Washington Administrative Code

Low outlier cases are paid by multiplying each hospital's specific percent of allowed charges (POAC) factor by the allowed charges for the case.[Statutory Authority: RCW 51.04.020, 51.04.030 and 51.36.080. WSR 97-06-066, § 296-23A-0540, filed 2/28/97, effective 4/1/97.]

The department will deny interim bills which are assigned to diagnosis-related-groups (DRGs) paid per case rates by the department.If an interim bill is coded as a diagnosis-related-group (DRG) not paid per case rates by the department, then the bill will be paid using the applic…

The department will review hospital readmissions occurring within seven days of discharge and will determine whether the second admission resulted from premature discharge. Payment for services associated with readmission will depend upon the review. For example:•If the second ad…

A transfer case is defined as an injured worker's admission to another acute care hospital within seven days of that worker's previous discharge. All bills for transfer cases will be subject to review by the department and payment will be determined based on that analysis. The tr…

When the stay at the transferring hospital is a diagnosis-related-group (DRG) paid by the department, and does not qualify as a low outlier, the transferring hospital is paid a graduated per diem rate for each day of care allowed by the department. If the case qualifies as a low …

The hospital receiving a transfer will be paid according to the department's review of the case. If the receiving hospital's stay is a diagnosis-related-group (DRG) paid by the department, then the hospital will receive the appropriate per case and outlier payments. If the case i…

Hospitals may submit a request for adjustment to their rate if:•The rate methodology or principles of reimbursement established in department publications were incorrectly applied, or•Incorrect data or erroneous calculations were used in the establishment of the hospital's rate.I…

Hospitals must submit requests for rate adjustments in writing to:Department of Labor and IndustriesHealth Services AnalysisRequest for Hospital Rate AdjustmentP.O. Box 44322Olympia, Washington 98504-4322.Requests must be received within sixty days after the facility receives not…

Upon receipt of the request, the department shall determine the need for a conference with the hospital and will contact the facility to arrange a conference if needed. The conference, if needed, must be held within sixty days of the department's receipt of the request.Within thi…

The APC outpatient prospective payment system (OPPS) is a reimbursement method that categorizes outpatient visits into groups according to the clinical characteristics, the typical resource use, and the costs associated with the diagnoses and the procedures performed. The groups …

"Alternate outpatient payment." A payment for proper and necessary services calculated using a method other than the APC method, such as the outpatient hospital rate or fee schedule."Ambulatory payment classification (APC) bill." An outpatient bill for hospital services that are …

(1) OPPS payment rates are calculated with a formula that blends a hospital-specific rate and a statewide rate. Each hospital's historic labor and industries' reimbursement level in combination with the department's statewide payments will determine payment rates.(2) For the stat…

The relative weight for each APC is the current relative weight listed by CMS for the corresponding APC.[Statutory Authority: RCW 51.04.020, 51.04.030, 51.36.080, 51.36.085. WSR 01-24-045, § 296-23A-0730, filed 11/29/01, effective 1/1/02.]

(1) Billed services that are reimbursed by the OPPS are grouped into one or more APCs using the outpatient code editor software.(2) Additional payment may be made for services classified by CMS as transitional pass-through.(3) Incidental services are grouped within an APC and are…

(1) Critical access hospitals as identified by the Washington state department of health (DOH).(2) All out-of-state hospitals. (3) Military/veterans hospitals.(4) Psychiatric hospitals.(5) Rehabilitation hospitals.(6) Cancer hospitals.(7) Children's hospitals.(8) Ambulatory surge…

Services excluded from APC-payment, if deemed appropriate for reimbursement, will be reimbursed using an alternate outpatient payment method, such as a specific fee schedule and/or using the hospital-specific or the statewide average percent of allowed charges (POAC).[Statutory A…

Each claim for services must include the required elements as described within the current L&I hospital billing and administrative guidelines.Note:Includes Provider General Billing Manual; Billing Instructions for Hospital Services; Provider Bulletins; and Provider Updates.[Statu…

