Women’s WAC Plan may not impose cost-sharing for directly accessed women's health Direct care services that is not required for access to primary care providers. Access (Cont’d) RCW 48.43.041; State Maternity services must include diagnosis of pregnancy, prenatal care, WAC benefit delivery, care for complications of pregnancy, physician services, and requirement hospital services for RCW 48.43.115 Must provide newborn coverage that is not less than the postnatal Maternity (3)(f); WAC coverage for the mother, for no less than three weeks; and and Newborn Services RCW 48.46.375; Prenatal diagnosis of congenital disorders by screening/diagnostic WAC procedures if medically necessary. RCW 48.43.115 Plan must permit the attending provider, in consultation with the (3)(a) mother, to make decisions on the length of inpatient stay. decisions must be based on accepted medical practice. RCW 48.43.115 Plan may not deny covered, eligible services for inpatient, postdelivery (3)(b) 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 State consultation with the mother. benefit RCW At the time of discharge, determination of the type and location of requirement 48.43.115(3) follow-up care must be made by the attending provider in consultation for (c) with the mother rather than by contract or agreement between the Maternity hospital and the insurer. These decisions must be based on accepted and medical practice. Newborn RCW Plan may not deny covered, eligible services for follow-up care, including Services 48.43.115(3) in-person care, as ordered by the attending provider in consultation with
Women’s Direct Access (Cont’d) WAC Plan may not impose cost-sharing for directly accessed women's health care services that is not required for access to primary care providers. State benefit requirement for Maternity and Newborn Services State benefit requirement for Maternity and Newborn Services RCW 48.43.041; WAC Maternity services must include diagnosis of pregnancy, prenatal care, delivery, care for complications of pregnancy, physician services, and hospital services RCW 48.43.115 (3)(f); WAC Must provide newborn coverage that is not less than the postnatal coverage for the mother, for no less than three weeks; and RCW 48.46.375; WAC Prenatal diagnosis of congenital disorders by screening/diagnostic procedures if medically necessary. 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. 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. RCW 48.43.115(3) Plan may not deny covered, eligible services for follow-up care, including in-person care, as ordered by the attending provider in consultation with
checklist-forms-2018-hmo-individual-analyst-checklist.docx