Experimental WAC If the contract includes exclusion, reduction or limitation for services that are experimental or investigational, contract must or Investigational include a definition of Experimental and Investigational Treatment services. WAC The definition must include an identification of the (2) authority or authorities which will make a determination of which services will be considered to be experimental or investigational. WAC If the Issuer or an affiliated entity is the authority making the determination, it must state the criteria it will utilize to make the determination. This requirement may be satisfied by using one or more of the following statements, or other similar statements. WAC "In determining whether services are experimental or Experimental investigational, the plan will consider whether the services or are in general use in the medical community in the state of Investigational Washington, whether the services are under continued Treatment scientific testing and research, whether the services show a (Cont’d) demonstrable benefit for a particular illness or disease, and whether they are proven to be safe and efficacious." WAC "In determining whether services are experimental or 284-50-377 investigational, the plan will consider whether the services (2)(b) result in greater benefits for a particular illness or disease than other generally available services, and do not pose a significant risk to health or safety of the patient." WAC The supporting documentation upon the criteria are established must be made available for inspection upon written request in all instances and may not be withheld as proprietary.
Experimental or Investigational Treatment Experimental or Investigational Treatment (Cont’d) WAC If the contract includes exclusion, reduction or limitation for services that are experimental or investigational, contract must include a definition of Experimental and Investigational services. WAC (2) The definition must include an identification of the authority or authorities which will make a determination of which services will be considered to be experimental or investigational. WAC If the Issuer or an affiliated entity is the authority making the determination, it must state the criteria it will utilize to make the determination. This requirement may be satisfied by using one or more of the following statements, or other similar statements. WAC "In determining whether services are experimental or investigational, the plan will consider whether the services are in general use in the medical community in the state of Washington, whether the services are under continued scientific testing and research, whether the services show a demonstrable benefit for a particular illness or disease, and whether they are proven to be safe and efficacious." WAC 284-50-377 (2)(b) "In determining whether services are experimental or investigational, the plan will consider whether the services result in greater benefits for a particular illness or disease than other generally available services, and do not pose a significant risk to health or safety of the patient." WAC The supporting documentation upon the criteria are established must be made available for inspection upon written request in all instances and may not be withheld as proprietary.