II

105TH CONGRESS

1ST SESSION S. 1147

To amend the Public Health Service Act, Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to provide

for nondiscriminatory coverage for substance abuse treatment services

under private group and individual health coverage.

IN THE SENATE OF THE UNITED STATES

SEPTEMBER 4, 1997

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

referred to the Committee on Labor and Human Resources

A BILL

To amend the Public Health Service Act, Employee Retirement Income Security Act of 1974, and the Internal

Revenue Code of 1986 to provide for nondiscriminatory

coverage for substance abuse treatment services under

private group and individual health coverage.

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 ‘‘Substance Abuse

5 Treatment Parity Act of 1997’’.
2

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1 SEC. 2. PARITY IN SUBSTANCE ABUSE TREATMENT BENE2 FITS.

3 (a) GROUP HEALTH PLANS.—

4 (1) PUBLIC HEALTH SERVICE ACT AMEND5 MENTS.—(A) Subpart 2 of part A of title XXVII of

6 the Public Health Service Act (as added by section

7 604(a) of the Newborns’ and Mothers’ Health Pro8 tection Act of 1996 and amended by section 703(a)

9 of the Mental Health Parity Act of 1996) is amend10 ed by adding at the end the following new section:

11 ‘‘SEC. 2706. PARITY IN THE APPLICATION OF TREATMENT

12 LIMITATIONS AND FINANCIAL REQUIRE13 MENTS TO SUBSTANCE ABUSE TREATMENT

14 BENEFITS.

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

16 plan (or health insurance coverage offered in connection

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

18 benefits and substance abuse treatment benefits, the plan

19 or coverage shall not impose treatment limitations or fi20 nancial requirements on the substance abuse treatment

21 benefits unless similar limitations or requirements are im22 posed for medical and surgical benefits.

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

24 be construed—

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

26 insurance coverage offered in connection with such a
3

•S 1147 IS

1 plan) to provide any substance abuse treatment ben2 efits; or

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

4 insurance issuer offering group health insurance cov5 erage from negotiating the level and type of reim6 bursement with a provider for care provided in ac7 cordance with this section.

8 ‘‘(c) EXEMPTIONS.—

9 ‘‘(1) SMALL EMPLOYER EXEMPTION.—

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

11 apply to any group health plan (and group

12 health insurance coverage offered in connection

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

14 a small employer.

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

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

17 means, in connection with a group health plan

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

19 an employer who employed an average of at

20 least 2 but not more than 50 employees on

21 business days during the preceding calendar

22 year and who employs at least 2 employees on

23 the first day of the plan year.
4

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1 ‘‘(C) APPLICATION OF CERTAIN RULES IN

2 DETERMINATION OF EMPLOYER SIZE.—For

3 purposes of this paragraph—

4 ‘‘(i) APPLICATION OF AGGREGATION

5 RULE FOR EMPLOYERS.—Rules similar to

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

7 and (o) of section 414 of the Internal Rev8 enue Code of 1986 shall apply for purposes

9 of treating persons as a single employer.

10 ‘‘(ii) EMPLOYERS NOT IN EXISTENCE

11 IN PRECEDING YEAR.—In the case of an

12 employer which was not in existence

13 throughout the preceding calendar year,

14 the determination of whether such em15 ployer is a small employer shall be based

16 on the average number of employees that

17 it is reasonably expected such employer

18 will employ on business days in the current

19 calendar year.

20 ‘‘(iii) PREDECESSORS.—Any reference

21 in this paragraph to an employer shall in22 clude a reference to any predecessor of

23 such employer.

24 ‘‘(2) INCREASED COST EXEMPTION.—This sec25 tion shall not apply with respect to a group health
5

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1 plan (or health insurance coverage offered in connec2 tion with a group health plan) if the application of

3 this section to such plan (or to such coverage) re4 sults in an increase in the cost under the plan (or

5 for such coverage) of 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 or health insurance cov16 erage, any day or visit limits imposed on coverage of

17 benefits under the plan or coverage during a period

18 of time.

19 ‘‘(2) FINANCIAL REQUIREMENT.—The term ‘fi20 nancial requirement’ means, with respect to benefits

21 under a group health plan or health insurance cov22 erage, any deductible, coinsurance, or cost-sharing

23 or an annual or lifetime dollar limit imposed with re24 spect to the benefits under the plan or coverage.
6

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

2 term ‘medical or surgical benefits’ means benefits

3 with respect to medical or surgical services, as de4 fined under the terms of the plan or coverage (as the

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

6 treatment benefits.

7 ‘‘(4) SUBSTANCE ABUSE TREATMENT BENE8 FITS.—The term ‘substance abuse treatment bene9 fits’ means benefits with respect to substance abuse

10 treatment services.

