beverages. It is further characterized by a frequent or intense pattern of pathological use to the extent the user exhibits a loss of self-control over the amount and circumstances of use; develops symptoms of tolerance or physiological and/or psychological withdrawal if use of the controlled substance or alcoholic beverage is reduced or discontinued; and the user's health is substantially impaired or endangered or his or her social or economic function is substantially disrupted. Any disorder defined by the plan as being or as not being a substance use disorder must be defined to be consistent with generally recognized independent standards of current medical practice (for example, the most current version of the DSM, the most current version of the ICD, or state guidelines).” Does the plan provide mental health services and prescription intended to treat any disorder RCW 48.21.241(2) Mandated covered under the definition of mental health services? Coverage If there is a MOOP or stop loss, it must be a single limit or stop loss for medical, surgical, and mental health services. Health benefit may not reduce the number of mental health outpatient visits or mental health RCW 48.21.241 (3) inpatient days below the level in effect on July 1, 2002. No preauthorization for mental health treatment rendered by a state hospital if the enrollee or RCW 48.21.242 covered dependent is involuntarily committed. Parity P.L. 110-343 Does the plan apply any financial requirement or treatment limitation to mental health or substance Wellstone / Requirement Domenici Mental use disorder benefits that is more restrictive than those applied to medical/surgical benefits? Health Parity and No separate deductible for mental health benefits. Addiction Equity Act of 2008 Does the health plan provide MH/SUD benefits in every classification in which medical/surgical (“MHPAEA”) benefits are provided? RCW 48.21.241(2) 6 Classifications: Inpatient, in-network; inpatient, out-of-network; outpatient, in-network; WAC 284-43-992 outpatient, out-of-network; emergency care; and prescription drugs. Outpatient services may be subclassified into office visits and all other outpatient items and services.
RCW 48.21.241(2) Mandated Coverage RCW 48.21.241 (3) RCW 48.21.242 beverages. It is further characterized by a frequent or intense pattern of pathological use to the extent the user exhibits a loss of self-control over the amount and circumstances of use; develops symptoms of tolerance or physiological and/or psychological withdrawal if use of the controlled substance or alcoholic beverage is reduced or discontinued; and the user's health is substantially impaired or endangered or his or her social or economic function is substantially disrupted. Any disorder defined by the plan as being or as not being a substance use disorder must be defined to be consistent with generally recognized independent standards of current medical practice (for example, the most current version of the DSM, the most current version of the ICD, or state guidelines).” Does the plan provide mental health services and prescription intended to treat any disorder covered under the definition of mental health services? If there is a MOOP or stop loss, it must be a single limit or stop loss for medical, surgical, and mental health services. Health benefit may not reduce the number of mental health outpatient visits or mental health inpatient days below the level in effect on July 1, 2002. No preauthorization for mental health treatment rendered by a state hospital if the enrollee or covered dependent is involuntarily committed. Parity Requirement P.L. 110-343 Wellstone / Domenici Mental Health Parity and Addiction Equity Act of 2008 (“MHPAEA”) RCW 48.21.241(2) WAC 284-43-992 Does the plan apply any financial requirement or treatment limitation to mental health or substance use disorder benefits that is more restrictive than those applied to medical/surgical benefits? No separate deductible for mental health benefits. Does the health plan provide MH/SUD benefits in every classification in which medical/surgical benefits are provided? 6 Classifications: Inpatient, in-network; inpatient, out-of-network; outpatient, in-network; outpatient, out-of-network; emergency care; and prescription drugs. Outpatient services may be subclassified into office visits and all other outpatient items and services.
checklist-forms-disability-large-group.docx