General News
Published December 7, 2020
Starting January 1, 2021, the “No Wrong Door” Inpatient Treatment Accessibility Act goes into effect in Washington state. The law will remove important health coverage barriers to care for some of your clients who may need detoxification and substance use disorder (SUD) treatment services.
Here are key things you should know about the new law:
- The law applies to members on fully insured group, individual, School Employees Benefits Board (SEBB), and Public Employees Benefits Board (PEBB) plans purchased in Washington and for care provided in Washington, with the exception of certain student-only plans. It does not apply to your clients on a self-funded plan, nor if care is provided outside of Washington.
- Treatment facilities and providers can admit patients for detoxification, SUD residential treatment, and SUD inpatient rehabilitation without prior authorization, which cannot be required by health plans. Health plans are required to provide coverage for residential detoxification for three calendar days, and for SUD residential treatment and SUD inpatient rehabilitation for two business days, prior to conducting a utilization or medical necessity review.
- After receiving a provider’s assessment and plan, Premera will complete the medical necessity review within one business day. If your client’s plan includes transition to a different facility or lower level of care, we’re required to pay the provider until the seamless transfer to the different facility or lower level of care is complete.
- Out-of-network providers can’t balance bill Premera members. Out-of-network providers will be paid no more than the rate that would have been paid if they were in-network.
To learn more about all the provisions of the law, HB 2642 is available on the Washington state legislature website.
If your client wants to know if they’ll be covered by this law, they can sign in to their online account or call the customer service number on the back of their member card.