WAC Within thirty days of receiving a request, an issuer must furnish its medical necessity criteria for any or all essential health benefit categories to an enrollee or provider. Medical Requirements Necessity of Medical (Cont’d) Necessity Determination Process (Cont’d) Mental Health Requirement 42 USC §18021 Plan must cover "mental health and substance use disorder services, and Substance for MH/SUD (a)(1)(B); including behavioral health treatment" substantially equal to the base Use Disorder Coverage 42 USC benchmark plan. For determining a plan's actuarial value, an issuer (MH/SUD) (b)(1)(E); WAC must classify as mental health and substance use disorder services, Services, 284-43-5642(5) including behavioral health treatment, medically necessary care, Including treatment and services for mental health conditions and substance use disorders categorized in the most recent version of the Behavioral Diagnostic Health and Statistical Manual of Mental Disorders (DSM), including behavioral Treatment health treatment for those conditions. (EHB) Required Plan must include the following services, which are specifically Services covered by the base benchmark plan, and classify them as mental health and substance use disorder services, including behavioral WAC health treatment:
Medical Necessity (Cont’d) Requirements of Medical Necessity Determination Process (Cont’d) WAC Within thirty days of receiving a request, an issuer must furnish its medical necessity criteria for any or all essential health benefit categories to an enrollee or provider. Mental Health and Substance Use Disorder (MH/SUD) Services, Including Behavioral Health Treatment (EHB) Requirement for MH/SUD Coverage 42 USC §18021 (a)(1)(B); 42 USC (b)(1)(E); WAC 284-43-5642(5) Plan must cover "mental health and substance use disorder services, including behavioral health treatment" substantially equal to the base benchmark plan. For determining a plan's actuarial value, an issuer must classify as mental health and substance use disorder services, including behavioral health treatment, medically necessary care, treatment and services for mental health conditions and substance use disorders categorized in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM), including behavioral health treatment for those conditions. Required Services WAC Plan must include the following services, which are specifically covered by the base benchmark plan, and classify them as mental health and substance use disorder services, including behavioral health treatment:
cl-forms-19-hcsc-sg-analyst-checklist.docx