Preventive and WAC Plan must cover medically necessary neurodevelopmental therapy for any DSM diagnosis without blanket exclusions. (e.g., Wellness Plan may not limit outpatient neurodevelopmental therapy services to persons age six and under.) State RCW Benefit benefit requirements classified in this category are: 48.43.043 Requirements Colorectal cancer screening. WAC 284-43-5642(9)(e)(i) (1)(b)(i) Classified in for a covered individual who is at least 50 years old; Preventive (1)(b)(ii) and Less than 50 and at high risk or very high risk for Wellness colorectal cancer. Services RCW Mammogram services, both diagnostic and screening. WAC 48.20.393 284-43-5642(9)(e)(ii) WAC Plan can apply standard contract provisions for diagnostic mammograms applicable to other benefits such as deductible cost sharing. E.g., may apply deductible and copay requirements; and RCW Prostate cancer screening if delivered upon the 48.20.392(1) recommendation of the patient’s physician, ARNP, or Physician Assistant. WAC 284-43-5642(9)(e)(iii) Benefit WAC Some state benefit requirements are limited to those receiving Requirements pediatric services, but are classified to other categories for Classified in purposes of determining actuarial value. These benefits include: Preventive and WAC Neurodevelopmental therapy, consisting of physical, Wellness occupational and speech therapy and maintenance to restore or Services improve function based on developmental delay, which cannot (Cont’d) be combined with rehabilitative services for the same condition. This state benefit requirement may be classified to ambulatory
Preventive and Wellness WAC Plan must cover medically necessary neurodevelopmental therapy for any DSM diagnosis without blanket exclusions. (e.g., Plan may not limit outpatient neurodevelopmental therapy services to persons age six and under.) State Benefit Requirements Classified in Preventive and Wellness Services Benefit Requirements Classified in Preventive and Wellness Services (Cont’d) RCW 48.43.043 (1)(b)(i) (1)(b)(ii) benefit requirements classified in this category are: Colorectal cancer screening. WAC 284-43-5642(9)(e)(i) for a covered individual who is at least 50 years old; Less than 50 and at high risk or very high risk for colorectal cancer. RCW 48.20.393 Mammogram services, both diagnostic and screening. WAC 284-43-5642(9)(e)(ii) WAC Plan can apply standard contract provisions for diagnostic mammograms applicable to other benefits such as deductible cost sharing. E.g., may apply deductible and copay requirements; and RCW 48.20.392(1) Prostate cancer screening if delivered upon the recommendation of the patient’s physician, ARNP, or Physician Assistant. WAC 284-43-5642(9)(e)(iii) WAC WAC Some state benefit requirements are limited to those receiving pediatric services, but are classified to other categories for purposes of determining actuarial value. These benefits include: Neurodevelopmental therapy, consisting of physical, occupational and speech therapy and maintenance to restore or improve function based on developmental delay, which cannot be combined with rehabilitative services for the same condition. This state benefit requirement may be classified to ambulatory
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