(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 July 24, 2005, or such subsequent date as may be
provided by the insurance commissioner by rule, consistent with
the purposes of chapter 6, Laws of 2005, 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 group health benefit plans for groups other than
small groups, as defined in RCW 48.43.005 delivered, issued for
delivery, or renewed on or after January 1, 2006, 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 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 health benefit plan.
(b) For all health benefit plans delivered, issued for
delivery, 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 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 health benefit plan.
(c) For all health benefit plans delivered, issued for
delivery, 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 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 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.
[2007 c 8 § 3; 2006 c 74 § 2; 2005 c 6 § 4.]
NOTES:
Effective date -- 2007 c 8: See note following RCW 48.20.580.
Effective date -- 2006 c 74: See note following RCW 48.21.241.
Findings -- Intent -- Severability -- 2005 c 6: See notes following RCW 41.05.600.