[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 1138 Introduced in Senate (IS)]







108th CONGRESS
  1st Session
                                S. 1138

 To amend the Employee Retirement Income Security Act of 1974, Public 
 Health Service Act, and the Internal Revenue Code of 1986 to provide 
 parity with respect to substance abuse treatment benefits under group 
              health plans and health insurance coverage.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 22, 2003

  Mr. Coleman introduced the following bill; which was read twice and 
  referred to the Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
 To amend the Employee Retirement Income Security Act of 1974, Public 
 Health Service Act, and the Internal Revenue Code of 1986 to provide 
 parity with respect to substance abuse treatment benefits under group 
              health plans and health insurance coverage.

    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 ``Help Expand Access to Recovery and 
Treatment Act of 2003'' or the ``HEART Act''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Substance abuse, if left untreated, is a medical 
        emergency and a private and public health crisis.
            (2) Nothing in this Act should be construed as prohibiting 
        application of the concept of parity to substance abuse 
        treatment provided by faith-based treatment providers.

SEC. 3. PARITY IN SUBSTANCE ABUSE TREATMENT BENEFITS.

    (a) Group Health Plans.--
            (1) Public health service act amendments.--
                    (A) In general.--Subpart 2 of part A of title XXVII 
                of the Public Health Service Act is amended by adding 
                at the end the following new section:

``SEC. 2707. PARITY IN THE APPLICATION OF TREATMENT LIMITATIONS AND 
              FINANCIAL REQUIREMENTS TO SUBSTANCE ABUSE TREATMENT 
              BENEFITS.

    ``(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 substance abuse 
treatment benefits, the plan or coverage shall not impose treatment 
limitations or financial requirements on the substance abuse treatment 
benefits unless similar limitations or requirements are imposed for 
medical and surgical benefits.
    ``(b) Construction.--Nothing in this section shall be construed--
            ``(1) as requiring a group health plan (or health insurance 
        coverage offered in connection with such a plan) to provide any 
        substance abuse treatment benefits; or
            ``(2) to prevent a group health plan or a health insurance 
        issuer offering group health insurance coverage from 
        negotiating the level and type of reimbursement with a provider 
        for care provided in accordance with this section.
    ``(c) Exemptions.--
            ``(1) Small employer exemption.--
                    ``(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 a small employer.
                    ``(B) Small employer.--For purposes of subparagraph 
                (A), the term `small employer' means, in connection 
                with a group health plan with respect to a calendar 
                year and a plan year, an employer who employed an 
                average of at least 2 but not more than 50 employees on 
                business days during the preceding calendar year and 
                who employs at least 2 employees on the first day of 
                the plan year.
                    ``(C) Application of certain rules in determination 
                of employer size.--For purposes of this paragraph--
                            ``(i) 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.
                            ``(ii) 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.
                            ``(iii) Predecessors.--Any reference in 
                        this paragraph to an employer shall include a 
                        reference to any predecessor of such employer.
            ``(2) Increased cost exemption.--This section shall not 
        apply with respect to a group health plan (or health insurance 
        coverage offered in connection with a group health plan) if the 
        application of this section to such plan (or to such coverage) 
        results in an increase in the cost under the plan (or for such 
        coverage) of at least 1 percent.
    ``(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) Treatment limitation.--The term `treatment 
        limitation' means, with respect to benefits under a group 
        health plan or health insurance coverage, any day or visit 
        limits imposed on coverage of benefits under the plan or 
        coverage during a period of time.
            ``(2) Financial requirement.--The term `financial 
        requirement' means, with respect to benefits under a group 
        health plan or health insurance coverage, any deductible, 
        coinsurance, or cost-sharing or an annual or lifetime dollar 
        limit imposed with respect to the benefits under the plan or 
        coverage.
            ``(3) 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 substance 
        abuse treatment benefits.
            ``(4) Substance abuse treatment benefits.--The term 
        `substance abuse treatment benefits' means benefits with 
        respect to substance abuse treatment services.
            ``(5) Substance abuse treatment services.--The term 
        `substance abuse treatment services' means any of the following 
        items and services provided for the treatment of substance 
        abuse:
                    ``(A) Inpatient treatment, including 
                detoxification.
                    ``(B) Nonhospital residential treatment.
                    ``(C) Outpatient treatment, including screening and 
                assessment, medication management, individual, group, 
                and family counseling, and relapse prevention.
                    ``(D) Prevention services, including health 
                education and individual and group counseling to 
                encourage the reduction of risk factors for substance 
                abuse.
            ``(6) Substance abuse.--The term `substance abuse' includes 
        chemical dependency.
    ``(f) Notice.--A group health plan under this part shall comply 
with the notice requirement under section 714(f) of the Employee 
Retirement Income Security Act of 1974 with respect to the requirements 
of this section as if such section applied to such plan.''.
                    (B) Conforming amendment.--Section 2723(c) of such 
                Act (42 U.S.C. 300gg-23(c)) is amended by striking 
                ``section 2704'' and inserting ``sections 2704 and 
                2707''.
            (2) ERISA amendments.--
                    (A) In general.--Subpart B of part 7 of subtitle B 
                of title I of the Employee Retirement Income Security 
                Act of 1974 is amended by adding at the end the 
                following new section:

