[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 796 Introduced in Senate (IS)]







106th CONGRESS
  1st Session
                                 S. 796

 To provide for full parity with respect to health insurance coverage 
for certain severe biologically based mental illnesses and to prohibit 
   limits on the number of mental-illness-related hospital days and 
      outpatient visits that are covered for all mental illnesses.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             April 14, 1999

Mr. Domenici (for himself, Mr. Wellstone, Mr. Chafee, Mr. Specter, Mr. 
  Reid, Mr. Sarbanes, and Mr. Kennedy) introduced the following bill; 
     which was read twice and referred to the Committee on Health, 
                     Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
 To provide for full parity with respect to health insurance coverage 
for certain severe biologically based mental illnesses and to prohibit 
   limits on the number of mental-illness-related hospital days and 
      outpatient visits that are covered for all mental illnesses.

    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 ``Mental Health Equitable Treatment 
Act of 1999''.

SEC. 2. AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 
              1974.

    (a) In General.--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:
            ``(3) Hospital day and outpatient visit limits.--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--
                    ``(A) No inpatient limits.--If the plan or coverage 
                does not include a limit on the number of days of 
                coverage provided for inpatient hospital stays in 
                connection with covered medical and surgical benefits, 
                the plan or coverage may not impose any limit on 
                inpatient hospital stays for mental health benefits.
                    ``(B) Certain inpatient limits.--If the plan or 
                coverage includes a limit on the number of days of 
                coverage provided for inpatient hospital stays in 
                connection with certain covered medical and surgical 
                benefits, the plan or coverage may impose comparable 
                limits on inpatient hospital stays for mental health 
                benefits.
                    ``(C) No outpatient limits.--If the plan or 
                coverage does not include a limit on the number of 
                outpatient visits in connection with covered medical 
                and surgical benefits, the plan or coverage may not 
                impose any limit on the number of outpatient visits for 
                mental health benefits.
                    ``(D) Certain outpatient limits.--If the plan or 
                coverage includes a limit on the number of outpatient 
                visits in connection with certain covered medical and 
                surgical benefits, the plan or coverage may impose 
                comparable limits on the number of outpatient visits 
                for mental health benefits.
            ``(4) Severe mental illness.--In the case of a group health 
        plan (or health insurance coverage offered in connection with 
        such a plan) that provides medical and surgical benefits and 
        mental health benefits, such plan or coverage shall not impose 
        any limitations on the coverage of benefits for severe 
        biologically-based mental illnesses unless comparable 
        limitations are imposed on medical and surgical benefits.'';
            (2) by striking subsection (b) and inserting the following:
    ``(b) Construction.--
            ``(1) In general.--Nothing in this section shall be 
        construed--
                    ``(A) as requiring a group health plan (or health 
                insurance coverage offered in connection with such a 
                plan) to provide any mental health benefits; or
                    ``(B) in the case of a group health plan (or health 
                insurance coverage offered in connection with such a 
                plan) that provides mental health benefits, as 
                affecting the terms and conditions (including cost 
                sharing and requirements relating to medical necessity) 
                relating to the amount, duration, or scope of mental 
                health benefits under the plan or coverage, except as 
                specifically provided in subsection (a) (in regard to 
                parity in the imposition of aggregate lifetime limits 
                and annual limits and limits on inpatient stays or 
                outpatient visits for mental health benefits).
            ``(2) Care, treatment, and delivery of services.--Nothing 
        in this subpart shall be construed to prohibit the provision of 
        care or treatment, or delivery of services, relating to mental 
        health services, by qualified health professionals within their 
        scope of practice as licensed or certified by the appropriate 
        State or jurisdiction.'';
            (3) in subsection (c)--
                    (A) by striking paragraph (2); and
                    (B) in paragraph (1)--
                            (i) by striking subparagraphs (A) and (B) 
                        and inserting the following:
                    ``(A) In general.--This section shall not apply to 
                any group health plan (and group health insurance 
                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 25 employees on 
                business days during the preceding calendar year.'';
                            (ii) by redesignating subparagraphs (A) and 
                        (C) as paragraphs (1) and (2), respectively, 
                        and realigning the margins accordingly; and
                            (iii) in paragraph (2) (as so 
                        redesignated), by redesignating clauses (i) 
                        through (iii) as subparagraphs (A) through (C), 
                        respectively;
            (4) in subsection (e), by adding at the end the following:
            ``(5) Severe biologically-based mental illness.--The term 
        `severe biologically-based mental illness' means an illness 
        that medical science in conjunction with the Diagnostic and 
        Statistical Manual of Mental Disorders (DSM IV) affirms as 
        biologically based and severe, including schizophrenia, bipolar 
        disorder, major depression, obsessive compulsive and panic 
        disorders, posttraumatic stress disorder, autism, and other 
        severe and disabling mental disorders such as anorexia nervosa 
        and attention-deficit/hyper activity disorder.''; and
            (5) by striking subsection (f).
    (b) Effective Date.--The amendments made by this section shall 
apply with respect to plan years beginning on or after January 1, 2000.

