I 

109TH CONGRESS 

1ST SESSION H. R. 1258

To amend the Employee Retirement Income Security Act of 1974, Public 

Health Service Act, and the Internal Revenue Code of 1986 to provide 

parity with respect to substance abuse treatment benefits under group 

health plans and health insurance coverage. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 10, 2005

Mr. RAMSTAD introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on 

Education and the Workforce and Ways and Means, for a period to be 

subsequently determined by the Speaker, in each case for consideration 

of such provisions as fall within the jurisdiction of the committee concerned 

A BILL

To amend the Employee Retirement Income Security Act 

of 1974, Public Health Service Act, and the Internal 

Revenue Code of 1986 to provide parity with respect 

to substance abuse treatment benefits under group health 

plans and health insurance coverage.

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

2 This Act may be cited as the ‘‘Time for Recovery and 

3 Equal Access to Treatment in America (TREAT America) 

4 Act of 2005’’. 

5 SEC. 2. FINDINGS. 

6 Congress finds the following: 

7 (1) Substance abuse, if left untreated, is a med8 ical emergency and a private and public health cri9 sis. 

10 (2) Nothing in this Act should be construed as 

11 prohibiting application of the concept of parity to 

12 substance abuse treatment provided by faith-based 

13 treatment providers. 

14 SEC. 3. PARITY IN SUBSTANCE ABUSE TREATMENT BENE15 FITS. 

16 (a) GROUP HEALTH PLANS.—

17 (1) PUBLIC HEALTH SERVICE ACT AMEND18 MENTS.—

19 (A) IN GENERAL.—Subpart 2 of part A of 

20 title XXVII of the Public Health Service Act is 

21 amended by adding at the end the following 

22 new section: 
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1 ‘‘SEC. 2707. PARITY IN THE APPLICATION OF TREATMENT 

2 LIMITATIONS AND FINANCIAL REQUIRE3 MENTS TO SUBSTANCE ABUSE TREATMENT 

4 BENEFITS. 

5 ‘‘(a) IN GENERAL.—In the case of a group health 

6 plan (or health insurance coverage offered in connection 

7 with such a plan) that provides both medical and surgical 

8 benefits and substance abuse treatment benefits, the plan 

9 or coverage shall not impose treatment limitations or fi10 nancial requirements on the substance abuse treatment 

11 benefits unless similar limitations or requirements are im12 posed for medical and surgical benefits. 

13 ‘‘(b) CONSTRUCTION.—Nothing in this section shall 

14 be construed—

15 ‘‘(1) as requiring a group health plan (or health 

16 insurance coverage offered in connection with such a 

17 plan) to provide any substance abuse treatment ben18 efits; or 

19 ‘‘(2) to prevent a group health plan or a health 

20 insurance issuer offering group health insurance cov21 erage from negotiating the level and type of reim22 bursement with a provider for care provided in ac23 cordance with this section. 

24 ‘‘(c) EXEMPTIONS.—

25 ‘‘(1) SMALL EMPLOYER EXEMPTION.—
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1 ‘‘(A) IN GENERAL.—This section shall not 

2 apply to any group health plan (and group 

3 health insurance coverage offered in connection 

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

5 a small employer. 

6 ‘‘(B) SMALL EMPLOYER.—For purposes of 

7 subparagraph (A), the term ‘small employer’ 

8 means, in connection with a group health plan 

9 with respect to a calendar year and a plan year, 

10 an employer who employed an average of at 

11 least 2 but not more than 50 employees on 

12 business days during the preceding calendar 

13 year and who employs at least 2 employees on 

14 the first day of the plan year. 

15 ‘‘(C) APPLICATION OF CERTAIN RULES IN

16 DETERMINATION OF EMPLOYER SIZE.—For 

17 purposes of this paragraph—

18 ‘‘(i) APPLICATION OF AGGREGATION

19 RULE FOR EMPLOYERS.—Rules similar to 

20 the rules under subsections (b), (c), (m), 

21 and (o) of section 414 of the Internal Rev22 enue Code of 1986 shall apply for purposes 

23 of treating persons as a single employer. 

