BILL REQ. #: S-0474.2
| State of Washington | 59th Legislature | 2005 Regular Session |
Read first time 01/25/2005. Referred to Committee on Health & Long-Term Care.
AN ACT Relating to mental health parity; amending RCW 48.21.240, 48.44.340, and 48.46.290; adding new sections 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; adding new sections to chapter 70.47 RCW; adding a new section to chapter 48.02 RCW; creating a new section; and declaring an emergency.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
NEW SECTION. Sec. 1 The legislature finds that the costs of
leaving mental disorders untreated or undertreated are significant, and
often include: Decreased job productivity, loss of employment,
increased disability costs, deteriorating school performance, increased
use of other health services, treatment delays leading to more costly
treatments, suicide, family breakdown and impoverishment, and
institutionalization, whether in hospitals, juvenile detention, jails,
or prisons.
Treatable mental disorders are prevalent and often have a high
impact on health and productive life. The legislature finds that the
potential benefits of improved access to mental health services are
significant. Additionally, the legislature declares that it is not
cost-effective to treat persons with mental disorders differently than
persons with medical and surgical disorders.
Therefore, the legislature intends to require that insurance
coverage be at parity for mental health services, which means this
coverage be delivered under the same terms and conditions as medical
and surgical services.
NEW SECTION. Sec. 2 A new section is added to chapter 41.05 RCW
to read as follows:
(1) For the purposes of this section, "mental health services"
means medically necessary outpatient and inpatient services provided to
treat mental disorders covered by the diagnostic categories listed in
the most current version of the diagnostic and statistical manual of
mental disorders, published by the American psychiatric association, on
the effective date of this section, or such subsequent date as may be
provided by the administrator by rule, consistent with the purposes of
this act, with the exception of the following categories, codes, and
services: (a) Substance related disorders; (b) life transition
problems, currently referred to as "V" codes, and diagnostic codes 302
through 302.9 as found in the diagnostic and statistical manual of
mental disorders, 4th edition, published by the American psychiatric
association; (c) skilled nursing facility services, home health care,
residential treatment, and custodial care; and (d) court ordered
treatment unless the authority's or contracted insuring entity's
medical director determines the treatment to be medically necessary.
(2) All health benefit plans offered to public employees and their
covered dependents under this chapter that provide coverage for medical
and surgical services shall provide:
(a) For all health benefit plans established or renewed on or after
July 1, 2005, coverage for:
(i) Mental health services. The copayment or coinsurance for
mental health services may be no more than the copayment or coinsurance
for medical and surgical services otherwise provided under the health
benefit plan. Wellness and preventive services that are provided or
reimbursed at a lesser copayment, coinsurance, or other cost sharing
than other medical and surgical services are excluded from this
comparison; and
(ii) Prescription drugs intended to treat any of the disorders
identified in subsection (1) of this section to the same extent, and
under the same terms and conditions, as other prescription drugs
covered by the health benefit plan.
(b) For all health benefit plans established or renewed on or after
January 1, 2008, coverage for:
(i) Mental health services. The copayment or coinsurance for
mental health services may be no more than the copayment or coinsurance
for medical and surgical services otherwise provided under the health
benefit plan. Wellness and preventive services that are provided or
reimbursed at a lesser copayment, coinsurance, or other cost sharing
than other medical and surgical services are excluded from this
comparison. If the health benefit plan imposes a maximum out-of-pocket
limit or stop loss, it shall be a single limit or stop loss for
medical, surgical, and mental health services; and
(ii) Prescription drugs intended to treat any of the disorders
identified in subsection (1) of this section to the same extent, and
under the same terms and conditions, as other prescription drugs
covered by the health benefit plan.
