### IN THE SUPREME COURT OF THE STATE OF WASHINGTON 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 ) behalfand on behalfofall similarlysituated ) individuals, ) Respondents, V. REGENCE BLUESHIELO, a Washington corporation, Appellant. ) ) ) ) 

### ) ) ) ) ) ) No. 88940-6 En Bane
Filed 

### OCT 09 2014



## -----------------

WIGGINS, J.-Today's controversy arises from the enactment of two laws: the neurodevelopmental therapies mandate, RCW48.44.450, and the mental health parity act, RCW 48.44.341. In 1989, the Washington Legislature mandated coveragefor neurodevelopmentaltherapies (neurodevelopmentaltherapies or NOT) (speech, occupational, and physicaltherapy) in employer-sponsored group plansfor children under age seven (the neurodevelopmental therapies mandate or NOT mandate). RCW48.44.450. In 2005, the legislatureenactedthe mental health parity act, which mandates coverage for "mental health services." RCW 48.44.341. We hold thatthe statutes do not conflict-neurodevelopmental therapies may constitute "mental health services" if the therapies are medically necessary to treat a mentalO.S.T. byandthrough hisparents, G.T. andE.S. eta/. v. Regence 8/ueshie/d, No. 88940-6 disorder identified in the American Psychiatric Association's Diagnostic and StatisticalManual ofMentalDisorders (4th rev. ed. 2000) (DSM-IV-TR). Therefore, the blanket exclusions of neurodevelopmental therapies in the plaintiffs' health contracts are void and unenforceable.FACTS Thetwo named plaintiffs in this case are O.S.T. and L.H. O.S.T. was sixyears old atthetimethis lawsuitcommenced. When hewasjustsix monthsold, he began having difficultiesfeeding and was diagnosedwith afeeding disorder. Problemswith O.S.T.'s health worsened as he got older. "He went from having normal language developmentto 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 therapyfrom Boyer Children's Clinic.

1Thesetherapiesweresubsidized bythe BoyerChildren'sClinic. Attheageofthree, O.S.T. was no longereligibleforthe subsidy.
20.S. T. byandthrough hisparents, G. T. andE.S. eta/. 

### v. Regence B/ueshield, No. 88940-6 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 coverO.S.T.'stherapies, so O.S.T.'s parents paid forthe services. It is unclearwhether 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 orafterJanuary 1, 2008[21thatexclude coverage ofneurodevelopmental 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 NOT coverage in individual plans when the therapies are medically necessary to

2 This is the date the mental health parity act became applicable to individual health plans. See LAWS OF 2007, ch. 8, § 1.

30.S. T. byandthrough hisparents, G. T. andE.S. eta/. v. Regence Blueshield, No. 88940-6 treat mental disorders recognized in the 

### DSM-IV-TR ifthe insurance contract covers medical and surgical services.3 We also affirm the trial court's order granting partial summaryjudgment. A Standard of Review We review matters of statutory interpretation de novo. Oep't ofEcology 

### v. Campbell 

### & Gwinn, LLC, 146 Wn.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., 179Wn.2d 684, 693, 317 P.3d 987 (2014). B. Statutory Interpretation Ourfundamental goal in statutory interpretation is to "discern and implement the legislature's intent." State 

### v. Armendariz, 160 Wn.2d 106, 110, 156 P.3d 201 (2007). Ifastatute's meaning is plain on itsface, we "give effecttothat plain meaning
as an expression of legislative intent." Campbell

### & Gwinn, LLC, 146Wn.2d at 9-10. We derive the plain meaning from the language ofthe statute and related statutes. 

### /d. "When the plain language is unambiguous-that is, when the statutory language adt11its of only one meaning-the legislative intent is apparent, and we will not construe the statute otherwise." State v. 

### J.P., 149 Wn.2d 444, 450, 69 P.3d 318

3 Regence BlueShield argues that there is no justiciable issue before the court, so a declaratoryjudgmentwould be inappropriate. We rejectthis argument. O.S.T and L.H. are both diagnosed with mental disorders recognized inthe DSM-IV-TR, Regence BlueShield insures both ofthem on individual plans, both oftheir contracts contain blanket exclusions for neurodevelopmental therapies, and both need neurodevelopmentaltherapies. Regence BlueShield has denied coverageto O.S.T. While Regence BlueShield has notdenied claims for L.H., the risk of it doing so is more than merely hypothetical or speculative. Diversified Indus. Dev. Corp. v. Ripley, 82 Wn.2d 811, 814,.15, 514 P.2d 137 (1973).

