RCW For inpatient admission, the issuer may require notification within a 48.43.093 (2) specified time frame or as soon thereafter as medically possible, but no less than twenty-four hours. 48.43.093 (1)(d) The issuer must have someone available 24/7 for preauth of or post-stabilization services RCW The issuer may reserve the right to require transfer of a hospitalized 48.43.093 (2) enrollee upon stabilization. Prescription WAC Plan must cover prescription medications associated with an Drugs emergency medical condition including those purchased in a foreign country. Every Category Requirements 42 U.S.C. Plan and Issuer must not discriminate with respect to participation §300gg-5(a) under the plan against any provider acting within the scope of that of Provider See provider’s license or certification under applicable State law. (Reimbursement rates may vary based on quality or performance measures.) RCW Every category of provider must be permitted to provide covered 48.43.045 services, if the treatment is within the scope of the provider’s (1)(a)(i); licensure. WAC Each health plan’s defined service area must have a comprehensive range of primary, specialty, institutional, and ancillary services available without unreasonable delay to all enrollees and that emergency services are accessible twenty-four hours per day, seven days per week without unreasonable delay. RCW Each enrollee must have adequate choice among health care 48.43.515(1); providers, including those providers which must be included in the WAC under WAC 284-170-270, and for qualified health plans and qualified stand-alone dental plans under WAC 284-170-310.
RCW 48.43.093 (2) For inpatient admission, the issuer may require notification within a specified time frame or as soon thereafter as medically possible, but no less than twenty-four hours. 48.43.093 (1)(d) The issuer must have someone available 24/7 for preauth of or post-stabilization services RCW 48.43.093 (2) The issuer may reserve the right to require transfer of a hospitalized enrollee upon stabilization. Prescription Drugs WAC Plan must cover prescription medications associated with an emergency medical condition including those purchased in a foreign country. Every Category of Provider Requirements 42 U.S.C. §300gg-5(a) See Plan and Issuer must not discriminate with respect to participation under the plan against any provider acting within the scope of that provider’s license or certification under applicable State law. (Reimbursement rates may vary based on quality or performance measures.) RCW 48.43.045 (1)(a)(i); Every category of provider must be permitted to provide covered services, if the treatment is within the scope of the provider’s licensure. WAC Each health plan’s defined service area must have a comprehensive range of primary, specialty, institutional, and ancillary services available without unreasonable delay to all enrollees and that emergency services are accessible twenty-four hours per day, seven days per week without unreasonable delay. RCW 48.43.515(1); WAC Each enrollee must have adequate choice among health care providers, including those providers which must be included in the under WAC 284-170-270, and for qualified health plans and qualified stand-alone dental plans under WAC 284-170-310.
cl-forms-19-hmo-sg-analyst-checklist.docx