(c) For all health benefit plans established or renewed on or after
July 1, 2010, coverage for:
(i) Mental health services. The copayment or coinsurance for
mental health services may be no more than the copayment or coinsurance
for medical and surgical services otherwise provided under the health
benefit plan. Wellness and preventive services that are provided or
reimbursed at a lesser copayment, coinsurance, or other cost sharing
than other medical and surgical services are excluded from this
comparison. If the health benefit plan imposes a maximum out-of-pocket
limit or stop loss, it shall be a single limit or stop loss for
medical, surgical, and mental health services. If the health benefit
plan imposes any deductible, mental health services shall be included
with medical and surgical services for the purpose of meeting the
deductible requirement. Treatment limitations or any other financial
requirements on coverage for mental health services are only allowed if
the same limitations or requirements are imposed on coverage for
medical and surgical services; and
(ii) Prescription drugs intended to treat any of the disorders
identified in subsection (1) of this section to the same extent, and
under the same terms and conditions, as other prescription drugs
covered by the health benefit plan.
(3) In meeting the requirements of subsection (2)(a) and (b) of
this section, health benefit plans may not reduce the number of mental
health outpatient visits or mental health inpatient days below the
level in effect on July 1, 2002.
(4) This section does not prohibit a requirement that mental health
services be medically necessary as determined by the medical director
or designee, if a comparable requirement is applicable to medical and
surgical services.
(5) Nothing in this section shall be construed to prevent the
management of mental health services.
(6) The administrator will consider care management techniques for
mental health services, including but not limited to: (a) Authorized
treatment plans; (b) preauthorization requirements based on the type of
service; (c) concurrent and retrospective utilization review; (d)
utilization management practices; (e) discharge coordination and
planning; and (f) contracting with and using a network of participating
providers.
NEW SECTION. Sec. 3 A new section is added to chapter 48.21 RCW
to read as follows:
(1) For the purposes of this section, "mental health services"
means medically necessary outpatient and inpatient services provided to
treat mental disorders covered by the diagnostic categories listed in
the most current version of the diagnostic and statistical manual of
mental disorders, published by the American psychiatric association, 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 this act, with the exception of the following categories,
codes, and services: (a) Substance related disorders; (b) life
transition problems, currently referred to as "V" codes, and diagnostic
codes 302 through 302.9 as found in the diagnostic and statistical
manual of mental disorders, 4th edition, published by the American
psychiatric association; (c) skilled nursing facility services, home
health care, residential treatment, and custodial care; and (d) court
ordered treatment unless the insurer's medical director or designee
determines the treatment to be medically necessary.
(2) All group disability insurance contracts and blanket disability
insurance contracts providing health benefit plans that provide
coverage for medical and surgical services shall provide:
(a) For all health benefit plans established or renewed on or after
July 1, 2005, for groups of more than fifty employees coverage for:
(i) Mental health services. The copayment or coinsurance for
mental health services may be no more than the copayment or coinsurance
for medical and surgical services otherwise provided under the health
benefit plan. Wellness and preventive services that are provided or
reimbursed at a lesser copayment, coinsurance, or other cost sharing
than other medical and surgical services are excluded from this
comparison; and
(ii) Prescription drugs intended to treat any of the disorders
identified in subsection (1) of this section to the same extent, and
under the same terms and conditions, as other prescription drugs
covered by the health benefit plan.
(b) For all health benefit plans established or renewed on or after
January 1, 2008, for groups of more than fifty employees coverage for:
(i) Mental health services. The copayment or coinsurance for
mental health services may be no more than the copayment or coinsurance
for medical and surgical services otherwise provided under the health
benefit plan. Wellness and preventive services that are provided or
reimbursed at a lesser copayment, coinsurance, or other cost sharing
than other medical and surgical services are excluded from this
comparison. If the health benefit plan imposes a maximum out-of-pocket
limit or stop loss, it shall be a single limit or stop loss for
medical, surgical, and mental health services; and
(ii) Prescription drugs intended to treat any of the disorders
identified in subsection (1) of this section to the same extent, and
under the same terms and conditions, as other prescription drugs
covered by the health benefit plan.
