Washington Legislation

This bill amends state insurance law by restricting step therapy for medications for the treatment of mental illness for individual plans, group plans, public employee plans, and Medicaid. These plans must immediately cover a prescribed drug after demonstration of or providers proof of past demonstration of a failed first attempt treatment of the same drug or a drug in the same pharmacologic class, with failure being determined by the prescribing practitioner.

This bill established the children’s mental health work group to identify barriers to children’s access to mental health services, including identification, diagnosis, treatment, billing, workforce, and treatment standards, and advise the legislature with recommendations.
Additionally, the bill requires the state Medicaid agency to report to the legislature data related to network adequacy and access to services. The bill also requires the joint legislative audit and review committee to conduct an inventory of mental health service models used by schools, schools. Finally, the bill , subject to the availability of funding, would require Medicaid to cover provider payment and universal screening for depression of children aged 11 to 21.

This bill tried to change the sections of state law relevant to parity so that they would no longer exclude coverage of residential treatment for mental health conditions.

This bill tried to change state law so that large employer fully-insured plans, small employer fully-insured plans, individual plans, and state employee plans would have to cover autism services. It required:

• Copayments, coinsurance, and deductibles must be the same as those in place for other medical services.
• There cannot be any visit limits for outpatient care.
• Insurance plans can review a child’s treatment plan once every 12 months.
• Treatment for autism is defined as behavioral health treatment (includes applied behavior analysis), pharmacy care, psychiatric care, psychological care, and therapeutic care. These are all defined in detail within the bill.

Autism is defined as any of the pervasive developmental disorders in the DSM including autistic disorder, Asperger’s disorder, and pervasive developmental disorder not otherwise specified.

This bill tried to change state law so that large employer fully-insured plans, small employer fully-insured plans, individual plans, and state employee plans would have to cover autism services through age 20. It required:

• $50,000 annual maximum that can be adjusted for inflation each year
• Copayments, coinsurance, and deductibles must be the same as those in place for other medical services.
• here cannot be any visit limits for outpatient care.
• Insurance plans can review a child’s treatment plan once every 6 months.
• Treatment for autism is defined as applied behavior analysis, pharmacy care, psychiatric care, psychological care, and therapeutic care. These are all defined in detail within the bill.

Autism is defined as any of the pervasive developmental disorders in the DSM including autistic disorder, Asperger’s disorder, and pervasive developmental disorder not otherwise specified.