SEC. 3. AMENDMENTS 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--
            (1) in subsection (a), by adding at the end the following:
            ``(3) Hospital day and outpatient visit limits.--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--
                    ``(A) No inpatient limits.--If the plan or coverage 
                does not include a limit on the number of days of 
                coverage provided for inpatient hospital stays in 
                connection with covered medical and surgical benefits, 
                the plan or coverage may not impose any limit on 
                inpatient hospital stays for mental health benefits.
                    ``(B) Certain inpatient limits.--If the plan or 
                coverage includes a limit on the number of days of 
                coverage provided for inpatient hospital stays in 
                connection with certain covered medical and surgical 
                benefits, the plan or coverage may impose comparable 
                limits on inpatient hospital stays for mental health 
                benefits.
                    ``(C) No outpatient limits.--If the plan or 
                coverage does not include a limit on the number of 
                outpatient visits in connection with covered medical 
                and surgical benefits, the plan or coverage may not 
                impose any limit on the number of outpatient visits for 
                mental health benefits.
                    ``(D) Certain outpatient limits.--If the plan or 
                coverage includes a limit on the number of outpatient 
visits in connection with certain covered medical and surgical 
benefits, the plan or coverage may impose comparable limits on the 
number of outpatient visits for mental health benefits.
            ``(4) Severe mental illness.--In the case of a group health 
        plan (or health insurance coverage offered in connection with 
        such a plan) that provides medical and surgical benefits and 
        mental health benefits, such plan or coverage shall not impose 
        any limitations on the coverage of benefits for severe 
        biologically-based mental illnesses unless comparable 
        limitations are imposed on medical and surgical benefits.'';
            (2) by striking subsection (b) and inserting the following:
    ``(b) Construction.--
            ``(1) In general.--Nothing in this section shall be 
        construed--
                    ``(A) as requiring a group health plan (or health 
                insurance coverage offered in connection with such a 
                plan) to provide any mental health benefits; or
                    ``(B) in the case of a group health plan (or health 
                insurance coverage offered in connection with such a 
                plan) that provides mental health benefits, as 
                affecting the terms and conditions (including cost 
                sharing and requirements relating to medical necessity) 
                relating to the amount, duration, or scope of mental 
                health benefits under the plan or coverage, except as 
                specifically provided in subsection (a) (in regard to 
                parity in the imposition of aggregate lifetime limits 
                and annual limits and limits on inpatient stays or 
                outpatient visits for mental health benefits).
            ``(2) Care, treatment, and delivery of services.--Nothing 
        in this part shall be construed to prohibit the provision of 
        care or treatment, or delivery of services, relating to mental 
        health services, by qualified health professionals within their 
        scope of practice as licensed or certified by the appropriate 
        State or jurisdiction.'';
            (3) by striking subsection (c) and inserting the following:
    ``(c) Exemption.--This section shall not apply to any group health 
plan (and group health insurance 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 25 employees on business days 
during the preceding calendar year.'';
            (4) in subsection (e), by adding at the end the following:
            ``(5) Severe biologically-based mental illness.--The term 
        `severe biologically-based mental illness' means an illness 
        that medical science in conjunction with the Diagnostic and 
        Statistical Manual of Mental Disorders (DSM IV) affirms as 
        biologically based and severe, including schizophrenia, bipolar 
        disorder, major depression, obsessive compulsive and panic 
        disorders, posttraumatic stress disorder, autism, and other 
        severe and disabling mental disorders such as anorexia nervosa 
        and attention-deficit/hyper activity disorder.''; and
            (5) by striking subsection (f).
    (b) Effective Date.--The amendments made by this section shall 
apply with respect to plan years beginning on or after January 1, 2000.

SEC. 4. PREEMPTION.

    Nothing in the amendments made by this Act shall be construed to 
preempt any provision of State law that provides protections to 
enrollees that are greater than the protections provided under such 
amendments.
                                 <all>