11 ‘‘(5) SUBSTANCE ABUSE TREATMENT SERV12 ICES.—The term ‘substance abuse services’ means

13 any of the following items and services provided for

14 the treatment of substance abuse:

15 ‘‘(A) Inpatient treatment, including detoxi16 fication.

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

18 ‘‘(C) Outpatient treatment, including

19 screening and assessment, medication manage20 ment, individual, group, and family counseling,

21 and relapse prevention.

22 ‘‘(D) Prevention services, including health

23 education and individual and group counseling

24 to encourage the reduction of risk factors for

25 substance abuse.
7

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

2 abuse’ includes chemical dependency.

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

4 shall comply with the notice requirement under section

5 713(f) of the Employee Retirement Income Security Act

6 of 1974 with respect to the requirements of this section

7 as if such section applied to such plan.

8 ‘‘(g) SUNSET.—This section shall not apply to bene9 fits for services furnished on or after September 30,

10 2002.’’.

11 (B) Section 2723(c) of such Act (42 U.S.C.

12 300gg–23(c)), as amended by section 604(b)(2) of

13 Public Law 104–204, is amended by striking ‘‘sec14 tion 2704’’ and inserting ‘‘sections 2704 and 2706’’.

15 (2) ERISA AMENDMENTS.—(A) Subpart B of

16 part 7 of subtitle B of title I of the Employee Re17 tirement Income Security Act of 1974 (as added by

18 section 603(a) of the Newborns’ and Mothers’

19 Health Protection Act of 1996 and amended by sec20 tion 702(a) of the Mental Health Parity Act of

21 1996) is amended by adding at the end the following

22 new section:
8

•S 1147 IS

1 ‘‘SEC. 713. 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.—
9

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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
10

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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.
11

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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
12

•S 1147 IS

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 UNDER GROUP HEALTH PLAN.—The

17 imposition of the requirements of this section shall be

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

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

20 notice of such requirements under the plan; except that

21 the summary description required to be provided under the

22 last sentence of section 104(b)(1) with respect to such

23 modification shall be provided by not later than 60 days

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

25 requirements apply.
13

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1 ‘‘(g) SUNSET.—This section shall not apply to bene2 fits for services furnished on or after September 30,

3 2002.’’.

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

5 1191(c)), as amended by section 603(b)(1) of Public

6 Law 104–204, is amended by striking ‘‘section 711’’

7 and inserting ‘‘sections 711 and 713’’.

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

9 1191a(a)), as amended by section 603(b)(2) of Pub10 lic Law 104–204, is amended by striking ‘‘section

11 711’’ and inserting ‘‘sections 711 and 713’’.

12 (D) The table of contents in section 1 of such

13 Act is amended by inserting after the item relating

14 to section 712 the following new item:

‘‘Sec. 713. Parity in the application of treatment limitations and financial requirements to substance abuse treatment benefits.’’.

15 (3) INTERNAL REVENUE CODE AMEND16 MENTS.—(A) Subtitle K of the Internal Revenue

17 Code of 1986 (as added by section 401(a) of the

18 Health Insurance Portability and Accountability Act

19 of 1996) is amended—

20 (i) by striking all that precedes section

21 9801 and inserting the following:

22 ‘‘Subtitle K—Group Health Plan

23 Requirements

‘‘CHAPTER 100. Group health plan requirements.
14

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1 ‘‘CHAPTER 100—GROUP HEALTH PLAN

2 REQUIREMENTS

‘‘Subchapter A. Requirements relating to portability, access, and

renewability.

‘‘Subchapter B. Other requirements.

‘‘Subchapter C. General provisions.

3 ‘‘Subchapter A—Requirements Relating to

4 Portability, Access, and Renewability

‘‘Sec. 9801. Increased portability through limitation on preexisting condition exclusions.

‘‘Sec. 9802. Prohibiting discrimination against individual participants and beneficiaries based on health status.

‘‘Sec. 9803. Guaranteed renewability in multiemployer plans and

certain multiple employer welfare arrangements.’’,

5 (ii) by redesignating sections 9804, 9805,

6 and 9806 as sections 9831, 9832, and 9833, re7 spectively,

8 (iii) by inserting before section 9831 (as so

9 redesignated) the following:

10 ‘‘Subchapter C—General Provisions

‘‘Sec. 9831. General exceptions.

‘‘Sec. 9832. Definitions.

‘‘Sec. 9833. Regulations.’’, and

11 (iv) by inserting after section 9803 the fol12 lowing:

13 ‘‘Subchapter B—Other Requirements

‘‘Sec. 9811. Parity in the application of treatment limitations

and financial requirements to substance abuse

treatment benefits.
15

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1 ‘‘SEC. 9811. 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.—
16

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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
17

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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.
18

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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
19

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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) SUNSET.—This section shall not apply to bene17 fits for services furnished on or after September 30,

18 2002.’’.

