[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1797 Introduced in House (IH)]







104th CONGRESS
  1st Session
                                H. R. 1797

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

                              June 8, 1995

  Ms. DeLauro (for herself, Mr. McHale, Mr. Ward, and Mr. Gejdenson) 
 introduced the following bill; which was referred to the Committee on 
   Ways and Means, and in addition to the Committees on Economic and 
      Educational Opportunities, 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 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 Representatives 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 1995''.

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 restrictive coverage for treatments 
        of those illnesses in comparison to coverage provided for 
        treatments of other medical problems;
            (4) unequal health insurance coverage contributes 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 Mental 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 TREATMENT OF NEUROBIOLOGICAL 
              DISORDERS FOR EMPLOYER HEALTH BENEFIT PLANS.

    (a) In General.--The standards for the nondiscriminatory and 
equitable treatment by employer health benefit 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 provided 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 employer 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 expenses.
            (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, including treatment in non-traditional 
        settings.
            (4) Coverage of visits for psychological supportive, 
        therapeutic, and rehabilitative services, with coinsurance and 
        fees set to ensure effective cost control of high demand 
        services.
            (5) Coverage of prescription drugs essential to the cost 
        effective treatment of neurobiological disorders.
            (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 Revenue Code of 1986 
(relating to qualified pension, etc., plans) is amended by adding at 
the end thereof the following new section:

``SEC. 4980C. 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 1995.
    ``(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 received by the carrier or under the 
        plan for coverage during the period such failure persists.
            ``(2) Limitation in case of individual failures.--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 1995.''
    (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. 4980C. 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, 1995.

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 benefits 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 Employee 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 Retirement Income Security Act of 1974) which is 
        offered to employees through an employer and for which the 
        employer provides for any contribution to such plan or any 
        premium for such plan are deducted 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, vision, 
                disability income, or long-term care insurance, or any 
                combination thereof,
                    (B) medicare supplemental health insurance,
                    (C) coverage issued as a supplement to liability 
                insurance,
                    (D) worker's compensation or similar insurance, 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 diagnosed 
                with one or more of the following conditions:
                            (i) Affective disorders, including bipolar 
                        disorder and major depressive disorder.
                            (ii) Anxiety disorders, including 
                        obsessive-compulsive disorder and panic 
                        disorder.
                            (iii) Attention deficit disorders.
                            (iv) Autism and other pervasive 
                        developmental 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 regulations directing the 
                        National Institute of Mental Health to conduct 
                        a biannual review of the definition of 
                        neurobiological disorders under subparagraph 
                        (A). In conducting such review, the National 
                        Institute of Mental Health shall consult with 
                        extramural researchers to review such 
                        definition and make recommendations for 
                        necessary revisions.
                            (ii) Review by advisory council required.--
                        The Secretary may not promulgate any regulation 
                        modifying the definition 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.
                                 <all>