evidence of the type usually considered and relied upon in making determinations of cost-effectiveness or clinical efficacy. However, health plans must not contain unreasonable limits. WAC may use restricted networks. 270(4) WAC Plans that use “gatekeepers” or “Medical Homes” for access to specialists may use them for access to specified categories of providers. No Separate WAC Issuers may not coverage for services by certain categories of Benefit providers solely as a separately-priced optional benefit (e.g., chiropractic care; acupuncture). Services by 48.21.130; Contract must cover services performed by a Registered Nurse, RNs, ARNPs 48.21.141; Advanced Registered Nurse Practitioner, or podiatrist if: and the service is within the scope of the provider’s license, and Podiatrists The contract would have covered the service if it had been performed by a physician licensed under Chapter 18.71 RCW. 48.43.190 Plan must cover chiropractic care on the same basis as other care. Every Category Coverage of RCW 48.21.142 Benefits cannot be denied for any service performed by a of Provider Chiropractic chiropractor if the service was within the lawful scope of that license (Cont’d) Care and the contract would have provided benefits if the service had been performed by a physician licensed under Chapter 18.57 or 18.71 RCW. WAC Must provide direct access to a chiropractor without a referral for covered chiropractic benefits, but can restrict this to in-network chiropractors. Denturist if RCW 48.21.148; If plan offers dental coverage, Denturist must be able to provide Dental 48.43.180 services within the of their license if the plan would provide the Covered same benefits performed by a dentist.
evidence of the type usually considered and relied upon in making determinations of cost-effectiveness or clinical efficacy. However, health plans must not contain unreasonable limits. WAC 270(4) may use restricted networks. WAC Plans that use “gatekeepers” or “Medical Homes” for access to specialists may use them for access to specified categories of providers. No Separate Benefit WAC Issuers may not coverage for services by certain categories of providers solely as a separately-priced optional benefit (e.g., chiropractic care; acupuncture). Services by RNs, ARNPs 48.21.130; 48.21.141; Contract must cover services performed by a Registered Nurse, Advanced Registered Nurse Practitioner, or podiatrist if: and the service is within the scope of the provider’s license, and Podiatrists The contract would have covered the service if it had been performed by a physician licensed under Chapter 18.71 RCW. 48.43.190 Plan must cover chiropractic care on the same basis as other care. Every Category of Provider (Cont’d) Coverage of Chiropractic Care RCW 48.21.142 Benefits cannot be denied for any service performed by a chiropractor if the service was within the lawful scope of that license and the contract would have provided benefits if the service had been performed by a physician licensed under Chapter 18.57 or 18.71 RCW. WAC Must provide direct access to a chiropractor without a referral for covered chiropractic benefits, but can restrict this to in-network chiropractors. Denturist if Dental Covered RCW 48.21.148; 48.43.180 If plan offers dental coverage, Denturist must be able to provide services within the of their license if the plan would provide the same benefits performed by a dentist.
checklist-forms-2018-disability-sg-analyst-checklist.docx