Federal Judge Issues Key Ruling on Mental Health Parity

NEW YORK, NY (June 12, 2012) – – Autism Speaks hailed a federal court ruling that a Washington health plan’s refusal to cover Applied Behavior Analysis (ABA), speech, occupational, physical and other neurodevelopmental therapies after age six violated the state’s Mental Health Parity Act. The therapies are commonly used to treat the developmentally disabled, including persons with autism.

Ruling in Seattle on Z.D. v. Group Health Cooperative, U.S. District Court Judge Robert Lasnik found that treatments for developmental disabilities are covered under Washington state’s mental Health Parity Act and issued an immediate injunction. The case was brought as a class action on behalf of “Z.D.,” a 12-year-old with developmental disabilities who had received speech therapy from Group Health until she was cut off at age seven.

"“This is wonderful news for children with autism and other disabilities in Washington state who need critical therapies, such as ABA, to improve their quality of life and achieve greater independence,"” said Lorri Unumb, Esq., Autism Speaks vice president for state government affairs. “"The plaintiff’s attorneys, Eleanor Hamburger and Rick Spoonemore of Sirianni Youtz Spoonemore, deserve great credit for prevailing in this case which could have wider implications nationally.”"

In his ruling, Lasnik said, "““the Court ORDERS Defendants to cease their application of any treatment limitations [for mental health services] that are not generally imposed on coverage of medical and surgical services. The Court will not look kindly on failures to immediately implement its directive."”

The class action against Group Health was one of six brought against Washington insurers over their exclusion of neurodevelopmental and behavioral therapies. Lawsuits are pending against Premera Blue Cross, Regence Blue Shield, and the public employees’ coverage, the Uniform Medical Plan.

The use of exclusionary clauses to eliminate coverage for most or all specialty services to treat developmental disabilities is a common practice among Washington insurers, according to Hamburger and Spoonemore.

"“Every insurer in Washington state does what Judge Lasnik found was illegal,"” said Hamburger. "“Judge Lasnik'’s decision is a wake-up call to the other insurers to stop using blanket exclusions and special treatment limitations for mental health services now.”"

Lasnik’'s decision against Group Health follows on a similar ruling issued in March by King County Superior Court Judge Michael Trickey against Premera Blue Cross. In June 2011, Judge Susan Craighead found that the Uniform Medical Plan used an illegal blanket exclusion of ABA coverage for children with autism.