Emergency Medical Services (EHB) (Cont’d) Every Category Requirements 42 U.S.C. Plan and Issuer must not discriminate with respect to participation of Provider §300gg-5(a) the plan against any provider acting within the scope of that provider’s See 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 services, 48.43.045 if the treatment is within the scope of the provider’s licensure. Each enrollee (1)(a)(i); must have adequate choice among providers. WAC 284-43-9970(2) / WAC RCW 284-170-200(2); WAC 284-43-9975(1) / WAC 284-170-270(1) 48.43.515(1) WAC Each health plan’s defined service area must have a comprehensive 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. WAC Each enrollee must have adequate choice health care providers, including those providers which must be included in the network under WAC 284-170-270 for qualified health plans and qualified stand-alone dental plans under WAC 284-170-310. WAC Issuers must not exclude any category of providers licensed by the State of Washington who provide health care services or care within the scope of their practice for services covered as essential health benefits.
Emergency Medical Services (EHB) (Cont’d) Every Category of Provider Requirements 42 U.S.C. §300gg-5(a) See Plan and Issuer must not discriminate with respect to participation 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); RCW 48.43.515(1) Every category of provider must be permitted to provide covered services, if the treatment is within the scope of the provider’s licensure. Each enrollee must have adequate choice among providers. WAC 284-43-9970(2) / WAC 284-170-200(2); WAC 284-43-9975(1) / WAC 284-170-270(1) WAC Each health plan’s defined service area must have a comprehensive 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. WAC Each enrollee must have adequate choice health care providers, including those providers which must be included in the network under WAC 284-170-270 for qualified health plans and qualified stand-alone dental plans under WAC 284-170-310. WAC Issuers must not exclude any category of providers licensed by the State of Washington who provide health care services or care within the scope of their practice for services covered as essential health benefits.
cl-forms-19-hmo-ind-analyst-checklist.docx