O.S.T ex rel. G.T. v. Blueshield

• Citation: 335 P.3d 416,181 Wash.2d 691
• Decision Date: 09 October 2014
• Docket Number: No. 88940–6.,88940–6.
• Court: Washington Supreme Court
• Parties: O.S.T, by and through his parents, G.T. and E.S.; and L.H., by and through his parents, M.S. and K.H., each on his own behalf and on behalf of all similarly situated individuals, Respondents, v. Regence BLUESHIELD, a Washington corporation, Appellant.

181 Wash.2d 691

335 P.3d 416

O.S.T, by and through his parents, G.T. and E.S.; and L.H., by and through his parents, M.S. and K.H., each on his own behalf and on behalf of all similarly situated individuals, Respondents

v.Regence BLUESHIELD, a Washington corporation, Appellant.

No. 88940–6.

Supreme Court of Washington, En Banc.

Oct. 9, 2014.

Timothy James Parker, Jason Wayne Anderson, Gregory Mann Miller, Carney Badley Spellman PS, Seattle, WA, for Appellant.

Eleanor Hamburger, Richard E. Spoonemore, Sirianni Youtz Spoonemore Hamburger, Seattle, WA, for Respondent.

Opinion

WIGGINS, J.

¶ 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 48.44.341. In 1989, the Washington Legislature mandated coverage for neurodevelopmental therapies (neurodevelopmental therapies or NDT) (speech, occupational, and physical therapy) in employer-sponsored group plans for children under age seven (the neurodevelopmental therapies mandate or NDT mandate). RCW 48.44.450. In 2005, the legislature enacted the mental health parity act, which mandates coverage for “mental health services.” RCW 48.44.341. We hold that the statutes do not conflict—neurodevelopmental therapies may constitute “mental health services” if the therapies are medically necessary to treat a mental disorder identified in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (4th rev. ed.2000) (DSM–IV–TR). Therefore, the blanket exclusions of neurodevelopmental therapies in the plaintiffs' health contracts are void and unenforceable.

FACTS

The two named plaintiffs in this case are O.S.T. and L.H. O.S.T. was six years old at the time this law suit commenced. When he was just six months old, he began having difficulties feeding and was diagnosed with a feeding disorder. Problems with O.S.T.'s health worsened as he got older. “He went from having normal language development to nearly no language at all.” By his third birthday, therapists believed that O.S.T. was autistic. Between 2006 and 2008 he received speech, physical, and occupational therapy from Boyer Children's Clinic.¹ After leaving the Boyer Children's Clinic, he continued to receive neurodevelopmental therapies from Children's Communication Corner; the Hearing, Speech and Deafness Center; and Seattle Children's Hospital. In 2009, the autism

diagnosis was confirmed following an evaluation with Seattle Children's Hospital.

The second named plaintiff, L.H., was two years old when this suit began. He is diagnosed with expressive language disorder

, myotubular myopathy, profound hypotonia, and severe hydrocephalus. He receives speech, occupational, and physical therapy from Boyer Children's Clinic.

Both plaintiffs either are or have been insured under health policies issued by Regence BlueShield that contain blanket exclusions for neurodevelopmental therapies. Regence BlueShield did not cover O.S.T.'s therapies, so O.S.T.'s parents paid for the services. It is unclear whether Regence BlueShield denied any of L.H.'s claims.

The plaintiffs filed a class-action complaint, alleging breach of contract; declaratory relief; violation of the Washington Consumer Protection Act, chapter 19.86 RCW; and seeking injunctive relief. Judge Erlick granted partial summary judgment to the plaintiffs on December 12, 2012. He held that “any provisions contained in Regence BlueShield policies issued and delivered to Plaintiffs O.S.T. and L.H. on or after January 1, 2008² that exclude coverage of neurodevelopmental therapies regardless of medical necessity are declared invalid, void and unenforceable by Defendant and its agents.” He further certified the order for interlocutory review under RAP 2.3(b)(4). The Court of Appeals granted discretionary review, and we accepted transfer.

ANALYSIS

We hold the neurodevelopmental therapies mandate and the mental health parity act do not conflict. The mental health parity act requires insurers to provide NDT coverage in individual plans when the therapies are medically necessary to treat mental disorders recognized in the DSM–IV–TR if the insurance contract covers medical and surgical services.³ We also affirm the trial court's order granting partial summary judgment.

