I 
109TH CONGRESS 
1ST SESSION H. R. 1402 
To provide for equal coverage of mental health benefits with respect to 
health insurance coverage unless comparable limitations are imposed on 
medical and surgical benefits. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 17, 2005 
Mr. KENNEDY of Rhode Island (for himself and Mr. RAMSTAD) introduced the 
following bill; which was referred to the Committee on Education and the 
Workforce, and in addition to the Committee on Energy and Commerce, 
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 provide for equal coverage of mental health benefits with 
respect to health insurance coverage unless comparable 
limitations are imposed on medical and surgical benefits. 
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 ‘‘Paul Wellstone Mental 
Health Equitable Treatment Act of 2005’’.
SEC. 2. AMENDMENTS TO THE EMPLOYEE RETIREMENT IN-
COME SECURITY ACT OF 1974. 
(a) IN GENERAL.—Section 712 of the Employee Re-
tirement Income Security Act of 1974 (29 U.S.C. 1185a) 
is amended to read as follows: 
‘‘SEC. 712. MENTAL HEALTH PARITY. 
‘‘(a) IN GENERAL.—In the case of a group health 
plan (or health insurance coverage offered in connection 
with such a plan) that provides both medical and surgical 
benefits and mental health benefits, such plan or coverage 
shall not impose any treatment limitations or financial re-
quirements with respect to the coverage of benefits for 
mental illnesses unless comparable treatment limitations 
or financial requirements are imposed on medical and sur-
gical benefits. 
‘‘(b) CONSTRUCTION.— 
‘‘(1) IN
GENERAL.—Nothing in this section 
shall be construed as requiring a group health plan 
(or health insurance coverage offered in connection 
with such a plan) to provide any mental health bene-
fits. 
‘‘(2) MEDICAL
MANAGEMENT
OF
MENTAL 
HEALTH BENEFITS.—Consistent with subsection (a), 
nothing in this section shall be construed to prevent 
the medical management of mental health benefits, 
including through concurrent and retrospective utili-
zation review and utilization management practices, 
preauthorization, and the application of medical ne-
cessity and appropriateness criteria applicable to be-
havioral health and the contracting and use of a net-
work of participating providers. 
‘‘(3) NO
REQUIREMENT
OF
SPECIFIC
SERV-
ICES.—Nothing in this section shall be construed as 
requiring a group health plan (or health insurance 
coverage offered in connection with such a plan) to 
provide coverage for specific mental health services, 
except to the extent that the failure to cover such 
services would result in a disparity between the cov-
erage of mental health and medical and surgical 
benefits. 
‘‘(c) SMALL EMPLOYER EXEMPTION.— 
‘‘(1) IN GENERAL.—This section shall not apply 
to any group health plan (and group health insur-
ance coverage offered in connection with a group 
health plan) for any plan year of any employer who 
employed an average of at least 2 but not more than 
50 employees on business days during the preceding 
calendar year. 
‘‘(2) APPLICATION OF CERTAIN RULES IN DE-
TERMINATION OF EMPLOYER SIZE.—For purposes of 
this subsection—
‘‘(A) APPLICATION OF AGGREGATION RULE 
FOR EMPLOYERS.—Rules similar to the rules 
under subsections (b), (c), (m), and (o) of sec-
tion 414 of the Internal Revenue Code of 1986 
shall apply for purposes of treating persons as 
a single employer. 
‘‘(B) EMPLOYERS NOT IN EXISTENCE IN 
PRECEDING YEAR.—In the case of an employer 
which was not in existence throughout the pre-
ceding calendar year, the determination of 
whether such employer is a small employer shall 
be based on the average number of employees 
that it is reasonably expected such employer 
will employ on business days in the current cal-
endar year. 
‘‘(C) PREDECESSORS.—Any reference in 
this paragraph to an employer shall include a 
reference to any predecessor of such employer. 
‘‘(d) SEPARATE APPLICATION TO EACH OPTION OF-
FERED.—In the case of a group health plan that offers 
a participant or beneficiary two or more benefit package 
options under the plan, the requirements of this section 
shall be applied separately with respect to each such op-
tion.
‘‘(e) IN-NETWORK AND OUT-OF-NETWORK RULES.— 
In the case of a plan or coverage option that provides in- 
network mental health benefits, out-of-network mental 
health benefits may be provided using treatment limita-
tions or financial requirements that are not comparable 
to the limitations and requirements applied to medical and 
surgical benefits if the plan or coverage provides such in- 
network mental health benefits in accordance with sub-
section (a) and provides reasonable access to in-network 
providers and facilities. 
‘‘(f) DEFINITIONS.—For purposes of this section— 
‘‘(1) FINANCIAL
REQUIREMENTS.—The term 
‘financial requirements’ includes deductibles, coin-
surance, co-payments, other cost sharing, and limita-
tions on the total amount that may be paid by a 
participant or beneficiary with respect to benefits 
under the plan or health insurance coverage and 
shall include the application of annual and lifetime 
limits. 
‘‘(2) MEDICAL OR SURGICAL BENEFITS.—The 
term ‘medical or surgical benefits’ means benefits 
with respect to medical or surgical services, as de-
fined under the terms of the plan or coverage (as the 
case may be), but does not include mental health 
benefits.
‘‘(3) MENTAL HEALTH BENEFITS.—The term 
‘mental health benefits’ means benefits with respect 
to services, as defined under the terms and condi-
tions of the plan or coverage (as the case may be), 
for all categories of mental health conditions listed 
in the Diagnostic and Statistical Manual of Mental 
Disorders, Fourth Edition (DSM IV–TR), or the 
most recent edition if different than the Fourth Edi-
tion, if such services are included as part of an au-
thorized treatment plan that is in accordance with 
standard protocols and such services meet the plan 
or issuer’s medical necessity criteria. 
‘‘(4) TREATMENT
LIMITATIONS.—The term 
‘treatment limitations’ means limitations on the fre-
quency of treatment, number of visits or days of cov-
erage, or other similar limits on the duration or 
scope of treatment under the plan or coverage.’’. 
(b) CLERICAL AMENDMENT.—The table of contents 
in section 1 of such Act is amended by striking the item 
relating to section 712 and inserting the following new 
item: 
‘‘Sec. 712. Mental health parity.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to plan years begin-
ning on or after January 1, 2006.