Hospitalization (EHB) (Cont’d) Classified to RCW ; IF a plan covers care in a long term care facility, carrier must allow the enrollee to return to the same long term care facility after hospitalization, Hospitalization as long as the following criteria are met (WAC 284-43-5642(3)(e)(iv)): Category (Cont’d) RCW 48.13.125 The person's primary care physician determines that the medical (1)(a) care needs of the person can be met at the requested facility; RCW 48.43.125 The requested facility has all applicable licenses and certifications, (1)(b) and is not under a stop placement order that prevents the person's readmission; RCW 48.43.125 The requested facility agrees to accept payment from the carrier (1)(c) for covered services at the rate paid to similar facilities that otherwise contract with the carrier to provide such services; and RCW The requested facility, with regard to the following, agrees to 48.43.125 abide by the standards, terms, and conditions required by the (1)(d) carrier of similar facilities with which the carrier otherwise contracts: (i) Utilization review, quality assurance, and peer review; and (ii) management and administrative procedures, including data and financial reporting that may be required by the carrier.
Hospitalization (EHB) (Cont’d) Classified to the Hospitalization Category RCW ; IF a plan covers care in a long term care facility, carrier must allow enrollee to return to the same long term care facility after hospitalization, as long as the following criteria are met (WAC 284-43-5642(3)(e)(iv)): (Cont’d) RCW 48.13.125 (1)(a) The person's primary care physician determines that the medical care needs of the person can be met at the requested facility; RCW 48.43.125 (1)(b) The requested facility has all applicable licenses and certifications, and is not under a stop placement order that prevents the person's readmission; RCW 48.43.125 (1)(c) The requested facility agrees to accept payment from the carrier for covered services at the rate paid to similar facilities that otherwise contract with the carrier to provide such services; and RCW 48.43.125 (1)(d) The requested facility, with regard to the following, agrees to abide by the standards, terms, and conditions required by the carrier of similar facilities with which the carrier otherwise contracts: (i) Utilization review, quality assurance, and peer review; and (ii) management and administrative procedures, including data and financial reporting that may be required by the carrier.
checklist-forms-2018-hcsc-small-group-analyst-checklist.docx