HOUSE BILL REPORT

HB 1085

As Amended by the Senate

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

Majority Report:  Do pass.  (11)

      Signed by Representatives Dellwo, Chair; Zellinsky, Vice Chair; Chandler, Ranking Republican Member; Anderson, Baugher, Beck, Crane, Day, Dorn, Inslee and K. Wilson.

Minority Report:  Do not pass.  (1)

      Signed by Representative P. King.  (1) 

House Staff:John Conniff (786-7119)

AS PASSED HOUSE MARCH 13, 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 existing before the 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 needed primarily by small children born with a disability.

SUMMARY:

Employer-sponsored group health care contracts, policies, and agreements including any health plan provided by the State Employees Insurance Board, 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 SEIB retain freedom to design neurodevelopmental coverage to include deductibles, coinsurance, and benefit utilization restrictions.

EFFECT OF SENATE AMENDMENTS:  A misspelled word is corrected.

Fiscal Note:      Requested February 16, 1989.

House Committee ‑ Testified For:    Other than sponsors, no one testified in favor.  However, supporters were present at hearings and were satisfied by sponsors' testimony.

House Committee - Testified Against:      George Schneider, M.D. Washington State Medical Association; Jim Halstrom, Health Care Purchasers Association; and Joan Gaumer, Association Washington Business.

House Committee - Testimony For:    Health insurance coverage for children with neurodevelopmental disorders is inconsistent and often limited.  Without coverage to pay for physical therapy, speech therapy, special education, and other therapies, many children do not obtain adequate treatment for neurodevelopmental disorders.  Such treatment is cost effective because a child who can walk, talk, or help with his or her own care creates lower costs to care for the child as the child grows.  More importantly, coverage for treatment will allow the child to reach his or her full potential.

House Committee - Testimony Against:      Mandated benefits of any type increase the cost of insurance and force employers to consider self-insurance.  For those small employers who cannot self-insure or cannot afford health insurance containing a variety of mandated benefits, the only alternative is to discontinue health insurance benefits for employees.

VOTE ON FINAL PASSAGE:

      Yeas 95; Excused 3

Excused:    Representatives Belcher, Schoon and Wang