Section 284-43B-015 - Coverage of emergency services(1) Coverage of emergency services is governed by RCW 48.43.093. Emergency services, as defined in RCW 48.43.005, include services provided after an en-rollee is stabilized and as part of outpatient observation or an inpa-tient or outpatient stay with respect to the visit during which screening and stabilization services have been furnished. Poststabili-zation services relate to medical, mental health or substance use disorder treatment necessary in the short term to avoid placing the health of the individual, or with respect to a pregnant person, the health of a person or their unborn child, in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.(2) A carrier may require notification of stabilization or inpa-tient admission of an enrollee as provided in RCW 48.43.093. Regardless of such notification, payment and cost-sharing for poststabiliza-tion services provided by a nonparticipating facility, provider or behavioral health emergency services provider and dispute resolution related to those services are governed by RCW 48.49.040 and 48.49.160.Wash. Admin. Code § 284-43B-015
Adopted by WSR 23-01-110, Filed 12/19/2022, effective 1/19/2023