S-1832

AN ACT Relating to comparable mental health benefits; amending RCW 48.21.240, 48.44.340, and 48.46.290; adding a new section to chapter 41.05 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; creating new sections; and providing an effective date.

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

NEW SECTION. Sec. 1. Children are our future. We spend millions of dollars educating Washington state children to ensure their success. In order for our children to learn, they must be healthy. They need strong minds as well as strong bodies. Yet according to Washington state data, one or two children in every Washington classroom is suffering from serious emotional and behavioral problems.

But without adequate mental health insurance coverage for children, families are often unable to pay for needed treatment. As a result, many children do not receive the services they need. The costs of this are enormous, often including increased disability costs, deteriorating school performance, increased use of other health care services, treatment delays leading to more costly treatments, suicide, family breakdown and impoverishment, violence, and institutionalization, whether in hospitals, juvenile detention, jails, or prisons.

The current disparity between insurance coverage for mental health services and coverage for medical and surgical services threatens the financial stability of many families and places Washington state children at risk. The legislature therefore intends to address this disparity and require a minimum level of mental health coverage for children.

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 outpatient therapy and inpatient services provided to treat any of the mental disorders covered by the diagnostic categories listed in the most current version of the diagnostic and statistical manual of mental disorders on the effective date of this section, or such subsequent date as may be provided by the board by rule, consistent with the purposes of chapter . . ., Laws of 2001 (this act), except V codes and those codes defining substance abuse disorders, 291.0 through 292.9 and 303.0 through 305.9 as of the effective date of this section.

(2) Each health benefit plan offered under this chapter that is not subject to Title 48 RCW that provides coverage for medical and surgical services shall provide, for any covered dependent other than a spouse or domestic partner, coverage of:

(a) Mental health services for a minimum of fifteen inpatient days and thirty outpatient therapy visits per plan year. The copay or coinsurance for each of these days or visits may be no more than the copay or coinsurance for an outpatient visit or inpatient day for medical and surgical services otherwise provided under the plan. If a plan imposes a deductible, it shall be a single deductible for medical, surgical, and mental health services; and

(b) Prescription drugs intended to treat any of the disorders covered in subsection (1) of this section to the same extent, and under the same terms and conditions, as other prescription drugs covered by the plan.

NEW SECTION. Sec. 3. 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 outpatient therapy and inpatient services provided to treat any of the mental disorders covered by the diagnostic categories listed in the most current version of the diagnostic and statistical manual of mental disorders on the effective date of this section, or such subsequent date as may be provided by the insurance commissioner by rule, consistent with the purposes of chapter . . ., Laws of 2001 (this act), except V codes and those codes defining substance abuse disorders, 291.0 through 292.9 and 303.0 through 305.9 as of the effective date of this section.

(2) All group disability insurance contracts and blanket disability insurance contracts providing health benefit plans to groups of twenty-five or more that provide coverage for medical and surgical services shall provide, for any covered dependent other than a spouse or domestic partner, coverage of:

(a) Mental health services for a minimum of thirty outpatient therapy visits and fifteen inpatient days per plan year. The copay or coinsurance for each of these visits or days may be no more than the copay or coinsurance for an outpatient visit or inpatient day for medical and surgical services otherwise provided under the plan. If a plan imposes a deductible, it shall be a single deductible for medical, surgical, and mental health services; and

NEW SECTION. Sec. 4. 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 outpatient therapy and inpatient services provided to treat any of the mental disorders covered by the diagnostic categories listed in the most current version of the diagnostic and statistical manual of mental disorders on the effective date of this section, or such subsequent date as may be provided by the insurance commissioner by rule, consistent with the purposes of chapter . . ., Laws of 2001 (this act), except V codes and those codes defining substance abuse disorders, 291.0 through 292.9 and 303.0 through 305.9 as of the effective date of this section.

(2) All health service contracts providing health benefit plan coverage to groups of twenty-five or more that provide coverage for medical and surgical services shall provide, for any covered dependent other than a spouse or domestic partner, coverage of:

NEW SECTION. Sec. 5. 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 outpatient therapy and inpatient services provided to treat any of the mental disorders covered by the diagnostic categories listed in the most current version of the diagnostic and statistical manual of mental disorders on the effective date of this section, or such subsequent date as may be provided by the insurance commissioner by rule, consistent with the purposes of chapter . . ., Laws of 2001 (this act), except V codes and those codes defining substance abuse disorders, 291.0 through 292.9 and 303.0 through 305.9 as of the effective date of this section.

