S-3837.2  _______________________________________________

 

                         SENATE BILL 6566

          _______________________________________________

 

State of Washington      55th Legislature     1998 Regular Session

 

By Senators Thibaudeau, Kline, Fairley, Long, Wojahn and Kohl

 

Read first time 01/21/98.  Referred to Committee on Health & Long‑Term Care.

Establishing mental health parity with medical and surgical services.


    AN ACT Relating to mental health parity; adding a new section to chapter 41.05 RCW; adding a new section to chapter 48.20 RCW; adding a new section to chapter 48.21 RCW; adding a new section to chapter 48.44 RCW; adding a new section to chapter 48.46 RCW; adding a new section to chapter 48.41 RCW; adding a new section to chapter 74.09 RCW; and creating a new section.

 

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

 

    NEW SECTION.  Sec. 1.  The legislature intends to end discrimination in Washington state in the offering of insurance coverage for mental disorders by requiring that health insurers provide coverage for mental health services at parity with medical and surgical services.

    The legislature finds that mental disorders occur at an alarming rate.  National data suggests that in any given year one in ten Americans experience some disability from a mental health disorder, and one in five adult Americans will have a mental disorder during his or her lifetime that requires treatment.  The legislature also finds that the impact on the business sector is significant when national data suggests that at least sixty percent of employee absences are due to mental health disorders.

    Therefore, the legislature declares that it is no longer cost-efficient to continue to treat persons with mental disorders differently than persons with medical and surgical disorders.  The cost of our children, families, businesses, and society as a whole is too high.  Mental health disorders are treatable.  Providing insurance parity for coverage of these crucial services will save health care dollars.

 

    NEW SECTION.  Sec. 2.  A new section is added to chapter 41.05 RCW to read as follows:

    (1) For the purpose of this section, "mental health services" means services provided to treat any of the diagnostic categories listed by the diagnostic and statistical manual of mental disorders IV or any subsequent revision.

    (2) All state-purchased health care purchased or renewed after January 1, 1999, except the basic health plan described in chapter 70.47 RCW:

    (a) Shall not impose treatment limitations or financial requirements on coverage for mental health services, if similar requirements are not imposed on coverage for medical and surgical services.  Wellness and preventive services are excluded from this comparison.  By way of illustration and not limitation, this applies to co-pays, cost sharing, dollar limits, outpatient visit limits, outpatient day limits, and inpatient limits;

    (b) Shall require one single annual deductible, and one single annual maximum out-of-pocket limit for medical and surgical and mental health services; and

    (c) Shall require coverage for all mental disorders included in the diagnostic and statistical manual of mental disorders IV or subsequent revisions.

    (3) This section does not mandate coverage of mental health services.

    (4) This section does not prohibit the use of preauthorization screening prior to authorization of mental health services, or the requirement that mental health services must be medically necessary.

 

    NEW SECTION.  Sec. 3.  A new section is added to chapter 48.20 RCW to read as follows:

    (1) For the purpose of this section, "mental health services" means services provided to treat any of the diagnostic categories listed by the diagnostic and statistical manual of mental disorders IV or any subsequent revision.

    (2) All disability insurance contracts providing health care services issued or renewed after January 1, 1999:

    (a) Shall not impose treatment limitations or financial requirements on coverage for mental health services, if similar requirements are not imposed on coverage for medical and surgical services.  Wellness and preventive services are excluded from this comparison.  By way of illustration and not limitation, this applies to co-pays, cost sharing, dollar limits, outpatient visit limits, outpatient day limits, and inpatient limits;

    (b) Shall require one single annual deductible, and one single annual maximum out-of-pocket limit for medical and surgical and mental health services; and

    (c) Shall require coverage for all mental disorders included in the diagnostic and statistical manual of mental disorders IV or subsequent revisions.

    (3) This section does not mandate coverage of mental health services.

    (4) This section does not prohibit the use of preauthorization screening prior to authorization of mental health services, or the requirement that mental health services must be medically necessary.

 

    NEW SECTION.  Sec. 4.  A new section is added to chapter 48.21 RCW to read as follows:

    (1) For the purpose of this section, "mental health services" means services provided to treat any of the diagnostic categories listed by the diagnostic and statistical manual of mental disorders IV or any subsequent revision.

    (2) All group disability insurance contracts and blanket disability insurance contracts providing health care services to groups with fifteen or more persons, issued or renewed after January 1, 1999:

    (a) Shall not impose treatment limitations or financial requirements on coverage for mental health services, if similar requirements are not imposed on coverage for medial and surgical services.  Wellness and preventive services are excluded from this comparison.  By way of illustration and not limitation, this applies to co-pays, cost sharing, dollar limits, outpatient visit limits, outpatient day limits, and inpatient limits;

    (b) Shall require one single annual deductible, and one single annual maximum out-of-pocket limit for medical and surgical and mental health services; and

    (c) Shall require coverage for all mental disorders included in the diagnostic and statistical manual of mental disorders IV or subsequent revisions.

