HR 1515 IH
106th CONGRESS
1st Session
H. R. 1515
To amend the Public Health Service Act, Employee Retirement Income
Security Act of 1974, and the Internal Revenue Code of 1986 to prohibit group
and individual health plans from imposing treatment limitations or financial
requirements on the coverage of mental health benefits and on the coverage of
substance abuse and chemical dependency benefits if similar limitations or
requirements are not imposed on medical and surgical benefits.
IN THE HOUSE OF REPRESENTATIVES
April 21, 1999
Mrs. ROUKEMA (for herself, Mr. WISE, Mr. DEFAZIO, Mr. STRICKLAND, Mr. BAIRD,
Mrs. CAPPS, Ms. KAPTUR, Mr. GEORGE MILLER of California, Mrs. MCCARTHY of New
York, Mr. ANDREWS, Ms. DELAURO, Mr. MCDERMOTT, Mr. GILMAN, Mrs. MORELLA, Mr.
SHAYS, Mrs. KELLY, Mr. SANDERS, Mr. MICA, Mr. LEACH, Mr. MCCOLLUM, Mr.
GREENWOOD, Mr. BOEHLERT, and Mrs. JOHNSON of Connecticut) introduced the
following bill; which was referred to the Committee on Commerce, and in addition
to the Committees on Education and the Workforce, and Ways and Means, for a
period to be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the
committee concerned
A BILL
To amend the Public Health Service Act, Employee Retirement Income
Security Act of 1974, and the Internal Revenue Code of 1986 to prohibit group
and individual health plans from imposing treatment limitations or financial
requirements on the coverage of mental health benefits and on the coverage of
substance abuse and chemical dependency benefits if similar limitations or
requirements are not imposed on medical and surgical benefits.
Be it enacted by the Senate and House of Representatives of the United
States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the `Mental Health and Substance Abuse Parity
Amendments of 1999'.
SEC. 2. REVISION IN LIMITS APPLIED TO MENTAL HEALTH BENEFITS.
(a) APPLICATION TO GROUP HEALTH PLANS AND GROUP HEALTH INSURANCE UNDER
ERISA-
(1) EXPANSION TO COVER TREATMENT LIMITATIONS AND FINANCIAL REQUIREMENTS
GENERALLY- Section 712 of the Employee Retirement Income Security Act of
1974 (29 U.S.C. 1185a) is amended--
(A) in the heading, by striking `certain';
(B) by amending subsections (a) and (b) to read as follows:
`(a) IN GENERAL- In the case of a group health plan (or health insurance
coverage offered in connection with such a plan) that provides both medical
and surgical benefits and mental health benefits, such plan or coverage shall
not impose treatment limitations or financial requirements on the coverage of
mental health benefits if similar limitations or requirements are not imposed
on coverage of medical and surgical benefits in comparable settings (including
inpatient and outpatient settings).
`(b) CONSTRUCTION- Nothing in this section shall be construed--
`(1) as prohibiting a group health plan (or health insurance coverage
offered in connection with such a plan) from--
`(A) negotiating separate reimbursement rates and service delivery
systems for different benefits; or
`(B) managing the provision of benefits through the use of
pre-admission screening, prior authorization of services, and other
mechanisms designed to limit coverage of items and services to those
deemed to be medically necessary;
`(2) as requiring a group health plan (or health insurance coverage
offered in connection with such a plan) to provide any specific mental
health benefits; or
`(3) as preventing a group health plan or health insurance issuer
applying subsection (a) without regard to benefits for preventive care.';
and
(C) in subsection (e), by striking paragraphs (1) and (2) and
inserting the following:
`(1) TREATMENT LIMITATIONS- The term `treatment limitations' means
limits on the frequency of treatment, number of visits, or other limits on
the scope and duration of treatment, as covered by a group health plan (or
health insurance coverage offered in connection with such a plan). Such term
does not include limits on benefits or coverage based solely on medical
necessity.
`(2) FINANCIAL REQUIREMENTS- The term `financial requirements' means
copayments, deductibles, out-of-network charges, out-of-pocket contributions
or fees, annual limits, and lifetime aggregate limits imposed on covered
individuals.'.
(2) ELIMINATION OF COST EXEMPTION- Such section is further amended by
striking paragraph (2) of subsection (c).
(3) ELIMINATION OF SUNSET- Such section is further amended by striking
subsection (f).
(4) CLERICAL AMENDMENT- The item in the table of contents in section 1
of such Act relating to section 712 is amended by striking `certain'.
(b) APPLICATION TO GROUP HEALTH PLANS AND HEALTH INSURANCE ISSUERS UNDER
THE PUBLIC HEALTH SERVICE ACT-
(1) EXPANSION TO COVER TREATMENT LIMITATIONS AND FINANCIAL REQUIREMENTS
GENERALLY- Section 2705 of the Public Health Service Act (42 U.S.C. 300gg-5)
is amended--
(A) in the heading, by striking `certain';
(B) by amending subsections (a) and (b) to read as follows:
`(a) IN GENERAL- In the case of a group health plan (or health insurance
coverage offered in connection with such a plan) that provides both medical
and surgical benefits and mental health benefits, such plan or coverage shall
not impose treatment limitations or financial requirements on the coverage of
mental health benefits if similar limitations or requirements are not imposed
on coverage of medical and surgical benefits in comparable settings (including
inpatient and outpatient settings).
