terms of the contract. WAC Benefits for MH/SUD may not be limited or denied based solely on age or condition. 284-43-995(3) Medically necessary benefits for MH/SUD treatment may not be denied solely because they were WAC court ordered. 284-43-995(4) Home Health WAC Mental health services and substance use disorder treatment must be delivered in a home health Services for setting on parity with medical surgical benefits, consistent with federal and state law. MH/SUD Required WAC 284-43-996 Does the policy inform enrollees of their rights to free information, including: Disclosures access to and copies of all information relevant to a claim the criteria, processes, strategies, evidentiary standards and factors used to make medical necessity determinations of MH/SUD benefits and apply an NQTL to medical/surgical and MH/SUD benefits under the plan? RCW Does the contract provide benefits for neurodevelopment therapies? 48.44.450(1) Must provide benefits for mental health diagnoses (Diagnoses listed in the DSM) without any Therapy O.S.T. v. Regence BlueShield, No. limitations” (e.g., age six and under) “blanket 88940-6 (WN Services covered must include physical, speech, and occupational therapies. October 9, 2014). RCW Benefits shall be payable only where the services have been delivered pursuant to the referral 48.44.450(2) and periodic review of a holder of a license issued pursuant to chapter 18.71 or 18.57 RCW or where covered services have been rendered by such licensee. Benefits shall be provided to restore and improve function, and for the maintenance of a covered individual in cases where significant deterioration in the patient's condition would result without the service. Benefits must be for medically necessary services. Benefits may not be subject to annual or lifetime dollar limits, but may be subject to visit limits, RCW 48.44.450(4) deductible, cost sharing, and requirements for written treatment plans. The contract may not exclude or limit coverage for assessment or testing to determine the amount and type of neurodevelopmental therapy needed.
WAC 284-43-995(3) WAC 284-43-995(4) terms of the contract. Benefits for MH/SUD may not be limited or denied based solely on age or condition. Medically necessary benefits for MH/SUD treatment may not be denied solely because they were court ordered. Home Health Services for MH/SUD WAC Mental health services and substance use disorder treatment must be delivered in a home health setting on parity with medical surgical benefits, consistent with federal and state law. Required Disclosures WAC 284-43-996 Does the policy inform enrollees of their rights to free information, including: access to and copies of all information relevant to a claim the criteria, processes, strategies, evidentiary standards and factors used to make medical necessity determinations of MH/SUD benefits and apply an NQTL to medical/surgical and MH/SUD benefits under the plan? Therapy RCW 48.44.450(1) O.S.T. v. Regence BlueShield, No. 88940-6 (WN October 9, 2014). RCW 48.44.450(2) RCW 48.44.450(4) Does the contract provide benefits for neurodevelopment therapies? Must provide benefits for mental health diagnoses (Diagnoses listed in the DSM) without any “blanket limitations” (e.g., age six and under) Services covered must include physical, speech, and occupational therapies. Benefits shall be payable only where the services have been delivered pursuant to the referral and periodic review of a holder of a license issued pursuant to chapter 18.71 or 18.57 RCW or where covered services have been rendered by such licensee. Benefits shall be provided to restore and improve function, and for the maintenance of a covered individual in cases where significant deterioration in the patient's condition would result without the service. Benefits must be for medically necessary services. Benefits may not be subject to annual or lifetime dollar limits, but may be subject to visit limits, deductible, cost sharing, and requirements for written treatment plans. The contract may not exclude or limit coverage for assessment or testing to determine the amount and type of neurodevelopmental therapy needed.