Presented by The Kennedy Forum Scattergood Foundation

Menu Close

This page lists some of the action toward parity compliance undertaken by Washington regulatory agencies since 2008.

Are we missing any actions taken by state regulatory agencies? Let us know at info@paritytrack.org.

Action in the Regulatory Arena

The Washington State Office of the Insurance Commissioner has a webpage on mental health parity. The page defines mental health parity, how this law impacts consumers, and how to resolve benefit concerns.

The Washington State Office of the Insurance Commissioner requires plans to fill out checklists demonstrating how they comply with certain sections of the state insurance law and with relevant federal laws. These checklists include boxes for addressing the sections of the state insurance law relevant to parity and the Federal Parity Law. There are many of these checklists that are identical or very similar. For simplicity’s sake, here is an example of one (pdf | Get Adobe® Reader®) that is for small employer fully-insured plans that are required to offer essential health benefits by the Affordable Care Act.

9/2015

Primary Focus: Parity: General
Agency: The Office of the Insurance Commissioner
Title/Description: Essential health benefit categories
Citation: WAC § 284-43-5642, as created by WSR 15-20-042
Summary: A health benefit plan must cover “mental health and substance use disorder services, including behavioral health treatment” in a manner substantially equal to the base-benchmark plan. For purposes of determining a plan’s actuarial value, an issuer must classify as mental health and substance use disorder services, including behavioral health treatment, the medically necessary care, treatment and services for mental health conditions and substance use disorders categorized in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM), including behavioral health treatment for those conditions.
Effective Date: September 29, 2015
Notes: WSR 15-20-042 (Matter No. R 2015-02), § 284-43-8781, filed 9/29/15, effective 9/29/15.

12/2014

Primary Focus: Parity: General
Agency: The Office of the Insurance Commissioner
Title/Description: Mental Health and Substance Use Disorder
Citation: WAC § 284-43-7000, WAC § 284-43-7010, WAC § 284-43-7020, WAC § 284-43-7040, WAC § 284-43-7060, WAC § 284-43-7080, WAC § 284-43-7100, WAC § 284-43-7120, as created by WSR 14-23-057
Summary: Selected provisions include:

This subchapter applies to all health plans and issuers. The purpose of this rule is to consolidate existing state mental health and chemical dependency regulation with federal mental health and substance use disorder parity requirements into state regulation. This rule also provides health plans and issuers with the method of demonstrating compliance with these requirements.

A health plan providing mental health or substance use disorder benefits, must provide mental health or substance use disorder benefits in every classification in which medical/surgical benefits are provided.

(1)  Health plans and issuers must file a justification demonstrating the analysis of each plan’s financial requirements and quantitative treatment limitations as required under WAC 284-43-7040.

(2)  Filing of this justification is subject to the requirements of chapters 284-44A, 284-46A, and 284-58 WAC and may be rejected and closed if it does not comply.

Effective Date: December 18, 2014
Notes: N/A

11/2014

The Washington State Office of the Insurance Commissioner released a report to explain the recent rule issued in September, 2014. The report provides background information on the Federal Parity Law and state parity law. It also details the rule development process, differences between the proposed and final rule, and a summary of comments received on the proposed rule.

10/2014

The Washington State Office of the Insurance Commissioner issued this letter to plans, which clarified their obligations due to the then recently-decided Washington State Supreme Court Case, O.S.T. v. Regence Blueshield. The court decided that the sections of the state insurance law relevant to parity (summarized at the bottom of this page) do not allow insurance plans to use blanket exclusions for mental health services that could be medically necessary.

The Commissioner informed plans that the Office was going to examine all plans for 2015 and make sure they complied with the sections of the law as interpreted by the Court. He also instructed plans that their current practices must comply with the court’s interpretation, no matter what language is currently in any given plan.

