Use Disorder (Cont’d) 6 Classifications: Inpatient, in-network; inpatient, out-of-network; WAC (MH/SUD) outpatient, in-network; outpatient, out-of-network; emergency Services, care; and prescription Outpatient services may be &(6)(a)(i)(ii) Including subclassified into office visits and all other outpatient items and Behavioral services. Health In determining the classification in which a particular benefit WAC Treatment belongs, a plan must apply the same standards to (EHB) medical/surgical benefits as applied to MH/SUD benefits. An (Cont’d) issuer must assign covered intermediate MH/SUD benefits such as residential treatment, partial hospitalization, and intensive outpatient treatment, to the existing six classifications in the same way that they assign comparable intermediate medical/surgical benefits to these classifications. For example, if a health plan classifies medical care in skilled nursing facilities as inpatient benefits, then it must also treat covered mental health care in residential treatment facilities as inpatient benefits. If a health plan or issuer treats home health care as an outpatient benefit, then any covered intensive outpatient mental health or substance use disorder services and partial hospitalization must be considered outpatient benefits as well. Medical/surgical benefits and mental health or substance use WAC disorder benefits cannot be categorized as being offered outside of these six classifications and therefore not subject to the parity analysis. A health plan or issuer must treat the least restrictive level of the financial requirement or quantitative treatment limitation that applies to at least two-thirds of medical/surgical benefits across all provider tiers in a classification as the predominant level that it may
(Cont’d) Use Disorder (MH/SUD) Services, Including Behavioral WAC &(6)(a)(i)(ii) 6 Classifications: Inpatient, in-network; inpatient, out-of-network; outpatient, in-network; outpatient, out-of-network; emergency care; and prescription Outpatient services may be subclassified into office visits and all other outpatient items and services. Health Treatment (EHB) (Cont’d) WAC In determining the classification in which a particular benefit belongs, a plan must apply the same standards to medical/surgical benefits as applied to MH/SUD benefits. An issuer must assign covered intermediate MH/SUD benefits such as residential treatment, partial hospitalization, and intensive outpatient treatment, to the existing six classifications in the same way that they assign comparable intermediate medical/surgical benefits to these classifications. For example, if a health plan classifies medical care in skilled nursing facilities as inpatient benefits, then it must also treat covered mental health care in residential treatment facilities as inpatient benefits. If a health plan or issuer treats home health care as an outpatient benefit, then any covered intensive outpatient mental health or substance use disorder services and partial hospitalization must be considered outpatient benefits as well. WAC Medical/surgical benefits and mental health or substance use disorder benefits cannot be categorized as being offered outside of these six classifications and therefore not subject to the parity analysis. A health plan or issuer must treat the least restrictive level of the financial requirement or quantitative treatment limitation that applies to at least two-thirds of medical/surgical benefits across all provider tiers in a classification as the predominant level that it may
cl-forms-19-disability-sg-analyst-checklist.docx