(c) For all health benefit plans established or renewed on or after
July 1, 2010, for groups of more than fifty employees coverage for:
(i) Mental health services. The copayment or coinsurance for
mental health services may be no more than the copayment or coinsurance
for medical and surgical services otherwise provided under the health
benefit plan. Wellness and preventive services that are provided or
reimbursed at a lesser copayment, coinsurance, or other cost sharing
than other medical and surgical services are excluded from this
comparison. If the health benefit plan imposes a maximum out-of-pocket
limit or stop loss, it shall be a single limit or stop loss for
medical, surgical, and mental health services. If the health benefit
plan imposes any deductible, mental health services shall be included
with medical and surgical services for the purpose of meeting the
deductible requirement. Treatment limitations or any other financial
requirements on coverage for mental health services are only allowed if
the same limitations or requirements are imposed on coverage for
medical and surgical services; and
(ii) Prescription drugs intended to treat any of the disorders
identified in subsection (1) of this section to the same extent, and
under the same terms and conditions, as other prescription drugs
covered by the health benefit plan.
(3) In meeting the requirements of subsection (2)(a) and (b) of
this section, health benefit plans may not reduce the number of mental
health outpatient visits or mental health inpatient days below the
level in effect on July 1, 2002.
(4) This section does not prohibit a requirement that mental health
services be medically necessary as determined by the medical director
or designee, if a comparable requirement is applicable to medical and
surgical services.
(5) Nothing in this section shall be construed to prevent the
management of mental health services.
NEW SECTION. Sec. 4 A new section is added to chapter 48.44 RCW
to read as follows:
(1) For the purposes of this section, "mental health services"
means medically necessary outpatient and inpatient services provided to
treat mental disorders covered by the diagnostic categories listed in
the most current version of the diagnostic and statistical manual of
mental disorders, published by the American psychiatric association, 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 this act, with the exception of the following categories,
codes, and services: (a) Substance related disorders; (b) life
transition problems, currently referred to as "V" codes, and diagnostic
codes 302 through 302.9 as found in the diagnostic and statistical
manual of mental disorders, 4th edition, published by the American
psychiatric association; (c) skilled nursing facility services, home
health care, residential treatment, and custodial care; and (d) court
ordered treatment unless the health care service contractor's medical
director or designee determines the treatment to be medically
necessary.
(2) All health service contracts providing health benefit plans
that provide coverage for medical and surgical services shall provide:
(a) For all health benefit plans established or renewed on or after
July 1, 2005, for groups of more than fifty employees coverage for:
(i) Mental health services. The copayment or coinsurance for
mental health services may be no more than the copayment or coinsurance
for medical and surgical services otherwise provided under the health
benefit plan. Wellness and preventive services that are provided or
reimbursed at a lesser copayment, coinsurance, or other cost sharing
than other medical and surgical services are excluded from this
comparison; and
(ii) Prescription drugs intended to treat any of the disorders
identified in subsection (1) of this section to the same extent, and
under the same terms and conditions, as other prescription drugs
covered by the health benefit plan.
(b) For all health benefit plans established or renewed on or after
January 1, 2008, for groups of more than fifty employees coverage for:
(i) Mental health services. The copayment or coinsurance for
mental health services may be no more than the copayment or coinsurance
for medical and surgical services otherwise provided under the health
benefit plan. Wellness and preventive services that are provided or
reimbursed at a lesser copayment, coinsurance, or other cost sharing
than other medical and surgical services are excluded from this
comparison. If the health benefit plan imposes a maximum out-of-pocket
limit or stop loss, it shall be a single limit or stop loss for
medical, surgical, and mental health services; and
(ii) Prescription drugs intended to treat any of the disorders
identified in subsection (1) of this section to the same extent, and
under the same terms and conditions, as other prescription drugs
covered by the health benefit plan.
