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O.S.T v. Regence BlueShield

Supreme Court of Washington, En Banc

October 9, 2014

O.S.T. et al., Individually and on Behalf of All Similarly Situated Individuals, Respondents ,
Regence BlueShield, Petitioner

Argued June 12, 2014.

Page 417

Appeal from King County Superior Court 11-2-34187-9 Honorable John P. Erlick.

Timothy J. Parker, Jason W. Anderson, and Gregory M. Miller (of Carney Badley Spellman PS ), for petitioner.

Eleanor Hamburger and Richard E. Spoonemore (of Sirianni Youtz Spoonemore Hamburger ), for respondents.

AUTHOR: Justice Charles K. Wiggins. WE CONCUR: Chief Justice Barbara A. Madsen, Justice Charles W. Johnson, Justice Susan Owens, Justice Mary E. Fairhurst, Justice Debra L. Stephens, Justice Steven C. Gonzá alez, Justice Sheryl Gordon McCloud, Justice Mary I. Yu.


Page 418

[181 Wn.2d 694] 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.


¶ 2 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." bye 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 [181 Wn.2d 695] 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.

¶ 3 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.

¶ 4 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.

¶ 5 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

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1, 2008 [2] 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.


¶ 6 We hold the neurodevelopmental therapies mandate and the mental health parity act do not conflict. The mental [181 Wn.2d 696] 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

¶ 7 We review matters of statutory interpretation de novo. Dep'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

¶ 8 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. 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 Wn.2d 444, 450, 69 P.3d 318 (2003). However, when the statute is ambiguous or there are conflicting provisions, " we may [181 Wn.2d 697] arrive at the legislature's intent by applying recognized principles of statutory construction." Id.

¶ 9 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; ...

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