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296-20-025  <<  296-20-02700 >>   296-20-02701

What is a medical coverage decision?

A medical coverage decision is a general policy decision by the director or the director's designee to include or exclude a specific health care service or supply as a covered benefit. These decisions are made to insure quality of care and prompt treatment of workers. Medical coverage decisions include, but are not limited to, decisions on health care services and supplies rendered for the purpose of diagnosis, treatment or prognosis, such as:
• Ancillary services including, but not limited to, home health care services, ambulatory services, specific rehabilitative modalities;
• Devices;
• Diagnostic tests;
• Drugs, biologics, and other therapeutic modalities;
• Durable medical equipment;
• Procedures;
• Prognostic tests; and
• Supplies.
[Statutory Authority: RCW 51.04.020 and 51.04.030. WSR 00-01-037, § 296-20-02700, filed 12/7/99, effective 1/8/00.]