(c) For all health benefit plans established or renewed on or after
July 1, 2010, for groups of more than fifty employees coverage for:
(i) Mental health services. The copayment or coinsurance for
mental health services may be no more than the copayment or coinsurance
for medical and surgical services otherwise provided under the health
benefit plan. Wellness and preventive services that are provided or
reimbursed at a lesser copayment, coinsurance, or other cost sharing
than other medical and surgical services are excluded from this
comparison. If the health benefit plan imposes a maximum out-of-pocket
limit or stop loss, it shall be a single limit or stop loss for
medical, surgical, and mental health services. If the health benefit
plan imposes any deductible, mental health services shall be included
with medical and surgical services for the purpose of meeting the
deductible requirement. Treatment limitations or any other financial
requirements on coverage for mental health services are only allowed if
the same limitations or requirements are imposed on coverage for
medical and surgical services; and
(ii) Prescription drugs intended to treat any of the disorders
identified in subsection (1) of this section to the same extent, and
under the same terms and conditions, as other prescription drugs
covered by the health benefit plan.
(3) In meeting the requirements of subsection (2)(a) and (b) of
this section, health benefit plans may not reduce the number of mental
health outpatient visits or mental health inpatient days below the
level in effect on July 1, 2002.
(4) This section does not prohibit a requirement that mental health
services be medically necessary as determined by the medical director
or designee, if a comparable requirement is applicable to medical and
surgical services.
(5) Nothing in this section shall be construed to prevent the
management of mental health services.
NEW SECTION. Sec. 5 A new section is added to chapter 48.46 RCW
to read as follows:
(1) For the purposes of this section, "mental health services"
means medically necessary outpatient and inpatient services provided to
treat mental disorders covered by the diagnostic categories listed in
the most current version of the diagnostic and statistical manual of
mental disorders, published by the American psychiatric association, 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 this act, with the exception of the following categories,
codes, and services: (a) Substance related disorders; (b) life
transition problems, currently referred to as "V" codes, and diagnostic
codes 302 through 302.9 as found in the diagnostic and statistical
manual of mental disorders, 4th edition, published by the American
psychiatric association; (c) skilled nursing facility services, home
health care, residential treatment, and custodial care; and (d) court
ordered treatment unless the health maintenance organization's medical
director or designee determines the treatment to be medically
necessary.
(2) All health benefit plans offered by health maintenance
organizations that provide coverage for medical and surgical services
shall provide:
(a) For all health benefit plans established or renewed on or after
July 1, 2005, for groups of more than fifty employees coverage for:
(i) Mental health services. The copayment or coinsurance for
mental health services may be no more than the copayment or coinsurance
for medical and surgical services otherwise provided under the health
benefit plan. Wellness and preventive services that are provided or
reimbursed at a lesser copayment, coinsurance, or other cost sharing
than other medical and surgical services are excluded from this
comparison; and
(ii) Prescription drugs intended to treat any of the disorders
identified in subsection (1) of this section to the same extent, and
under the same terms and conditions, as other prescription drugs
covered by the health benefit plan.
(b) For all health benefit plans established or renewed on or after
January 1, 2008, for groups of more than fifty employees coverage for:
(i) Mental health services. The copayment or coinsurance for
mental health services may be no more than the copayment or coinsurance
for medical and surgical services otherwise provided under the health
benefit plan. Wellness and preventive services that are provided or
reimbursed at a lesser copayment, coinsurance, or other cost sharing
than other medical and surgical services are excluded from this
comparison. If the health benefit plan imposes a maximum out-of-pocket
limit or stop loss, it shall be a single limit or stop loss for
medical, surgical, and mental health services; and
(ii) Prescription drugs intended to treat any of the disorders
identified in subsection (1) of this section to the same extent, and
under the same terms and conditions, as other prescription drugs
covered by the health benefit plan.
