SHB 2218
In CommitteeHouse
Workers' comp. medical care
Concerning access to medical care in workers' compensation.
This status may be delayed. See Action History below for the latest updates.
How does a bill become law?
- Introduced: The bill is filed and assigned a number.
- Committee: A subject-matter committee holds hearings, takes public testimony, and decides whether to advance the bill.
- Floor Vote: The full chamber (House or Senate) debates and votes on the bill.
- Opposite Chamber: The bill repeats the committee and floor vote process in the other chamber.
- Governor: The Governor reviews the bill and decides whether to sign or veto it.
- Signed: The bill has been signed into law.
AI Analysis
This bill creates a new medical provider network for Washington’s workers’ compensation system to improve access to high-quality care and ensure providers follow evidence-based treatment guidelines. It strengthens protections for injured workers to choose their own doctors, limits employer influence over provider choice, and adds quality incentives for providers—including a second-tier designation for top performers.
- Establishes a state-certified medical provider network for injured workers, with minimum standards for provider participation (e.g., malpractice history, licensing, hospital privileges).
- Prohibits employers from requiring or诱导 injured workers to use a specific provider or clinic, and requires employers to inform workers of their right to choose a provider.
- Creates a second tier of network providers based on demonstrated use of occupational health best practices, with financial and nonfinancial incentives for participation.
- Allows injured workers to see non-network providers for an initial visit only (unless no network provider is within 15 miles), but limits reimbursement to the state’s fee schedule.
- Requires utilization review of treatments within 10 business days, and pays for initial prescription drugs for any filed claim—even if the claim is later denied.
- Expands the centers for occupational health and education and sets quality benchmarks for providers, with incentives tied to measurable improvements in care.
- Strengthens oversight and removal processes for providers who show patterns of low-quality care, while protecting providers from removal for isolated outcomes.
Who is affected
- Injured workers — Injured workers gain the right to choose their own medical provider (if conveniently located), and are protected from employer pressure to use specific clinics; they may also access care from non-network providers under specific conditions, including if no network provider is within 15 miles.
- Employers (including self-insured employers) — Must inform injured workers of their right to choose a provider; may not require or诱导 workers to use a specific clinic; face penalties for violations.
- Health care providers (doctors, chiropractors, nurse practitioners, etc.) — Must apply to join a state-certified provider network, meet quality and credentialing standards, and may be removed for poor care or failure to follow guidelines; may qualify for incentives if they meet higher standards.
- Health care providers in the provider network — Must follow evidence-based treatment guidelines and may be subject to utilization review; may be required to accept the state’s fee schedule for services provided to injured workers.
- Department of Labor & Industries (L&I) — Must establish and maintain a network of qualified providers, credential providers, monitor quality of care, and assist workers when a provider is removed from the network.
Pro/Con Analysis
Stronger case for benefits
Potential Benefits (5)
Grants injured workers explicit legal rights to choose their own provider (if conveniently located), prohibits employer coercion into specific clinics, and creates a clear path to non-network care if no network provider is within 15 miles — this significantly strengthens worker autonomy and protects against employer interference in medical care decisions.
Rights & LibertiesPeopleRef: Sec. 1(2)(a)(i), (ii); Sec. 1(2)(g)Requires payment for initial prescriptions regardless of claim acceptance and guarantees access to care from a provider of the worker’s choice — this reduces financial barriers to urgent care and prevents delays in treatment due to claim disputes, directly benefiting low-income and vulnerable injured workers.
HealthcarePeopleRef: Sec. 1(4)(a); Sec. 1(2)(a)(i)Strengthens provider accountability by allowing removal for patterns of low-quality care (e.g., chronic pain, functional decline) while protecting against removal for isolated outcomes — this improves quality assurance and patient safety, especially for workers with complex or chronic injuries.
HealthcarePeopleRef: Sec. 1(6)(b), (c), (d); Sec. 1(2)(c)Mandates timely utilization review (10 business days) and requires electronic tracking of quality measures to prevent prolonged disability — this reduces delays in care, improves coordination, and supports early intervention, which can shorten recovery time and reduce long-term disability costs.
HealthcarePeopleRef: Sec. 1(3)(b); Sec. 1(5)(g)Establishes financial and non-financial incentives for providers who meet higher quality benchmarks (second tier) and for centers that improve occupational health outcomes — this encourages evidence-based care and innovation, potentially improving long-term functional outcomes for injured workers.
HealthcarePeopleRef: Sec. 1(5)(f); Sec. 1(2)(f)
Potential Concerns (5)
Prohibits employers from requiring or inducing injured workers to use a specific provider, and allows workers to seek non-network care only under narrow conditions (e.g., no network provider within 15 miles), but limits reimbursement to state fee schedule and restricts access to ongoing non-network care — this strengthens worker autonomy in theory but constrains practical choice in practice, especially in rural or underserved areas where network providers may be scarce.
Rights & LibertiesPeopleRef: Sec. 1(2)(a)(ii), (g); Sec. 1(2)(b)While the bill expands access to initial care and mandates payment for initial prescriptions regardless of claim acceptance, it caps reimbursement for non-network providers at the state fee schedule and restricts ongoing non-network care — this may reduce provider participation (especially specialists) due to lower reimbursement rates and administrative burden, potentially worsening access over time.
HealthcarePeopleRef: Sec. 1(2)(b), (g); Sec. 1(4)(a)Quality incentives and second-tier designation are tied to adherence to occupational health best practices and measurable outcomes, but the criteria for qualification (e.g., credentialing by other health plans, hospital privileges) may exclude solo practitioners, rural providers, and certain alternative providers (e.g., chiropractors, naturopaths), limiting provider diversity and potentially reducing access for workers in non-metropolitan areas.
HealthcarePeopleRef: Sec. 1(2)(c), (f); Sec. 1(5)(f), (g)Mandates utilization review within 10 business days and requires payment for initial prescriptions even if claims are denied — while this may reduce delays in care, it increases administrative burden on providers and may incentivize providers to avoid treating high-risk or complex claims due to uncertainty about reimbursement and potential disputes over medical necessity.
Public SafetyLean peopleRef: Sec. 1(3)(b); Sec. 1(4)(a)The bill expires June 30, 2027 (sunset), and the 2013/2015 access goals in subsection (5)(b) are obsolete — this undermines long-term planning and sustainability of the provider network and centers for occupational health and education, potentially wasting upfront investment and creating future uncertainty for providers and workers.
Local GovernmentLean peopleRef: Sec. 1(5)(b); sunset date (Sec. 6)
Who Is Most Affected
Injured workers — especially low-income, rural, or those with complex injuries — benefit significantly from stronger provider choice, protections against employer coercion, and guaranteed access to initial care. However, those in areas with limited provider networks may face practical barriers despite legal rights.
Employers (especially self-insured) face new obligations to inform workers of rights and avoid provider coercion, with penalties for violations — this increases administrative burden but may reduce long-term costs by improving care quality and reducing prolonged disability.
Health care providers — especially those in rural or solo practice — may struggle with credentialing requirements, fee schedule constraints, and administrative burdens, but may benefit from quality incentives and reduced disputes over medical necessity. Large, well-resourced clinics are better positioned to meet new standards.
The Department of Labor & Industries gains expanded authority but also increased administrative and oversight responsibilities, including managing the network, certifying centers, and resolving disputes — this increases state costs but strengthens its role in ensuring quality care.
Workers’ compensation insurers (including state fund) may see short-term cost increases due to expanded access and utilization review, but potential long-term savings from reduced disability duration and improved outcomes — net effect depends on implementation and provider participation.