A federal judge has ruled that a health plan in the state of Washington must remove age restrictions on habilitation services for children with developmental disabilities.
The case, Z.D. v. Group Health Cooperative, was brought by the parents of a 12-year-old girl diagnosed with "moderate-severe receptive language disorder" and "other specific developmental learning disabilities." The child received speech-language treatment from the Group Health Cooperative until she was 7, when the plan refused to provide further treatment because of its policy limiting neurodevelopmental treatments to beneficiaries age 6 and younger.
A U.S. District Court judge found that treatments for developmental disabilities are covered under the state's Mental Health Parity Act, which forbids treatment limitations for mental health services if those limitations are not generally imposed on medical and surgical services.
The class action against Group Health is one of six brought against insurers in the state over the exclusion of neurodevelopmental and behavioral therapies. These types of treatments are "habilitative"—they help a person learn, keep, or improve skills and functional abilities that they may not be developing normally—rather than "rehabilitative," which focus on regaining skills and abilities lost to injury or illness.
The use of exclusionary clauses to eliminate coverage for specialty services to treat developmental disabilities is a common practice among Washington insurers, according to the plaintiff's attorneys. Lawsuits are pending against Premera Blue Cross, Regence Blue Shield, and the public employees' coverage, the Uniform Medical Plan.
A notice on the Group Health website indicates that "Given a recent federal district court ruling regarding the reach of Washington's Mental Health Parity Act, Group Health has expanded coverage of certain therapies for children over the age of 7 with neurodevelopmental disabilities."