Only facilities that meet the criteria below may bill for ambulatory surgery center (ASC) services.An ambulatory surgery center is an outpatient facility where surgical services are provided and that meets the following three requirements:(1) Must be licensed by the state(s) in w…

Ambulatory surgery centers must submit bills for services on a national standard form specified by the department of labor and industries. Bills also may be submitted electronically using department file format specifications. Providers must follow the instructions in the General…

The department will use the Centers for Medicare and Medicaid Services (CMS) list of procedures covered in an ambulatory surgery center plus additional procedures as determined by the department. All procedures covered in an ambulatory surgery center are listed in the Medical Aid…

The department pays the lesser of the billed charge (the ASC's usual and customary fee) or the fee schedule's maximum allowed rate. The fee schedule for ambulatory surgery centers is in the Medical Aid Rules and Fee Schedules.[Statutory Authority: RCW 51.36.080, 51.04.030, 51.36.…

The fee schedule, codes, and policies for ambulatory surgery centers will be reviewed periodically. The department will publish provider bulletins to clarify, update, and inform ambulatory surgery centers about changes in policies or fees. They also will be published each July in…

(1) That portion of section numeration appearing after the chapter designation appears in either a three digit or a five digit format (e.g. 296-24-330 and 296-24-33002). The final two digits of the section number are implied decimal extensions of the first three digits and repres…

The rules in this chapter are designed to protect the safety and health of employees by creating a healthy work environment by establishing requirements to control safety hazards in the workplace. Chapter 296-800 WAC, the safety and health core rules, contain safety and health ru…

Note:Meaning of words. Unless the context indicates otherwise, words used in this chapter shall have the meaning given in this section.Approved. Approved by the director of the department of labor and industries or their authorized representative: Provided, however, That should a…

[Order 73-5, § 296-24-215, filed 5/9/73 and Order 73-4, § 296-24-215, filed 5/7/73.]

You must allow sufficient safe clearances for aisles, at loading docks, through doorways and wherever turns or passage must be made where mechanical handling equipment is used. You must keep aisles and passageways clear and in good repair, with no obstruction across or in aisles …

You must provide clearance signs to warn of clearance limits.[Statutory Authority: RCW 49.17.010, 49.17.040, 49.17.050, and 49.17.060. WSR 15-24-100, § 296-24-21509, filed 12/1/15, effective 1/5/16; Order 73-5, § 296-24-21509, filed 5/9/73 and Order 73-4, § 296-24-21509, filed 5/…

(1) You must ensure that derail and/or bumper blocks are provided on spur railroad tracks where a rolling car could contact other cars being worked, enter a building, work or traffic area. This does not apply to cars being moved by a locomotive, switch engine, donkey engine, or a…

You must provide covers and/or guardrails to protect personnel from the hazards of open pits, tanks, vats, ditches, etc.[Statutory Authority: RCW 49.17.010, 49.17.040, 49.17.050, and 49.17.060. WSR 15-24-100, § 296-24-21513, filed 12/1/15, effective 1/5/16; Order 73-5, § 296-24-2…

[Order 73-5, § 296-24-235, filed 5/9/73 and Order 73-4, § 296-24-235, filed 5/7/73.]

ANSI. The American National Standards Institute.Appointed. Assigned specific responsibilities by the employer or the employer's representative.Automatic crane. A crane which when activated operates through a preset cycle or cycles.Auxiliary hoist. A supplemental hoisting unit of …

(1) Application. This section applies to overhead and gantry cranes, including semigantry, cantilever gantry, wall cranes, storage bridge cranes, and others having the same fundamental characteristics. These cranes are grouped because they all have trolleys and similar travel cha…

(1) Cab location.(a) You must ensure that the general arrangement of the cab and the location of control and protective equipment is such that all operating handles are within convenient reach of the operator when facing the area to be served by the load hook, or while facing the…