    (3) This section does not mandate coverage of mental health services.

    (4) This section does not prohibit the use of preauthorization screening prior to authorization of mental health services, or the requirement that mental health services must be medically necessary.

 

    NEW SECTION.  Sec. 5.  A new section is added to chapter 48.44 RCW to read as follows:

    (1) For the purpose of this section, "mental health services" means services provided to treat any of the diagnostic categories listed by the diagnostic and statistical manual of mental disorders IV or any subsequent revision.

    (2) All health benefit plans offered by health care service contractors to groups with fifteen or more persons, issued or renewed after January 1, 1999:

    (a) Shall not impose treatment limitations or financial requirements on coverage for mental health services, if similar requirements are not imposed on coverage for medical and surgical services.  Wellness and preventive services are excluded from this comparison.  By way of illustration and not limitation, this applies to co-pays, cost sharing, dollar limits, outpatient visit limits, outpatient day limits, and inpatient limits;

    (b) Shall require one single annual deductible, and one single annual maximum out-of-pocket limit for medical and surgical and mental health services; and

    (c) Shall require coverage for all mental disorders as included in the diagnostic and statistical manual of mental disorders IV or subsequent revisions.

    (3) This section does not mandate coverage of mental health services.

    (4) This section does not prohibit the use of preauthorization screening prior to authorization of mental health services, or the requirement that mental health services must be medically necessary.

 

    NEW SECTION.  Sec. 6.  A new section is added to chapter 48.46 RCW to read as follows:

    (1) For the purpose of this section, "mental health services" means services provided to treat any of the diagnostic categories listed by the diagnostic and statistical manual of mental disorders IV or any subsequent revision.

    (2) All health benefit plans offered by health maintenance organizations to groups with fifteen or more persons, issued or renewed after January 1, 1999:

    (a) Shall not impose treatment limitations or financial requirements on coverage for mental health services, if similar requirements are not imposed on coverage for medical and surgical services.  Wellness and preventive services are excluded from this comparison.  By way of illustration and not limitation, this applies to co-pays, cost sharing, dollar limits, outpatient visit limits, outpatient day limits, and inpatient limits;

    (b) Shall require one single annual deductible, and one single annual maximum out-of-pocket limit for medical and surgical and mental health services; and

    (c) Shall require coverage for all mental disorders included in the diagnostic and statistical manual of mental disorders IV or subsequent revisions.

    (3) This section does not mandate coverage of mental health services.

    (4) This section does not prohibit the use of preauthorization screening prior to authorization of mental health services, or the requirement that mental health services must be medically necessary.

 

    NEW SECTION.  Sec. 7.  A new section is added to chapter 48.41 RCW to read as follows:

    (1) For the purpose of this section, "mental health services" means services provided to treat any of the diagnostic categories listed by the diagnostic and statistical manual of mental disorders IV or any subsequent revision.

    (2) After January 1, 1999, the pool:

    (a) Shall not impose treatment limitations or financial requirements on coverage for mental health services, if similar requirements are not imposed on coverage for medical and surgical services.  Wellness and preventive services are excluded from this comparison.  By way of illustration and not limitation, this applies to co-pays, cost sharing, dollar limits, outpatient visit limits, outpatient day limits, and inpatient limits;

    (b) Shall require one single annual deductible, and one single annual maximum out-of-pocket limit for medical and surgical and mental health services; and

    (c) Shall require coverage for all mental disorders included in the diagnostic and statistical manual of mental disorders IV or subsequent revisions.

    (3) This section does not mandate coverage of mental health services.

    (4) This section does not prohibit the use of preauthorization screening prior to authorization of mental health services, or the requirement that mental health services must be medically necessary.

 

    NEW SECTION.  Sec. 8.  A new section is added to chapter 74.09 RCW to read as follows:

    (1) For the purpose of this section, "mental health services" means services provided to treat any of the diagnostic categories listed by the diagnostic and statistical manual of mental disorders IV or any subsequent revision.

    (2) After January 1, 1999, health coverage offered through medical assistance or the children's health program:

    (a) Shall not impose treatment limitations or financial requirements on coverage for mental health services, if similar requirements are not imposed on coverage for medical and surgical services.  Wellness and preventive services are excluded from this comparison.  By way of illustration and not limitation, this applies to co-pays, cost sharing, dollar limits, outpatient visit limits, outpatient day limits, and inpatient limits;

    (b) Shall require one single annual deductible, and one single annual maximum out-of-pocket limit for medical and surgical and mental health services; and

    (c) Shall require coverage for all mental disorders included in the diagnostic and statistical manual of mental disorders IV or subsequent revisions.

    (3) This section does not mandate coverage of mental health services.

    (4) This section does not prohibit the use of preauthorization screening prior authorization of mental health services, or the requirement that mental health services must be medically necessary.

 


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