WAC Issuers must not exclude any category or providers licensed by the State of Washington who provide health care services or care within the scope of their practice for services covered as essential health benefits. American WAC Issuer must maintain arrangements that ensure that American Indians/ Indians/Alaska Natives who are enrollees have access to covered Alaska medical and behavioral health services provided by Indian health care Natives providers. Allowable RCW 48.43.045 Providers can be required to conform with carrier standards for cost - Limits (1)(a)(ii) Containment, administrative procedures, and provision of clinically effective services. WAC Issuers may place reasonable limits on specific services rendered by specific categories of providers based on relevant information or 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. Every Category of WAC Plans may use restricted networks. Provider 270(4) “gatekeepers” “Medical (Cont’d) WAC 284-170- Plans that use or Homes” for access to 270(4)(a) specialists may use them for access to specified categories of providers. No Separate WAC 284-170 Issuers may not offer coverage for services by certain categories of Benefit 270(5) providers solely as a separately-priced optional benefit (e.g., chiropractic care; acupuncture). Coverage of RCW 48.43.190 Plan must cover chiropractic care on the same basis as other care. Chiropractic RCW Each carrier provide enrollees with direct access to the care participating chiropractor of the enrollee's choice for covered chiropractic health care without the necessity of prior referral.
WAC Issuers must not exclude any category or providers licensed by the State of Washington who provide health care services or care within the scope of their practice for services covered as essential health benefits. American Indians/ Alaska Natives WAC Issuer must maintain arrangements that ensure that American Indians/Alaska Natives who are enrollees have access to covered medical and behavioral health services provided by Indian health care providers. Allowable Limits RCW 48.43.045 (1)(a)(ii) Providers can be required to conform with carrier standards for cost - Containment, administrative procedures, and provision of clinically effective services. WAC Issuers may place reasonable limits on specific services rendered by specific categories of providers based on relevant information or 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. Every Category of Provider WAC 270(4) Plans may use restricted networks. (Cont’d) WAC 284-170- 270(4)(a) 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 284-170 270(5) Issuers may not offer coverage for services by certain categories of providers solely as a separately-priced optional benefit (e.g., chiropractic care; acupuncture). Coverage of RCW 48.43.190 Plan must cover chiropractic care on the same basis as other care. Chiropractic care RCW Each carrier provide enrollees with direct access to the participating chiropractor of the enrollee's choice for covered chiropractic health care without the necessity of prior referral.
cl-forms-19-hmo-sg-analyst-checklist.docx