``SEC. 714. PARITY IN THE APPLICATION OF TREATMENT LIMITATIONS AND 
              FINANCIAL REQUIREMENTS TO SUBSTANCE ABUSE TREATMENT 
              BENEFITS.

    ``(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 substance abuse 
treatment benefits, the plan or coverage shall not impose treatment 
limitations or financial requirements on the substance abuse treatment 
benefits unless similar limitations or requirements are imposed for 
medical and surgical benefits.
    ``(b) Construction.--Nothing in this section shall be construed--
            ``(1) as requiring a group health plan (or health insurance 
        coverage offered in connection with such a plan) to provide any 
        substance abuse treatment benefits; or
    ``(2) to prevent a group health plan or a health insurance issuer 
offering group health insurance coverage from negotiating the level and 
type of reimbursement with a provider for care provided in accordance 
with this section.
    ``(c) Exemptions.--
            ``(1) Small employer exemption.--
                    ``(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 a small employer.
                    ``(B) Small employer.--For purposes of subparagraph 
                (A), the term `small employer' means, in connection 
                with a group health plan with respect to a calendar 
                year and a plan year, an employer who employed an 
                average of at least 2 but not more than 50 employees on 
                business days during the preceding calendar year and 
                who employs at least 2 employees on the first day of 
                the plan year.
                    ``(C) Application of certain rules in determination 
                of employer size.--For purposes of this paragraph--
                            ``(i) 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.
                            ``(ii) 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.
                            ``(iii) Predecessors.--Any reference in 
                        this paragraph to an employer shall include a 
                        reference to any predecessor of such employer.
            ``(2) Increased cost exemption.--This section shall not 
        apply with respect to a group health plan (or health insurance 
        coverage offered in connection with a group health plan) if the 
        application of this section to such plan (or to such coverage) 
        results in an increase in the cost under the plan (or for such 
        coverage) of at least 1 percent.
    ``(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) Treatment limitation.--The term `treatment 
        limitation' means, with respect to benefits under a group 
        health plan or health insurance coverage, any day or visit 
        limits imposed on coverage of benefits under the plan or 
        coverage during a period of time.
            ``(2) Financial requirement.--The term `financial 
        requirement' means, with respect to benefits under a group 
        health plan or health insurance coverage, any deductible, 
        coinsurance, or cost-sharing or an annual or lifetime dollar 
        limit imposed with respect to the benefits under the plan or 
        coverage.
            ``(3) 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 substance 
        abuse treatment benefits.
            ``(4) Substance abuse treatment benefits.--The term 
        `substance abuse treatment benefits' means benefits with 
        respect to substance abuse treatment services.
            ``(5) Substance abuse treatment services.--The term 
        `substance abuse treatment services' means any of the following 
        items and services provided for the treatment of substance 
        abuse:
                    ``(A) Inpatient treatment, including 
                detoxification.
                    ``(B) Nonhospital residential treatment.
                    ``(C) Outpatient treatment, including screening and 
                assessment, medication management, individual, group, 
                and family counseling, and relapse prevention.
                    ``(D) Prevention services, including health 
                education and individual and group counseling to 
                encourage the reduction of risk factors for substance 
                abuse.
            ``(6) Substance abuse.--The term `substance abuse' includes 
        chemical dependency.
    ``(f) Notice Under Group Health Plan.--The imposition of the 
requirements of this section shall be treated as a material 
modification in the terms of the plan described in section 102(a)(1), 
for purposes of assuring notice of such requirements under the plan; 
except that the summary description required to be provided under the 
last sentence of section 104(b)(1) with respect to such modification 
shall be provided by not later than 60 days after the first day of the 
first plan year in which such requirements apply.''.
                    (B) Section 731(c) of such Act (29 U.S.C. 1191(c)) 
                is amended by striking ``section 711'' and inserting 
                ``sections 711 and 714''.
                    (C) Section 732(a) of such Act (29 U.S.C. 1191a(a)) 
                is amended by striking ``section 711'' and inserting 
                ``sections 711 and 714''.
                    (D) The table of contents in section 1 of such Act 
                is amended by inserting after the item relating to 
                section 713 the following new item:

