| To: | Chief Medical Officers, Chief Nursing Officers, Human Resources Leads, Legal Counsel and Government Affairs Staff
Please forward to clinic managers and staff who may be involved in education and implementation of this new requirement |
| Staff Contact: | Cara Helmer, RN, JD, Policy Director, Legal Affairs CaraH@wsha.org | (206) 577-1827 Mary Storace, Policy Analyst, Government Affairs |
| Subject: | New Washington State Law Relating to Provider Certification of a Serious Health Condition for Paid Family Medical Leave Benefits |
Purpose
The purpose of this bulletin is to inform health care providers and facilities of a new law, effective June 6, 2024, that requires timely certification of a serious health condition for qualifying individuals to begin receiving benefits under 50A.15 RCW, the Washington State Paid Family and Medical Leave (PFML) program.
The law, passed under SHB 2102, requires health care providers to return a completed medical certification form for PFML to a patient within seven calendar days of receiving the request. Health care facilities and providers are prohibited from charging a fee for executing the certification.
Applicability/Scope
SHB 2102, which will be codified in Chapter 70.02 RCW, applies to all health care providers practicing in Washington State required or authorized to complete PFML forms under 50A.15 RCW. Restrictions on charging patients for completing forms, and timelines for administrative review apply to health care facilities, including acute care hospitals licensed under 70.41 RCW and psychiatric hospitals licensed under 71.12 RCW.
Recommendations
- Review this bulletin and SHB 2102 to understand the new requirements for health care providers and facilities.
- Ensure that health care providers responsible for completing a medical certification form are aware of the new seven calendar day deadline.
- Begin planning for compliance by updating policies and procedures.
Overview
SHB 2102 has two new main requirements for providers and health care facilities: (1) a timeline requirement for returning forms and (2) a prohibition on charging fees for PFML paperwork.
New Seven Calendar Day Requirement
Under the new law, a provider must complete and submit a Medical Certification of Serious Health Condition form within seven calendar days of receiving a certification request and authorization to disclose health care information from a patient.
If providers have not received the required paperwork or do not yet have sufficient information to complete the forms, this timeline is not applicable.
For example, if a provider needs to examine the patient in-office before completing the forms, that office visit would not need to occur within seven days. The seven-day requirement would only take effect once the office visit to collect the relevant information had been completed. Similarly, if the provider has not received an authorization to disclose confidential medical information, the patient should be reminded about the missing form, however, the timeline does not apply until the form is completed.
If health care facility policies require an administrative review of patient information before a health care provider may return the certification form to the patient, no additional time is granted for the administrative review. The administrative review process may not extend the timeline past the seven-day deadline.
Prohibited Fees
Under the new law, providers and facilities are prohibited from charging a fee for completing PFML forms. However, a provider is permitted to charge a fee associated with any office visit necessary to evaluate the patient to complete the form.
Enforcement
In the case that a provider or healthcare facility does not comply with these newly prescribed timelines, RCW 70.02.170 permits a patient to seek civil relief against a health care provider or facility. Relief can be sought in the form of obtaining actual damages, or court order mandating compliance.
Background
In 2017, the Washington state legislature passed SSB 5975 to create a Washington State Paid Family and Medical Leave (PFML) insurance program. The PFML program authorizes eligible workers to take paid, job-protected leave for up to 12 weeks to recover from a serious health condition or to care for a family member.
To begin receiving benefits under the PFML program, a Washington state worker must submit a medical certification form signed by a health care provider. SHB 2102 amends Chapter 70.02 RCW to institute a deadline in which health care providers are required to submit certification of a patient’s or their family member’s serious health condition.
WSHA’s 2024 New Law Implementation Guide
Please visit WSHA’s new law implementation guide online. The Government Affairs team is hard at work preparing resources and information on the high priority bills that passed in 2024 to help members implement the new laws, as well as links to resources such as this bulletin. In addition, you will find the Government Affairs team’s schedule for release of upcoming resources on other laws and additional resources for implementation.
References
Substitute House Bill 2102 – Paid Family and Medical Leave – Certification of a serious health condition
Substitute Senate Bill 5975 – Establishing the Washington State Paid Family and Medical Leave program
Chapter 70.02 RCW – Medical records – Health care information access and disclosure
Paid Family & Medical Leave Medical Certification Form
RCW 70.02.030 – Patient authorization of disclosure – Health care information
RCW 70.02.170 – Civil Remedies
Paid Family and Medical Leave (PFML) program details from Washington State.
