Wash. Rev. Code » Title 48 · Chapter 48.44

Wash. Rev. Code § 48.44.450

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(1) Each employer-sponsored group contract for comprehensive health care service which is entered into, or renewed, on or after twelve months after July 23, 1989, shall include coverage for neurodevelopmental therapies for covered individuals age six and under.
(2) Benefits provided under this section shall cover the services of those authorized to deliver occupational therapy, speech therapy, and physical therapy. Benefits shall be payable only where the services have been delivered pursuant to the referral and periodic review of a holder of a license issued pursuant to chapter 18.71 or 18.57 RCW or where covered services have been rendered by such licensee. Nothing in this section shall prohibit a health care service contractor from requiring that covered services be delivered by a provider who participates by contract with the health care service contractor unless no participating provider is available to deliver covered services. Nothing in this section shall prohibit a health care service contractor from negotiating rates with qualified providers.
(3) Benefits provided under this section shall be for medically necessary services as determined by the health care service contractor. Benefits shall be payable for services for the maintenance of a covered individual in cases where significant deterioration in the patient's condition would result without the service. Benefits shall be payable to restore and improve function.
(4) It is the intent of this section that employers purchasing comprehensive group coverage including the benefits required by this section, together with the health care service contractor, retain authority to design and employ utilization and cost controls. Therefore, benefits delivered under this section may be subject to contractual provisions regarding deductible amounts and/or copayments established by the employer purchasing coverage and the health care service contractor. Benefits provided under this section may be subject to standard waiting periods for preexisting conditions, and may be subject to the submission of written treatment plans.
(5) In recognition of the intent expressed in subsection (4) of this section, benefits provided under this section may be subject to contractual provisions establishing annual and/or lifetime benefit limits. Such limits may define the total dollar benefits available or may limit the number of services delivered as agreed by the employer purchasing coverage and the health care service contractor.
[ 1989 c 345 s 1.]
Notes of Decisions
Cited in 4 cases, 2011–2014 · leading case: O.S.T. v. Regence BlueShield
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O.S.T. v. Regence BlueShield (2014) wash · cites it 7× “*694 ¶1 Today’s controversy arises from the enactment of two laws: the neurodevelopmental therapies mandate, RCW 48.44.450, and the mental health parity act, RCW 48.”
Z.D. ex rel. J.D. v. Group Health Cooperative (2011) wawd · cites it 9× “291’s mandate, Defendants argue that its provisions conflict with Washington’s previously enacted Neurodevelopmental Therapy Mandate, which provides in part: Each employer-sponsored group contract for comprehensive health care service which is entered into, or renewed, on or…”
O.S.T. v. Regence BlueShield (2014) wash · cites it 7× “In 1989, the Washington Legislature mandated coverage for neurodevelopmental therapies (neurodevelopmental therapies or NOT) (speech, occupational, and physical therapy) in employer-sponsored group plans for children under age seven (the neurodevelopmental therapies mandate or…”
O.S.T. v. Regence BlueShield (2014) wash · cites it 6× “In 1989, the Washington Legislature mandated coverage for neurodevelopmental therapies (neurodevelopmental therapies or NOT) (speech, occupational, and physical therapy) in employer-sponsored group plans for children under age seven (the neurodevelopmental therapies mandate or…”
— Wash. Rev. Code § 48.44.450(1) — 2 cases
O.S.T. v. Regence BlueShield (2014) wash “*694 ¶1 Today’s controversy arises from the enactment of two laws: the neurodevelopmental therapies mandate, RCW 48.44.450, and the mental health parity act, RCW 48.”
Z.D. ex rel. J.D. v. Group Health Cooperative (2011) wawd “291’s mandate, Defendants argue that its provisions conflict with Washington’s previously enacted Neurodevelopmental Therapy Mandate, which provides in part: Each employer-sponsored group contract for comprehensive health care service which is entered into, or renewed, on or…”
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