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WAC 284-53-005

Agency filings affecting this section

Definitions.

(1) "Approved treatment program" means a discrete program of chemical dependency treatment provided by a treatment program certified by the department of social and health services as meeting standards adopted under chapter 70.96A RCW.
(2) "Chemical dependency" means the illness as defined in RCW 48.21.195.
(3) "Chemical dependency professional" means a person certified as a chemical dependency professional by the Washington state department of health under chapter 18.205 RCW.
(4) "Cost sharing" includes deductibles, copayments, coinsurance and out-of-pocket expenses.
(5) "Emergency medical condition" means the condition as defined in RCW 48.43.005.
(6) "Medically necessary" or "medical necessity," with respect to chemical dependency coverage is defined by the American Society of Addiction Medicine patient placement criteria. "Patient placement criteria" means the admission, continued service, and discharge criteria set forth in the most recent version of the Patient Placement Criteria for the Treatment of Substance Abuse-Related Disorders as published by the American Society of Addiction Medicine.
(7) "Substance use disorder" as used in P.L. 110-343 (October 3, 2008) as currently enacted or hereafter amended (short title: The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008) includes those conditions meeting the definition of chemical dependency in RCW 48.21.195, 48.44.245, and 48.46.355.
(8) "Treatment limitation" includes limits on the frequency of treatment, number of visits, days of coverage, waiting periods, or other similar limits on the scope or duration of treatment.
[Statutory Authority: RCW 48.02.060, 48.21.197, and Mental Health Parity and Addiction Equity Act of 2008, Pub. L No 110-343 (Oct. 3, 2008). WSR 09-15-023 (Matter No. R 2008-27), § 284-53-005, filed 7/7/09, effective 8/7/09. Statutory Authority: RCW 48.02.060, 48.21.197, 48.44.050, and 48.46.200. WSR 04-22-051 (Matter No. R 2003-08), § 284-53-005, filed 10/28/04, effective 11/28/04. Statutory Authority: RCW 48.02.060, 48.44.050, 48.46.200, 48.21.160, 48.21.180, 48.21.197, 48.44.240 and 48.46.350. WSR 99-16-005 (Matter No. R 97-8), § 284-53-005, filed 7/22/99, effective 8/22/99.]