19 (B) CONFORMING AMENDMENTS.—

20 (i) Chapter 100 of such Code (as added by

21 section 401 of the Health Insurance Portability

22 and Accountability Act of 1996 and as pre23 viously amended by this section) is further

24 amended—
20

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1 (I) in the last sentence of section

2 9801(c)(1), by striking ‘‘section 9805(c)’’

3 and inserting ‘‘section 9832(c)’’;

4 (II) in section 9831(b), by striking

5 ‘‘9805(c)(1)’’ and inserting ‘‘9832(c)(1)’’;

6 (III) in section 9831(c)(1), by striking

7 ‘‘9805(c)(2)’’ and inserting ‘‘9832(c)(2)’’;

8 (IV) in section 9831(c)(2), by striking

9 ‘‘9805(c)(3)’’ and inserting ‘‘9832(c)(3)’’;

10 and

11 (V) in section 9831(c)(3), by striking

12 ‘‘9805(c)(4)’’ and inserting ‘‘9832(c)(4)’’.

13 (ii) Section 4980D of such Code (as added

14 by section 402 of the Health Insurance Port15 ability and Accountability Act of 1996) is

16 amended—

17 (I) in subsection (c)(3)(B)(i)(I), by

18 striking ‘‘9805(d)(3)’’ and inserting

19 ‘‘9832(d)(3)’’;

20 (II) in subsection (d)(1), by inserting

21 ‘‘(other than a failure attributable to sec22 tion 9811)’’ after ‘‘on any failure’’;

23 (III) in subsection (d)(3), by striking

24 ‘‘9805’’ and inserting ‘‘9832’’;
21

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1 (IV) in subsection (f)(1), by striking

2 ‘‘9805(a)’’ and inserting ‘‘9832(a)’’.

3 (iii) The table of subtitles for such Code is

4 amended by striking the item relating to sub5 title K (as added by section 401(b) of the

6 Health Insurance Portability and Accountability

7 Act of 1996) and inserting the following new

8 item:

‘‘SUBTITLE K. Group health plan requirements.’’

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

10 of title XXVII of the Public Health Service Act (as added

11 by section 605(a) of the Newborn’s and Mother’s Health

12 Protection Act of 1996) is amended by inserting after sec13 tion 2751 the following new section:

14 ‘‘SEC. 2752. PARITY IN THE APPLICATION OF TREATMENT

15 LIMITATIONS AND FINANCIAL REQUIRE16 MENTS TO SUBSTANCE ABUSE BENEFITS.

17 ‘‘(a) IN GENERAL.—The provisions of section 2706

18 (other than subsection (e)) shall apply to health insurance

19 coverage offered by a health insurance issuer in the indi20 vidual market in the same manner as it applies to health

21 insurance coverage offered by a health insurance issuer

22 in connection with a group health plan in the small or

23 large group market.

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

25 part shall comply with the notice requirement under sec-
22

•S 1147 IS

1 tion 713(f) of the Employee Retirement Income Security

2 Act of 1974 with respect to the requirements referred to

3 in subsection (a) as if such section applied to such issuer

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

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

6 300gg–62(b)(2)), as added by section 605(b)(3)(B) of

7 Public Law 104–204, is amended by striking ‘‘section

8 2751’’ and inserting ‘‘sections 2751 and 2752’’.

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

10 (3), the amendments made by subsection (a) shall apply

11 with respect to group health plans for plan years begin12 ning on or after January 1, 1999.

13 (2) The amendment made by subsection (b) shall

14 apply with respect to health insurance coverage offered,

15 sold, issued, renewed, in effect, or operated in the individ16 ual market on or after such date.

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

18 pursuant to 1 or more collective bargaining agreements

19 between employee representatives and 1 or more employ20 ers ratified before the date of enactment of this Act, the

21 amendments made subsection (a) shall not apply to plan

22 years beginning before the later of—

23 (A) the date on which the last collective bar24 gaining agreements relating to the plan terminates

25 (determined without regard to any extension thereof
23

•S 1147 IS

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

2 or

3 (B) January 1, 1999.

4 For purposes of subparagraph (A), any plan amendment

5 made pursuant to a collective bargaining agreement relat6 ing to the plan which amends the plan solely to conform

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

8 treated as a termination of such collective bargaining

9 agreement.

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

11 of Health Insurance Portability and Accountability Act of

12 1996 is amended by striking ‘‘this subtitle (and the

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

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

15 I of the Employee Retirement Income Security Act of

16 1974, and the provisions of parts A and C of title XXVII

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

18 Internal Revenue Code of 1986’’.

Æ