Under the Office of Insurance Commissioner(OIC)’s proposed rules(attached below), developmentally disabled children could receive very limited medically necessary therapy before coverage would run out. Under that scenario, children could lose all the progress made as a result of the therapy until they have coverage again the next calendar year. Please take action asking the OIC to address this disparity.
- Please call Meg L. Jones (Policy & Rules Manager, Office of Insurance Commissioner) at (360) 725-7170 or e-mail MegJ@OIC.WA.Gov .
Let M. Jones know, as a constituent, you need the OIC to add language to the rulemaking section on “Habilitative Services” that the definition of “habilitation services” excludes any service that is a “mental health service” under our state’s Mental Health Parity Act. Without that clarification, health insurers will argue that the OIC intended to allow visit limits to be imposed on neurodevelopmental therapies including those to treat DSM-IV conditions. Let her know how detrimental this is to your loved one with autism or developmental disability.
Rule making that results in a combined annual 25 visit limit for neurodevelopmental therapies to treat DSM-IV conditions would result in inadequate — even illusory – coverage. Neurodevelopmental therapies are the essential health benefits for developmentally disabled children.
Ideally, the final rule would expressly include ABA and neurodevelopmental therapies to treat DSM-IV conditions as “mental health services” consistent with the Parity Act, as we saw in an earlier version of these rules.
- Please forward this note to 25 family members, friends, therapists and coworkers and ask them to please do the same.
Thank your for your consideration.