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 ) 

behalf and on behalf of all similarly situated ) 

individuals, ) 

Respondents, 

V. 

REGENCE BLUESHIELO, a Washington 

corporation, 

Appellant. 

) 

) 

) 

) 

) 

) 

) 

) 

) 

) 

No. 88940-6 

En Bane 

Filed OCT 0 9 2014 -----------------

WIGGINS, J.-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 NOT) 

(speech, occupational, and physical therapy) in employer-sponsored group plans for 

children under age seven (the neurodevelopmental therapies mandate or NOT 

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 
O.S. T. by and through his parents, G. T. and E.S. eta/. 

v. Regence 8/ueshie/d, No. 88940-6 

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. 

1 These therapies were subsidized by the Boyer Children's Clinic. At the age of three, O.S.T. 

was no longer eligible for the subsidy. 

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0. S. T. by and through his parents, G. T. and E. 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 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, 2008[21 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 

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. 

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v. Regence Blueshield, No. 88940-6 

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. Oep't of Ecology 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., 179 Wn.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 Wn.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 Wn.2d at 9-10. 

We derive the plain meaning from the language of the 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 

declaratory judgment would be inappropriate. We reject this argument. O.S.T and L.H. are 

both diagnosed with mental disorders recognized in the DSM-IV-TR, Regence BlueShield 

insures both of them on individual plans, both of their contracts contain blanket exclusions 

for neurodevelopmental therapies, and both need neurodevelopmental therapies. Regence 

BlueShield has denied coverage to O.S.T. While Regence BlueShield has not denied 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). 

4 
0. S. T by and through his parents, G. T and E. 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 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. /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 after finding that the cost of leaving 

5 
0. S. T by and through his parents, G. T and E. S. et at. 

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 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. 

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: 

4 The 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 

of improved access to mental health services are significant. Additionally, the 

legislature declares that it is not cost-effective to treat persons with mental 

disorders differently than 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 of the mental health parity act to cover all health benefit plans. LAWS 

OF 2007, ch. 8, § 3. 

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0. S. T by and through his parents, G. T and E. S. et at. 

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 .... " 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-/V-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 

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 

services that are provided or reimbursed at a lesser copayment, coinsurance, 

or other cost sharing than other medical and surgical services are excluded. 

from this comparison. If the 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"). 

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0. S. T by and through his parents, G. T and E. S. eta/. 

v. Regence B/ueshield, No. 88940-6 

act requires coverage for medically necessary neurodevelopmental therapies if they 

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 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 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 meet the requirements of both acts. 9 

8 Because the statutory language is unambiguous, we find it unnecessary to inquire 

into legislative history or failed, subsequent bills. See Campbell & Gwinn, LLC, 146 Wn.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 NOT exclusion. We decline to do so. Assuming that this constitutes an agency 

interpretation, we afford the agency interpretation deference only if the interpretation is not 

contrary to the plain language of the statute. Port of Seattle 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 of the mental health parity act, and OIC's action (or inaction) 

is irrelevant. 

8 
O.S. T. by and through his parents, G.T and E.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 NOT coverage to 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 that the 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 if the 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 

subordinate to the primary rule of statutory interpretation, which is to follow legislative 

intent. See De Grief v. City of Seattle, 50 Wn.2d 1, 12, 297 P.2d 940 (1956). The 

9 
0. S. T by and through his parents, G. T and E. S. eta/. 

v. Regence 8/ueshie/d, No. 88940-6 

legislature's clear intent is to require coverage for all medically necessary services 

that treat mental disorders. 

Regence BlueShield's reliance on the general-specific rule of statutory 

interpretation is also misplaced. We will not apply the rule because the statutes do 

not conflict. The rule of statutory construction applies only if, after attempting to read 

statutes governing the same subject matter in pari materia, we conclude that the 

statutes conflict to the extent they cannot be harmonized. In re Estate of Kerr, 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, 

165 Wn.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, so there is no need to apply the rule of statutory construction. 

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 inconsistent with 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 not find repeal by implication "where earlier and later statutes 

may logically stand side by side and be held valid." Bellevue Sch. Dist. No. 405 v. 

10 
0. S. T by and through his parents, G. T and E. S. et at. 

