FINAL BILL REPORT

HB 1085

                                  C 345 L 89

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

SYNOPSIS AS ENACTED

BACKGROUND:

Health insurance policies, health care contracts, and health maintenance agreements commonly provide coverage for rehabilitative care or treatment.  The purpose of such treatment is to restore a person to the level of functioning existing before a disabling injury or disease.  Coverage for habilitative care or treatment,  which attempts to create functioning where none has existed, is less common and often unavailable.  Habilitative care or treatment is needed primarily 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.

Coverage for neurodevelopmental therapies may be conditioned upon medical referral by a licensed physician or osteopath, and may be limited to the services of contracting therapy providers.

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

Insurers, health care service contractors, health maintenance organizations, and the state retain freedom to design neurodevelopmental coverage to include deductibles, co-insurance, and benefit utilization restrictions.

VOTES ON FINAL PASSAGE:

      House 95   0

      Senate    45     0 (Senate amended)

      House 96   0 (House concurred)

EFFECTIVE:July 23, 1989