40.S. T byandthrough hisparents, G. T andE. S. eta/. 

### v. Regence 8/ueshie/d, No. 88940-6 (2003). However, when the statute is ambiguous orthere are conflicting provisions, "we may arrive at the legislature's intent by applying recognized principles of statutory construction." 

### !d. We begin with an analysis of the plain language of the NOT 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 underthis section shall coverthe 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 underage seven. 

### /d. 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 afterfinding thatthe cost of leaving

50.S. T byand through hisparents, G. T andE. S. etat. v. Regence Blueshield, No. 88940-6 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 ofother health services, treatment delays leading to more costly treatments, suicide, family breakdown and impoverishment, and institutionalization, whether in hospitals, juvenile detention, jails, or prisons.

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 plans[5l delivered

... on or after January 1, 2008, coverage for:

4The legislature also found:

/d. Treatable mental disorders are prevalent and often have high impact on health and productive life. The legislature finds that the potential benefits ofimproved access to mental health services are significant. Additionally, the legislature declares that it is not cost-effective to treat persons with mental disorders differentlythan persons with medical and surgical disorders. Therefore, the legislature intends to require that insurance coverage be at parity for mental health services, which means this coverage be delivered under the same terms and conditions as medical and surgical services.

5 Originally, the mental health parity act covered only group health benefit plans for groups of more than 50 employees. LAWS OF 2005, ch. 6, § 4. However, in 2007, the legislature expanded the scope ofthe mental health parity act to cover all health benefit plans. LAWS OF 2007, ch. 8, § 3.

60.S. T byandthrough hisparents, G. T andE.S. etat. 

### v. Regence Blueshield, No. 88940-6 (i) Mental health services[61
.... 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

...." RCW48.44.341(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-/V-TR at pages 58-61 and 70-75. By the plain language ofthe 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, underthe language ofthe statute, the mental health parity

6 RCW 48.44.341(2)(i) continues: The copayment or coinsurance for mental health services may be no more than the copayment or coinsurance for medical and surgical services otherwise provided under the health benefit plan. Wellness and preventive servicesthatare provided or reimbursed at a lessercopayment, coinsurance, or other cost sharing than other medical and surgical services are excluded. from this comparison. Ifthe health benefit plan imposes a maximum out-ofpocket limit or stop loss, it shall be a single limit or stop loss for medical, surgical, and mental health services

. . . . · 7 The legislature expressly excluded certain services from the definition of "mental health services." See RCW 48.44.341 (1) ("(a) Substance related disorders; (b) life transition problems

... ; (c) skilled nursing facility services, home health care, residential treatment, and custodial care; and (d) court ordered treatment unless the health care service contractor's medical director or designee determines the treatment to be medically necessary").

70.S. T byandthrough hisparents, G. T andE.S. eta/. v. Regence B/ueshield, No. 88940-6 act requires coveragefor medically necessary neurodevelopmental therapies ifthey
are used to treat a mental disorder recognized in the 

### DSM-IV-TR. The NOT mandate and mental health parity act are unambiguous and do not conflict. 8 The scope ofeach is different. One statuteaddresses neurodevelopmental therapies generallyand does not requirethatthey 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, exceptas expressly excluded (providedthe contractcovers medical and surgical services). See RCW 48.44.341(1), (2). Under the plain language ofthe statute, we conclude that the NOT 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 meetthe requirements of both acts.9

8 Because the statutory language is unambiguous, we find it unnecessary to inquire into legislative history orfailed, subsequent bills. See Campbell& Gwinn, LLC, 146Wn.2d at 12.
9 Regence BlueShield asks us to attach significance to the fact that the Washington State Office of the Insurance Commissioner (OIC) has never disapproved Regence BlueShield's NOTexclusion. We declineto do so. Assuming thatthis constitutes an agency interpretation, we afford the agency interpretation deference only ifthe interpretation is not contrary to the plain language ofthe statute. PortofSeattle v. Pollution Control 1-lr'gs Bd., 151 Wn.2d 568, 612, 90 P.3d 659 (2004). According to the plain language of the mental health parity act, insurers must provide coverage for mental health services, including neurodevelopmental therapies, if they are medically necessary to treat mental disorders recognized in the DSM-IV-TR. RCW 48.44.341. Regence BlueShield's exclusion was contrary to the plain language ofthe mental health parity act, and OIC's action (or inaction) is irrelevant.

