II

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 mentalillness-related hospital days and outpatient visits that

are covered for all mental illnesses.

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 Equi5 table Treatment Act of 1999’’.
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1 SEC. 2. AMENDMENTS TO THE EMPLOYEE RETIREMENT IN2 COME SECURITY ACT OF 1974.

3 (a) IN GENERAL.—Section 712 of the Employee Re4 tirement Income Security Act of 1974 (29 U.S.C. 1185a)

5 is amended—

6 (1) in subsection (a), by adding at the end the

7 following:

8 ‘‘(3) HOSPITAL DAY AND OUTPATIENT VISIT

9 LIMITS.—In the case of a group health plan (or

10 health insurance coverage offered in connection with

11 such a plan) that provides both medical and surgical

12 benefits and mental health benefits—

13 ‘‘(A) NO INPATIENT LIMITS.—If the plan

14 or coverage does not include a limit on the

15 number of days of coverage provided for inpa16 tient hospital stays in connection with covered

17 medical and surgical benefits, the plan or cov18 erage may not impose any limit on inpatient

19 hospital stays for mental health benefits.

20 ‘‘(B) CERTAIN INPATIENT LIMITS.—If the

21 plan or coverage includes a limit on the number

22 of days of coverage provided for inpatient hos23 pital stays in connection with certain covered

24 medical and surgical benefits, the plan or cov25 erage may impose comparable limits on inpa26 tient hospital stays for mental health benefits.
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1 ‘‘(C) NO OUTPATIENT LIMITS.—If the plan

2 or coverage does not include a limit on the

3 number of outpatient visits in connection with

4 covered medical and surgical benefits, the plan

5 or coverage may not impose any limit on the

6 number of outpatient visits for mental health

7 benefits.

8 ‘‘(D) CERTAIN OUTPATIENT LIMITS.—If

9 the plan or coverage includes a limit on the

10 number of outpatient visits in connection with

11 certain covered medical and surgical benefits,

12 the plan or coverage may impose comparable

13 limits on the number of outpatient visits for

14 mental health benefits.

15 ‘‘(4) SEVERE MENTAL ILLNESS.—In the case of

16 a group health plan (or health insurance coverage

17 offered in connection with such a plan) that provides

18 medical and surgical benefits and mental health ben19 efits, such plan or coverage shall not impose any

20 limitations on the coverage of benefits for severe bio21 logically-based mental illnesses unless comparable

22 limitations are imposed on medical and surgical ben23 efits.’’;

24 (2) by striking subsection (b) and inserting the

25 following:
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1 ‘‘(b) CONSTRUCTION.—

2 ‘‘(1) IN GENERAL.—Nothing in this section

3 shall be construed—

4 ‘‘(A) as requiring a group health plan (or

5 health insurance coverage offered in connection

6 with such a plan) to provide any mental health

7 benefits; or

8 ‘‘(B) in the case of a group health plan (or

9 health insurance coverage offered in connection

10 with such a plan) that provides mental health

11 benefits, as affecting the terms and conditions

12 (including cost sharing and requirements relat13 ing to medical necessity) relating to the

14 amount, duration, or scope of mental health

15 benefits under the plan or coverage, except as

16 specifically provided in subsection (a) (in regard

17 to parity in the imposition of aggregate lifetime

18 limits and annual limits and limits on inpatient

19 stays or outpatient visits for mental health ben20 efits).

21 ‘‘(2) CARE, TREATMENT, AND DELIVERY OF

22 SERVICES.—Nothing in this subpart shall be con23 strued to prohibit the provision of care or treatment,

24 or delivery of services, relating to mental health

25 services, by qualified health professionals within
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1 their scope of practice as licensed or certified by the

2 appropriate State or jurisdiction.’’;

3 (3) in subsection (c)—

4 (A) by striking paragraph (2); and

5 (B) in paragraph (1)—

6 (i) by striking subparagraphs (A) and

7 (B) and inserting the following:

8 ‘‘(A) IN GENERAL.—This section shall not

9 apply to any group health plan (and group

10 health insurance coverage offered in connection

11 with a group health plan) for any plan year of

12 any employer who employed an average of at

13 least 2 but not more than 25 employees on

14 business days during the preceding calendar

15 year.’’;

16 (ii) by redesignating subparagraphs

17 (A) and (C) as paragraphs (1) and (2), re18 spectively, and realigning the margins ac19 cordingly; and

20 (iii) in paragraph (2) (as so redesig21 nated), by redesignating clauses (i)

22 through (iii) as subparagraphs (A) through

23 (C), respectively;

24 (4) in subsection (e), by adding at the end the

25 following:
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1 ‘‘(5) SEVERE BIOLOGICALLY-BASED MENTAL

2 ILLNESS.—The term ‘severe biologically-based men3 tal illness’ means an illness that medical science in

4 conjunction with the Diagnostic and Statistical Man5 ual of Mental Disorders (DSM IV) affirms as bio6 logically based and severe, including schizophrenia,

7 bipolar disorder, major depression, obsessive compul8 sive and panic disorders, posttraumatic stress dis9 order, autism, and other severe and disabling mental

10 disorders such as anorexia nervosa and attention11 deficit/hyper activity disorder.’’; and

12 (5) by striking subsection (f).

