I
107TH CONGRESS
2D SESSION
H. R. 4066
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 20, 2002
Mrs. ROUKEMA (for herself, Mr. KENNEDY of Rhode Island, Mr. BROWN of
Ohio, Mr. EHRLICH, Mr. GEORGE MILLER of California, Mr. NORWOOD,
Mr. RAMSTAD, and Mr. STARK) introduced the following bill; which was
referred to the Committee on Education and the Workforce, and in addi-
tion to the Committee on Energy and Commerce, for a period to be sub-
sequently 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 ‘‘Mental Health Equi-
table Treatment Act of 2002’’.
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. Such term does
not include benefits with respect to the treatment of
substance abuse or chemical dependency.
‘‘(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, 2003.
SEC. 3. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT
RELATING TO THE GROUP MARKET.
(a) IN GENERAL.—Section 2705 of the Public Health
Service Act (42 U.S.C. 300gg–5) is amended to read as
follows:
‘‘SEC. 2705. 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
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. Such term does
not include benefits with respect to the treatment of
substance abuse or chemical dependency.
‘‘(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) EFFECTIVE DATE.—The amendment made by
this section shall apply with respect to plan years begin-
ning on or after January 1, 2003.
SEC. 4. PREEMPTION.
Nothing in the amendments made by this Act shall
be construed to preempt any provision of State law, with
respect to health insurance coverage offered by a health
insurance issuer in connection with a group health plan,
that provides protections to enrollees that are greater than
the protections provided under such amendments. Nothing
in the amendments made by this Act shall be construed
to affect or modify section 514 of the Employee Retire-
ment Income Security Act of 1974 (29 U.S.C. 1144).
SEC. 5. GENERAL ACCOUNTING OFFICE STUDY.
(a) STUDY.—The Comptroller General shall conduct
a study that evaluates the effect of the implementation
of the amendments made by this Act on the cost of health
insurance coverage, access to health insurance coverage
(including the availability of in-network providers), the
quality of health care, and other issues as determined ap-
propriate by the Comptroller General. Such study also
shall include an estimation of the costs of extending the
provisions of such amendments to treatment of substance
abuse and chemical dependency.
(b) REPORT.—Not later than 2 years after the date
of enactment of this Act, the Comptroller General shall
prepare and submit to the appropriate committees of Con-
gress a report containing the results of the study con-
ducted under subsection (a).
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