8O.S. T. byand through hisparents, G.T andE.S. eta/. v. Regence Blueshield, No. 88940-6 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 NOT mandate has both positive and negative requirements. The positive is that employersponsored plans must provide NOTcoverageto children through age six. See RCW 48.44.450(1). The negative is that no employer-sponsored plan is required to cover NOT to children over age six, and no other health plan is required to provide NOT benefits. See RCW 48.44.450(1). Under this interpretation, Regence BlueShield argues thatthe two statutes conflict-the mental health parity act requires coverage not required by the NOT mandate. Regence BlueShield concludes that the NOT mandate is the more specific statute and, therefore, controls. Consequently, O.S.T. and L.H. are not entitled to coverage. Regence BlueShield's argument is unpersuasive. It would make sense to apply the maxim expressio unius est exclusio alterius ifthe statutory language was ambiguous and the legislature never had enacted the mental health parity act. However, once the legislature passed the mental health parity act, the statute requires coverage regardless of the NOT mandate. The statutory maxim is subordinateto the primary rule ofstatutory interpretation, which istofollow legislative intent. See De Griefv. CityofSeattle, 50 Wn.2d 1, 12, 297 P.2d 940 (1956). The

90.S. T byandthrough hisparents, G. T andE.S. eta/. 

### v. Regence 8/ueshie/d, No. 88940-6 legislature's clear intent is to require coverage for all medically necessary services thattreat mental disorders. Regence BlueShield's reliance on the general-specific rule of statutory interpretation is also misplaced. We will not applythe rule because the statutes do notconflict. The rule ofstatutoryconstruction applies only if, afterattempting to read statutes governing the same subject matter in pari materia, we conclude that the statutes conflict to the extentthey cannot be harmonized. In re Estate ofKerr, 134 Wn.2d 328, 343, 949 P.2d 810 (1998); Residents Opposed to Kittitas Turbines 

### v. State Energy Facility Site Evaluation Council, 165 Wn.2d 275, 308-10, 197 P.3d 1153, 1170 (2008) (EFSEC). Under the principle of statutory construction, the specific statute prevails over a general statute. Kerr, 134 Wn.2d at 343; EFSEC, 165Wn.2d at 308-310. In situations where the legislature enacts a general statute after a specific statute, we construe "the original specific statute as an exception to the general statute, unless expressly repealed." EFSEC, 165 Wn.2d at 309. The statutes do not conflict, sothere is no needto applythe rule ofstatutoryconstruction. Second, Regence BlueShield argues that our interpretation of the mental health parity act constitutes an implicit repeal. "Repeal by implication occurs when
an act not purporting to repeal any prior act is wholly or partially inconsistentwith a prior statute
...." 1A NORMAN J. SINGER 

### &J.D. SHAMBlE SINGER, SUTHERLAND STATUTORY CONSTRUCTION 

### § 22:22, at 320-21 (7th ed. 2007). We disfavor repeals by implication, and will notfind repeal by implication "where earlierand laterstatutes may logically stand side by side and be held valid." Bellevue Sch. Dist. No. 405 v.

100.S. T byandthrough hisparents, G. T andE.S. etat. 

### v. Regence Blueshield, No. 88940-6 Brazier Constr. Co., 103 Wn.2d 111, 123, 691 P.2d 178 (1984); see Tardiff v. Shoreline Sch. Dist., 68 Wn.2d 164, 166, 411 P.2d 889 (1966); OurLadyofLourdes Hosp. 

### v. Franklin County, 120 Wn.2d 439, 450, 842 P.2d .956 (1993) ("Under the 2- pronged test for such repealer, the later act must coverthe entire subject matter of the earlier legislation, be complete in itself, and be intended to supersede prior legislation on the subject; and the two acts must be so clearly inconsistent and so repugnant to each other that they cannot be reconciled."). "Where an amendment may be harmonizedwith the existing provisions and purposes ofastatutoryscheme, there is no implicit repeal." Gilbert

### v. SacredHeart Med. Ctr., 127 Wn.2d 370, 375, 900 P.2d 552 (1995); see 1A SUTHERLAND STATUTORY CONSTRUCTION, supra, 

### § 23:9, at468-69 ("[l]fthe'inconsistency between a lateract and an earlier one is notfatal to the operation ofeither, the two may stand together and no repeal is effected."). Here, the statutes may stand side by side and fulfill their respective purposes. The NOT mandate changed common law. Insurers may limittheir liability, unlessthe exclusion is inconsistentwith public policyorastatutory mandate. Carrv. Blue Cross of Wash. 

