Women’s Direct Access (Cont’d) WAC State Benefit Maternity services must include diagnosis of pregnancy, prenatal Requirements care, delivery, care for complications of pregnancy, physician for Maternity services, and hospital services and Newborn 48.43.115 Must provide newborn coverage that is not less than the postnatal Service (3)(f); coverage for the mother, for no less than three weeks; and RCW 48.44.344 Prenatal diagnosis of congenital disorders by screening/diagnostic procedures if medically necessary. WAC 284-43-5642(4)(d)(iii). State benefit RCW 48.43.115 Plan must permit the attending provider, in consultation with the Maternity and requirements Newborn (3)(a) mother, to make decisions on the length of inpatient stay. These for Maternity Services (EHB) decisions must be based on accepted medical practice. and Newborn (Cont’d) RCW 48.43.115 Plan may not deny covered, eligible services for inpatient, Services (3)(b) postdelivery care to a mother and her newly born child after a (Cont’d) vaginal delivery or a cesarean section delivery that is ordered by the attending provider in consultation with the mother. RCW 48.43.115 At the time of discharge, determination of the type and location of (3)(c) follow-up care must be made by the attending provider in consultation with the mother rather than by contract or agreement between the hospital and the insurer. These decisions must be based on accepted medical practice.
Women’s Direct Access (Cont’d) State Benefit Requirements for Maternity and Newborn Service State benefit requirements for Maternity and Newborn Services (Cont’d) WAC Maternity services must include diagnosis of pregnancy, prenatal care, delivery, care for complications of pregnancy, physician services, and hospital services 48.43.115 (3)(f); Must provide newborn coverage that is not less than the postnatal coverage for the mother, for no less than three weeks; and RCW 48.44.344 Prenatal diagnosis of congenital disorders by screening/diagnostic procedures if medically necessary. WAC 284-43-5642(4)(d)(iii). Maternity and Newborn Services (EHB) (Cont’d) RCW 48.43.115 (3)(a) Plan must permit the attending provider, in consultation with the mother, to make decisions on the length of inpatient stay. These decisions must be based on accepted medical practice. RCW 48.43.115 (3)(b) Plan may not deny covered, eligible services for inpatient, postdelivery care to a mother and her newly born child after a vaginal delivery or a cesarean section delivery that is ordered by the attending provider in consultation with the mother. RCW 48.43.115 (3)(c) At the time of discharge, determination of the type and location of follow-up care must be made by the attending provider in consultation with the mother rather than by contract or agreement between the hospital and the insurer. These decisions must be based on accepted medical practice.
cl-forms-19-hcsc-sg-analyst-checklist.docx