(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 determined by the
administrator, 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
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 January 1, 2006,
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 covered 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 covered 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 covered 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.
[2005 c 6 § 6.]
NOTES:
Findings -- Intent -- Severability -- 2005 c 6: See notes following RCW 41.05.600.