`(b) CONSTRUCTION- Nothing in this section shall be construed--
`(1) as prohibiting a group health plan (or health insurance coverage
offered in connection with such a plan) from--
`(A) negotiating separate reimbursement rates and service delivery
systems for different benefits; or
`(B) managing the provision of benefits through the use of
pre-admission screening, prior authorization of services, and other
mechanisms designed to limit coverage of items and services to those
deemed to be medically necessary;
`(2) as requiring a group health plan (or health insurance coverage
offered in connection with such a plan) to provide any specific mental
health benefits; or
`(3) as preventing a group health plan or health insurance issuer
applying subsection (a) without regard to benefits for preventive care.';
and
(C) in subsection (e), by striking paragraphs (1) and (2) and
inserting the following:
`(1) TREATMENT LIMITATIONS- The term `treatment limitations' means
limits on the frequency of treatment, number of visits, or other limits on
the scope and duration of treatment, as covered by a group health plan (or
health insurance coverage offered in connection with such a plan). Such term
does not include limits on benefits or coverage based solely on medical
necessity.
`(2) FINANCIAL REQUIREMENTS- The term `financial requirements' means
copayments, deductibles, out-of-network charges, out-of-pocket contributions
or fees, annual limits, and lifetime aggregate limits imposed on covered
individuals.'.
(2) ELIMINATION OF COST EXEMPTION- Such section is further amended by
striking paragraph (2) of subsection (c).
(3) ELIMINATION OF SUNSET- Such section is further amended by striking
subsection (f).
(c) APPLICATION TO GROUP HEALTH PLANS UNDER THE INTERNAL REVENUE CODE OF
1986-
(1) EXPANSION TO COVER TREATMENT LIMITATIONS AND FINANCIAL REQUIREMENTS
GENERALLY- Section 9812 of the Internal Revenue Code of 1986 (relating to
parity in the application of certain limits to mental health benefits) is
amended--
(A) in the heading, by striking `certain';
(B) by amending subsections (a) and (b) to read as follows:
`(a) IN GENERAL- In the case of a group health plan that provides both
medical and surgical benefits and mental health benefits, such plan shall not
impose treatment limitations or financial requirements on the coverage of
mental health benefits if similar limitations or requirements are not imposed
on coverage of medical and surgical benefits in comparable settings (including
inpatient and outpatient settings).
`(b) CONSTRUCTION- Nothing in this section shall be construed--
`(1) as prohibiting a group health plan from--
`(A) negotiating separate reimbursement rates and service delivery
systems for different benefits; or
`(B) managing the provision of benefits through the use of
pre-admission screening, prior authorization of services, and other
mechanisms designed to limit coverage of items and services to those
deemed to be medically necessary;
`(2) as requiring a group health plan to provide any specific mental
health benefits; or
`(3) as preventing a group health plan applying subsection (a) without
regard to benefits for preventive care.'; and
(C) in subsection (e), by striking paragraphs (1) and (2) and
inserting the following:
`(1) TREATMENT LIMITATIONS- The term `treatment limitations' means
limits on the frequency of treatment, number of visits, or other limits on
the scope and duration of treatment, as covered by a group health plan. Such
term does not include limits on benefits or coverage based solely on medical
necessity.
`(2) FINANCIAL REQUIREMENTS- The term `financial requirements' means
copayments, deductibles, out-of-network charges, out-of-pocket contributions
or fees, annual limits, and lifetime aggregate limits imposed on covered
individuals.'.
(2) ELIMINATION OF COST EXEMPTIONS- Such section is further amended by
striking paragraph (2) of subsection (c).
(3) ELIMINATION OF SUNSET- Such section is further amended by striking
subsection (f).
(4) CLERICAL AMENDMENT- The item relating to section 9812 in the table
of sections of subchapter B of chapter 100 of the Internal Revenue Code of
1986 is amended by striking `certain'.
(d) APPLICATION TO INDIVIDUAL HEALTH INSURANCE- Part B of title XXVII of
the Public Health Service Act is amended by inserting after section 2752 the
following new section:
`SEC. 2753. PARITY IN THE APPLICATION OF LIMITS TO MENTAL HEALTH
BENEFITS.
`The provisions of subsections (a), (b), and (e) of section 2705 shall
apply to health insurance coverage offered by a health insurance issuer in the
individual market in the same manner as they apply to health insurance
coverage offered by a health insurance issuer in connection with a group
health plan.'.
(A) IN GENERAL- Subject to subparagraph (B), the amendments made by
subsections (a), (b), and (c) shall apply with respect to group health
plans for plan years beginning on or after July 1, 2000.
