exams required to stabilize a patient experiencing an emergency medical condition; WAC Prescription medications associated with an emergency medical condition, including those purchased in a foreign country. WAC Plan may not specifically exclude any services classified to the emergency medical services category or establish visit limitations (2)(b, c, & d) on services in the emergency medical services category. Emergency Required RCW 48.43.093 Plan must include the services necessary to screen and stabilize a Medical Emergency covered person, classified to the emergency medical services Services (EHB) Services category. (Cont’d) WAC If plan restricts treatment to services by in-network providers, must include a reasonable provision to emergency treatment consistent with the scope of the benefits regularly provided by the contract. Enrollees must have access to emergency services twenty-four hours WAC per day, seven days per week. Definition of 42 U.S.C. Plan’s definition of "Emergency services" must be consistent with “Emergency §300gg-19a (b) RCW 48.43.005(14), which states: Services” (2)(B); RCW “’Emergency Services’ means a medical screening examination, as 48.43.005 (14) required under section 1867 of the social security act (42 U.S.C. 1395dd), that is within the capability of the emergency department of a hospital, including ancillary services routinely available to the emergency department to evaluate that emergency medical condition, and further medical examination and treatment, to the extent they are within the capabilities of the staff and facilities available at the hospital, as are required under section 1867 of the social security act (42 U.S.C. 1395dd) to stabilize the patient.
exams required to stabilize a patient experiencing an emergency medical condition; WAC Prescription medications associated with an emergency medical condition, including those purchased in a foreign country. WAC (2)(b, c, & d) Plan may not specifically exclude any services classified to the emergency medical services category or establish visit limitations on services in the emergency medical services category. Emergency Medical Services (EHB) Required Emergency Services (Cont’d) RCW 48.43.093 Plan must include the services necessary to screen and stabilize a covered person, classified to the emergency medical services category. WAC If plan restricts treatment to services by in-network providers, must include a reasonable provision to emergency treatment consistent with the scope of the benefits regularly provided by the contract. WAC Enrollees must have access to emergency services twenty-four hours per day, seven days per week. Definition of “Emergency Services” 42 U.S.C. §300gg-19a (b) (2)(B); RCW 48.43.005 (14) Plan’s definition of "Emergency services" must be consistent with RCW 48.43.005(14), which states: “’Emergency Services’ means a medical screening examination, as required under section 1867 of the social security act (42 U.S.C. 1395dd), that is within the capability of the emergency department of a hospital, including ancillary services routinely available to the emergency department to evaluate that emergency medical condition, and further medical examination and treatment, to the extent they are within the capabilities of the staff and facilities available at the hospital, as are required under section 1867 of the social security act (42 U.S.C. 1395dd) to stabilize the patient.
cl-forms-19-disability-sg-analyst-checklist.docx