WAC Within thirty days of receiving a request, an issuer must furnish its medical necessity criteria for any or all essential health benefit categories to an enrollee or provider. Medical Necessity (Cont’d) Requirements for Process (Cont’d) Mental Health Requirement 42 USC Plan must cover "mental health and substance use disorder for MH/SUD §18021 services, including behavioral health treatment" substantially and Substance Use Disorder Coverage (a)(1)(B); equal to the base-benchmark plan. For determining a plan's (MH/SUD) 42 USC actuarial value, an issuer must classify as mental health and Services, §18022 substance use disorder services, including behavioral health Including (b)(1)(E); treatment, medically necessary care, treatment and services for Behavioral WAC mental health conditions and substance use disorders categorized Health in the most recent version of the Diagnostic and Statistical Manual Treatment of Mental Disorders (DSM), including behavioral health treatment (EHB) for those conditions.
Medical Necessity (Cont’d) Requirements for Process (Cont’d) WAC Within thirty days of receiving a request, an issuer must furnish its medical necessity criteria for any or all essential health benefit categories to an enrollee or provider. Mental Health and Substance Use Disorder (MH/SUD) Services, Including Behavioral Health Treatment (EHB) Requirement for MH/SUD Coverage 42 USC §18021 (a)(1)(B); 42 USC §18022 (b)(1)(E); WAC Plan must cover "mental health and substance use disorder services, including behavioral health treatment" substantially equal to the base-benchmark plan. For determining a plan's actuarial value, an issuer must classify as mental health and substance use disorder services, including behavioral health treatment, medically necessary care, treatment and services for mental health conditions and substance use disorders categorized in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM), including behavioral health treatment for those conditions.