(1) Location of footwalks.(a) If sufficient headroom is available on cab-operated cranes, you must provide a footwalk on the drive side along the entire length of the bridge of all cranes having the trolley running on the top of the girders. To give sufficient access to the oppos…

(1) Trolley stops.(a) You must ensure that stops are provided at the limits of travel of the trolley.(b) You must ensure that stops are fastened to resist forces applied when contacted.(c) You must ensure that a stop engaging the tread of the wheel is of a height at least equal t…

(1) Brakes for hoists.(a) You must ensure that each independent hoisting unit of a crane is equipped with at least one self-setting brake, hereafter referred to as a holding brake, applied directly to the motor shaft or some part of the gear train.(b) You must ensure that each in…

(1) General.(a) Wiring and equipment must comply with chapter 296-24 WAC Part L, and WAC 296-800-280.(b) The control circuit voltage must not exceed 600 volts for a.c. or d.c. current.(c) The voltage at pendant pushbuttons must not exceed 150 volts for a.c. and 300 volts for d.c.…

(1) Sheaves.(a) You must ensure that sheave grooves are smooth and free from surface defects which could cause rope damage.(b) You must provide sheaves carrying ropes which can be momentarily unloaded with close-fitting guards or other suitable devices to guide the rope back into…

You must provide a gong or other effective warning signal for each crane equipped with a powered traveling mechanism except for floor operated cranes.[Statutory Authority: RCW 49.17.010, 49.17.040, 49.17.050, and 49.17.060. WSR 15-24-100, § 296-24-23517, filed 12/1/15, effective …

(1) Inspection classification.(a) Initial inspection. You must perform an initial inspection prior to initial use all new and altered cranes to ensure compliance with the provisions of these standards.(b) Inspection procedure for cranes in regular service is divided into two gene…

(1) Operational tests.(a) Prior to initial use you must test all new and altered cranes to insure compliance with this section including the following functions:(i) Hoisting and lowering.(ii) Trolley travel.(iii) Bridge travel.(iv) Limit switches, locking and safety devices.(b) Y…

(1) Preventive maintenance. You must establish a preventive maintenance program based on the crane manufacturer's recommendations.(2) Maintenance procedure.(a) Before adjustments and repairs are started on a crane you must take the following precautions:(i) The crane to be repair…

(1) Running ropes. You must perform a thorough inspection of all ropes at least once a month and keep a full written, dated, and signed report of rope condition on file where readily available to appointed personnel. You must carefully note any deterioration, resulting in appreci…

(1) Size of load. You must ensure that the crane is not loaded beyond its rated load except for test purposes as provided in WAC 296-24-23521.(2) Attaching the load.(a) You must ensure that the hoist chain or hoist rope is free from kinks or twists and is not be wrapped around th…

(1) You must ensure that cranes are operated only by regular crane operators, authorized substitutes who have had adequate experience and training under the supervision of a competent operator, or by crane repairmen or inspectors.(2) You must ensure that crane operators are able …

(1) Ladders.(a) The employer must ensure that hands are free from encumbrances while personnel are using ladders.(b) You must lift and lower articles which are too large to be carried in pockets or belts by hand line.(2) Cabs.(a) You must store necessary clothing and personal bel…

(1) Scope and application. This standard applies to the design, construction, testing, use and maintenance of personnel platforms, and the hoisting of personnel platforms on the load lines of cranes or derricks.(2) Definitions. For the purposes of this section, the following defi…

(1) You must ensure that chain and electric hoists are of what is known as "all steel construction." No cast iron may be used in parts subject to tension except drums, bearings or brake shoes.(2) You must ensure that the chains are made of the best quality steel or iron with weld…

(1) You must prevent piston rod lock nuts from becoming loose and allowing rod to drop when supporting a load. A lock nut must be secured to piston rod by a castellated nut and cotter-pin.(2) You must use a clevis or other means to prevent hoists cylinder becoming detached from h…