(6) (a) Findings

1. American families should have health insurance protection for the costs of treating severe mental illnesses that is commensurate with the protection provided for other illnesses.
2. Currently, many private health insurance policies and public insurance programs discriminate against persons with severe mental illnesses by providing more restrictive coverage for treatments of those illnesses compared to coverage provided for treatments of other medical problems.
3. Many health insurance plans limit the number of days allowed for inpatient care or limit the number of outpatient visits allowed for the treatment of severe mental illnesses while providing no limit for the treatment of other physical illnesses.
4. According to a May/June 1998 Health Affairs study by Jensen, Rost, Burton, and Bulycheva, only 18 percent of all health insurance policies provide inpatient coverage for severe mental illnesses comparable to coverage for other illnesses, and only 2 percent have comparable outpatient coverage.
5. Unequal health insurance coverage contributes to the destructive and unfair stigmatization of persons with severe mental illnesses, illnesses that are beyond the control of the individuals, just like cancer, diabetes, and other serious physical health problems.
6. Legislation to reform the health care system should not condone or perpetuate discrimination against persons with severe mental illnesses.
7. Two recent national government studies (April 1997 National Institute of Mental Health "Parity In Coverage of Mental Health Services In An Era of Managed Care" and May 1998 National Institute of Mental Health "Parity in Financing Mental Health Services Managed Care Effects on Cost, Access, and Quality") have concluded that implementing parity results in a minimal increase in total health care costs, state parity laws have had a small effect on premiums, and employers do not tend to pass on the cost of parity to employees.

(6) (b) Purposes

1. In general, it is the public policy that:
   1. persons with severe mental illnesses must not be discriminated against in the health care system; and
   2. health care coverage, whether provided through public or private health insurance or any other means of financing, must provide for the treatment of severe mental illnesses in a manner that is equitable and commensurate with that provided for other major physical illnesses.
2. Nondiscriminatory and Equitable Health Care Coverage – With respect to persons with severe mental illnesses, to be considered nondiscriminatory and equitable under this Act, health care coverage shall cover services that are essential to the effective treatment of severe mental illnesses in a manner that:
   1. is not more restrictive than coverage provided for other major physical illnesses;
   2. provides adequate financial protection to the person requiring the medical treatment for a severe mental illness;
   3. is consistent with effective and common methods of controlling health care costs for other major physical illnesses; and
   4. specifically, prohibits in group and individual and public and private health plans from imposing lifetime and annual financial limits, from imposing day and visits limits, and from imposing coinsurance, copayment, deductible, and annual out-of-pocket maximums obligations for severe mental illnesses if similar limitations or requirements are differently imposed or are not imposed on medical and surgical benefits.

(6) (c) Target Population

The priority population are those persons of all ages who have severe and persistent mental illnesses, including:

1. Schizophrenia, schizoaffective disorder, bipolar disorder, major depressive disorder, obsessive-compulsive disorder, panic and other severe anxiety disorders, autism and pervasive developmental disorders, and attention deficit/hyperactivity disorder. These disorders represent the major mental disorders that current scientific data and consensus conclude are identifiable, disabling medical illnesses, with significant biological underpinnings, and requiring treatment.
2. Other severe and persistent mental illnesses that affect the brain:
   
   1. with seriously disabling consequences or a high risk of mortality; and
   2. that have a long-term course.
3. Also of particular concern are persons dually diagnosed with severe and persistent mental illnesses and addictive disorders. Addictive disorders are those illnesses tied to biological changes in brain structure and function characterized by dramatic physical withdrawal symptom and/or compulsive drug seeking and use. Citing previous government studies, the 1998 Substance Abuse and Mental Health Services Administration report, "Improving Services for Individuals at Risk of, or with, Co-Occurring Substance-Related and Mental Health Disorders," stated that 47 percent of persons with schizophrenia and 61 percent of persons with bipolar (manic-depressive illness) disorder have a substance-related disorder while 51 percent of those with any mental disorders have at least one addictive disorder.

(6) (d) 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:
   1. negotiating separate reimbursement rates and service delivery systems for different benefits; or
   2. 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.

1. Findings (Section 3)
2. Purposes (Section 4)
3. Increase Consumer and Family Member Participation in Mental Illness Services Planning (Section 5)
4. Equitable Health Care Coverage – Parity (Section 6)
5. Access to Newer Medications (Section 7)
6. Assertive Community Treatment, Including the Evidence-Based PACT Model (Section 8)
7. Creation of Work Incentives for Persons with Severe Mental Illnesses (Section 9)
8. Reduction in Life Threatening and Harmful Actions (Restraints and Seclusions) - Section 10
9. Reduction in the Criminalization of Persons with Severe Mental Illnesses (Section 11)
10. Increase Access to Permanent, Safe, and Affordable Housing With Appropriate Community-Based Services (Section 12)

With more than 220,000 members, NAMI is the nation's leading grassroots advocacy organization solely dedicated to improving the lives of persons with severe mental illnesses including schizophrenia, bipolar disorder (manic-depressive illness), major depression, obsessive-compulsive disorder, and severe anxiety disorders.