Volunteer Needed for

Department’s Curriculum Review Committee

The Department is looking for a replacement for Hal Longan on their Curriculum Review Committee – the Committee that reviews the continuing education submissions from organizations and individuals in furtherance of maintaining your Approved Certified Claims Administrator designation.  Course materials submitted for credit are reviewed by the Continuing Education Curriculum Review Committee.  All credit decisions are made by this committee, which is composed of representatives from the self-insured business community, the labor community, and L&I.  The term of one committee member representing the self-insured business community expires in August. They need a new member to participate in this vital function. If you volunteer, you are committing to:  Serve a two-year term (September 2009 through August 2011); Each month, review in advance the materials sent to you; Participate in a monthly telephone conference; and Once per quarter, travel to Tumwater to meet in person (in place of the monthly phone conference).  If you are interested in volunteering, please send an e-mail to the Continuing Education mailbox at SIContEDU@lni.wa.gov.  Include the following information: Your name; Company name, address, and phone number; a brief description of your current job duties; and the reason(s) you would like to serve on this committee.   Please let the Department know by July 10, 2009 if you are interested, AND please be sure to copy WSIA on your submission (just to let us know that you’ve applied).  If the Department receives a large number of volunteers, we may ask you to complete a short questionnaire to assist them in making a decision.  The Committee will meet in person in Tumwater on August 6, 2009.  They hope to use this as a transition and orientation meeting for the new committee member.  If you volunteer, please mark your calendar for this date.

Tracking of Continuing Education Credits

Online in Late 2009, Early 2010

Many of you have asked when you will be able to track your CEC’s for Certified Claims Administrator over the internet.  The Department of Labor & Industries’ Self-Insurance Section has indicated that the ability for you as a Certified Claims Administrator to track your own continuing education credits on the web will be in place late in 2009 or early 2010.  The Department has benefited from some available resources to help get this up and running, based on software used for tracking continuing education for plumbers.  Watch our FYI newsletters and your email in-box for announcements as to when this will become available.

Mandatory Certification Training Scheduled

for late August, late September 2009

For those of you maintaining your Claims Administrator certification by Continuing Education Credits, the Department of Labor & Industries Self-Insurance Section has announced the dates for the annual Mandatory Training.  “Update 2009” will be held August 26, August 27, September 21, and September 22.  Registration for the mandatory class, held in Tumwater at the Department’s Self-Insurance Section, begins on July 1, 2009 for Department approved administrators ONLY.  Registration for others wishing to take the course will open up August 1, 2009.  Each session is limited to 30 enrollees.  If those four sessions are filled, the Department has committed to providing at least one additional session to accommodate all those who need to take the mandatory training.  You must attend the mandatory training programs each year to maintain your Certification thru CEC’s.  If you miss one, you WILL have to take the exam again when your Certification is up for renewal.  For more information, check out the latest Continuing Education News at http://www.wsiassn.org/documents/ContEdunewsletterApril22009.pdf and at http://www.wsiassn.org/documents/ContEduNewsletter-June-17-2009.pdf.

Medicare Reporting Updates

to be Added to WSIA Website

There are a number of important Medicare Reporting updates for you to review, so please go to the Medicare Reporting page here at the WSIA website for the latest important information.  Included in the new information are: new registration and reporting deadlines; the Department’s take on what needs to be reported (for both the State Fund and self-insurers) [this came from a meeting WSIA recently held with them]; and efforts to amend current federal law to set up a process for appeal of Centers of Medicare and Medicaid Services decisions.  Please o to the MEDICARE REPORTING INFORMATION page at our website.  The information should be posted by close of business on Friday, June 19th, 2009

Rule on Second Injury Fund

Experience Rated Assessment Adopted, Takes Effect July 6, 2009

As required by Substitute Senate Bill 5992 Chapter 475, Laws 2005 to establish an experience rating system for self-insurers’ use of the industrial insurance Second Injury Fund, the Department proposed rules, held a hearing, and the rules have been adopted on the experience rating for 50% of the cost of the Second Injury Fund. The purpose of this rulemaking was to consider modifying WAC 296-15-221 for simplification and clarity. The proposal creates four new sections to specifically address self-insured assessments, including the Administrative Assessment, the Second Injury Fund Assessment, the Insolvency Trust Fund Assessment, and the Supplemental Pension Reimbursement Fund and Asbestosis Fund Assessments.  The rule has been adopted, and takes effect July 6, 2009.  In reality, this will be applied beginning with your 2010 Second Injury Fund assessments.  Here is the text of the adopted rule: http://www.lni.wa.gov/rules/AO07/02/0702Adoption.pdf.

Workers’ Compensation Manual (“George Book”)

Being Updated and Made Available Online

The Department’s Workers’ Compensation Manual – A Guide to Claims Administration in Washington State, otherwise known as the “George Book” with its large logo of George Washington on the cover, is being updated for the first time in eleven years.  Given all of the court decisions, law and rule changes during that time, the Manual will have a substantial number of changes in it.  In addition to being able to purchase printed copies, the Manual will be posted at the Department’s website on the new Self-Insurance page to be unveiled at the end of August 2009.  To order a copy of the Workers’ Compensation Manual – A Guide to Claims Administration in Washington State, contact Sharon McCahan at 360.902.6838 beginning in mid-July.  The price of the current Manual is $43.12.

