Wash. Rev. Code § 51.36.010

Findings — Minimum standards for providers — Health care provider network — Advisory group — Best practices treatment guidelines — Extent and duration of treatment — Centers for occupational health and education — Rules — Reports

Washington, in an effort to improve quality medical care for injured employees, has directed the department to create a network of providers and an advisory group. Providers must meet the standards specified by the department and agree to comply with department guidelines in order to participate in the network. The advisory group will be comprised of interested stakeholders and will help the department carry out their duties under this section.

The Advisory Group will help the department create policies relating to the oversight of network providers and minimum standards for provider participation in the network. The standards may include requirements regarding the provider’s (1) level of malpractice insurance coverage; (2) history of malpractice, disciplinary, or licensing actions; and (3) credentialing by other health plans that use national quality assurance guidelines.

The department must create additional compliance criteria, such as administrative and billing policies, for the purpose of monitoring care quality and efficiency.

The department must implement utilization review for self-insured employers in an effort to provide quality and cost-effective care for the employees of self-insured employers.

Washington has established The Centers for Occupational Health and Education for the purpose of reducing preventable disabilities by focusing provider resources on care during the 12 weeks after an injury. Because many workers in Washington cannot access these centers, the department must undertake an expansion so that all workers have access by December of 2015.

The department must establish center certification standards that include criteria such as location, institutional leadership, and the ability of providers to meet the needs of workers. Washington permits health care delivery organizations (e.g. hospitals, HMOs) to apply for certification.

Centers must implement benchmark quality indicators of occupational health practices for providers and must remove providers that fail to attain the benchmarks on a consistent basis.  The department must establish incentives for centers based on measurable gains in occupational health best practices.  The department must create a means of tracking “evidence-based quality measures” electronically in an effort to improve patient outcomes and prevent disabilities. The department must use this electronic system to give physicians feedback about the quality of their care.  The department may remove providers from the network if they fail to meet the network standards or consistently provide care that creates a risk of harm or death to the patient.