RCW The requested facility has all applicable licenses and certifications, 48.43.125 and is not under a stop placement order that prevents the person's (1)(b) readmission; RCW The requested facility agrees to accept payment from the carrier for 48.43.125 covered services at the rate paid to similar facilities that otherwise (1)(c) contract with the carrier to provide such services; and RCW The requested facility, with regard to the following, agrees to by 48.43.125 the standards, terms, and conditions required by the carrier of similar (1)(d) facilities with which the carrier otherwise contracts: (i) Utilization review, quality assurance, and peer review; and (ii) management and Hospitalization administrative procedures, including data and financial reporting that (EHB) may be required by the carrier. (Cont’d) Laboratory 42 USC Required §18021 Plan must cover "laboratory services" in a manner substantially equal to the Services (EHB) Laboratory (a)(1)(B) base-benchmark plan. For purposes of determining actuarial value, an 42 USC Services 18022 issuer must classify as laboratory services the medically necessary (b)(1)(H); WAC laboratory services and testing, including those performed by a licensed 284-43-5642(8) provider to determine differential diagnoses, conditions, outcomes and treatment, and including blood and blood services, storage and procurement, and ultrasound, X ray, MRI, CAT scan and PET scans.
Hospitalization (EHB) (Cont’d) 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 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. Laboratory Services (EHB) Required Laboratory Services 42 USC §18021 (a)(1)(B) 42 USC 18022 (b)(1)(H); WAC 284-43-5642(8) Plan must cover "laboratory services" in a manner substantially equal to the base-benchmark plan. For purposes of determining actuarial value, an issuer must classify as laboratory services the medically necessary laboratory services and testing, including those performed by a licensed provider to determine differential diagnoses, conditions, outcomes and treatment, and including blood and blood services, storage and procurement, and ultrasound, X ray, MRI, CAT scan and PET scans.
checklist-forms-2018-hmo-individual-analyst-checklist.docx