S 796 IS
106th CONGRESS
1st Session
S. 796
To provide for full parity with respect to health insurance coverage
for certain severe biologically based mental illnesses and to prohibit limits on
the number of mental-illness-related hospital days and outpatient visits that
are covered for all mental illnesses.
IN THE SENATE OF THE UNITED STATES
April 14, 1999
Mr. DOMENICI (for himself, Mr. WELLSTONE, Mr. CHAFEE, Mr. SPECTER, Mr. REID,
Mr. SARBANES, and Mr. KENNEDY) introduced the following bill; which was read
twice and referred to the Committee on Health, Education, Labor, and Pensions
A BILL
To provide for full parity with respect to health insurance coverage
for certain severe biologically based mental illnesses and to prohibit limits on
the number of mental-illness-related hospital days and outpatient visits that
are covered for all mental illnesses.
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 Equitable Treatment Act of
1999'.
SEC. 2. AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF
1974.
(a) IN GENERAL- Section 712 of the Employee Retirement Income Security Act
of 1974 (29 U.S.C. 1185a) is amended--
(1) in subsection (a), by adding at the end the following:
`(3) HOSPITAL DAY AND OUTPATIENT VISIT LIMITS- 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--
`(A) NO INPATIENT LIMITS- If the plan or coverage does not include a
limit on the number of days of coverage provided for inpatient hospital
stays in connection with covered medical and surgical benefits, the plan
or coverage may not impose any limit on inpatient hospital stays for
mental health benefits.
`(B) CERTAIN INPATIENT LIMITS- If the plan or coverage includes a
limit on the number of days of coverage provided for inpatient hospital
stays in connection with certain covered medical and surgical benefits,
the plan or coverage may impose comparable limits on inpatient hospital
stays for mental health benefits.
`(C) NO OUTPATIENT LIMITS- If the plan or coverage does not include a
limit on the number of outpatient visits in connection with covered
medical and surgical benefits, the plan or coverage may not impose any
limit on the number of outpatient visits for mental health
benefits.
`(D) CERTAIN OUTPATIENT LIMITS- If the plan or coverage includes a
limit on the number of outpatient visits in connection with certain
covered medical and surgical benefits, the plan or coverage may impose
comparable limits on the number of outpatient visits for mental health
benefits.
`(4) SEVERE MENTAL ILLNESS- In the case of a group health plan (or
health insurance coverage offered in connection with such a plan) that
provides medical and surgical benefits and mental health benefits, such plan
or coverage shall not impose any limitations on the coverage of benefits for
severe biologically-based mental illnesses unless comparable limitations are
imposed on medical and surgical benefits.';
(2) by striking subsection (b) and inserting the following:
`(1) IN GENERAL- Nothing in this section shall be construed--
`(A) as requiring a group health plan (or health insurance coverage
offered in connection with such a plan) to provide any mental health
benefits; or
`(B) in the case of a group health plan (or health insurance coverage
offered in connection with such a plan) that provides mental health
benefits, as affecting the terms and conditions (including cost sharing
and requirements relating to medical necessity) relating to the amount,
duration, or scope of mental health benefits under the plan or coverage,
except as specifically provided in subsection (a) (in regard to parity in
the imposition of aggregate lifetime limits and annual limits and limits
on inpatient stays or outpatient visits for mental health
benefits).
`(2) CARE, TREATMENT, AND DELIVERY OF SERVICES- Nothing in this subpart
shall be construed to prohibit the provision of care or treatment, or
delivery of services, relating to mental health services, by qualified
health professionals within their scope of practice as licensed or certified
by the appropriate State or jurisdiction.';
(A) by striking paragraph (2); and
(i) by striking subparagraphs (A) and (B) and inserting the
following:
`(A) IN GENERAL- This section shall not apply to any group health plan
(and group health insurance coverage offered in connection with a group
health plan) for any plan year of any employer who employed an average of
at least 2 but not more than 25 employees on business days during the
preceding calendar year.';
(ii) by redesignating subparagraphs (A) and (C) as paragraphs (1)
and (2), respectively, and realigning the margins accordingly;
and
(iii) in paragraph (2) (as so redesignated), by redesignating
clauses (i) through (iii) as subparagraphs (A) through (C),
respectively;
(4) in subsection (e), by adding at the end the following:
`(5) SEVERE BIOLOGICALLY-BASED MENTAL ILLNESS- The term `severe
biologically-based mental illness' means an illness that medical science in
conjunction with the Diagnostic and Statistical Manual of Mental Disorders
(DSM IV) affirms as biologically based and severe, including schizophrenia,
bipolar disorder, major depression, obsessive compulsive and panic
disorders, posttraumatic stress disorder, autism, and other severe and
disabling mental disorders such as anorexia nervosa and
attention-deficit/hyper activity disorder.'; and
(5) by striking subsection (f).