WSIA Asked for Department’s

Policy Manual to be Put Online

The Revised Code of Washington, Washington Administrative Code, and Provider Bulletins are online so why isn’t the Claims Administration Policy Manual?  That’s the question WSIA has posed to the Department in a number of meetings.  Apparently there has been some sort of computer access issue.  We believe that if the Policy Manual is to be used as our guide on claims management issues, they need to provide this resource online, and keep it maintained on a regular basis.  The Department has agreed to look at this issue, so look for updates in future newsletters.

Self-Insurance Access to the

Vocational Rehabilitation Registry

As part of the Vocational Rehabilitation Pilot Project adopted by the Legislature in 2007, all of those individuals who were found eligible for vocational services were to be listed on a registry, so that the State Fund, State Fund employers, and self-insured employers could check to see if someone was attempting to obtain vocational benefits for a second time – an effort to stem the “second bite at the apple.”  While the State Fund will have direct access to review the registry, self-insured employers will need to request that the self-insurance vocational consultants (Jerry Myron and Bill Walkowski) check the registry on your behalf.  If you have claims where the worker becomes voc eligible, be sure to check the registry.  IMPORTANT NOTE:  No vocational services provided prior to January 1, 2008 will be listed on the registry.  You will need to check prior claim files for vocational services awarded prior to January 1, 2008.

Vocational Benefit Increase

Effective July 1, 2009 Announced

The maximum vocational training benefit will increase from $12,240 to $13,096.80 effective 7-1-09.  The new benefit will apply to any plan approved on or after 7-1-09.  This is a 7% increase, reflecting the increase in tuition at the state’s colleges (not a true COLA).  The increased benefit applies regardless of whether a worker chooses Option 1 or Option 2 after plan approval.  This increase is the result of an annual adjustment that is required under the statute governing vocational rehabilitation services.  If you have any questions please e-mail us at VocRehabProgram@LNI.wa.gov.

Department Announces Changes to

Medical Aid Rules & Fee Schedules for July 1, 2009

The Department has released the Medical Aid Rules and Fee Schedules that will take effect on July 1, 2009.  There are a number of interesting changes that you'll want to check out.  You can find the fee schedules at http://www.lni.wa.gov/ClaimsIns/Providers/Billing/FeeSched/ on the Department’s website.

Hearings Set for Proposed IME Rule Changes

The Department has announced that 1:00pm, June 23 at their Tukwila Service Location and 9:00am, June 29 at the Hampton Inn in Spokane will be the dates for the public hearings on the proposed rule changes governing IME provider qualifications.  You can find the text of the proposed rules at the Department’s website www.lni.wa.gov/rules/AO08/14/0814Proposal.pdf.  In addition to making comments at the hearings, you can submit comments regarding to the rules to the attention of Anita Austin, Department of Labor & Industries, P.O. Box 44322, Olympia, WA  98504-4322, by fax to 360.902.4292, or by email to SUND235@lni.wa.gov.  Comments must be submitted no later than July 7, 2009 to be considered.

Dr. Amin’s Provider Numbers Expire July 1, 2009

The Department announced that, effective July 1, 2009, Chirag Amin, MD, provider numbers 157137 and 195882, will close his practice to treat injured/ill workers covered by the Washington State Department of Labor and Industries.  They ask that both state fund and self insured employers should assist workers in finding Department approved treating doctors if they were previously treating with Dr. Amin.

Department Initiates Heat Stress

and Crane Safety WISHA Regional Directives

The Department has finalized the agency’s Directives regarding outdoor heat exposure, and acceptable methods for complying with the recently adopted crane safety rules.  Regarding outdoor heat exposure, DOSH issued a WISHA Regional Directive making violations of the rules a “serious” violation rather than a general violation.  The WRD took effect May 26, 2009.  Here is the text of the WRD on heat exposure http://www.lni.wa.gov/Safety/Rules/Policies/PDFs/WRD1015.pdf.  Regarding crane safety, Phase 2 of rule development is under way.  In the interim, the Department has issued a WRD on acceptable methods of compliance for crane operator qualifications and certification.  The WRD took effect on May 22, 2009.  Here is the test of the WRD on crane operators http://www.lni.wa.gov/safety/rules/policies/pdfs/wrd860.pdf.  For more information on the crane safety issue, please check out the Department’s webpage at http://www.lni.wa.gov/Safety/Topics/AtoZ/Cranes/default.asp.

