Wac Medically Necessary

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WAC 182-500-0070: - Washington

https://apps.leg.wa.gov/wac/default.aspx?cite=182-500-0070

"Medically necessary" is a term for describing requested service which is reasonably calculated to prevent, diagnose, correct, cure, alleviate or prevent worsening of conditions in the client that endanger life, or cause suffering or pain, or result in an …

WAC 182-501-0165: - Washington

https://apps.leg.wa.gov/WAC/default.aspx?cite=182-501-0165

The process the agency uses to assess medical necessity is based on: (a) The evaluation of submitted and obtainable medical, dental, or behavioral health evidence as …

WAC 284-43-5440: - Washington

https://apps.leg.wa.gov/WAC/default.aspx?cite=284-43-5440

Medical necessity determination. (1) An issuer's certificate of coverage and the summary of coverage for the health benefit plan must specifically explain any …

WAC 182-543-0500: - Washington

https://apps.leg.wa.gov/WAC/default.aspx?cite=182-543-0500

The agency considers all of the following when establishing utilization criteria: (d) Safety. (8) The agency evaluates a request for equipment that does not meet the definition of …

WAC 182-500-0070 Definitions -- M. Managed care

https://www.hca.wa.gov/free-or-low-cost-health-care/i-help-others-apply-and-access-apple-health/wac-182-500-0070-definitions-m-managed-care-organization-mco

"Medically necessary" is a term for describing requested service which is reasonably calculated to prevent, diagnose, correct, cure, alleviate or prevent worsening of …

Allowable medical expenses | Washington State Health …

https://www.hca.wa.gov/free-or-low-cost-health-care/i-help-others-apply-and-access-apple-health/allowable-medical-expenses

In order to allow a medically necessary non covered item, we will need verification: Of the cost; Item is prescribed by an allowable practitioner and is considered …

WAC 182-531-1675: - Washington

https://apps.leg.wa.gov/waC/default.aspx?cite=182-531-1675

The agency allows a provider to use the EPA process for clients age seventeen and older for the following medically necessary procedures: (i) Bilateral mastectomy or reduction …

WAC 182-501-0070: - Washington

https://app.leg.wa.gov/WAC/default.aspx?cite=182-501-0070

Health care coverage — Noncovered services. (1) The medicaid agency or its designee does not pay for any health care service not listed or referred to as a covered health care …

WAC 182-513-1350 Defining the resource standard and …

https://www.hca.wa.gov/free-or-low-cost-health-care/i-help-others-apply-and-access-apple-health/wac-182-513-1350-defining-resource-standard-and-determining-resource-eligibility-ssi-related-long-term-care-ltc-services

WAC 182-513-1350 Defining the resource standard and determining resource eligibility for SSI-related long-term care (LTC) services. | Washington State Health Care Authority …

WAC 182-538-050 Definitions | Washington State Health …

https://www.hca.wa.gov/free-or-low-cost-health-care/i-help-others-apply-and-access-apple-health/wac-182-538-050-definitions

(B) Need for psychological, educational, medical, or related services over and above the usual for the child's age; or (C) Special ongoing treatments, such as …

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