advanced registered practitioner specialists in women's health and midwifery under chapter RCW. RCW Women's health care services must include, but need not be limited 48.42.100(3); to: Maternity care; reproductive health services, gynecological care, WAC contraceptive services, testing and treatment for sexually transmitted diseases, pregnancy termination, breast feeding, complications of pregnancy, general examination, preventive care as medically appropriate and medically appropriate follow-up visits for these services; and any appropriate health care service for other health problems, discovered and treated during the course of a visit to a women's health care practitioner for a women's health care service, which is within the practitioner's scope of practice. Maternity and Optional WAC A health benefit plan may, but is not required to, include genetic Newborn Maternity testing of the father as part of the EHB-benchmark package. The and base-benchmark plan specifically excludes this service. If an issuer Services (EHB) (Cont’d) Newborn covers this benefit, the issuer may not include this benefit in Services establishing actuarial value for the maternity and newborn category. Allowable WAC Plan may limit coverage of home birth by a midwife or nurse midwife Limitations to low risk pregnancy only. Women’s 48.42.100(4) Female enrollees must have direct access to timely and appropriate Direct Access and (5)(a); WAC covered women's health care services from the type of health care practitioner of their choice for appropriate covered women’s health care services without the necessity of prior referral from another type of health care practitioner. RCW Plan may restrict women’s direct access to in-network providers, but 48.42.100(4) must not limit access to a subset of participating women's health and (5)(c); WAC care practitioners within the network. Such an impermissible limitation might arise when a primary care provider's group practice receives a capitation payment for comprehensive care to an enrollee
advanced registered practitioner specialists in women's health and midwifery under chapter RCW. RCW 48.42.100(3); WAC Women's health care services must include, but need not be limited to: Maternity care; reproductive health services, gynecological care, contraceptive services, testing and treatment for sexually transmitted diseases, pregnancy termination, breast feeding, complications of pregnancy, general examination, preventive care as medically appropriate and medically appropriate follow-up visits for these services; and any appropriate health care service for other health problems, discovered and treated during the course of a visit to a women's health care practitioner for a women's health care service, which is within the practitioner's scope of practice. Maternity and Newborn Services (EHB) (Cont’d) Optional Maternity and Newborn Services WAC A health benefit plan may, but is not required to, include genetic testing of the father as part of the EHB-benchmark package. The base-benchmark plan specifically excludes this service. If an issuer covers this benefit, the issuer may not include this benefit in establishing actuarial value for the maternity and newborn category. Allowable Limitations WAC Plan may limit coverage of home birth by a midwife or nurse midwife to low risk pregnancy only. Women’s Direct Access 48.42.100(4) and (5)(a); WAC Female enrollees must have direct access to timely and appropriate covered women's health care services from the type of health care practitioner of their choice for appropriate covered women’s health care services without the necessity of prior referral from another type of health care practitioner. RCW 48.42.100(4) and (5)(c); WAC Plan may restrict women’s direct access to in-network providers, but must not limit access to a subset of participating women's health care practitioners within the network. Such an impermissible limitation might arise when a primary care provider's group practice receives a capitation payment for comprehensive care to an enrollee