apply to mental health or substance use disorder benefits in the same classification. Mental Health Parity analysis must be done for each classification and applies to all WAC and Substance treatment limitations (frequency of treatment, number of visits, days Use Disorder of coverage, days in a waiting period, or other similar limits on the WAC (MH/SUD) scope or duration of treatment). Look at: Services, Quantitative treatment limitations: expressed numerically (such WAC Mental Including as fifty outpatient visits per year) Health Parity Behavioral Includes annual, episode, and lifetime day and visit limits. (Cont’d) Nonquantitative treatment limitations (“NQTL”): processes, Health WAC Treatment strategies, or evidentiary standards, or factors that are not (EHB) expressed numerically, but otherwise limit the scope or duration (Cont’d) of benefits for treatment. Includes, but not limited to: Limiting or excluding benefits based on medical necessity or WAC medical appropriateness, or based on whether the treatment (a) is experimental or investigative; Formulary design; (b) For plans with multiple network tiers (such as preferred providers (c) and participating providers), network tier design; Standards for provider admission to participate in a network, (d) including reimbursement rates; Methods for determining usual, customary, and reasonable (e) charges; Use of fail-first policies or step therapy protocols; (f) Exclusions on failure to complete a course of treatment; (g) and
Mental Health Parity (Cont’d) apply to mental health or substance use disorder benefits in the same classification. Mental Health and Substance Use Disorder (MH/SUD) WAC WAC Parity analysis must be done for each classification and applies to all treatment limitations (frequency of treatment, number of visits, days of coverage, days in a waiting period, or other similar limits on the scope or duration of treatment). Look at: Services, Including Behavioral WAC Quantitative treatment limitations: expressed numerically (such as fifty outpatient visits per year) Includes annual, episode, and lifetime day and visit limits. Health Treatment (EHB) (Cont’d) WAC Nonquantitative treatment limitations (“NQTL”): processes, strategies, or evidentiary standards, or factors that are not expressed numerically, but otherwise limit the scope or duration of benefits for treatment. Includes, but not limited to: WAC (a) Limiting or excluding benefits based on medical necessity or medical appropriateness, or based on whether the treatment is experimental or investigative; (b) Formulary design; (c) For plans with multiple network tiers (such as preferred providers and participating providers), network tier design; (d) Standards for provider admission to participate in a network, including reimbursement rates; (e) Methods for determining usual, customary, and reasonable charges; (f) Use of fail-first policies or step therapy protocols; (g) Exclusions on failure to complete a course of treatment; and