If the plan provides dental coverage, does it cover medically necessary general anesthesia RCW 48.43.185(2) services in conjunction with any covered dental procedure performed in a dental office if the general anesthesia services are medically necessary because the covered person is under the age of seven or physically or developmentally disabled? Issuer may apply cost-sharing,maximum annual limits, and prior authorization to these services; RCW 48.43.185(3) can limit to in-network providers, and negotiate provider rates. Does the health plan provide SUD benefits by an treatment program” under RCW “approved RCW 48.46.350 70.96A.020(3)? Mental Health Benefit Does the plan define Health Services” consistent with RCW 48.46.291(1)? or Substance “Mental RCW 48.46.291 Requirement necessary outpatient and inpatient services provided to treat mental disorders Use Disorder “Medically covered by the diagnostic categories listed in the most current version of the diagnostic and (“MH/SUD”) statistical manual of mental disorders, published by the American psychiatric association, on July 24, 2005, or such subsequent date as may be provided by the insurance commissioner by rule, consistent with the purposes of chapter 6, Laws of 2005, with the exception of the following categories, codes, and services: (a) Substance related disorders; (b) life transition problems, currently referred to as "V" codes, and diagnostic codes 302 through 302.9 as found in the diagnostic and statistical manual of mental disorders, 4th edition, published by the American psychiatric association; (c) skilled nursing facility services, home health care, residential treatment, and custodial care; and (d) court ordered treatment unless the issuer’s medical director or designee determines the treatment to be medically necessary.” Does the plan define Substance Use Disorder consistent with RCW 48.46.355 and WAC RCW 48.46.355 WAC 284-43-991 use disorder includes illness characterized by a physiological or psychological “Substance dependency, or both, on a controlled substance regulated under chapter RCW and/or alcoholic beverages. It is further characterized by a frequent or intense pattern of pathological use to the extent the user exhibits a loss of self-control over the amount and circumstances of use; develops
RCW 48.43.185(2) RCW 48.43.185(3) If the plan provides dental coverage, does it cover medically necessary general anesthesia services in conjunction with any covered dental procedure performed in a dental office if the general anesthesia services are medically necessary because the covered person is under the age of seven or physically or developmentally disabled? Issuer may apply cost-sharing,maximum annual limits, and prior authorization to these services; can limit to in-network providers, and negotiate provider rates. Mental Health or Substance Use Disorder (“MH/SUD”) Benefit Requirement RCW 48.46.350 RCW 48.46.291 RCW 48.46.355 WAC 284-43-991 Does the health plan provide SUD benefits by an “approved treatment program” under RCW 70.96A.020(3)? Does the plan define “Mental Health Services” consistent with RCW 48.46.291(1)? “Medically necessary outpatient and inpatient services provided to treat mental disorders covered by the diagnostic categories listed in the most current version of the diagnostic and statistical manual of mental disorders, published by the American psychiatric association, on July 24, 2005, or such subsequent date as may be provided by the insurance commissioner by rule, consistent with the purposes of chapter 6, Laws of 2005, with the exception of the following categories, codes, and services: (a) Substance related disorders; (b) life transition problems, currently referred to as "V" codes, and diagnostic codes 302 through 302.9 as found in the diagnostic and statistical manual of mental disorders, 4th edition, published by the American psychiatric association; (c) skilled nursing facility services, home health care, residential treatment, and custodial care; and (d) court ordered treatment unless the issuer’s medical director or designee determines the treatment to be medically necessary.” Does the plan define Substance Use Disorder consistent with RCW 48.46.355 and WAC “Substance use disorder includes illness characterized by a physiological or psychological dependency, or both, on a controlled substance regulated under chapter RCW and/or alcoholic beverages. It is further characterized by a frequent or intense pattern of pathological use to the extent the user exhibits a loss of self-control over the amount and circumstances of use; develops