(b) EFFECTIVE DATE- The amendments made by this section shall apply with
respect to plan years beginning on or after January 1, 2000.
SEC. 3. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT RELATING TO THE GROUP
MARKET.
(a) IN GENERAL- Section 2705 of the Public Health Service Act (42 U.S.C.
300gg-5) is amended--
(1) in subsection (a), by adding at the end the following:
`(3) HOSPITAL DAY AND OUTPATIENT VISIT LIMITS- 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--
`(A) NO INPATIENT LIMITS- If the plan or coverage does not include a
limit on the number of days of coverage provided for inpatient hospital
stays in connection with covered medical and surgical benefits, the plan
or coverage may not impose any limit on inpatient hospital stays for
mental health benefits.
`(B) CERTAIN INPATIENT LIMITS- If the plan or coverage includes a
limit on the number of days of coverage provided for inpatient hospital
stays in connection with certain covered medical and surgical benefits,
the plan or coverage may impose comparable limits on inpatient hospital
stays for mental health benefits.
`(C) NO OUTPATIENT LIMITS- If the plan or coverage does not include a
limit on the number of outpatient visits in connection with covered
medical and surgical benefits, the plan or coverage may not impose any
limit on the number of outpatient visits for mental health
benefits.
`(D) CERTAIN OUTPATIENT LIMITS- If the plan or coverage includes a
limit on the
number of outpatient visits in connection with certain covered medical and
surgical benefits, the plan or coverage may impose comparable limits on the
number of outpatient visits for mental health benefits.
`(4) SEVERE MENTAL ILLNESS- In the case of a group health plan (or
health insurance coverage offered in connection with such a plan) that
provides medical and surgical benefits and mental health benefits, such plan
or coverage shall not impose any limitations on the coverage of benefits for
severe biologically-based mental illnesses unless comparable limitations are
imposed on medical and surgical benefits.';
(2) by striking subsection (b) and inserting the following:
`(1) IN GENERAL- Nothing in this section shall be construed--
`(A) as requiring a group health plan (or health insurance coverage
offered in connection with such a plan) to provide any mental health
benefits; or
`(B) in the case of a group health plan (or health insurance coverage
offered in connection with such a plan) that provides mental health
benefits, as affecting the terms and conditions (including cost sharing
and requirements relating to medical necessity) relating to the amount,
duration, or scope of mental health benefits under the plan or coverage,
except as specifically provided in subsection (a) (in regard to parity in
the imposition of aggregate lifetime limits and annual limits and limits
on inpatient stays or outpatient visits for mental health
benefits).
`(2) CARE, TREATMENT, AND DELIVERY OF SERVICES- Nothing in this part
shall be construed to prohibit the provision of care or treatment, or
delivery of services, relating to mental health services, by qualified
health professionals within their scope of practice as licensed or certified
by the appropriate State or jurisdiction.';
(3) by striking subsection (c) and inserting the following:
`(c) EXEMPTION- This section shall not apply to any group health plan (and
group health insurance coverage offered in connection with a group health
plan) for any plan year of any employer who employed an average of at least 2
but not more than 25 employees on business days during the preceding calendar
year.';
(4) in subsection (e), by adding at the end the following:
`(5) SEVERE BIOLOGICALLY-BASED MENTAL ILLNESS- The term `severe
biologically-based mental illness' means an illness that medical science in
conjunction with the Diagnostic and Statistical Manual of Mental Disorders
(DSM IV) affirms as biologically based and severe, including schizophrenia,
bipolar disorder, major depression, obsessive compulsive and panic
disorders, posttraumatic stress disorder, autism, and other severe and
disabling mental disorders such as anorexia nervosa and
attention-deficit/hyper activity disorder.'; and
(5) by striking subsection (f).
(b) EFFECTIVE DATE- The amendments made by this section shall apply with
respect to plan years beginning on or after January 1, 2000.
SEC. 4. PREEMPTION.
Nothing in the amendments made by this Act shall be construed to preempt
any provision of State law that provides protections to enrollees that are
greater than the protections provided under such amendments.
END