identification of disease or illness of value to specific populations, such as women, children and seniors. WAC Requirements If the plan does not have in its a provider who can for Preventive perform the particular service, then the plan must cover the (9)(a); and Wellness WAC item or service when performed by an out-of-network provider Services and must not impose cost-sharing with respect to the item or service. WAC Plan must not limit sex-specific recommended preventive services based on an individual's sex assigned at birth, gender (9)(a) identity or recorded gender. If a provider determines that a recommended preventive service is medically appropriate for an individual, and the individual otherwise Requirements satisfies the coverage requirements, the plan must provide for Preventive coverage without cost-sharing. and Wellness WAC Plan must include the following services as preventive and Services wellness services, including chronic disease management: (Cont’d) Immunizations recommended by the Centers for Disease Control's Advisory Committee on Immunization Practices; WAC Screening and tests for which the U.S. Preventive Services Task Force for Prevention and Chronic Care have issued A (9)(b)(ii)(A) and B recommendations on or before the applicable plan year; WAC To the extent not specified in a recommendation or guideline, a plan may rely on the relevant evidence base (9)(b)(ii)(B) and reasonable medical management techniques, based on necessity or appropriateness, to determine the frequency, method, treatment, or setting for the provision of a recommended preventive health service;
identification of disease or illness of value to specific populations, such as women, children and seniors. Requirements for Preventive and Wellness Services Requirements for Preventive and Wellness Services (Cont’d) WAC (9)(a); WAC If the plan does not have in its a provider who can perform the particular service, then the plan must cover the item or service when performed by an out-of-network provider and must not impose cost-sharing with respect to the item or service. WAC (9)(a) Plan must not limit sex-specific recommended preventive services based on an individual's sex assigned at birth, gender identity or recorded gender. If a provider determines that a recommended preventive service is medically appropriate for an individual, and the individual otherwise satisfies the coverage requirements, the plan must provide coverage without cost-sharing. WAC Plan must include the following services as preventive and wellness services, including chronic disease management: Immunizations recommended by the Centers for Disease Control's Advisory Committee on Immunization Practices; WAC (9)(b)(ii)(A) Screening and tests for which the U.S. Preventive Services Task Force for Prevention and Chronic Care have issued A and B recommendations on or before the applicable plan year; WAC (9)(b)(ii)(B) To the extent not specified in a recommendation or guideline, a plan may rely on the relevant evidence base and reasonable medical management techniques, based on necessity or appropriateness, to determine the frequency, method, treatment, or setting for the provision of a recommended preventive health service;
checklist-forms-2018-disability-individual-analyst-checklist.docx