### &Alaska, 93 Wn. App. 941, 948, 971 P.2d 102 (1999). By enacting the NOT mandate, the legislature changed the law as applied toemployer-sponsored plans for children under age seven, thus setting the floor on required coverage concerning employer-sponsored plans. Almost two decades later, the legislature added another coverage mandate-this time requiring parity for mental health services. The effect ofthe laterstatute does not nullifythe effects oftheformer. The express languageofthe NOT mandatesimply requires coverageforgroup planswith



### 110.S. T byand through hisparents, G. T andE.S. etat. v. Regence 8/ueshie/d, No. 88940-6 children under age seven. The mental health parity act created a different floor for medically necessary treatments for mental disorders. Therefore, the mental health parity act does not implicitly repealthe NOT mandate

.. Finally, Regence BlueShield. argues that

. because "providers of neurodevelopmental therapies-occupational, speech, and physical therapistsmay not provide mental-health services, those therapies cannot be considered mental-health services, and the [mental health] ParityAct does not apply." Appellant Regence BlueShield's Opening Br. at 18. It reaches this conclusion by exporting from anotherchapterofthe statutethedefinition of"mental health care practitioners." See RCW48.43.087. Regence BlueShield's reasoning isflawed. The definitionwas only "for purposes of [the] section" ofthe statute that allows insurance enrollees to agreeto contractfor otherservices attheirown expense. RCW48.43.087(1)(c), (2). An additional red flag is that RCW 48.43.087(1)(d) provides a definition for "mental health services" that is differentfrom the one provided in the mental health parityact. Clearly, the definitions in RCW 48.43.087 do not apply to the mental health parity act. D. Summary Judgment Having interpreted the statutes, we now analyze whether the trial court properly granted summary judgment. Summary judgment is appropriate only if "there is no genuine issue as to any material fact and

...the moving party is entitled to ajudgment as a matter of law." CR 56(c). We grant motions only if reasonable people could reach one conclusion based on the evidencewhen viewing the facts in

120.S.T byandthrough hisparents, G.T andE.S. eta/. v. Regence Blueshield, No. 88940-6 the light most favorable to the nonmoving party. Korslund v. DynCorp Tri-Cities Servs., Inc., 156 Wn.2d 168, 177, 125 P.3d 119 (2005). Here, the trial court appropriately granted summaryjudgment on the declaratoryjudgment claim. Under the Uniform Declaratory JudgmentsAct, chapter 7.24 RCW, "[c]ourts of record within their respective jurisdictions shall have power to declare rights, status and other legal relations whether or not further relief is or could be claimed." RCW 7.24.010. "A person interested under a deed, will, written contract or other writings constituting a contract, or whose rights, status or other legal relations are affected by a statute [or] contract
... may have determined any question of construction or validity arising underthe instrument, statute, ordinance, contract or franchise and obtain a declaration of rights, status or other legal relations thereunder." RCW 7.24.020. Here, the plaintiffs ask the court to determine the validity of a provision in their health contracts underWashington law. Under the mental health parity act, all health benefit plans must provide coverage for "mental health services" if they provide coverage for medical and surgical services. RCW 48.44.341(2)(c). Neurodevelopmental therapies qualify as "mental health services" if they are medically necessary to treat a mental disorder covered by the DSM-IV-TR. RCW 48.44.341. Regence BlueShield is a health care service contractor, it entered into contractswith O.S.T. and L.H. for individual policies, and neitherpartyquestionsthat the plans provide coverage for medical and surgical services. The plans contain a blanket exclusion for all neurodevelopmental therapies, meaning that the plans

