Optional WAC Plan may, but is not required to, include the following services as Rehabilitative part of the EHB-benchmark package. If plan includes these and Habilitative benefits, they cannot be included in establishing AV for this Services WAC category: 5642(7)(c)(i) Off-the-shelf shoe inserts and orthopedic shoes; (7)(c)(ii) Exercise equipment for medically necessary conditions; (7)(c)(iii) Durable medical equipment that serves solely as a comfort or convenience item; and (7)(c)(iv) Hearing aids than cochlear implants. Habilitative WAC For purposes of determining a plan's AV, issuer must classify as Services habilitative services the range of medically necessary health care Definition (7)(d) services and devices designed to assist a person to keep, learn or Rehabilitative improve skills and functioning for daily living. Examples include and Habilitative services for a child who isn't walking or talking at the expected Habilitative Services age, or services to assist with keeping or learning skills and Definition functioning within an individual's environment, or to compensate (Cont’d) for a person's progressive physical, cognitive, and emotional illness. These services may include physical and occupational therapy, speech-language pathology and other services for people with disabilities in a variety of inpatient or outpatient settings. Requirement for WAC As a minimum of coverage, limitations on habilitative services Parity between must be on parity with those for rehabilitative services. Plan may Habilitative and include such limitations only if the limitations take into account Rehabilitative the unique needs of the individual, and target measurable and services specific treatment goals appropriate for the person's age and physical and mental condition. WAC However, when habilitative services are delivered to treat a mental health diagnosis categorized in the most recent version
Rehabilitative and Habilitative Optional Rehabilitative and Habilitative Services WAC WAC 5642(7)(c)(i) Plan may, but is not required to, include the following services as part of the EHB-benchmark package. If plan includes these benefits, they cannot be included in establishing AV for this category: Off-the-shelf shoe inserts and orthopedic shoes; (7)(c)(ii) Exercise equipment for medically necessary conditions; (7)(c)(iii) Durable medical equipment that serves solely as a comfort or convenience item; and (7)(c)(iv) Hearing aids than cochlear implants. Habilitative Services Definition Habilitative Services Definition (Cont’d) WAC (7)(d) For purposes of determining a plan's AV, issuer must classify as habilitative services the range of medically necessary health care services and devices designed to assist a person to keep, learn or improve skills and functioning for daily living. Examples include services for a child who isn't walking or talking at the expected age, or services to assist with keeping or learning skills and functioning within an individual's environment, or to compensate for a person's progressive physical, cognitive, and emotional illness. These services may include physical and occupational therapy, speech-language pathology and other services for people with disabilities in a variety of inpatient or outpatient settings. Requirement for Parity between Habilitative and Rehabilitative services WAC As a minimum of coverage, limitations on habilitative services must be on parity with those for rehabilitative services. Plan may include such limitations only if the limitations take into account the unique needs of the individual, and target measurable and specific treatment goals appropriate for the person's age and physical and mental condition. WAC However, when habilitative services are delivered to treat a mental health diagnosis categorized in the most recent version