13 (b) EFFECTIVE DATE.—The amendments made by

14 this section shall apply with respect to plan years begin15 ning on or after January 1, 2000.

16 SEC. 3. AMENDMENTS TO THE PUBLIC HEALTH SERVICE

17 ACT RELATING TO THE GROUP MARKET.

18 (a) IN GENERAL.—Section 2705 of the Public Health

19 Service Act (42 U.S.C. 300gg–5) is amended—

20 (1) in subsection (a), by adding at the end the

21 following:

22 ‘‘(3) HOSPITAL DAY AND OUTPATIENT VISIT

23 LIMITS.—In the case of a group health plan (or

24 health insurance coverage offered in connection with
7

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1 such a plan) that provides both medical and surgical

2 benefits and mental health benefits—

3 ‘‘(A) NO INPATIENT LIMITS.—If the plan

4 or coverage does not include a limit on the

5 number of days of coverage provided for inpa6 tient hospital stays in connection with covered

7 medical and surgical benefits, the plan or cov8 erage may not impose any limit on inpatient

9 hospital stays for mental health benefits.

10 ‘‘(B) CERTAIN INPATIENT LIMITS.—If the

11 plan or coverage includes a limit on the number

12 of days of coverage provided for inpatient hos13 pital stays in connection with certain covered

14 medical and surgical benefits, the plan or cov15 erage may impose comparable limits on inpa16 tient hospital stays for mental health benefits.

17 ‘‘(C) NO OUTPATIENT LIMITS.—If the plan

18 or coverage does not include a limit on the

19 number of outpatient visits in connection with

20 covered medical and surgical benefits, the plan

21 or coverage may not impose any limit on the

22 number of outpatient visits for mental health

23 benefits.

24 ‘‘(D) CERTAIN OUTPATIENT LIMITS.—If

25 the plan or coverage includes a limit on the
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1 number of outpatient visits in connection with

2 certain covered medical and surgical benefits,

3 the plan or coverage may impose comparable

4 limits on the number of outpatient visits for

5 mental health benefits.

6 ‘‘(4) SEVERE MENTAL ILLNESS.—In the case of

7 a group health plan (or health insurance coverage

8 offered in connection with such a plan) that provides

9 medical and surgical benefits and mental health ben10 efits, such plan or coverage shall not impose any

11 limitations on the coverage of benefits for severe bio12 logically-based mental illnesses unless comparable

13 limitations are imposed on medical and surgical ben14 efits.’’;

15 (2) by striking subsection (b) and inserting the

16 following:

17 ‘‘(b) CONSTRUCTION.—

18 ‘‘(1) IN GENERAL.—Nothing in this section

19 shall be construed—

20 ‘‘(A) as requiring a group health plan (or

21 health insurance coverage offered in connection

22 with such a plan) to provide any mental health

23 benefits; or

24 ‘‘(B) in the case of a group health plan (or

25 health insurance coverage offered in connection
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1 with such a plan) that provides mental health

2 benefits, as affecting the terms and conditions

3 (including cost sharing and requirements relat4 ing to medical necessity) relating to the

5 amount, duration, or scope of mental health

6 benefits under the plan or coverage, except as

7 specifically provided in subsection (a) (in regard

8 to parity in the imposition of aggregate lifetime

9 limits and annual limits and limits on inpatient

10 stays or outpatient visits for mental health ben11 efits).

12 ‘‘(2) CARE, TREATMENT, AND DELIVERY OF

13 SERVICES.—Nothing in this part shall be construed

14 to prohibit the provision of care or treatment, or de15 livery of services, relating to mental health services,

16 by qualified health professionals within their scope

17 of practice as licensed or certified by the appropriate

18 State or jurisdiction.’’;

19 (3) by striking subsection (c) and inserting the

20 following:

21 ‘‘(c) EXEMPTION.—This section shall not apply to

22 any group health plan (and group health insurance cov23 erage offered in connection with a group health plan) for

24 any plan year of any employer who employed an average
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1 of at least 2 but not more than 25 employees on business

2 days during the preceding calendar year.’’;

3 (4) in subsection (e), by adding at the end the

4 following:

5 ‘‘(5) SEVERE BIOLOGICALLY-BASED MENTAL

6 ILLNESS.—The term ‘severe biologically-based men7 tal illness’ means an illness that medical science in

8 conjunction with the Diagnostic and Statistical Man9 ual of Mental Disorders (DSM IV) affirms as bio10 logically based and severe, including schizophrenia,

11 bipolar disorder, major depression, obsessive compul12 sive and panic disorders, posttraumatic stress dis13 order, autism, and other severe and disabling mental

14 disorders such as anorexia nervosa and attention15 deficit/hyper activity disorder.’’; and

16 (5) by striking subsection (f).

17 (b) EFFECTIVE DATE.—The amendments made by

18 this section shall apply with respect to plan years begin19 ning on or after January 1, 2000.

20 SEC. 4. PREEMPTION.

21 Nothing in the amendments made by this Act shall

22 be construed to preempt any provision of State law that

23 provides protections to enrollees that are greater than the

24 protections provided under such amendments.

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