[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[S. 543 Introduced in Senate (IS)]







107th CONGRESS
  1st Session
                                 S. 543

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 SENATE OF THE UNITED STATES

                             March 15, 2001

Mr. Domenici (for himself, Mr. Wellstone, Mr. Specter, Mr. Kennedy, Mr. 
  Chafee, Mr. Dodd, Mr. Cochran, Mr. Reed, Mr. Reid, Mr. Warner, Mr. 
  Grassley, Mr. Roberts, Mr. Durbin, and Mr. Johnson) introduced the 
 following bill; which was read twice and referred to the Committee on 
                 Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 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 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 2001''.

SEC. 2. AMENDMENT 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 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 requirements with respect to the coverage of benefits for 
mental illnesses unless comparable treatment limitations or financial 
requirements are imposed on medical and surgical benefits.
    ``(b) Construction.--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 benefits.
    ``(c) Small Employer Exemption.--
            ``(1) 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.
            ``(2) Application of certain rules in determination 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 section 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 preceding 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 calendar 
                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 Offered.--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 option.
    ``(e) Definitions.--For purposes of this section--
            ``(1) Financial requirements.--The term `financial 
        requirements' includes deductibles, coinsurance, co-payments, 
        other cost sharing, and limitations on the total amount that 
        may be paid with respect to benefits under the plan or health 
        insurance coverage with respect to an individual or other 
        coverage unit (including 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 defined 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 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 
        Edition, as defined under the terms of the plan or coverage (as 
        the case may be), if such services are included as part of an 
        authorized treatment plan that is in accordance with standard 
        protocols and such services meet applicable medical necessity 
        criteria, but 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 frequency of treatment, 
        number of visits or days of coverage, or other 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 beginning on or after January 1, 2002.

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 requirements with respect to the coverage of benefits for 
mental illnesses unless comparable treatment limitations or financial 
requirements are imposed on medical and surgical benefits.
    ``(b) Construction.--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 benefits.
    ``(c) Small Employer Exemption.--
            ``(1) 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.
            ``(2) Application of certain rules in determination 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 section 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 preceding 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 calendar 
                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 Offered.--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 option.
    ``(e) Definitions.--For purposes of this section--
            ``(1) Financial requirements.--The term `financial 
        requirements' includes deductibles, coinsurance, co-payments, 
        other cost sharing, and limitations on the total amount that 
        may be paid with respect to benefits under the plan or health 
        insurance coverage with respect to an individual or other 
        coverage unit (including 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 defined 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 for all 
        categories of mental health conditions listed in the Diagnostic 
        and Statistical Manual of Mental Disorders, Fourth Edition (DSM 
        IV), or the most recent edition if different than the Fourth 
        Edition, as defined under the terms of the plan or coverage (as 
        the case may be), if such services are included as part of an 
        authorized treatment plan that is in accordance with standard 
        protocols and such services meet applicable medical necessity 
        criteria, but 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 frequency of treatment, 
        number of visits or days of coverage, or other 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 beginning on or after January 1, 2002.

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.

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 
appropriate by the Comptroller General.
    (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 Congress a report containing the results of 
the study conducted under subsection (a).
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