Department Adopts New Provider Bulletin

on Cervical and lumbar Artificial Disc Replacement

Effective March 20, 2009, Cervical and lumbar Artificial Disc Replacement (ADR) is covered for

accepted conditions when the following criteria are met: For Lumbar ADR:  1) Patients must first complete a structured, intensive, multi-disciplinary program for management of pain; 2) Patients must be 60 years or under at the time of surgery; 3) Patients must meet FDA approved indications for use of the specific ADR device and not have any contra-indications.  FDA approved indications for lumbar ADR includes: Failure of at least six months of conservative treatment; Skeletally mature patient; Replacement of a single disc for degenerative disc disease at one level confirmed by patient history and imaging.  Lumbar ADR, FDA general contra-indications: Active systemic infection or infection localized to site of implantation; Allergy or sensitivity to implant materials; Certain bone and spine diseases (e.g. osteoporosis, spondylosis).  For Cervical ADR: 1) Patients must meet FDA approved indications for use of the specific device and not have any contra-indications.  FDA approved indications for cervical ADR includes: Skeletally mature patient; Reconstruction of a disc following single level discectomy for intractable symptomatic cervical disc disease (radiculopathy or myelopathy) confirmed by patient findings and imaging.  Cervical ADR, FDA general contra-indications: Active systemic infection or infection localized to site of implantation; Allergy or sensitivity to implant materials; Certain bone and spine diseases (e.g. severe spondylosis or marked

cervical instability).  All requests for Artificial Disc Replacement, Revision and Removal require prior authorization and will be reviewed by L&I’s utilization review (UR) vendor (Qualis) or for Crime Victims’ contact the Compensation Program’s Manager.  For access to updated and complete information about this coverage decision visit the L&I Website:

http://www.lni.wa.gov/ClaimsIns/Providers/Treatment/CovMedDev/SpecCovDec/default.asp

To print a copy of Provider Bulletin PB 09-03 visit the L&I Website:

 http://www.lni.wa.gov/ClaimsIns/Providers/Billing/ProvBulletins/default.asp with an issue date 2009/06.

Department Adopts Treatment Guidelines

for Acute Cauda Equina Syndrome, Proximal Median Nerve Entrapment

These guidelines apply to workers covered by Washington State Workers Compensation under Title 51 RCW, including both the State Fund and Self Insured Employers.  Labor & Industries has published two medical treatment guidelines that take effect on August 1, 2009.  Revised guideline for Acute Cauda Equina Syndrome can be found at http://www.lni.wa.gov/ClaimsIns/Files/OMD/CESGuidelineFinal.pdf.  New treatment guideline for Proximal Median Nerve Entrapment can be found at http://www.lni.wa.gov/ClaimsIns/Files/OMD/PMNEFinalGuideline.pdf.  These guidelines were developed and approved by the Industrial Insurance Medical Advisory Committee and its subcommittee on Upper Extremity Entrapment Neuropathies with input from physicians, surgeons, and the public.  A more complete description of the guideline development process can be found at http://www.lni.wa.gov/ClaimsIns/Files/OMD/MedTreat/GuidelineProcess.pdf. 

As medical treatment guidelines are developed, drafts are posted for public input at http://www.lni.wa.gov/ClaimsIns/Providers/Treatment/PAC/PubComment.asp?WT.svl=3.

Medicare Reporting Updates

to be Added to WSIA Website

WSIA has been working to keep our members in the loop on all of the requirements regarding Medicare reporting.  A new page on the WSIA website is up and running soon, with as much information as we can possibly provide.  In addition, we already have a well-versed attorney speaking at the WSIA Annual Conference -- so you're not going to want to miss out on this very important topic.  Also, we are contemplating doing a webinar on this topic.  Watch the website and your emails for notices and further information.  Go to the MEDICARE REPORTING INFORMATION page at our website.

Department Releases Updated

Third Party Contact Phone List

At the request of self-insured employers, the Department has provided an updated list of contacts within the Third Party Recovery Unit.  Click HERE to see the updated Phone List for the Third Party Claims Unit.

Requesting Self-Insured and

Requesting State Fund Claims Files

In response to changes in public disclosure law, the Department of Labor & Industries has changed the way they process and respond to requests for prior industrial insurance claims files.  You will need to submit TWO requests: one to Norm Voiles for information on self insured claims (faxed to 360-902-6900), and then requests for State Fund claims histories to Paula Clayton (faxed to 360-902-6970.)  If you have questions on the status of State Fund claims information requests, you can call 360-902-5656.  Most State Fund requests will be handled within 10 business days.

Department Publishes

Helpful Leave Guide

With the adoption of yet more leave laws by the Legislature, the Department of Labor & Industries has developed a table listing all of the leave laws, and what the requirements are.  You can find the leave listing table at http://www.lni.wa.gov/WorkplaceRights/files/FamilyLeaveLawsTable.pdf.  For more detailed information on each type of leave, go HERE.  Coordination of leave benefits with workers' compensation benefits will become an even bigger issue in the future, so watch the WSIA website for more information.

Updated Self-Insurance

Phone Contact Listing

Need an updated list of Self-Insurance section phone numbers?  Periodically they up the list, and here it is!  http://www.lni.wa.gov/ClaimsIns/Files/SelfIns/SelfInsPhoneList.pdf, updated February 2, 2009.  Note that the list still includes which adjudicator and which consultant work on which claims Team.  Check back at this link periodically for updated information.  Just in case the link isn't updated at the Department's website, you can access the same document HERE.

as of 6/18/2009