(c) For all health benefit plans established or renewed on or after
July 1, 2010, for groups of more than fifty employees coverage for:
(i) Mental health services. The copayment or coinsurance for
mental health services may be no more than the copayment or coinsurance
for medical and surgical services otherwise provided under the health
benefit plan. Wellness and preventive services that are provided or
reimbursed at a lesser copayment, coinsurance, or other cost sharing
than other medical and surgical services are excluded from this
comparison. If the health benefit plan imposes a maximum out-of-pocket
limit or stop loss, it shall be a single limit or stop loss for
medical, surgical, and mental health services. If the health benefit
plan imposes any deductible, mental health services shall be included
with medical and surgical services for the purpose of meeting the
deductible requirement. Treatment limitations or any other financial
requirements on coverage for mental health services are only allowed if
the same limitations or requirements are imposed on coverage for
medical and surgical services; and
(ii) Prescription drugs intended to treat any of the disorders
identified in subsection (1) of this section to the same extent, and
under the same terms and conditions, as other prescription drugs
covered by the health benefit plan.
(3) In meeting the requirements of subsection (2)(a) and (b) of
this section, health benefit plans may not reduce the number of mental
health outpatient visits or mental health inpatient days below the
level in effect on July 1, 2002.
(4) This section does not prohibit a requirement that mental health
services be medically necessary as determined by the medical director
or designee, if a comparable requirement is applicable to medical and
surgical services.
(5) Nothing in this section shall be construed to prevent the
management of mental health services.
NEW SECTION. Sec. 6 A new section is added to chapter 70.47 RCW
to read as follows:
(1) For the purposes of this section, "mental health services"
means medically necessary outpatient and inpatient services provided to
treat mental disorders covered by the diagnostic categories listed in
the most current version of the diagnostic and statistical manual of
mental disorders, published by the American psychiatric association, on
the effective date of this section, or such subsequent date as may be
determined by the administrator, by rule, consistent with the purposes
of this act, with the exception of the following categories, codes, and
services: (a) Substance related disorders; (b) life transition
problems, currently referred to as "V" codes, and diagnostic codes 302
through 302.9 as found in the diagnostic and statistical manual of
mental disorders, 4th edition, published by the American psychiatric
association; (c) skilled nursing facility services, home health care,
residential treatment, and custodial care; and (d) court ordered
treatment, unless the Washington basic health plan's or contracted
managed health care system's medical director or designee determines
the treatment to be medically necessary.
(2)(a) Any schedule of benefits established or renewed by the
Washington basic health plan on or after July 1, 2005, shall provide
coverage for:
(i) Mental health services. The copayment or coinsurance for
mental health services may be no more than the copayment or coinsurance
for medical and surgical services otherwise provided under the schedule
of benefits. Wellness and preventive services that are provided or
reimbursed at a lesser copayment, coinsurance, or other cost sharing
than other medical and surgical services are excluded from this
comparison; and
(ii) Prescription drugs intended to treat any of the disorders
identified in subsection (1) of this section to the same extent, and
under the same terms and conditions, as other prescription drugs
covered under the schedule of benefits.
(b) Any schedule of benefits established or renewed by the
Washington basic health plan on or after January 1, 2008, shall provide
coverage for:
(i) Mental health services. The copayment or coinsurance for
mental health services may be no more than the copayment or coinsurance
for medical and surgical services otherwise provided under the schedule
of benefits. Wellness and preventive services that are provided or
reimbursed at a lesser copayment, coinsurance, or other cost sharing
than other medical and surgical services are excluded from this
comparison. If the schedule of benefits imposes a maximum out-of-pocket limit or stop loss, it shall be a single limit or stop loss for
medical, surgical, and mental health services; and
(ii) Prescription drugs intended to treat any of the disorders
identified in subsection (1) of this section to the same extent, and
under the same terms and conditions, as other prescription drugs
covered under the schedule of benefits.
