SENATE BILL REPORT

HB 1085

BYRepresentatives Ferguson, Dellwo, Day, Heavey, May, Haugen, D. Sommers, Brough, Winsley, Nelson, Beck, R. Meyers, Moyer, Van Luven, Doty, Betrozoff, Sayan, Chandler, Miller, Silver, Rector, Holland, Walker, Rasmussen, Valle and Anderson

Providing insurance coverage for neurodevelopmental therapy.

House Committe on Financial Institutions & Insurance

Senate Committee on Financial Institutions & Insurance

Senate Hearing Date(s):March 21, 1989; March 23, 1989

Majority Report:  Do pass as amended.

      Signed by Senators von Reichbauer, Chairman; Johnson, Vice Chairman; McMullen, Moore, Rasmussen, Smitherman.

Senate Staff:Walt Corneille (786-7416)

                  March 23, 1989

AS REPORTED BY COMMITTEE ON FINANCIAL INSTITUTIONS & INSURANCE, MARCH 23, 1989

BACKGROUND:

Health insurance policies, health care contracts, and health maintenance agreements commonly provide coverage for rehabilitative care or treatment.  Such treatment attempts to restore a person to the level of functioning which existed before a disabling injury or disease.  Less common and often unavailable is coverage for habilitative care or treatment.  Such treatment attempts to create functioning where none has existed.  Habilitative care or treatment is often needed by small children born with a disability.

SUMMARY:

Employer-sponsored group health care contracts, policies, and agreements including any health plan offered to state employees, must provide coverage for neurodevelopmental therapies for covered individuals age 6 and under.

Benefits for neurodevelopmental therapies are payable only if the covered services are referred and periodically reviewed or provided by a licensed physician or osteopath.  A health care service contractor may require that covered services be delivered by a participating provider unless there is none available.

Coverage may be limited to treatment medically necessary and necessary to prevent deterioration of a physical condition.  Coverage must include treatment to restore and improve function.

Insurers, health care service contractors, health maintenance organizations, and the administrator of the Washington State Health Care Authority retain freedom to design neurodevelopmental coverage to include deductibles, coinsurance, and benefit utilization restrictions.

Appropriation:    none

Revenue:    none

Fiscal Note:      requested February 16, 1989

SUMMARY OF PROPOSED SENATE AMENDMENT:

A minor spelling error is corrected.

Senate Committee - Testified: PRO:  Representative Roy A. Ferguson; Judith Moore, EDCAW; Tami Waritz, self; Luci Phillips, SHCC; Mel Sorensen, Washington Physicians