WAC 284-43-3110 (6)

January 22, 2025 12:44 am | Published by

Review of adverse determinations must be performed by health care providers or staff who were not involved in the initial decision, and who are not subordinates of the persons involved in the initial decision. If the determination involves, even in part, medical judgment, the reviewer must be or must consult with a health care professional who has appropriate training and experience in the field of medicine encompassing the appellant’s condition or disease and make a determination that is within the clinical standard of care for an appellant’s disease or condition.

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