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); Our Lady of Lourdes 

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 cover the 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 harmonized with the existing provisions and purposes of a statutory scheme, 

there is no implicit repeal." Gilbert v. Sacred Heart Med. Ctr., 127 Wn.2d 370, 375, 

900 P.2d 552 (1995); see 1A SUTHERLAND STATUTORY CONSTRUCTION, supra, § 23:9, 

at 468-69 ("[l]f the 'inconsistency between a later act and an earlier one is not fatal to 

the operation of either, 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 limit their liability, unless the 

exclusion is inconsistent with public policy or a statutory mandate. Carr v. 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 to employer-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 of the later statute does not nullify the effects of the former. The 

express language of the NOT mandate simply requires coverage for group plans with 

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0. S. T by and through his parents, G. T and E. S. et at. 

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 repeal the 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] Parity Act does not apply." Appellant 

Regence BlueShield's Opening Br. at 18. It reaches this conclusion by exporting 

from another chapter of the statute the definition of "mental health care practitioners." 

See RCW 48.43.087. Regence BlueShield's reasoning is flawed. The definition was 

only "for purposes of [the] section" of the statute that allows insurance enrollees to 

agree to contract for other services at their own expense. RCW 48.43.087(1 )(c), (2). 

An additional red flag is that RCW 48.43.087(1 )(d) provides a definition for "mental 

health services" that is different from the one provided in the mental health parity act. 

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 a judgment as a matter of law." CR 56(c). We grant motions only if reasonable 

people could reach one conclusion based on the evidence when viewing the facts in 

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0. S. T by and through his parents, G. T and E. 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 summary judgment on the declaratory judgment claim. 

Under the Uniform Declaratory Judgments Act, 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 7.24.01 0. "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 under the 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 under Washington 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 

contracts with O.S.T. and L.H. for individual policies, and neither party questions that 

the plans provide coverage for medical and surgical services. The plans contain a 

blanket exclusion for all neurodevelopmental therapies, meaning that the plans 

13 
0. S. T by and through his parents, G. T and E. S. et at. 

v. Regence B/ueshield, No. 88940-6 

exclude therapies regardless of whether they are medically necessary. Therefore, 

the blanket exclusion violates the mental health parity act if neurodevelopmental 

therapies may be medically necessary to treat mental disorders. 

"Medically necessary" is defined under Regence BlueShield contracts: 

MEDICALLY NECESSARY: Means health care services or supplies 

that a Physician or other health care provider exercising prudent clinical 

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 of the 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 of the Member's illness, injury or disease. 

For these purposes, "generally accepted standards of medical 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 relevant factors .. 

(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 disagreement that neurodevelopmental therapies meet the 

definition of "medically necessary" in Regence BlueShield's own contract By the 

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0. S. T by and through his parents, G. T and E. S. et a/. 

v. Regence Blueshield, No. 88940-6 

terms of the contract, a service may be "medically necessary" if it treats the 

symptoms of a disease or illness (and meets other enumerated qualifications). The 

service does not need to cure the illness; it is sufficient to treat the symptoms of the 

illness. 

The executive medical director at Regence BlueShield, Dr. Joseph Gifford, 

recognizes, "[Autism Spectrum Disorder (ASD)] is a complex disorder, the exact 

cause of which is unknown. Most services are focused on improving physical, social, 

and functional problems that impact the 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 of Washington School of Medicine. He 

states: 

Neurodevelopmental therapies (such as speech, occupational, and 

physical therapies) are a critical component of treating autism. Often, 

these therapies are the 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 states that neurodevelopmental therapies do not actually treat the 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." 

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0. S. T by and through his parents, G. T and E. S. eta!. 

v. Regence Blueshield, No. 88940-6 

the conditions and can dramatically improve those symptoms. The 

purpose of neurodevelopmental therapies ... is to attempt to restore a 

child's functional capacity to develop in a manner more consistent with 

the normal pattern of human development. With these therapeutic 

interventions, a child with ASD 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 summary judgment-reasonable minds could not differ when viewing the 

evidence in the light most favorable to the defendant. Neurodevelopmental 

therapies may be medically necessary under Regence BlueShield's broad definition 

of the term because neurodevelopmental therapies treat the symptoms of autism (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 of VVashington law. 

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0. S. T by and through his parents, G. T and E. S. eta!. 

v. Regence Blueshie/d, No. 88940-6 

WE CONCUR. 

17