The commissioner then ordered plans to identify any claims denied since 1/1/2006 that may have violated the law, as currently interpreted by the court, and inform those consumers that their claims can be reevaluated. He then ordered plans to submit the following to the Office:

  • Number of notices sent to consumers
  • Number of consumers who request to have their denial reevaluated
  • Outcome of each claim reevaluated

09/2014

The Washington State Office of the Insurance Commissioner issued an updated regulation regarding parity. The purpose of this regulation was to consolidate into one regulation all parity regulations regarding the Federal Parity Law and relevant sections of the state insurance law. This regulation defined all of the following:

It specified that parity requirements must be applied to the 6 different classifications of benefits. It also made clear that all services must fall into one of these 6 classifications of benefits. In other words, something like residential treatment or partial hospitalization cannot be an excluded service on the grounds that it is not in one of the 6 classifications. It then listed permitted subclassifications within each classification and stated that no other subclassifications are allowed.

The regulation then went into great detail about the parity requirements for quantitative treatment limitations, financial requirements, and non-quantitative treatment limitations. These parts are worded similarly to corresponding sections of the final regulation for the Federal Parity Law.

The regulation also listed forbidden exclusions of care:

  • Denials because a treatment plan was not completed
  • Denials of medically necessary treatment because it is part of category of services specifically excluded by the plan
  • Services cannot be denied only because of a person’s age or the type of condition the service is for; for example, no exclusions for all services for anorexia (example added by ParityTrack, not the regulation itself)
  • Denials for court-ordered treatment

The regulation also lists information plans must disclose and release to patients regarding denials and NQTLs.

And finally, the regulation requires plans to submit filings that demonstrate plans’ parity analysis of quantitative treatment limitations and financial requirements.

6/2014

The Washington State Office of the Insurance Commissioner issued this letter to insurance plans informing them that denying coverage for medically necessary services on the basis of gender identity or a diagnosis of gender dysphoria is against state and federal law. The Commissioner clarifies that the section of state law about discrimination explicitly supersedes any section of the state insurance law that might seem to allow these kinds of denials.

4/2014

The Washington State Office of the Insurance Commissioner released an explanatory statement on a recent regulation that addressed network adequacy. A response to a comment on the final rule explains why the regulation does not directly address adequate networks for substance use disorder treatment. The response states that other rules already address adequacy in substance use disorder treatment and that, therefore, an emphasis on this area would be redundant.

Washington Parity Law

There are multiple sections of the state insurance law relevant to parity for mental health coverage and substance use disorder coverage. Some of these sections are virtually identical and have no meaningful differences. For the sake of simplicity, they will all be listed and hyperlinked here, and summarized below in the “Mental Health Coverage” and “Substance Use Disorder Coverage” sections. Any other sections relevant to parity are linked within the summaries below.

Identical mental health Sections: 41.05.600; 48.20.580; 48.21.241; 48.44.341; 48.46.291; 48.41.220; 70.47.200

Identical substance use disorder sections: 48.21.180; 48.44.240; 48.46.350

This section authorizes the Washington State Office of the Insurance Commissioner to issue regulations regarding the sections of the insurance law relevant to parity.

Mental Health Coverage

These sections (links are above) require individual plans, small employer fully-insured plans, large employer fully-insured, public employee plans, plans offered by the Washington State Health Insurance Pool, and the Washington Basic Health Plan (currently not active) to cover all mental health services in the DSM with the exception of V codes and substance use disorders (other sections do require coverage for substance use disorders; these sections are summarized below).

These sections require the following of plans:

  • Copayments and coinsurance must be the same for mental health services as what they are for other medical services
  • Patients’ out-of-pocket costs for mental health services and other medical services must all go towards the same deductible
  • Mental health services and other medical services must go towards the same out-of-pocket stop loss amount
  • Treatment limitations and any other financial requirements not listed above must be the same for mental health services as they are for other medical services
  • Prescription medication benefits for mental health treatment must be on “the same terms and conditions” as prescription medications for other medical treatment

Plans are allowed to use managed care, and there is no language saying that it must applied the same for mental health services as it is for other medical services.

Plans are exempted from covering residential treatment.

There is a section of the law and another identical section that forbid plans from requiring prior authorization for inpatient care if the patient is involuntarily committed.

Substance Use Disorder Coverage

These sections of the law (linked above) require plans to cover services for substance use disorders as long as the services are part of an “approved treatment plan.” Approved treatment plan is defined as a “discrete program of chemical dependency treatment provided by a treatment program certified by the department of social and health services.”

Get Support

Common Violations

In seeking care or services, be aware of the common ways parity rights can be violated.

Common Violations

Definition

Term Name


View in Glossary