The UM Process Will Be Impacted - Washington State Local Health Insurance - CHPW

The UM Process Will Be Impacted

Effective January 1st, 2021 Washington State updated guidelines to House bill 2642- No Wrong Door Initiative.  House bill 2642 was created to remove health coverage barriers for accessing substance use disorder treatment services.  Utilization management process for substance use disorder service is impacted by these updates.

The following levels of care are impacted by the utilization changes of substance use disorder treatment (SUD). No Prior authorization is needed for the following levels of care.

Levels of care impacted:

  • Withdrawal Management: ASAM level 3.2 & 3.7
  • Residential Substance Use Disorder Treatment: ASAM levels 3.1, 3.3 &3.5
  • Inpatient Substance Use Disorder Treatment: ASAM Level: 3.7

The initial utilization review for admission into services will be determined by the SUD treating provider.  CHPW will cover no less than two business days, in a behavioral health agency that provides inpatient or residential substance use disorder treatment prior to conducting a utilization review.  CHPW will provide coverage for no less than three calendar days in a behavioral health agency that provides withdrawal management at inpatient or residential prior to conducting a utilization review.

What Happens if Criteria is Not Met?

A Partial or Full adverse determination (denial) may be issued. A denial will be communicated to the provider within 24 hours of the determination.

No Wrong door was implemented to help patients get into treatment with ease.  We are here to help them get to through right door for care!

For any questions regarding these changes, please email CHPW UM –  [email protected]

Form to submit notification and clinicals Substance Use Disorder Service Request Form

For More Information:

2020 Legislation       HB2642  RCW 71.24.618

 

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