II 
Calendar No. 610 
110TH CONGRESS 
2D SESSION 
H. R. 1424 
IN THE SENATE OF THE UNITED STATES 
MARCH 6, 2008 
Received and read the first time 
MARCH 7, 2008 
Read the second time and placed on the calendar 
AN ACT 
To amend section 712 of the Employee Retirement Income 
Security Act of 1974, section 2705 of the Public Health 
Service Act, section 9812 of the Internal Revenue Code 
of 1986 to require equity in the provision of mental 
health and substance-related disorder benefits under 
group health plans, to prohibit discrimination on the 
basis of genetic information with respect to health insur-
ance and employment, and for other purposes. 
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Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. ORGANIZATION OF ACT INTO DIVISIONS; TABLE 
OF CONTENTS. 
(a) DIVISIONS.—This Act is organized into two divi-
sions as follows: 
(1) Division A—Paul Wellstone Mental Health 
and Addiction Equity Act of 2008. 
(2) Division B—Genetic Information Non-
discrimination Act of 2008. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Organization of Act into divisions; table of contents. 
DIVISION A—PAUL WELLSTONE MENTAL HEALTH AND 
ADDICTION EQUITY ACT OF 2008 
Sec. 101. Short title. 
Sec. 102. Amendments to the Employee Retirement Income Security Act of 
1974. 
Sec. 103. Amendments to the Public Health Service Act relating to the group 
market. 
Sec. 104. Amendments to the Internal Revenue Code of 1986. 
Sec. 105. Medicaid drug rebate. 
Sec. 106. Limitation on Medicare exception to the prohibition on certain physi-
cian referrals for hospitals. 
Sec. 107. Studies and reports. 
DIVISION B—GENETIC INFORMATION NONDISCRIMINATION ACT 
OF 2008 
Sec. 100. Short title; findings. 
TITLE I—GENETIC NONDISCRIMINATION IN HEALTH INSURANCE 
Sec. 101. Amendments to Employee Retirement Income Security Act of 1974. 
Sec. 102. Amendments to the Public Health Service Act. 
Sec. 103. Amendments to the Internal Revenue Code of 1986. 
Sec. 104. Amendments to title XVIII of the Social Security Act relating to 
medigap. 
Sec. 105. Privacy and confidentiality. 
Sec. 106. Assuring coordination. 
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TITLE II—PROHIBITING EMPLOYMENT DISCRIMINATION ON THE 
BASIS OF GENETIC INFORMATION 
Sec. 201. Definitions. 
Sec. 202. Employer practices. 
Sec. 203. Employment agency practices. 
Sec. 204. Labor organization practices. 
Sec. 205. Training programs. 
Sec. 206. Confidentiality of genetic information. 
Sec. 207. Remedies and enforcement. 
Sec. 208. Disparate impact. 
Sec. 209. Construction. 
Sec. 210. Medical information that is not genetic information. 
Sec. 211. Regulations. 
Sec. 212. Authorization of appropriations. 
Sec. 213. Effective date. 
TITLE III—MISCELLANEOUS PROVISIONS 
Sec. 301. Guarantee agency collection retention. 
Sec. 302. Severability. 
DIVISION A—PAUL WELLSTONE 
MENTAL HEALTH AND ADDIC-
TION EQUITY ACT OF 2008 
SEC. 101. SHORT TITLE. 
This division may be cited as the ‘‘Paul Wellstone 
Mental Health and Addiction Equity Act of 2008’’. 
SEC. 102. AMENDMENTS TO THE EMPLOYEE RETIREMENT 
INCOME SECURITY ACT OF 1974. 
(a) EXTENSION OF PARITY TO TREATMENT LIMITS 
AND BENEFICIARY FINANCIAL REQUIREMENTS.—Section 
712 of the Employee Retirement Income Security Act of 
1974 (29 U.S.C. 1185a) is amended— 
(1) in subsection (a), by adding at the end the 
following new paragraphs: 
‘‘(3) TREATMENT
LIMITS.—In the case of a 
group health plan that provides both medical and 
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surgical benefits and mental health or substance-re-
lated disorder benefits— 
‘‘(A) NO TREATMENT LIMIT.—If the plan 
or coverage does not include a treatment limit 
(as defined in subparagraph (D)) on substan-
tially all medical and surgical benefits in any 
category of items or services, the plan or cov-
erage may not impose any treatment limit on 
mental health or substance-related disorder 
benefits that are classified in the same category 
of items or services. 
‘‘(B) TREATMENT LIMIT.—If the plan or 
coverage includes a treatment limit on substan-
tially all medical and surgical benefits in any 
category of items or services, the plan or cov-
erage may not impose such a treatment limit on 
mental health or substance-related disorder 
benefits for items and services within such cat-
egory that is more restrictive than the predomi-
nant treatment limit that is applicable to med-
ical and surgical benefits for items and services 
within such category. 