24 ‘‘(ii) EMPLOYERS NOT IN EXISTENCE

25 IN PRECEDING YEAR.—In the case of an 
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1 employer which was not in existence 

2 throughout the preceding calendar year, 

3 the determination of whether such em4 ployer is a small employer shall be based 

5 on the average number of employees that 

6 it is reasonably expected such employer 

7 will employ on business days in the current 

8 calendar year. 

9 ‘‘(iii) PREDECESSORS.—Any reference 

10 in this paragraph to an employer shall in11 clude a reference to any predecessor of 

12 such employer. 

13 ‘‘(2) INCREASED COST EXEMPTION.—This sec14 tion shall not apply with respect to a group health 

15 plan (or health insurance coverage offered in connec16 tion with a group health plan) if the application of 

17 this section to such plan (or to such coverage) re18 sults in an increase in the cost under the plan (or 

19 for such coverage) of at least 1 percent. 

20 ‘‘(d) SEPARATE APPLICATION TO EACH OPTION OF21 FERED.—In the case of a group health plan that offers 

22 a participant or beneficiary two or more benefit package 

23 options under the plan, the requirements of this section 

24 shall be applied separately with respect to each such op25 tion. 
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1 ‘‘(e) DEFINITIONS.—For purposes of this section—

2 ‘‘(1) TREATMENT LIMITATION.—The term 

3 ‘treatment limitation’ means, with respect to benefits 

4 under a group health plan or health insurance cov5 erage, any day or visit limits imposed on coverage of 

6 benefits under the plan or coverage during a period 

7 of time. 

8 ‘‘(2) FINANCIAL REQUIREMENT.—The term ‘fi9 nancial requirement’ means, with respect to benefits 

10 under a group health plan or health insurance cov11 erage, any deductible, coinsurance, or cost-sharing 

12 or an annual or lifetime dollar limit imposed with re13 spect to the benefits under the plan or coverage. 

14 ‘‘(3) MEDICAL OR SURGICAL BENEFITS.—The 

15 term ‘medical or surgical benefits’ means benefits 

16 with respect to medical or surgical services, as de17 fined under the terms of the plan or coverage (as the 

18 case may be), but does not include substance abuse 

19 treatment benefits. 

20 ‘‘(4) SUBSTANCE ABUSE TREATMENT BENE21 FITS.—The term ‘substance abuse treatment bene22 fits’ means benefits with respect to substance abuse 

23 treatment services. 

24 ‘‘(5) SUBSTANCE ABUSE TREATMENT SERV25 ICES.—The term ‘substance abuse services’ means 
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1 any of the following items and services provided for 

2 the treatment of substance abuse: 

3 ‘‘(A) Inpatient treatment, including detoxi4 fication. 

5 ‘‘(B) Non-hospital residential treatment. 

6 ‘‘(C) Outpatient treatment, including 

7 screening and assessment, medication manage8 ment, individual, group, and family counseling, 

9 and relapse prevention. 

10 ‘‘(D) Prevention services, including health 

11 education and individual and group counseling 

12 to encourage the reduction of risk factors for 

13 substance abuse. 

14 ‘‘(6) SUBSTANCE ABUSE.—The term ‘substance 

15 abuse’ includes chemical dependency. 

16 ‘‘(f) NOTICE.—A group health plan under this part 

17 shall comply with the notice requirement under section 

18 714(f) of the Employee Retirement Income Security Act 

19 of 1974 with respect to the requirements of this section 

20 as if such section applied to such plan.’’. 

21 (B) CONFORMING AMENDMENT.—Section 

22 2723(c) of such Act (42 U.S.C. 300gg–23(c)) is 

23 amended by striking ‘‘section 2704’’ and insert24 ing ‘‘sections 2704 and 2707’’. 