(c) Any schedule of benefits established or renewed by the
Washington basic health plan on or after July 1, 2010, shall include
coverage for:
(i) Mental health services. The copayment or coinsurance for
mental health services may be no more than the copayment or coinsurance
for medical and surgical services otherwise provided under the schedule
of benefits. Wellness and preventive services that are provided or
reimbursed at a lesser copayment, coinsurance, or other cost sharing
than other medical and surgical services are excluded from this
comparison. If the schedule of benefits imposes a maximum out-of-pocket limit or stop loss, it shall be a single limit or stop loss for
medical, surgical, and mental health services. If the schedule of
benefits imposes any deductible, mental health services shall be
included with medical and surgical services for the purpose of meeting
the deductible requirement. Treatment limitations or any other
financial requirements on coverage for mental health services are only
allowed if the same limitations or requirements are imposed on coverage
for medical and surgical services; and
(ii) Prescription drugs intended to treat any of the disorders
identified in subsection (1) of this section to the same extent, and
under the same terms and conditions, as other prescription drugs
covered under the schedule of benefits.
(3) In meeting the requirements of subsection (2)(a) and (b) of
this section, the Washington basic health plan may not reduce the
number of mental health outpatient visits or mental health inpatient
days below the level in effect on July 1, 2002.
(4) This section does not prohibit a requirement that mental health
services be medically necessary as determined by the medical director
or designee, if a comparable requirement is applicable to medical and
surgical services.
(5) Nothing in this section shall be construed to prevent the
management of mental health services.
Sec. 7 RCW 48.21.240 and 1987 c 283 s 3 are each amended to read
as follows:
(1) For groups not covered by 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)) licensed mental health
provider regulated under chapter 18.57, 18.71, 18.79, 18.83, or 18.225
RCW; (((c))) (b) a community mental health agency licensed by the
department of social and health services pursuant to chapter 71.24 RCW;
or (((d))) (c) 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)) the different categories of providers listed in (a) through
(c) of this subsection. 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)) one of the
categories of providers listed in (a) of this subsection.
(3) For groups not covered by section 3 of this act, 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. 8 RCW 48.44.340 and 1987 c 283 s 4 are each amended to read
as follows:
(1) For groups not covered by 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.
(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)) licensed mental health
provider regulated under chapter 18.57, 18.71, 18.79, 18.83, or 18.225
RCW; (((c))) (b) a community mental health agency licensed by the
department of social and health services pursuant to chapter 71.24 RCW;
or (((d))) (c) 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)) the different categories of providers listed in (a) through
(c) of this subsection. 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)) one of the
categories of providers listed in (a) of this subsection.
(3) For groups not covered by section 4 of this act, 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. 9 RCW 48.46.290 and 1987 c 283 s 5 are each amended to read
as follows:
(1) For groups not covered by 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)) by: (a) A
((physician licensed under chapter 18.71 or 18.57 RCW; (b) a
psychologist licensed under chapter 18.83)) licensed mental health
provider regulated under chapter 18.57, 18.71, 18.79, 18.83, or 18.225
RCW; (((c))) (b) a community mental health agency licensed by the
department of social and health services pursuant to chapter 71.24 RCW;
or (((d))) (c) 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)) the different categories of providers listed in (a) through
(c) of this subsection. 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)) one of the
categories of providers listed in (a) of this subsection.
(3) For groups not covered by section 5 of this act, 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. 10 A new section is added to chapter 48.02 RCW
to read as follows:
The insurance commissioner may adopt rules to implement sections 3
through 5 of this act, except that the rules do not apply to health
benefit plans administered or operated under chapter 41.05 or 70.47
RCW.
NEW SECTION. Sec. 11 A new section is added to chapter 70.47 RCW
to read as follows:
The administrator may adopt rules to implement section 6 of this
act.
NEW SECTION. Sec. 12 A new section is added to chapter 41.05 RCW
to read as follows:
The administrator may adopt rules to implement section 2 of this
act.
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.
NEW SECTION. Sec. 14 This act is necessary for the immediate
preservation of the public peace, health, or safety, or support of the
state government and its existing public institutions, and takes effect
immediately.