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L&I outlines rollout of medical-access law and plan to hire claim managers to reduce caseloads
Summary
L&I officials briefed the advisory committee on implementing Senate Bill 5847: new individualized medical-decision language, network-provider rules, deadlines for utilization review, and authority to hire claim managers to lower average caseloads from above 200 toward a 141 target.
Cindy Gaddis and Kim Wallace from L&I's Insurance Services told the Workers' Comp Advisory Committee that several provisions of Senate Bill 5847 (the medical-access bill) are already in effect and that others require near-term planning.
Gaddis said the bill added an intent section to the existing statute and requires that, when medically appropriate, network providers follow the department's evidence-based coverage decisions and national treatment guidelines. She listed implementation tasks that fall to the agency: revising nonnetwork provider agreements, preparing medical-bill payment processes for more nonnetwork claims, and updating utilization-review contracts to meet a new 10-day decision requirement. "If utilization review does not complete in time, then the treatment that's requested is automatically authorized," she said.
Kim Wallace, the medical administrator, described the "when medically appropriate" change as emphasizing individualized reviews grounded in L&I's treatment guidelines and coverage decisions; L&I has expanded its complex treatment unit to support increased individualized review workload.
Kirsten Glenn discussed the bill's staffing authority: the department may hire claim managers to the point that average caseloads approach an industry-referenced 141 per claim manager. Glenn said current average caseloads are well above 200; the new authority includes reporting duties (first report starts 12/01/2026) and assessment requirements (department assessment due June 2029; JLARC review due December 2032). "We have to be careful so training and retaining claim managers keeps pace with hiring," she told the committee.
Committee members asked about transparency and oversight of the hiring authority, the operational burden of onboarding, and potential productivity changes as existing claim managers help train new hires. Officials said they expect to phase hiring and to work closely with the governor's office, the Workers' Comp Advisory Committee and external stakeholders on implementation decisions.
Ending: The agency will return with implementation details and periodic reports to the advisory committee as hiring and system changes proceed.