25 (2) ERISA AMENDMENTS.—
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1 (A) IN GENERAL.—Subpart B of part 7 of 

2 subtitle B of title I of the Employee Retirement 

3 Income Security Act of 1974 is amended by 

4 adding at the end the following new section: 

5 ‘‘SEC. 714. PARITY IN THE APPLICATION OF TREATMENT 

6 LIMITATIONS AND FINANCIAL REQUIRE7 MENTS TO SUBSTANCE ABUSE TREATMENT 

8 BENEFITS. 

9 ‘‘(a) IN GENERAL.—In the case of a group health 

10 plan (or health insurance coverage offered in connection 

11 with such a plan) that provides both medical and surgical 

12 benefits and substance abuse treatment benefits, the plan 

13 or coverage shall not impose treatment limitations or fi14 nancial requirements on the substance abuse treatment 

15 benefits unless similar limitations or requirements are im16 posed for medical and surgical benefits. 

17 ‘‘(b) CONSTRUCTION.—Nothing in this section shall 

18 be construed—

19 ‘‘(1) as requiring a group health plan (or health 

20 insurance coverage offered in connection with such a 

21 plan) to provide any substance abuse treatment ben22 efits; or 

23 ‘‘(2) to prevent a group health plan or a health 

24 insurance issuer offering group health insurance cov25 erage from negotiating the level and type of reim-
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1 bursement with a provider for care provided in ac2 cordance with this section. 

3 ‘‘(c) EXEMPTIONS.—

4 ‘‘(1) SMALL EMPLOYER EXEMPTION.—

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

6 apply to any group health plan (and group 

7 health insurance coverage offered in connection 

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

9 a small employer. 

10 ‘‘(B) SMALL EMPLOYER.—For purposes of 

11 subparagraph (A), the term ‘small employer’ 

12 means, in connection with a group health plan 

13 with respect to a calendar year and a plan year, 

14 an employer who employed an average of at 

15 least 2 but not more than 50 employees on 

16 business days during the preceding calendar 

17 year and who employs at least 2 employees on 

18 the first day of the plan year. 

19 ‘‘(C) APPLICATION OF CERTAIN RULES IN

20 DETERMINATION OF EMPLOYER SIZE.—For 

21 purposes of this paragraph—

22 ‘‘(i) APPLICATION OF AGGREGATION

23 RULE FOR EMPLOYERS.—Rules similar to 

24 the rules under subsections (b), (c), (m), 

25 and (o) of section 414 of the Internal Rev-
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1 enue Code of 1986 shall apply for purposes 

2 of treating persons as a single employer. 

3 ‘‘(ii) EMPLOYERS NOT IN EXISTENCE

4 IN PRECEDING YEAR.—In the case of an 

5 employer which was not in existence 

6 throughout the preceding calendar year, 

7 the determination of whether such em8 ployer is a small employer shall be based 

9 on the average number of employees that 

10 it is reasonably expected such employer 

11 will employ on business days in the current 

12 calendar year. 

13 ‘‘(iii) PREDECESSORS.—Any reference 

14 in this paragraph to an employer shall in15 clude a reference to any predecessor of 

16 such employer. 

17 ‘‘(2) INCREASED COST EXEMPTION.—This sec18 tion shall not apply with respect to a group health 

19 plan (or health insurance coverage offered in connec20 tion with a group health plan) if the application of 

21 this section to such plan (or to such coverage) re22 sults in an increase in the cost under the plan (or 

23 for such coverage) of at least 1 percent. 

24 ‘‘(d) SEPARATE APPLICATION TO EACH OPTION OF25 FERED.—In the case of a group health plan that offers 
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1 a participant or beneficiary two or more benefit package 

2 options under the plan, the requirements of this section 

3 shall be applied separately with respect to each such op4 tion. 

5 ‘‘(e) DEFINITIONS.—For purposes of this section—

6 ‘‘(1) TREATMENT LIMITATION.—The term 

7 ‘treatment limitation’ means, with respect to benefits 

8 under a group health plan or health insurance cov9 erage, any day or visit limits imposed on coverage of 

10 benefits under the plan or coverage during a period 

11 of time. 

