S-0124.4  _______________________________________________

                         SENATE BILL 5271

          _______________________________________________

State of Washington      57th Legislature     2001 Regular Session

By Senators Long, Thibaudeau, Gardner, Costa and Kohl‑Welles

Read first time 01/17/2001.  Referred to Committee on Health & Long‑Term Care.

Providing insurance coverage for certain mental illnesses.

    AN ACT Relating to insurance coverage for certain mental illnesses; and adding new sections to chapter 48.43 RCW.

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

NEW SECTION. Sec. 1.  A new section is added to chapter 48.43 RCW to read as follows:

    (1) Health carriers must cover, pay for, contract for, or reimburse for diagnosis and treatment of the following mental disorders defined in the most current edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American psychiatric association:

    (a) Schizophrenia;

    (b) Schizoaffective disorder;

    (c) Major depressive disorder;

    (d) Bipolar disorder;

    (e) Paranoid, schizoid, and schizotypal disorders;

    (f) Obsessive-compulsive disorder; and

    (g) Panic disorder.

    (2) For purposes of this section, and sections 2 and 3 of this act, "health carrier" or "carrier" means a disability insurer regulated under chapter 48.20 or 48.21 RCW, a health care service contractor as defined in RCW 48.44.010, a health maintenance organization as defined in RCW 48.46.020, plans operating under the state health care authority under chapter 41.05 RCW, the state health insurance pool operating under chapters 48.41 and 70.47 RCW, and insuring entities regulated in this chapter.

NEW SECTION. Sec. 2.  A new section is added to chapter 48.43 RCW to read as follows:

    (1) Health carriers must cover, pay for, contract for, or reimburse for diagnosis and treatment of a minor's mental condition not covered under section 1 of this act when:

    (a) The minor has accessed care from a licensed or certified mental health practitioner on more than one occasion;

    (b) The minor has been recommended for a mental health evaluation by a probation counselor within the juvenile justice system; or

    (c) The minor has been admitted to an emergency room for care and the mental status of the minor contributed to the need for care.

    (2) For purposes of this section:

    (a) "Mental condition" means identification of functional characteristics by a licensed or certified mental health practitioner through a mental status evaluation, which indicates the minor would likely suffer further deficit in functional characteristics without treatment from a licensed or certified mental health practitioner.

    (b) "Functional characteristics" means appearance and self-care, sensorium, relating, affect and mood, thought and language, executive functions, stress, and social functioning.

NEW SECTION. Sec. 3.  A new section is added to chapter 48.43 RCW to read as follows:

    Under the provisions of this act, a health carrier is prohibited from limiting benefits based on a criteria that is not applicable to the provision of benefits for chronic medical conditions.

NEW SECTION. Sec. 4.  A new section is added to chapter 48.43 RCW to read as follows:

    The office of the insurance commissioner may develop rules to implement this act.

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