(B) In the case of a group health plan maintained pursuant to 1 or
more collective bargaining agreements between employee representatives and
1 or more employers ratified before the date of enactment of this Act, the
amendments made by subsections (a), (b), and (c) shall not apply to plan
years beginning before the later of--
(i) the date on which the last collective bargaining agreements
relating to the plan terminates (determined without regard to any
extension thereof agreed to after the date of the enactment of this
Act), or
For purposes of clause (i), any plan amendment made pursuant to a
collective bargaining agreement relating to the plan which amends the plan
solely to conform to any requirement added by subsection (a), (b), or (c)
shall not be treated as a termination of such collective bargaining
agreement.
(2) INDIVIDUAL HEALTH INSURANCE COVERAGE- The amendment made by
subsection (d) shall apply with respect to health insurance coverage
offered, sold, issued, renewed, in effect, or operated in the individual
market on or after July 1, 2000.
(f) COORDINATION IN IMPLEMENTATION- Effective on the date of the enactment
of this Act, section 104(1) of the Health Insurance Portability and
Accountability Act of 1996 is amended by striking `this subtitle (and the
amendments made by this subtitle and section 401)' and inserting `the
provisions of part 7 of subtitle B of title I of the Employee Retirement
Income Security Act of 1974, the provisions of parts A and C of title XXVII of
the Public Health Service Act, and chapter 1000 of the Internal Revenue Code
of 1986'.
SEC. 3. PARITY IN THE APPLICATION OF LIMITS TO SUBSTANCE ABUSE AND CHEMICAL
DEPENDENCY BENEFITS.
(a) APPLICATION TO GROUP HEALTH PLANS UNDER ERISA-
(1) IN GENERAL- Part 7 of subtitle B of title II of the Employee
Retirement Income Security Act of 1974 is amended by inserting after section
713 the following new section:
`SEC. 714. PARITY IN THE APPLICATION OF LIMITS TO SUBSTANCE ABUSE AND
CHEMICAL DEPENDENCY BENEFITS.
`The provisions of section 712 shall apply to benefits with respect to
treatment of substance abuse or chemical dependency in the same manner as they
apply to mental health benefits.'.
(2) CLERICAL AMENDMENT- The table of contents in section 1 of such Act
is amended by inserting after the item relating to section 713 the following
new item:
`Sec. 714. Parity in the application of limits to substance abuse and
chemical dependency benefits.'.
(b) APPLICATION TO GROUP HEALTH PLANS AND HEALTH INSURANCE ISSUERS UNDER
THE PUBLIC HEALTH SERVICE ACT- Title XXVII of the Public Health Service Act is
amended by inserting after section 2706 the following new section:
`SEC. 2707. PARITY IN THE APPLICATION OF LIMITS TO SUBSTANCE ABUSE AND
CHEMICAL DEPENDENCY BENEFITS.
`The provisions of section 2705 shall apply to benefits with respect to
treatment of substance abuse or chemical dependency in the same manner as they
apply to mental health benefits.'.
(c) APPLICATION TO GROUP HEALTH PLANS UNDER THE INTERNAL REVENUE CODE OF
1986-
(1) IN GENERAL- Subchapter B of chapter 100 of the Internal Revenue Code
of 1986 is amended by adding at the end the following new section:
`SEC. 9813. PARITY IN THE APPLICATION OF LIMITS TO SUBSTANCE ABUSE AND
CHEMICAL DEPENDENCY BENEFITS.
`The provisions of section 9812 shall apply to benefits with respect to
treatment of substance abuse or chemical dependency in the same manner as they
apply to mental health benefits.'.
(2) CLERICAL AMENDMENT- The table of sections for such subchapter is
amended by adding at the end the following new item:
`Sec. 9813. Parity in the application of limits to substance abuse and
chemical dependency benefits.'.
(d) APPLICATION TO INDIVIDUAL HEALTH INSURANCE COVERAGE UNDER THE PUBLIC
HEALTH SERVICE ACT- Part B of title XXVII of the Public Health Service Act, as
amended by section 2(d), is amended by inserting after section 2753 the
following new section:
`SEC. 2754. PARITY IN THE APPLICATION OF LIMITS TO MENTAL HEALTH
BENEFITS.
`The provisions of section 2753 shall apply to benefits with respect to
treatment of substance abuse or chemical dependency in the same manner as they
apply to mental health benefits.'.
(A) IN GENERAL- Subject to subparagraph (B), the amendments made by
subsections (a), (b), and (c) shall apply with respect to group health
plans for plan years beginning on or after July 1, 2000.
(B) In the case of a group health plan maintained pursuant to 1 or
more collective bargaining agreements between employee representatives and
1 or more employers ratified before the date of enactment of this Act, the
amendments made by subsections (a), (b), and (c) shall not apply to plan
years beginning before the later of--
(i) the date on which the last collective bargaining agreements
relating to the plan terminates (determined without regard to any
extension thereof agreed to after the date of the enactment of this
Act), or
For purposes of clause (i), any plan amendment made pursuant to a
collective bargaining agreement relating to the plan which amends the plan
solely to conform to any requirement added by subsection (a), (b), or (c)
shall not be treated as a termination of such collective bargaining
agreement.
(2) INDIVIDUAL HEALTH INSURANCE COVERAGE- The amendment made by
subsection (d) shall apply with respect to health insurance coverage
offered, sold, issued, renewed, in effect, or operated in the individual
market on or after July 1, 2000.
END