12 ‘‘(2) FINANCIAL REQUIREMENT.—The term ‘fi13 nancial requirement’ means, with respect to benefits 

14 under a group health plan or health insurance cov15 erage, any deductible, coinsurance, or cost-sharing 

16 or an annual or lifetime dollar limit imposed with re17 spect to the benefits under the plan or coverage. 

18 ‘‘(3) MEDICAL OR SURGICAL BENEFITS.—The 

19 term ‘medical or surgical benefits’ means benefits 

20 with respect to medical or surgical services, as de21 fined under the terms of the plan or coverage (as the 

22 case may be), but does not include substance abuse 

23 treatment benefits. 

24 ‘‘(4) SUBSTANCE ABUSE TREATMENT BENE25 FITS.—The term ‘substance abuse treatment bene-
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1 fits’ means benefits with respect to substance abuse 

2 treatment services. 

3 ‘‘(5) SUBSTANCE ABUSE TREATMENT SERV4 ICES.—The term ‘substance abuse services’ means 

5 any of the following items and services provided for 

6 the treatment of substance abuse: 

7 ‘‘(A) Inpatient treatment, including detoxi8 fication. 

9 ‘‘(B) Non-hospital residential treatment. 

10 ‘‘(C) Outpatient treatment, including 

11 screening and assessment, medication manage12 ment, individual, group, and family counseling, 

13 and relapse prevention. 

14 ‘‘(D) Prevention services, including health 

15 education and individual and group counseling 

16 to encourage the reduction of risk factors for 

17 substance abuse. 

18 ‘‘(6) SUBSTANCE ABUSE.—The term ‘substance 

19 abuse’ includes chemical dependency. 

20 ‘‘(f) NOTICE UNDER GROUP HEALTH PLAN.—The 

21 imposition of the requirements of this section shall be 

22 treated as a material modification in the terms of the plan 

23 described in section 102(a)(1), for purposes of assuring 

24 notice of such requirements under the plan; except that 

25 the summary description required to be provided under the 
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1 last sentence of section 104(b)(1) with respect to such 

2 modification shall be provided by not later than 60 days 

3 after the first day of the first plan year in which such 

4 requirements apply.’’. 

5 (B) Section 731(c) of such Act (29 U.S.C. 

6 1191(c)) is amended by striking ‘‘section 711’’ 

7 and inserting ‘‘sections 711 and 714’’. 

8 (C) Section 732(a) of such Act (29 U.S.C. 

9 1191a(a)) is amended by striking ‘‘section 711’’ 

10 and inserting ‘‘sections 711 and 714’’. 

11 (D) The table of contents in section 1 of 

12 such Act is amended by inserting after the item 

13 relating to section 713 the following new item:

‘‘714. Parity in the application of treatment limitations and financial requirements to substance abuse treatment benefits.’’.

14 (3) INTERNAL REVENUE CODE AMEND15 MENTS.—(A) Subchapter B of chapter 100 of the 

16 Internal Revenue Code of 1986 (relating to other re17 quirements) is amended by adding at the end the 

18 following new section: 

19 ‘‘SEC. 9813. PARITY IN THE APPLICATION OF TREATMENT 

20 LIMITATIONS AND FINANCIAL REQUIRE21 MENTS TO SUBSTANCE ABUSE TREATMENT 

22 BENEFITS. 

23 ‘‘(a) IN GENERAL.—In the case of a group health 

24 plan that provides both medical and surgical benefits and 
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1 substance abuse treatment benefits, the plan shall not im2 pose treatment limitations or financial requirements on 

3 the substance abuse treatment benefits unless similar limi4 tations or requirements are imposed for medical and sur5 gical benefits. 

6 ‘‘(b) CONSTRUCTION.—Nothing in this section shall 

7 be construed—

8 ‘‘(1) as requiring a group health plan to provide 

9 any substance abuse treatment benefits; or 

10 ‘‘(2) to prevent a group health plan from nego11 tiating the level and type of reimbursement with a 

12 provider for care provided in accordance with this 

13 section. 

