Pension & Benefits Daily™ covers all major legislative, regulatory, legal, and industry developments in the area of employee benefits every business day, focusing on actions by Congress,...
Aug. 11 — Providence Health Plan violated state and federal mental health parity laws by denying coverage for certain autism-related behavioral treatments, the U.S. District Court for the District of Oregon concluded .
Judge Michael H. Simon ruled Aug. 8 that the insurer's failure to cover applied behavior analysis (ABA) therapy violated the federal mental health parity act, because it imposed a treatment limitation on mental health benefits that didn't apply to other types of benefits.
The coverage denials also violated Oregon law mandating mental health parity and coverage for minors with developmental disorders, the court determined.
The participants filed a class action challenging Providence's use of its developmental disability exclusion to exclude ABA therapy from coverage. According to the court, ABA therapy is an intensive behavior therapy that measures and evaluates observable behaviors and may provide significant benefits to children with autism.
The court certified the suit as a class action in December 2013.
In January, an Oregon-based nonprofit group that supports individuals with disabilities filed an amicus brief on behalf of the participants.
In the instant ruling, the court agreed with the participants that Providence's coverage denials violated the Oregon Mental Health Parity Act.
The court said that, while Providence could decline to cover autism altogether, it couldn't “simultaneously purport to cover autism and yet deny coverage for medically necessary ABA therapy through its Developmental Disability Exclusion.”
Further, the court said that the exclusion on its face violated the Oregon Mandatory Coverage for Minors with Pervasive Developmental Disorders Act, which requires health plans to cover treatment for children with pervasive developmental disorders.
Finally, the court determined that the exclusion violated the federal mental health parity act.
The court explained that the exclusion constituted an impermissible treatment limitation on mental health benefits, because it limited the treatment of plan members with developmental disabilities.
Given this, the court granted the participants' motion for partial summary judgment.
The participants were represented by Stoll Stoll Berne Lokting & Shlachter PC. and Megan E. Glor, Attorneys at Law PC. Providence was represented by Harrang Long Gary Rudnick PC.
All Bloomberg BNA treatises are available on standing order, which ensures you will always receive the most current edition of the book or supplement of the title you have ordered from Bloomberg BNA’s book division. As soon as a new supplement or edition is published (usually annually) for a title you’ve previously purchased and requested to be placed on standing order, we’ll ship it to you to review for 30 days without any obligation. During this period, you can either (a) honor the invoice and receive a 5% discount (in addition to any other discounts you may qualify for) off the then-current price of the update, plus shipping and handling or (b) return the book(s), in which case, your invoice will be cancelled upon receipt of the book(s). Call us for a prepaid UPS label for your return. It’s as simple and easy as that. Most importantly, standing orders mean you will never have to worry about the timeliness of the information you’re relying on. And, you may discontinue standing orders at any time by contacting us at 1.800.960.1220 or by sending an email to email@example.com.
Put me on standing order at a 5% discount off list price of all future updates, in addition to any other discounts I may quality for. (Returnable within 30 days.)
Notify me when updates are available (No standing order will be created).
This Bloomberg BNA report is available on standing order, which ensures you will all receive the latest edition. This report is updated annually and we will send you the latest edition once it has been published. By signing up for standing order you will never have to worry about the timeliness of the information you need. And, you may discontinue standing orders at any time by contacting us at 1.800.372.1033, option 5, or by sending us an email to firstname.lastname@example.org.
Put me on standing order
Notify me when new releases are available (no standing order will be created)