I
105TH CONGRESS
1ST SESSION
H. R. 2110
To require employer health benefit plans to meet standards relating to the
nondiscriminatory treatment of neurobiological disorders, and for other
purposes.
IN THE HOUSE OF REPRESENTATIVES
JULY 8, 1997
Ms. DELAURO (for herself, Mr. GEJDENSON, Mr. GONZALEZ, Mr. EVANS, Mr.
ABERCROMBIE, Ms. KILPATRICK, Mr. STARK, Mr. DELLUMS, and Ms.
RIVERS) introduced the following bill; which was referred to the Commit-
tee on Ways and Means, and in addition to the Committees on Education
and the Workforce, and Commerce, for a period to be subsequently deter-
mined by the Speaker, in each case for consideration of such provisions
as fall within the jurisdiction of the committee concerned
A BILL
To require employer health benefit plans to meet standards
relating 
to 
the 
nondiscriminatory 
treatment 
of
neurobiological disorders, and for other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Equitable Health Care
for Neurobiological Disorders Act of 1997’’.
SEC. 2. FINDINGS.
Congress finds that—
(1) there are sufficient neuroscientific data to
document that many severe ‘‘mental’’ illnesses are
actually physical illnesses known as neurobiological
disorders that are characterized by significant
neuroanatomical and neurochemical abnormalities;
(2) American families should have adequate
health insurance protection for the costs of treating
neurobiological disorders that is commensurate with
the protections provided for other illnesses;
(3) currently, many public and private health
insurance programs discriminate against persons
with neurobiological disorders by providing more re-
strictive coverage for treatments of those illnesses in
comparison to coverage provided for treatments of
other medical problems;
(4) unequal health insurance coverage contrib-
utes to the destructive and unfair stigmatization of
persons with neurobiological disorders that are as
beyond the control of the individuals as are cancer,
diabetes, and other serious physical health problems;
(5) about 95 percent of what is known about
both normal and abnormal structure and function of
the brain has been learned in the last 10 years, but
millions of severely mentally ill people have yet to
benefit from these startling research advances in
clinical and basic neuroscience; and
(6) according to the National Institutes of Men-
tal Health, equitable insurance coverage for severe
mental disorders will yield $2.2 billion annually in
net savings through decreased use of general medical
services and a substantial decrease in social costs.
SEC. 3. STANDARDS FOR NONDISCRIMINATORY TREAT-
MENT 
OF 
NEUROBIOLOGICAL 
DISORDERS
FOR EMPLOYER HEALTH BENEFIT PLANS.
(a) IN GENERAL.—The standards for the nondiscrim-
inatory and equitable treatment by employer health bene-
fit plans of individuals with neurobiological disorders are
requirements that such plans (and carriers offering such
plans) provide for coverage of services that are essential
to the effective treatment of neurobiological disorders in
a manner that—
(1) is not more restrictive than coverage pro-
vided for other major physical illnesses;
(2) provides adequate financial protection to the
person requiring the medical treatment for a
neurobiological disorder; and
(3) is consistent with effective and common
methods of controlling health care costs for other
major physical illnesses.
(b) PLAN DEEMED TO MEET STANDARDS.—An em-
ployer health benefit plan shall be deemed to meet the
standards described in subsection (a) if the plan provides
for the following:
(1) Stop-loss protection for catastrophic ex-
penses.
(2) Coverage of facility-based care.
(3) Coverage of outpatient medical management
on a par with other medical procedures to encourage
the use of cost-effective ambulatory treatment, in-
cluding treatment in non-traditional settings.
(4) Coverage of visits for psychological support-
ive, therapeutic, and rehabilitative services, with co-
insurance and fees set to ensure effective cost con-
trol of high demand services.
(5) Coverage of prescription drugs essential to
the cost effective treatment of neurobiological dis-
orders.
(6) Coverage of medically necessary services for
comorbidity of other disorders.
SEC. 4. ENFORCEMENT THROUGH EXCISE TAX.
(a) IN GENERAL.—Chapter 43 of the Internal Reve-
nue Code of 1986 (relating to qualified pension, etc.,
plans) is amended by adding at the end thereof the follow-
ing new section:
‘‘SEC. 
4980F. 
FAILURE 
TO 
COMPLY 
WITH 
EMPLOYER
HEALTH BENEFIT PLAN STANDARDS FOR
NONDISCRIMINATORY 
TREATMENT 
FOR
NEUROBIOLOGICAL DISORDERS.
‘‘(a) IMPOSITION OF TAX.—There is hereby imposed
a tax on the failure of a carrier or an employer health
benefit plan to comply with the standards relating to the
nondiscriminatory treatment of neurobiological disorders
under section 3 of the Equitable Health Care for
Neurobiological Disorders Act of 1997.
‘‘(b) AMOUNT OF TAX.—
‘‘(1) IN GENERAL.—Subject to paragraph (2),
the tax imposed by subsection (a) shall be an
amount not to exceed 25 percent of the amounts re-
ceived by the carrier or under the plan for coverage
during the period such failure persists.
