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By Mr. DOMENICI (for himself, Mr. WELLSTONE, Mr. CHAFEE,
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S. 796. 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; to the Committee on Health , Education, Labor, and Pensions.
MENTAL HEALTH EQUITABLE TREATMENT ACT OF 1999
Mr. DOMENICI. Mr. President, today I rise with great pleasure to introduce the Mental Health Equitable Treatment Act of 1999. I also thank Senator WELLSTONE, my cosponsor, and the other Senators who have already joined me in an effort to make this case. This will say to the insurance companies and the businesses of America, unless they have 25 or fewer employees, their insurance coverage of their employees and their employees' families, if there is going to be mental illness or mental disease coverage, they will have to, as to severe illnesses, have coverage with full parity . As to other mental illnesses, they will have to stop trying to get around the parity law by cutting some of the copays and the like. This will prohibit that.
Essentially, we are going to take a piece of America that is currently discriminated against in health care because those Americans do not have a disease that is a disease of the heart but have a disease of the brain. We now can define it sufficiently that there is no reason to cover one and not the other, and in the process we will stop discriminating against about 10 million American families.
Mr. President, I rise today with great pleasure and excitement to introduce the Mental Health Equitable Treatment Act of 1999. I would also like to thank Senator WELLSTONE for once again joining me to cosponsor this important piece of legislation.
The human brain is the organ of the mind and just like the other organs of our body, it is subject to illness. And just as illnesses to our other organs require treatment, so too do illnesses of the brain.
Medical science is in an era where we can accurately diagnose mental illnesses and treat those afflicted so they can be productive. I would ask then, why with this evidence would we not cover these individuals and treat their illnesses like any other disease?
We should not. So, I would submit there should not be a difference in the coverage provided by insurance companies for mental health benefits and medical benefits.
The introduction of this bill marks a historic opportunity for us to take the next step toward mental health parity . As my colleagues know, this is an issue I have a long involvement with and I would like to begin with a few observations.
I believe that we have made great strides in providing parity for the coverage of mental illness. However, mental illness continues to exact a heavy toll on many, many lives.
Even though we know so much more about mental illness, it can still bring devastating consequences to those it touches; their families, their friends, and their loved ones. These individuals and families not only deal with the societal prejudices and suspicions hanging on from the past, but they also must contend with unequal insurance coverage.
I would submit the Mental Health Parity Act of 1996 is a good first start, but the act is also not working. While there may be adherence to the letter of the law, there are certainly violations of the spirit of the law. For instance, ways are being found around the law by placing limits on the number of covered hospital days and outpatient visits.
That is why I believe it is time for a change.
Some will immediately say we cannot afford it or that inclusion of this treatment will cost too much. But, I would first direct them to the results of the Mental Health Parity Act of 1996. That law contains a provision allowing companies to no longer comply if their costs increase by more than 1 percent.
And do you know how many companies have opted out because their costs have increased by more than 1 percent? Only four companies out of all the companies throughout the country.
Mr. President, with that in mind I would like to share a couple of facts about mental illness with my colleagues:
Within the developed world, including the United States, 4 of the 10 leading causes of disability for individuals over the age of 5 are mental disorders.
In the order of prevalence the disorders are major depression, schizophrenia, bipolar disorder, and obsessive compulsive disorder.
Disability always has a cost and the direct cost to the United States per year for respiratory disease is $99 billion, cardiovascular disease is $160 billion, and finally $148 billion for mental illness.
One in every five people--more than 40 million adults--in this Nation will be afflicted by some type of mental illness.
Nearly 7.5 million children and adolescents, or 12 percent, suffer from one or more mental disorders.
Schizophrenia alone is 50 times more common than cystic fibrosis, 60 times more common than muscular dystrophy and will strike between 2 and 3 million Americans.
Let us also look at the efficacy of treatment for individuals suffering from certain mental illnesses, especially when compared with the success rates of treatments for other physical ailments. For a long time, many who are in this field--especially on the insurance side--have behaved as if you get far better results for angioplasty then you do for treatments for bipolar illness.
Treatment for bipolar disorders--this is, those disorders characterized by extreme lows and extreme highs--have an 80-percent success rate if you get treatment, both medicine and care. Schizophrenia, the most dreaded of mental illnesses, has a 60-percent success rate in the United States today if treated properly. Major depression has a 65-percent success rate.
Let's compare those success rates to several important surgical procedures that everybody thinks we ought to be doing: Angioplasty has a 41-percent success rate; atherectomy has a 52-percent success rate.
I would now like to take a minute to discuss the Mental Health Equitable Treatment Act of 1999. The bill seeks a very simple goal: (1) provide full parity for severe biologically based mental illnesses; (2) prohibit limits on the number of covered hospital days and outpatient visits; and (3) eliminate the Mental Health Parity Act's sunset provision.
The bill would provide full parity for the following mental illnesses: schizophrenia, bipolar disorder, major depression, obsessive compulsive and severe panic disorders, posttraumatic stress disorder, autism, and other severe and disability mental disorders.
Like the Mental Health Parity Act of 1996, the bill does not require a health plan to provide coverage for alcohol and substance abuse benefits. Moreover, the bill does not mandate the coverage of mental health benefits, rather the bill only applies if the plan already provides coverage for mental health benefits.
In conclusion, the bill expands full parity to those suffering from a severe biologically based mental illness and it closes a loophole in the Mental Health Parity Act of 1996 by prohibiting limits on the number of covered hospital days and outpatient visits and I would urge my colleagues to support this important piece of legislation.
Mr. President, I ask unanimous consent that the text of the bill and additional material be printed in the RECORD.
There being no objection, the material was ordered to be printed in the RECORD, as follows:
Be it enacted by the Senate and House of Representa tives 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
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``(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:
``(b) CONSTRUCTION.--
``(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.'';
(3) in subsection (c)--
(A) by striking paragraph (2); and
(B) in paragraph (1)--
(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:
``(b) CONSTRUCTION.--
``(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.
--
Mental Health Equitable Treatment Act of 1999--Summary
The Bill seeks to ensure greater parity in the coverage of mental health benefits by prohibiting limits on the number of covered hospital days and outpatient visits for all mental illnesses and providing full parity for specified severe adult and child mental illnesses.
The Bill only applies to group health plans already providing mental health benefits.
PROHIBITION ON DAY AND VISIT LIMITS FOR ALL MENTAL ILLNESSES
Expands the Mental Health Parity Act of 1996 (MHPA) to include parity for the number of covered hospital days and outpatient visits for all mental illnesses.
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