130.S. T byandthrough hisparents, G. T andE.S. etat. v. Regence B/ueshield, No. 88940-6 exclude therapies regardless ofwhether they are medically necessary. Therefore, the blanket exclusion violates the mental health parity act if neurodevelopmental therapies may be medically necessaryto treat mental disorders. "Medically necessary" is defined under Regence BlueShield contracts: MEDICALLY NECESSARY: Means health care services or supplies thata Physician orother health care providerexercising prudentclinical judgment, would provide to a Member for the purpose of preventing, evaluating, diagnosing or treating an illness, injury, disease or its symptoms and that are: 1.17.1 In accordance with generally accepted standards of medical practice; 1.17.2 Clinically appropriate, in terms of type, frequency, extent, site and duration, and considered effective for the Member's illness, injury or disease; and 1.17.3 Not primarily for the convenience ofthe Member, Physician or other health care provider, and not more costly than an alternative service or sequence of services, or supply at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment ofthe Member's illness, injury or disease. Forthese purposes, "generally accepted standards ofmedical practice" • means standards that are based ·on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, Physician Specialty Society recommendations and the views of Physicians practicing in relevant clinical areas and any other relevantfactors

.. (Emphasis added.) Regence BlueShield argues that there is a genuine issue of material fact concerning whether neurodevelopmental therapies may be "medically necessary." However, there is no real disagreementthat neurodevelopmentaltherapies meetthe definition of "medically necessary" in Regence BlueShield's own contract By the



### 140.S. T byandthrough hisparents, G. T andE.S. eta/. 

### v. Regence Blueshield, No. 88940-6 terms of the contract, a service may be "medically necessary" if it treats the symptoms ofa disease or illness (and meets other enumerated qualifications). The service does not need to cure the illness; it is sufficientto treatthe symptoms ofthe illness. The executive medical director at Regence BlueShield, Dr. Joseph Gifford, recognizes, "[Autism Spectrum Disorder (ASD)] is a complex disorder, the exact
causeofwhich is unknown. Mostservices arefocused on improving physical, social, and functional problems that impactthe functional status of individuals." 10 The plaintiffs submitted declarations from Dr. Charles Cowan, the medical director of Seattle Children's Hospital Autism Center and a clinical professor in pediatrics and psychiatry at the University ofWashington School of Medicine. He states:Neurodevelopmental therapies (such as speech, occupational, and physical therapies) are a critical component oftreating autism. Often, thesetherapies arethe only specialized medical interventions provided to young children with autism. In Washington [S]tate, it is a standard medical practice to have young children suspected of having autism evaluated by neurodevelopmental therapists, and if such evaluations reveal significant delays, treated with speech, occupational and physical therapy. Dr. Cowan additionally states: [T]he medical community has embraced the conclusion that neurodevelopmental therapies treat ASD as well as many other developmental disorders. Like insulin therapy for diabetics, neurodevelopmental therapies address the fundamental symptoms of

10 Dr. Gifford also statesthat neurodevelopmental therapies do not actuallytreatthe autism. He does not consider treatment to include services that improve the function of the beneficiary. However, such services meet Regence BlueShield's definition of "medically necessary." 

### 150.S. T byandthrough hisparents, G. T andE.S. eta!. v. Regence Blueshield, No. 88940-6 the conditions and can dramatically improve those symptoms. The purpose of neurodevelopmental therapies

... is to attemptto restore a child's functional capacityto develop in a manner more consistentwith the normal pattern of human development. With these therapeutic interventions, a child withASD may be restored to the normal curve of developmental milestones, or as near normal as possible. Despite Regence BlueShield's contention, there is no genuine issue preventing summaryjudgment-reasonable minds could not differwhen viewing the evidence in the light most favorable to the defendant. Neurodevelopmental therapies may be medically necessary under Regence BlueShield's broad definition ofthe term because neurodevelopmental therapies treatthe symptoms ofautism (a mental disorder recognized in the 

### DSM-IV-TR). Therefore, blanket exclusion of these therapies violates the mental health parity act. CONCLUSION We affirm the trial court's order of partial summary judgment. Regence BlueShield's blanket exclusion of neurodevelopmental therapies in its individual policies violates the mental health parity act. If neurodevelopmental therapies are medically necessary to treat mental disorders (and the contract provides coverage for medical and surgical services), Regence BlueShield must provide coverage for the therapies. The exclusion is void and invalid as a matter ofVVashington law.

160.S. T byand through hisparents, G. T andE.S. eta!. v. Regence Blueshie/d, No. 88940-6

WE CONCUR.

17