14 ‘‘(c) EXEMPTIONS.—

15 ‘‘(1) SMALL EMPLOYER EXEMPTION.—

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

17 apply to any group health plan for any plan 

18 year of a small employer. 

19 ‘‘(B) SMALL EMPLOYER.—For purposes of 

20 subparagraph (A), the term ‘small employer’ 

21 means, in connection with a group health plan 

22 with respect to a calendar year and a plan year, 

23 an employer who employed an average of at 

24 least 2 but not more than 50 employees on 

25 business days during the preceding calendar 
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1 year and who employs at least 2 employees on 

2 the first day of the plan year. 

3 ‘‘(C) APPLICATION OF CERTAIN RULES IN

4 DETERMINATION OF EMPLOYER SIZE.—For 

5 purposes of this paragraph—

6 ‘‘(i) APPLICATION OF AGGREGATION

7 RULE FOR EMPLOYERS.—Rules similar to 

8 the rules under subsections (b), (c), (m), 

9 and (o) of section 414 shall apply for pur10 poses of treating persons as a single em11 ployer. 

12 ‘‘(ii) EMPLOYERS NOT IN EXISTENCE

13 IN PRECEDING YEAR.—In the case of an 

14 employer which was not in existence 

15 throughout the preceding calendar year, 

16 the determination of whether such em17 ployer is a small employer shall be based 

18 on the average number of employees that 

19 it is reasonably expected such employer 

20 will employ on business days in the current 

21 calendar year. 

22 ‘‘(iii) PREDECESSORS.—Any reference 

23 in this paragraph to an employer shall in24 clude a reference to any predecessor of 

25 such employer. 
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1 ‘‘(2) INCREASED COST EXEMPTION.—This sec2 tion shall not apply with respect to a group health 

3 plan if the application of this section to such plan 

4 results in an increase in the cost under the plan of 

5 at least 1 percent. 

6 ‘‘(d) SEPARATE APPLICATION TO EACH OPTION OF7 FERED.—In the case of a group health plan that offers 

8 a participant or beneficiary two or more benefit package 

9 options under the plan, the requirements of this section 

10 shall be applied separately with respect to each such op11 tion. 

12 ‘‘(e) DEFINITIONS.—For purposes of this section—

13 ‘‘(1) TREATMENT LIMITATION.—The term 

14 ‘treatment limitation’ means, with respect to benefits 

15 under a group health plan, any day or visit limits 

16 imposed on coverage of benefits under the plan dur17 ing a period of time. 

18 ‘‘(2) FINANCIAL REQUIREMENT.—The term ‘fi19 nancial requirement’ means, with respect to benefits 

20 under a group health plan, any deductible, coinsur21 ance, or cost-sharing or an annual or lifetime dollar 

22 limit imposed with respect to the benefits under the 

23 plan. 

24 ‘‘(3) MEDICAL OR SURGICAL BENEFITS.—The 

25 term ‘medical or surgical benefits’ means benefits 
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1 with respect to medical or surgical services, as de2 fined under the terms of the plan, but does not in3 clude substance abuse treatment benefits. 

4 ‘‘(4) SUBSTANCE ABUSE TREATMENT BENE5 FITS.—The term ‘substance abuse treatment bene6 fits’ means benefits with respect to substance abuse 

7 treatment services. 

8 ‘‘(5) SUBSTANCE ABUSE TREATMENT SERV9 ICES.—The term ‘substance abuse services’ means 

10 any of the following items and services provided for 

11 the treatment of substance abuse: 

12 ‘‘(A) Inpatient treatment, including detoxi13 fication. 

14 ‘‘(B) Non-hospital residential treatment. 

15 ‘‘(C) Outpatient treatment, including 

16 screening and assessment, medication manage17 ment, individual, group, and family counseling, 

18 and relapse prevention. 

