11
(3) The department shall work with self-insurers and the 12
department utilization review provider to implement utilization 13
review for the self-insured community to ensure consistent quality, 14
cost-effective care for all injured workers and employers, and to 15
reduce administrative burden for providers. 16
(4) The department for state fund claims shall pay, in accordance 17
with the department's fee schedule, for any alleged injury for which 18
a worker files a claim, any initial prescription drugs provided in 19
relation to that initial visit, without regard to whether the 20
worker's claim for benefits is allowed. In all accepted claims, 21
treatment shall be limited in point of duration as follows:22
In the case of permanent partial disability, not to extend beyond 23
the date when compensation shall be awarded him or her, except when 24
the worker returned to work before permanent partial disability award 25
is made, in such case not to extend beyond the time when monthly 26
allowances to him or her shall cease; in case of temporary disability 27
not to extend beyond the time when monthly allowances to him or her 28
shall cease: PROVIDED, That after any injured worker has returned to 29
his or her work his or her medical and surgical treatment may be 30
continued if, and so long as, such continuation is deemed necessary 31
by the supervisor of industrial insurance to be necessary to his or 32
her more complete recovery; in case of a permanent total disability 33
not to extend beyond the date on which a lump sum settlement is made 34
with him or her or he or she is placed upon the permanent pension 35
roll: PROVIDED, HOWEVER, That the supervisor of industrial insurance, 36
solely in his or her discretion, may authorize continued medical and 37
surgical treatment for conditions previously accepted by the 38
department when such medical and surgical treatment is deemed 39
necessary by the supervisor of industrial insurance to protect such 40
p. 14 SB 6152
worker's life or provide for the administration of medical and 1
therapeutic measures including payment of prescription medications, 2
but not including those controlled substances currently scheduled by 3
the pharmacy quality assurance commission as Schedule I, II, III, or 4
IV substances under chapter 69.50 RCW, which are necessary to 5
alleviate continuing pain which results from the industrial injury. 6
In order to authorize such continued treatment the written order of 7
the supervisor of industrial insurance issued in advance of the 8
continuation shall be necessary. 9
The supervisor of industrial insurance, the supervisor's 10
designee, or a self-insurer, in his or her sole discretion, may 11
authorize inoculation or other immunological treatment in cases in 12
which a work-related activity has resulted in probable exposure of 13
the worker to a potential infectious occupational disease. 14
Authorization of such treatment does not bind the department or self-15
insurer in any adjudication of a claim by the same worker or the 16
worker's beneficiary for an occupational disease. 17
(5)(a) The legislature finds that the department and its business 18
and labor partners have collaborated in establishing centers for 19
occupational health and education to promote best practices and 20
prevent preventable disability by focusing additional provider-based 21
resources during the first twelve weeks following an injury. The 22
centers for occupational health and education represent innovative 23
accountable care systems in an early stage of development consistent 24
with national health care reform efforts. Many Washington workers do 25
not yet have access to these innovative health care delivery models.26
(b) To expand evidence-based occupational health best practices, 27
the department shall establish additional centers for occupational 28
health and education, with the goal of extending access to at least 29
fifty percent of injured and ill workers by December 2013 and to all 30
injured workers by December 2015. The department shall also develop 31
additional best practices and incentives that span the entire period 32
of recovery, not only the first twelve weeks. 33
(c) The department shall certify and decertify centers for 34
occupational health and education based on criteria including 35
institutional leadership and geographic areas covered by the center 36
for occupational health and education, occupational health leadership 37
and education, mix of participating health care providers necessary 38
to address the anticipated needs of injured workers, health services 39
coordination to deliver occupational health best practices, 40
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indicators to measure the success of the center for occupational 1
health and education, and agreement that the center's providers 2
shall, if feasible, treat certain injured workers if referred by the 3
department or a self-insurer. 4
(d) Health care delivery organizations may apply to the 5
department for certification as a center for occupational health and 6
education. These may include, but are not limited to, hospitals and 7
affiliated clinics and providers, multispecialty clinics, health 8
maintenance organizations, and organized systems of network 9
physicians. 10
(e) The centers for occupational health and education shall 11
implement benchmark quality indicators of occupational health best 12
practices for individual providers, developed in collaboration with 13
the department. A center for occupational health and education shall 14
remove individual providers who do not consistently meet these 15
quality benchmarks. 16
(f) The department shall develop and implement financial and 17
nonfinancial incentives for center for occupational health and 18
education providers that are based on progressive and measurable 19
gains in occupational health best practices, and that are applicable 20
throughout the duration of an injured or ill worker's episode of 21
care. 22
(g) The department shall develop electronic methods of tracking 23
evidence-based quality measures to identify and improve outcomes for 24
injured workers at risk of developing prolonged disability. In 25
addition, these methods must be used to provide systematic feedback 26
to physicians regarding quality of care, to conduct appropriate 27
objective evaluation of progress in the centers for occupational 28
health and education, and to allow efficient coordination of 29
services. 30
(6) If a provider fails to meet the minimum network standards 31
established in subsection (2) of this section, the department is 32
authorized to remove the provider from the network or take other 33
appropriate action regarding a provider's participation. The 34
department may also require remedial steps as a condition for a 35
provider to participate in the network. The department, with input 36
from the advisory group, shall establish waiting periods that may be 37
imposed before a provider who has been denied or removed from the 38
network may reapply. 39
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(7) The department may permanently remove a provider from the 1
network or take other appropriate action when the provider exhibits a 2
pattern of conduct of low quality care that exposes patients to risk 3
of physical or psychiatric harm or death. Patterns that qualify as 4
risk of harm include, but are not limited to, poor health care 5
outcomes evidenced by increased, chronic, or prolonged pain or 6
decreased function due to treatments that have not been shown to be 7
curative, safe, or effective or for which it has been shown that the 8
risks of harm exceed the benefits that can be reasonably expected 9
based on peer-reviewed opinion. 10
(8) The department may not remove a health care provider from the 11
network for an isolated instance of poor health and recovery outcomes 12
due to treatment by the provider. 13
(9) When the department terminates a provider from the network, 14
the department or self-insurer shall assist an injured worker 15
currently under the provider's care in identifying a new network 16
provider or providers from whom the worker can select an attending or 17
treating provider. In such a case, the department or self-insurer 18
shall notify the injured worker that he or she must choose a new 19
attending or treating provider. 20
(10) The department may adopt rules related to this section.21
(((11) The department shall report to the workers' compensation 22
advisory committee and to the appropriate committees of the 23
legislature on each December 1st, beginning in 2012 and ending in 24
2016, on the implementation of the provider network and expansion of 25
the centers for occupational health and education. The reports must 26
include a summary of actions taken, progress toward long-term goals, 27
outcomes of key initiatives, access to care issues, results of 28
disputes or controversies related to new provisions, and whether any 29
changes are needed to further improve the occupational health best 30
practices care of injured workers.))31
NEW SECTION. Sec. 8. Sections 2, 4, and 6 of this act expire 32
June 30, 2027.33
NEW SECTION. Sec. 9. Sections 3, 5, and 7 of this act take 34
effect June 30, 2027.35
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