• Performs services under full-time supervision of a physician or registered nurse • Provides services, for a fee, to persons receiving substance use disorder treatment, including room and board, as well as 24-hour nursing Therapeutic alternative A therapeutic alternative is a drug that is not chemically identical to a nonpreferred drug but has similar effects when given in therapeutically equivalent doses. Therapeutic equivalent A therapeutic equivalent is a drug that is chemically identical to a nonpreferred drug and is expected to have the same effectiveness and toxicity when given in the same doses. Therapeutic interchange Therapeutic interchange is when a pharmacist, with the endorsing provider’s permission (see page 101), substitutes a nonpreferred prescription drug with a preferred drug that is a therapeutic alternative or equivalent. Tobacco cessation services Tobacco cessation services are provided for quitting tobacco use through counseling and nicotine replacement therapy products. Unicompartmental Unicompartmental refers to a diagnosis or procedure affecting only one part, or “component,” of a joint (e.g. knee) as opposed to more than one part of a joint. Uniform Medical Plan Consumer-directed Health Plan (UMP CDHP) Uniform Medical Plan Consumer-directed Health Plan (UMP CDHP) is a self-insured PPO health plan offered through the PEBB Program and managed by HCA. VSP Choice network provider, vision VSP Choice network provider, vision means an optometrist or ophthalmologist licensed and otherwise qualified to practice vision care and/or provide vision care materials who has contracted with VSP to provide vision care services and/or vision care materials to members. This plan’s provider network is VSP Choice. Disclosures If you need this document in another format or if you need information about how to file a discrimination complaint, read the UMP nondiscrimination and language assistance notice by visiting hca.wa.gov/ump- nondiscrimination. Advice24, Ardon Health, CoverMyMeds, Moda Health, Postal Prescription Services (PPS), Costco Mail- Order Pharmacy, Washington State Rx Services (WSRxS), Premera Blue Cross, and SmartHealth do not provide Blue Cross Blue Shield services and are separate companies solely responsible for their products.VSP is a separate company that provides vision services. 192 2024 UMP CDHP (PEBB) Certificate of Coverage