II

106TH CONGRESS

2D SESSION S. 3238

To amend the Public Health Service Act to provide protections for individuals

who need mental health services, and for other purposes.

IN THE SENATE OF THE UNITED STATES

OCTOBER 25 (legislative day, SEPTEMBER 22), 2000

Mr. DURBIN introduced the following bill; which was read twice and referred

to the Committee on Health, Education, Labor, and Pensions

A BILL

To amend the Public Health Service Act to provide protections for individuals who need mental health services,

and for other purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Mental Health Access

5 Act’’.

6 SEC. 2. AMENDMENTS TO THE PUBLIC HEALTH SERVICE

7 ACT.

8 Subpart 1 of part B of the Public Health Service Act

9 (42 U.S.C. 300gg–41 et seq.) is amended by adding at

10 the end the following:
2

•S 3238 IS

1 ‘‘SEC. 2745. LIMITATION ON PREEXISTING CONDITION EX2 CLUSION PERIOD AND PREMIUMS WITH RE3 SPECT TO MENTAL HEALTH.

4 ‘‘(a) LIMITATION ON PREEXISTING CONDITION EX5 CLUSION PERIOD.—

6 ‘‘(1) IN GENERAL.—Notwithstanding any other

7 provision of law, a health insurance issuer that of8 fers health insurance coverage in the individual mar9 ket in a State may, with respect to an individual or

10 dependent of such individual, impose a preexisting

11 condition exclusion relating to a preexisting mental

12 health condition only if—

13 ‘‘(A) such exclusion relates to a mental

14 health condition, regardless of the cause of the

15 condition, for which medical advice, diagnosis,

16 care, or treatment was recommended or re17 ceived within the 6-month period ending on the

18 enrollment date;

19 ‘‘(B) such exclusion extends for a period of

20 not more than 12 months after the enrollment

21 date; and

22 ‘‘(C) the period of any such preexisting

23 condition exclusion is reduced by the aggregate

24 of the periods of creditable coverage (if any, as

25 defined in paragraph (3)(A)) applicable to the
3

•S 3238 IS

1 individual or dependent of such individual as of

2 the enrollment date.

3 ‘‘(2) DEFINITIONS.—In this section:

4 ‘‘(A) PREEXISTING MENTAL HEALTH CON5 DITION.—The term ‘preexisting mental health

6 condition’ means, with respect to coverage, a

7 mental health condition, including all clinical

8 disorders and personality disorders diagnosed

9 on Axis I or Axis II of the most recent edition

10 of the American Psychiatric Association’s Diag11 nostic and Statistical Manual of Mental Dis12 orders, that was present before the date of en13 rollment of such coverage, whether or not any

14 medical advice, diagnosis, care, or treatment

15 was recommended or received before such date.

16 ‘‘(B) OTHER TERMS.—The terms ‘pre17 existing condition exclusion’, ‘enrollment date’,

18 and ‘late enrollee’ shall have the meanings given

19 such terms in section 2701 as relating to indi20 vidual health insurance coverage.

21 ‘‘(3) CREDITING PREVIOUS COVERAGE.—For

22 purposes of subsection (a), the term ‘creditable cov23 erage’ has the meaning given such term in section

24 2701(c) and includes coverage of the individual

25 under any of the following:
4

•S 3238 IS

1 ‘‘(A) A college-sponsored health plan, or a

2 plan under which health benefits are offered by

3 or through an institution of higher education

4 (as defined in section 481(a) of the Higher

5 Education Act of 1965 (20 U.S.C. 1088(a)) in

6 relation to students at the institution (not in7 cluding benefits offered to such a student as a

8 participant or beneficiary in a group health

9 plan).

10 ‘‘(B) Title XXI of the Social Security Act.

11 ‘‘(C) A State or local employee health plan.

12 ‘‘(b) PROHIBITION ON INCREASED PREMIUMS BASED

13 ON PREEXISTING MENTAL HEALTH CONDITION.—A

14 health insurance issuer that offers health insurance cov15 erage in the individual market in a State may not, with

16 respect to an individual or dependent of such individual,

17 require any individual (as a condition of enrollment or con18 tinued enrollment) with a preexisting mental health condi19 tion to pay a premium or contribution which is greater

20 than a premium or contribution for an individual without

21 a preexisting mental health condition based solely on the

22 determination that such individual has a preexisting men23 tal health condition, as such term is defined in subsection

24 (a)(2)(A).
5

•S 3238 IS

1 ‘‘(c) NONAPPLICABILITY OF ACCEPTABLE ALTER2 NATIVE MECHANISMS.—The provisions of section

3 2741(a)(2) shall not apply to a health insurance issuer

4 that offers health insurance coverage in the individual

5 market in a State, but only with respect to an individual,

6 or dependent of such individual, with a preexisting mental

7 health condition desiring to enroll in such individual health

8 insurance coverage.’’.

Æ