Many thanks to all of you who have been calling and writing, the bills we're actively supporting are moving along the legislative process:

HB 1956 - This is one of the single most important bills for protecting and improving health insurance coverage for consumers. It will create transparency for consumers, the regulator, and the public in general. Washington created the independent review organization (IRO) system as part of the Patient Bill of Rights to review insurer denials after the consumer has exhausted the internal appeal process. The internal appeals process is discouraging, because it is difficult to convince insurers to overturn their denials. The IRO system uses medical reviewers to impartially resolve disputes without the courts. Sometimes the IRO upholds the decision of the insurer, and sometimes the IRO rules in favor of the patient. Many states followed Washington's lead, and the Affordable Care Act incorporates an external review process.

The problem is that insurers may continue to deny coverage for treatments for the same condition for other patients, even after the IRO overturns their decision. California has a detailed database which has helped consumers access decisions in cases that are similar to their own and has helped regulators identify patterns. This bill requires decisions to be publicly searchable, which will allow the public and the Office of the Insurance Commissioner (OIC) to find repeated denials for the same request and will allow families to reference successful IRO decisions as they pursue their own appeals. This bill levels the playing field by giving the OIC and consumers the same information as the health plans.

Currently, there is not much a consumer can do if the health plan does not follow an IRO's decision. There is no action taken if a consumer files a complaint, so the consumer has to go to court. Currently, at the Department of Health (DOH), the process is disconnected from insurance regulation, and it makes sense for the OIC, the regulatory agency with control over insurance companies, to regulate IROs. Having information about IRO decisions will give the OIC an additional piece of information along with other market analysis information to identify players who may be out of sync.

Washington has a strong mental health parity law, but it is not being followed in individual decisions by insurers. There is no way to know how widespread the violations are. Children with autism who are prescribed behavioral health therapy have been routinely denied coverage. An IRO found that behavioral health therapy is medically necessary, but there is no enforcement mechanism. Social workers have been frustrated trying to get their services covered, and clients are not guaranteed confidentiality if they file a complaint with the OIC. One cancer patient was denied benefits for surgery on the grounds that it was experimental. The patient eventually prevailed at the IRO level when the family found an advocate who had previously succeeded in obtaining a reversal for the same procedure under the same plan.

How you can help:

Call your senator, let them know SHB 1956 is important to your family. Ask them to please support this bill and vote YES, when it's moved it's way to the senate.

HB 1240 / SB 5809 - Regarding seclusion and restraints of students with disabilities in public schools.  Both bills have passed their committee of origin and are awaiting a full vote in each chamber.  Stay tuned for future action.

SB 5488 - Applied Behavior Analysis is an integral part of evidence based treatment for autism spectrum disorders.  This bill creates licensure for behavior analysts, assistant behavior analysts, and behavior technicians through the Washington State department of health.  This bill is awaiting a full vote in the House Rules Committee, after that it will move to the House of Representatives.  Stay tuned for future action.