‘‘(2) LIMITATION IN CASE OF INDIVIDUAL FAIL-
URES.—In the case of a failure that only relates to
specified individuals or employers (and not to the
plan generally), the amount of the tax imposed by
subsection (a) shall not exceed the aggregate of
$100 for each day during which such failure persists
for each individual to which such failure relates. A
rule similar to the rule of section 4980B(b)(3) shall
apply for purposes of this section.
‘‘(c) LIABILITY FOR TAX.—The tax imposed by this
section shall be paid by the carrier.
‘‘(d) EXCEPTIONS.—
‘‘(1) CORRECTIONS WITHIN 30 DAYS.—No tax
shall be imposed by subsection (a) by reason of any
failure if—
‘‘(A) such failure was due to reasonable
cause and not to willful neglect, and
‘‘(B) such failure is corrected within the
30-day period beginning on earliest date the
carrier knew, or exercising reasonable diligence
would have known, that such failure existed.
‘‘(2) WAIVER BY SECRETARY.—In the case of a
failure which is due to reasonable cause and not to
willful neglect, the Secretary may waive part or all
of the tax imposed by subsection (a) to the extent
that payment of such tax would be excessive relative
to the failure involved.
‘‘(e) DEFINITIONS.—For purposes of this section, the
terms ‘carrier’ and ‘employer health benefit plan’ have the
respective meanings given such terms in section 5 of the
Equitable Health Care for Neurobiological Disorders Act
of 1997.’’
(b) CLERICAL AMENDMENT.—The table of sections
for chapter 43 of such Code is amended by adding at the
end thereof the following new item:
‘‘Sec. 4980F. Failure to comply with employer health benefit plan
standards for nondiscriminatory treatment for
neurobiological disorders.’’.
(c) EFFECTIVE DATE.—The amendments made by
this subsection shall apply to plan years beginning after
December 31, 1998.
SEC. 5. DEFINITIONS.
In this Act, the following definitions shall apply:
(1) CARRIER.—The term ‘‘carrier’’ means any
entity which provides health insurance or health ben-
efits in a State, and includes a licensed insurance
company, a prepaid hospital or medical service plan,
a health maintenance organization, the plan sponsor
of a multiple employer welfare arrangement or an
employee benefit plan (as defined under the Em-
ployee Retirement Income Security Act of 1974), or
any other entity providing a plan of health insurance
subject to State insurance regulation.
(2) EMPLOYER HEALTH BENEFIT PLAN.—The
term ‘‘employer health benefit plan’’ means a health
benefit plan (including an employee welfare benefit
plan, as defined in section 3(1) of the Employee Re-
tirement Income Security Act of 1974) which is of-
fered to employees through an employer and for
which the employer provides for any contribution to
such plan or any premium for such plan are de-
ducted by the employer from compensation to the
employee.
(3) 
HEALTH
BENEFIT
PLAN.—The 
term
‘‘health benefit plan’’ means any hospital or medical
expense incurred policy or certificate, hospital or
medical service plan contract, or health maintenance
subscriber contract, or a multiple employer welfare
arrangement or employee benefit plan (as defined
under the Employee Retirement Income Security Act
of 1974) which provides benefits with respect to
health care services, but does not include—
(A) coverage only for accident, dental, vi-
sion, disability income, or long-term care insur-
ance, or any combination thereof,
(B) medicare supplemental health insur-
ance,
(C) coverage issued as a supplement to li-
ability insurance,
(D) worker’s compensation or similar in-
surance, or
(E) automobile medical-payment insurance,
or any combination thereof.
(4) NEUROBIOLOGICAL DISORDER.—
(A) IN GENERAL.—An individual with a
‘‘neurobiological disorder’’ is an individual diag-
nosed with one or more of the following condi-
tions:
(i) Affective disorders, including bipo-
lar disorder and major depressive disorder.
(ii) Anxiety disorders, including obses-
sive-compulsive disorder and panic dis-
order.
(iii) Attention deficit disorders.
(iv) Autism and other pervasive devel-
opmental disorders.
(v) 
Psychotic 
disorders, 
including
schizophrenia spectrum disorders.
(vi) Tourette’s disorder.
(B) PERIODIC REVIEW OF DEFINITION.—
(i) IN GENERAL.—Not later than 6
months after the date of the enactment of
this Act, the Secretary of Health and
Human Services shall promulgate regula-
tions directing the National Institute of
Mental Health to conduct a biannual re-
view of the definition of neurobiological
disorders under subparagraph (A). In con-
ducting such review, the National Institute
of Mental Health shall consult with extra-
mural researchers to review such definition
and make recommendations for necessary
revisions.
(ii) REVIEW
BY
ADVISORY
COUNCIL
REQUIRED.—The Secretary may not pro-
mulgate any regulation modifying the defi-
nition of neurobiological disorders under
subsection (a) until the recommendations
of the National Institute of Mental Health
under clause (i) have been reviewed by the
National Advisory Mental Health Council.
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