‘‘(C) CATEGORIES
OF
ITEMS
AND
SERV-
ICES FOR APPLICATION OF TREATMENT LIMITS 
AND
BENEFICIARY
FINANCIAL
REQUIRE-
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MENTS.—For purposes of this paragraph and 
paragraph (4), there shall be the following five 
categories of items and services for benefits, 
whether medical and surgical benefits or mental 
health and substance-related disorder benefits, 
and all medical and surgical benefits and all 
mental health and substance related benefits 
shall be classified into one of the following cat-
egories: 
‘‘(i) INPATIENT, IN-NETWORK.—Items 
and services not described in clause (v) 
furnished on an inpatient basis and within 
a network of providers established or rec-
ognized under such plan or coverage. 
‘‘(ii) INPATIENT, OUT-OF-NETWORK.— 
Items and services not described in clause 
(v) furnished on an inpatient basis and 
outside any network of providers estab-
lished or recognized under such plan or 
coverage. 
‘‘(iii) OUTPATIENT, 
IN-NETWORK.— 
Items and services not described in clause 
(v) furnished on an outpatient basis and 
within a network of providers established 
or recognized under such plan or coverage. 
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‘‘(iv) 
OUTPATIENT, 
OUT-OF-NET-
WORK.—Items and services not described 
in clause (v) furnished on an outpatient 
basis and outside any network of providers 
established or recognized under such plan 
or coverage. 
‘‘(v) EMERGENCY
CARE.—Items and 
services, whether furnished on an inpatient 
or outpatient basis or within or outside 
any network of providers, required for the 
treatment of an emergency medical condi-
tion (as defined in section 1867(e) of the 
Social Security Act, including an emer-
gency condition relating to mental health 
or substance-related disorders). 
‘‘(D) TREATMENT
LIMIT
DEFINED.—For 
purposes of this paragraph, the term ‘treatment 
limit’ means, with respect to a plan or coverage, 
limitation on the frequency of treatment, num-
ber of visits or days of coverage, or other simi-
lar limit on the duration or scope of treatment 
under the plan or coverage. 
‘‘(E) PREDOMINANCE.—For purposes of 
this subsection, a treatment limit or financial 
requirement with respect to a category of items 
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and services is considered to be predominant if 
it is the most common or frequent of such type 
of limit or requirement with respect to such cat-
egory of items and services. 
‘‘(4) 
BENEFICIARY
FINANCIAL
REQUIRE-
MENTS.—In the case of a group health plan that 
provides both medical and surgical benefits and 
mental health or substance-related disorder bene-
fits— 
‘‘(A) NO
BENEFICIARY
FINANCIAL
RE-
QUIREMENT.—If the plan or coverage does not 
include a beneficiary financial requirement (as 
defined in subparagraph (C)) on substantially 
all medical and surgical benefits within a cat-
egory of items and services (specified under 
paragraph (3)(C)), the plan or coverage may 
not impose such a beneficiary financial require-
ment on mental health or substance-related dis-
order benefits for items and services within 
such category. 
‘‘(B) BENEFICIARY
FINANCIAL
REQUIRE-
MENT.— 
‘‘(i) TREATMENT
OF
DEDUCTIBLES, 
OUT-OF-POCKET LIMITS, AND SIMILAR FI-
NANCIAL REQUIREMENTS.—If the plan or 
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coverage includes a deductible, a limitation 
on out-of-pocket expenses, or similar bene-
ficiary financial requirement that does not 
apply separately to individual items and 
services on substantially all medical and 
surgical benefits within a category of items 
and services (as specified in paragraph 
(3)(C)), the plan or coverage shall apply 
such requirement (or, if there is more than 
one such requirement for such category of 
items and services, the predominant re-
quirement for such category) both to med-
ical and surgical benefits within such cat-
egory and to mental health and substance- 
related disorder benefits within such cat-
egory and shall not distinguish in the ap-
plication of such requirement between such 
medical and surgical benefits and such 
mental health and substance-related dis-
order benefits. 
‘‘(ii) OTHER
FINANCIAL
REQUIRE-
MENTS.—If the plan or coverage includes a 
beneficiary financial requirement not de-
scribed in clause (i) on substantially all 
medical and surgical benefits within a cat-
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egory of items and services, the plan or 
coverage may not impose such financial re-
quirement on mental health or substance- 
related disorder benefits for items and 
services within such category in a way that 
results in greater out-of-pocket expenses to 
the participant or beneficiary than the pre-
dominant beneficiary financial requirement 
applicable to medical and surgical benefits 
for items and services within such cat-
egory. 
‘‘(C) BENEFICIARY
FINANCIAL
REQUIRE-
MENT DEFINED.—For purposes of this para-
graph, the term ‘beneficiary financial require-
ment’ includes, with respect to a plan or cov-
erage, any deductible, coinsurance, co-payment, 
other cost sharing, and limitation on the total 
amount that may be paid by a participant or 
beneficiary with respect to benefits under the 
plan or coverage, but does not include the appli-
cation of any aggregate lifetime limit or annual 
limit.’’; and 
(2) in subsection (b)— 
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