19 ‘‘(D) Prevention services, including health 

20 education and individual and group counseling 

21 to encourage the reduction of risk factors for 

22 substance abuse. 

23 ‘‘(6) SUBSTANCE ABUSE.—The term ‘substance 

24 abuse’ includes chemical dependency.’’. 
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1 (B) Section 4980D(d)(1) of such Code is 

2 amended by inserting ‘‘(other than a failure attrib3 utable to section 9813)’’ after ‘‘on any failure’’. 

4 (C) The table of sections of subchapter B of 

5 chapter 100 of such Code is amended by adding at 

6 the end the following new item:

‘‘9813. Parity in the application of treatment limitations and financial requirements to substance abuse treatment benefits.’’

7 (b) INDIVIDUAL HEALTH INSURANCE.—(1) Part B 

8 of title XXVII of the Public Health Service Act is amend9 ed by inserting after section 2752 the following new sec10 tion: 

11 ‘‘SEC. 2753. PARITY IN THE APPLICATION OF TREATMENT 

12 LIMITATIONS AND FINANCIAL REQUIRE13 MENTS TO SUBSTANCE ABUSE BENEFITS. 

14 ‘‘(a) IN GENERAL.—The provisions of section 2707 

15 (other than subsections (e)) shall apply to health insur16 ance coverage offered by a health insurance issuer in the 

17 individual market in the same manner as it applies to 

18 health insurance coverage offered by a health insurance 

19 issuer in connection with a group health plan in the small 

20 or large group market. 

21 ‘‘(b) NOTICE.—A health insurance issuer under this 

22 part shall comply with the notice requirement under sec23 tion 714(f) of the Employee Retirement Income Security 

24 Act of 1974 with respect to the requirements referred to 
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1 in subsection (a) as if such section applied to such issuer 

2 and such issuer were a group health plan.’’. 

3 (2) Section 2762(b)(2) of such Act (42 U.S.C. 

4 300gg–62(b)(2)) is amended by striking ‘‘section 2751’’ 

5 and inserting ‘‘sections 2751 and 2753’’. 

6 (c) EFFECTIVE DATES.—(1) Subject to paragraph 

7 (3), the amendments made by subsection (a) apply with 

8 respect to group health plans for plan years beginning on 

9 or after January 1, 2006. 

10 (2) The amendments made by subsection (b) apply 

11 with respect to health insurance coverage offered, sold, 

12 issued, renewed, in effect, or operated in the individual 

13 market on or after January 1, 2006. 

14 (3) In the case of a group health plan maintained 

15 pursuant to 1 or more collective bargaining agreements 

16 between employee representatives and 1 or more employ17 ers ratified before the date of enactment of this Act, the 

18 amendments made in subsection (a) shall not apply to plan 

19 years beginning before the later of—

20 (A) the date on which the last collective bar21 gaining agreements relating to the plan terminates 

22 (determined without regard to any extension thereof 

23 agreed to after the date of enactment of this Act), 

24 or 

25 (B) January 1, 2006. 
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1 For purposes of subparagraph (A), any plan amendment 

2 made pursuant to a collective bargaining agreement relat3 ing to the plan which amends the plan solely to conform 

4 to any requirement added by subsection (a) shall not be 

5 treated as a termination of such collective bargaining 

6 agreement. 

7 (d) COORDINATED REGULATIONS.—Section 104(1) 

8 of Health Insurance Portability and Accountability Act of 

9 1996 is amended by striking ‘‘this subtitle (and the 

10 amendments made by this subtitle and section 401)’’ and 

11 inserting ‘‘the provisions of part 7 of subtitle B of title 

12 I of the Employee Retirement Income Security Act of 

13 1974, and the provisions of parts A and C of title XXVII 

14 of the Public Health Service Act, and chapter 1000 of the 

15 Internal Revenue Code of 1986’’. 

16 (e) PREEMPTION.—Nothing in the amendments made 

17 by this section shall be construed to preempt any provision 

18 of State law that provides protections to individuals that 

19 are greater than the protections provided under such 

20 amendments.

Æ