A. Standard of Review

We review matters of statutory interpretation de novo. Dep't of Ecology v. Campbell & Gwinn, LLC, 146 Wash.2d 1, 9, 43 P.3d 4 (2002). We use that same standard to review grants of summary judgment. Camicia v. Howard S. Wright Constr. Co., 179 Wash.2d 684, 693, 317 P.3d 987 (2014).

B. Statutory Interpretation

Our fundamental goal in statutory interpretation is to “discern and implement the legislature's intent.” State v. Armendariz, 160 Wash.2d 106, 110, 156 P.3d 201 (2007). If a statute's meaning is plain on its face, we “give effect to that plain meaning as an expression of legislative intent.”Campbell & Gwinn, LLC, 146 Wash.2d at 9–10, 43 P.3d 4. We derive the plain meaning from the language of the statute and related statutes. Id. “When the plain language is unambiguous—that is, when the statutory language admits of only one meaning—the legislative intent is apparent, and we will not construe the statute otherwise.” State v. J.P., 149 Wash.2d 444, 450, 69 P.3d 318 (2003). However, when the statute is ambiguous or there are conflicting provisions, “we may arrive at the legislature's intent by applying recognized principles of statutory construction.” Id.

We begin with an analysis of the plain language of the NDT mandate. The legislature passed the mandate in 1989. Laws of 1989, ch. 345; RCW 48.44.450. It provides:

(1) Each employer-sponsored group contract for comprehensive health care service[s] ... 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....

(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.

RCW 48.44.450 (emphasis added).

The plain language of the mandate suggests legislative intent to expand coverage for therapies, but to do so in a limited way. It mandated expanded coverage only for group insurance plans and, within those plans, only for children under age seven. Id.

Sixteen years later, the legislature enacted another mandate, which requires health insurers to provide coverage for “mental health services.” See RCW 48.44.341. The legislature passed the mandate after finding that the cost of leaving mental disorders untreated is significant. See Laws of 2005, ch. 6, § 1. Costs include:

[d]ecreased job productivity, loss of employment, increased, disability costs, deteriorating school performance, increased use of other health services, treatment delays leading to more costly treatments, suicide, family breakdown and impoverishment, and institutionalization, whether in hospitals, juvenile detention, jails, or prisons.

Id.⁴

The mental health parity act provides:

(2) All health service contracts providing health benefit plans that provide coverage for medical and surgical services shall provide:

....

(b) For all health benefit plans⁵ delivered ... on or after January 1, 2008, coverage for:

(i) Mental health services⁶ ....

RCW 48.44.341. The legislature defined “mental health services” as “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 disorders....” RCW 48.44.341(1).⁷

The language of the mental health parity act evidences legislative intent to require health insurers to cover treatment for mental health disorders and to do so in parity with the medical and surgical services it covers. Expressive language disorder and autistic disorder

are mental disorders recognized in the DSM–IV–TR at pages 58–61 and 70–75. By the plain language of the mental health parity act, the legislature did not create an exception for autism (or expressive language disorder ) or the neurodevelopmental therapies that treat these disorders. See RCW 48.44.341(1). Therefore, under the language of the statute, the mental health parity act requires coverage for medically necessary neurodevelopmental therapies if they are used to treat a mental disorder recognized in the DSM–IV–TR.

The NDT mandate and mental health parity act are unambiguous and do not conflict.⁸ The scope of each is different. One statute addresses neurodevelopmental therapies generally and does not require that they be used to treat a mental disorder recognized in the DSM–IV–TR. See RCW 48.44.450. The other broadly mandates coverage for all medically necessary treatment for mental disorders recognized in the DSM–IV–TR, except as expressly excluded (provided the contract covers medical and surgical services). See RCW 48.44.341(1), (2).

Under the plain language of the statute, we conclude that the NDT mandate creates a minimum level of required coverage for neurodevelopmental therapies. However, when neurodevelopmental therapies are medically necessary to treat mental disorders in the DSM–IV–TR, the mental health parity act requires additional coverage. Insurers must meet the requirements of both acts.⁹

C. Regence BlueShield's Arguments

Regence BlueShield makes several failing arguments. It first argues that neurodevelopmental therapies are an exception to the mental health parity act. It arrives at this conclusion using the statutory maxim expressio unius est exclusio alterius. Applying this maxim, Regence BlueShield argues that the NDT mandate has both positive and...