Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-500 - Medical definitions › Section 182-500-0030 - Definitions-E

Current through Register Vol. 24-14, July 15, 2024
"Early and periodic screening, diagnosis and treatment
				  (EPSDT)"
is a comprehensive child health program that entitles infants,
				  children, and youth to preventive care and treatment services. EPSDT is
				  available to people age twenty and younger who are eligible for any agency
				  health care program. Access and services for EPSDT are governed by federal
				  rules at 42 C.F.R., Part 441, Subpart B. See chapter 182-534 WAC.
"Early elective delivery"
means any nonmedically
				  necessary induction or cesarean section before thirty-nine weeks of gestation.
				  Thirty-nine weeks of gestation is greater than thirty-eight weeks and six
				  days.
"Electronic signature"
means a signature in
				  electronic form attached to or associated with an electronic record including,
				  but not limited to, a digital signature.
"Emergency medical condition"
means the sudden
				  onset of a medical condition (including labor and delivery) manifesting itself
				  by acute symptoms of sufficient severity (including severe pain) such that the
				  absence of immediate medical attention could reasonably be expected to result
				  in:
(a) Placing the patient's health in serious jeopardy;
(b) Serious impairment to bodily functions; or
(c) Serious dysfunction of any bodily organ or part.
"Employer-sponsored dependent coverage"
means
				  creditable health coverage for dependents offered by a family member's employer
				  or union, for which the employer or union may contribute in whole or in part
				  towards the premium. Extensions of such coverage (e.g., COBRA extensions) also
				  qualify as employer-sponsored dependent coverage as long as there remains a
				  contribution toward the premiums by the employer or union.
"Evidence-based medicine (EBM)"
means the
				  application of a set of principles and a method for the review of well-designed
				  studies and objective clinical data to determine the level of evidence that
				  proves to the greatest extent possible, that a health care service is safe,
				  effective, and beneficial when making:
(a) Population-based health care coverage policies (WAC
				  182-501-0055
				  describes how the agency or its designee determines coverage of services for
				  its health care programs by using evidence and criteria based on health
				  technology assessments); and
(b) Individual medical necessity decisions (WAC
				  182-501-0165
				  describes how the agency or its designee uses the best evidence available to
				  determine if a service is medically necessary as defined in WAC 182-500-0030
				  ).
"Exception to rule."
See WAC
				  182-501-0160
				  for exceptions to noncovered health care services, supplies, and equipment. See
				  WAC
				  182-503-0090
				  for exceptions to program eligibility.
"Expedited prior authorization (EPA)"
means the
				  process for obtaining authorization for selected health care services in which
				  providers use a set of numeric codes to indicate to the agency or the agency's
				  designee which acceptable indications, conditions, or agency or agency's
				  designee-defined criteria are applicable to a particular request for
				  authorization. EPA is a form of "prior authorization."
"Extended care services"
means nursing and
				  rehabilitative care in a skilled nursing facility provided to a recently
				  hospitalized medicare patient.
11-14-075, recodified as §
											182-500-0030, filed 6/30/11,
					 effective 7/1/11. Statutory Authority:
					 RCW
					 74.08.090 and 2011 1st sp.s. c 15. 11-14-053,
					 § 388-500-0030, filed 6/29/11, effective
					 7/30/11.