S-4325               _______________________________________________

                                         SUBSTITUTE SENATE BILL NO. 4531

                        _______________________________________________

State of Washington                              49th Legislature                              1986 Regular Session

By Senate Committee on Financial Institutions (originally sponsored by Senators Talmadge, Newhouse, Bender, Lee, Rinehart, McManus, Bauer and Conner)

Read first time 1/31/86.

AN ACT Relating to insurance for mental health services; amending RCW 48.21.240, 48.44.340, and 48.46.290; creating a new section; and providing an effective date.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION. Sec. 1.     It is the intent of the legislature that all insurers, health care service contractors, and health maintenance organizations that provide health care coverage in the state shall offer the option of including mental health treatment in their health benefit plans.  Further it is the intent of the legislature that all mental health care benefit plans shall provide reimbursement for mental health treatment by every type of provider listed as follows:  Physicians licensed under chapter 18.71 or 18.57 RCW, psychologists licensed under chapter 18.83 RCW, and community mental health agencies licensed under chapter 71.24 RCW.

        Sec. 2.  Section 1, chapter 35, Laws of 1983 and RCW 48.21.240 are each amended to read as follows:

          (1) Each group insurer providing disability insurance coverage in this state for hospital or medical care under contracts which ((is)) are issued, delivered, or renewed in this state on or after July 1, ((1983)) 1986, shall offer optional supplemental coverage for mental health treatment for the insured and the insured's covered dependents.

(2) Treatment shall be covered ((under the optional supplemental coverage if)) for mental health benefits whether treatment is rendered by:  (a) A physician licensed under chapter 18.71 or 18.57 RCW; (b) a psychologist licensed under chapter 18.83 RCW; or (c) a community mental health agency licensed by the department of social and health services pursuant to chapter 71.24 RCW.  The treatment shall be covered at the usual and customary rates for such treatment.  However, the treatment may be subject to contract provisions with respect to reasonable deductible amounts or copayments.  In order to qualify for coverage under this section, a licensed community mental health agency shall have in effect a plan for quality assurance and peer review, and the treatment shall be supervised by a physician licensed under chapter 18.71 or 18.57 RCW or by a psychologist licensed under chapter 18.83 RCW.

          (((2))) (3) The group disability insurance contract may provide that all the coverage for mental health treatment is waived for all covered members if the contract holder so states in advance in writing to the insurer.

        Sec. 3.  Section 2, chapter 35, Laws of 1983 and RCW 48.44.340 are each amended to read as follows:

          (1) Each health care service contractor providing hospital or medical services or benefits in this state under group contracts for health care services under this chapter which ((is)) are issued, delivered, or renewed in this state on or after July 1, ((1983)) 1986, shall offer optional supplemental coverage for mental health treatment for the insured and the insured's covered dependents.

(2) Treatment shall be covered ((under the optional supplemental coverage if)) for mental health benefits whether treatment is rendered by:  (a) A physician licensed under chapter 18.71 or 18.57 RCW; (b) a psychologist licensed under chapter 18.83 RCW; or (c) a community mental health agency licensed by the department of social and health services pursuant to chapter 71.24 RCW.  The treatment shall be covered at the usual and customary rates for such treatment.  However, the treatment may be subject to contract provisions with respect to reasonable deductible amounts or copayments.  In order to qualify for coverage under this section, a licensed community mental health agency shall have in effect a plan for quality assurance and peer review, and the treatment shall be supervised by a physician licensed under chapter 18.71 or 18.57 RCW or by a psychologist licensed under chapter 18.83 RCW.

          (((2))) (3) The group contract for health care services may provide that all the coverage for mental health treatment is waived for all covered members if the contract holder so states in advance in writing to the health care service contractor.

        Sec. 4.  Section 3, chapter 35, Laws of 1983 and RCW 48.46.290 are each amended to read as follows:

          (1) Each health maintenance organization providing services or benefits for hospital or medical care coverage in this state under group health maintenance agreements which ((is)) are issued, delivered, or renewed in this state on or after July 1, ((1983)) 1986, shall offer optional supplemental coverage for mental health treatment to the enrolled participant and the enrolled participant's covered dependents.

(2) Treatment shall be covered ((under the optional supplemental coverage if)) for mental health benefits whether treatment is rendered by the health maintenance organization or ((if)) the health maintenance organization refers the enrolled participant or the enrolled participant's covered dependents for treatment to:  (a) A physician licensed under chapter 18.71 or 18.57 RCW; (b) a psychologist licensed under chapter 18.83 RCW; or (c) a community mental health agency licensed by the department of social and health services pursuant to chapter 71.24 RCW.  The treatment shall be covered at the usual and customary rates for such treatment.  However, the treatment may be subject to contract provisions with respect to reasonable deductible amounts or copayments.  In order to qualify for coverage under this section, a licensed community mental health agency shall have in effect a plan for quality assurance and peer review, and the treatment shall be supervised by a physician licensed under chapter 18.71 or 18.57 RCW or by a psychologist licensed under chapter 18.83 RCW.

          (((2))) (3) The group health maintenance agreement may provide that all the coverage for mental health treatment is waived for all covered members if the contract holder so states in advance in writing to the health maintenance organization.

NEW SECTION. Sec. 5.     This act shall take effect July 1, 1986.

NEW SECTION. Sec. 6.     If any provision of this act or its application to any person or circumstance is held invalid, the remainder of the act or the application of the provision to other persons or circumstances is not affected.