(2) All health benefit plans of health maintenance organizations for groups of twenty-five or more that provide coverage for medical and surgical services shall provide, for any covered dependent other than a spouse or domestic partner, coverage of:

Sec. 6. RCW 48.21.240 and 1987 c 283 s 3 are each amended to read as follows:

(1) In addition to the coverage it is required to provide under section 3 of this act, each group insurer providing disability insurance coverage in this state for hospital or medical care under contracts which are issued, delivered, or renewed in this state on or after July 1, 1986, shall offer optional supplemental coverage for mental health treatment for the insured and the insured's covered dependents.

(2) Benefits shall be provided under the optional supplemental coverage for mental health treatment 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; (c) a community mental health agency licensed by the department of social and health services pursuant to chapter 71.24 RCW; or (d) a state hospital as defined in RCW 72.23.010. The treatment shall be covered at the usual and customary rates for such treatment. The insurer, health care service contractor, or health maintenance organization providing optional coverage under the provisions of this section for mental health services may establish separate usual and customary rates for services rendered by physicians licensed under chapter 18.71 or 18.57 RCW, psychologists licensed under chapter 18.83 RCW, and community mental health centers licensed under chapter 71.24 RCW and state hospitals as defined in RCW 72.23.010. 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.

(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.

(4) This section shall not apply to a group disability insurance contract that has been entered into in accordance with a collective bargaining agreement between management and labor representatives prior to March 1, 1987.

Sec. 7. RCW 48.44.340 and 1987 c 283 s 4 are each amended to read as follows:

(1) In addition to the coverage it is required to provide under section 4 of this act, 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 are issued, delivered, or renewed in this state on or after July 1, 1986, shall offer optional supplemental coverage for mental health treatment for the insured and the insured's covered dependents.

(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.

(4) This section shall not apply to a group health care service contract that has been entered into in accordance with a collective bargaining agreement between management and labor representatives prior to March 1, 1987.

Sec. 8. RCW 48.46.290 and 1987 c 283 s 5 are each amended to read as follows:

(1) In addition to the coverage it is required to provide under section 5 of this act, each health maintenance organization providing services or benefits for hospital or medical care coverage in this state under group health maintenance agreements which are issued, delivered, or renewed in this state on or after July 1, 1986, shall offer optional supplemental coverage for mental health treatment to the enrolled participant and the enrolled participant's covered dependents.

(2) Benefits shall be provided under the optional supplemental coverage for mental health treatment whether treatment is rendered by the health maintenance organization or 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; (c) a community mental health agency licensed by the department of social and health services pursuant to chapter 71.24 RCW; or (d) a state hospital as defined in RCW 72.23.010. The treatment shall be covered at the usual and customary rates for such treatment. The insurer, health care service contractor, or health maintenance organization providing optional coverage under the provisions of this section for mental health services may establish separate usual and customary rates for services rendered by physicians licensed under chapter 18.71 or 18.57 RCW, psychologists licensed under chapter 18.83 RCW, and community mental health centers licensed under chapter 71.24 RCW and state hospitals as defined in RCW 72.23.010. 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.

(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.

(4) This section shall not apply to a group health maintenance agreement that has been entered into in accordance with a collective bargaining agreement between management and labor representatives prior to March 1, 1987.

NEW SECTION. Sec. 9. Any increase in the cost of plans offered by the public employees' benefits board due to the implementation of this act shall not be paid for by the state or any political subdivision of the state, but shall be accommodated through changes in the benefit design or amount of enrollee cost-sharing for such plans as determined by the public employees' benefits board.

NEW SECTION. Sec. 10. Any increase in the cost of a health plan offered by a private employer due to implementation of this act need not be paid for by the employer, but may be accommodated through changes in the benefit design or amount of enrollee cost-sharing for the plan.

NEW SECTION. Sec. 11. The insurance commissioner may adopt rules to implement sections 3 through 5 of this act.

NEW SECTION. Sec. 12. This act takes effect January 1, 2002.

NEW SECTION. Sec. 13. 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.