``714. Parity in the application of treatment limitations and financial 
                            requirements to substance abuse treatment 
                            benefits.''.
            (3) Internal revenue code amendments.--(A) Subchapter B of 
        chapter 100 of the Internal Revenue Code of 1986 (relating to 
        other requirements) is amended by adding at the end the 
        following new section:

``SEC. 9813. PARITY IN THE APPLICATION OF TREATMENT LIMITATIONS AND 
              FINANCIAL REQUIREMENTS TO SUBSTANCE ABUSE TREATMENT 
              BENEFITS.

    ``(a) In General.--In the case of a group health plan that provides 
both medical and surgical benefits and substance abuse treatment 
benefits, the plan shall not impose treatment limitations or financial 
requirements on the substance abuse treatment benefits unless similar 
limitations or requirements are imposed for medical and surgical 
benefits.
    ``(b) Construction.--Nothing in this section shall be construed--
            ``(1) as requiring a group health plan to provide any 
        substance abuse treatment benefits; or
            ``(2) to prevent a group health plan from negotiating the 
        level and type of reimbursement with a provider for care 
        provided in accordance with this section.
    ``(c) Exemptions.--
            ``(1) Small employer exemption.--
                    ``(A) In general.--This section shall not apply to 
                any group health plan for any plan year of a small 
                employer.
                    ``(B) Small employer.--For purposes of subparagraph 
                (A), the term `small employer' means, in connection 
                with a group health plan with respect to a calendar 
                year and a plan year, an employer who employed an 
                average of at least 2 but not more than 50 employees on 
                business days during the preceding calendar year and 
                who employs at least 2 employees on the first day of 
                the plan year.
                    ``(C) Application of certain rules in determination 
                of employer size.--For purposes of this paragraph--
                            ``(i) Application of aggregation rule for 
                        employers.--Rules similar to the rules under 
                        subsections (b), (c), (m), and (o) of section 
                        414 shall apply for purposes of treating 
                        persons as a single employer.
                            ``(ii) 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.
                            ``(iii) Predecessors.--Any reference in 
                        this paragraph to an employer shall include a 
                        reference to any predecessor of such employer.
            ``(2) Increased cost exemption.--This section shall not 
        apply with respect to a group health plan if the application of 
this section to such plan results in an increase in the cost under the 
plan of at least 1 percent.
    ``(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) Treatment limitation.--The term `treatment 
        limitation' means, with respect to benefits under a group 
        health plan, any day or visit limits imposed on coverage of 
        benefits under the plan during a period of time.
            ``(2) Financial requirement.--The term `financial 
        requirement' means, with respect to benefits under a group 
        health plan, any deductible, coinsurance, or cost-sharing or an 
        annual or lifetime dollar limit imposed with respect to the 
        benefits under the plan.
            ``(3) 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, but 
        does not include substance abuse treatment benefits.
            ``(4) Substance abuse treatment benefits.--The term 
        `substance abuse treatment benefits' means benefits with 
        respect to substance abuse treatment services.
            ``(5) Substance abuse treatment services.--The term 
        `substance abuse treatment services' means any of the following 
        items and services provided for the treatment of substance 
        abuse:
                    ``(A) Inpatient treatment, including 
                detoxification.
                    ``(B) Nonhospital residential treatment.
                    ``(C) Outpatient treatment, including screening and 
                assessment, medication management, individual, group, 
                and family counseling, and relapse prevention.
                    ``(D) Prevention services, including health 
                education and individual and group counseling to 
                encourage the reduction of risk factors for substance 
                abuse.
            ``(6) Substance abuse.--The term `substance abuse' includes 
        chemical dependency.''.
            (B) Section 4980D(d)(1) of such Code is amended by 
        inserting ``(other than a failure attributable to section 
        9813)'' after ``on any failure''.
            (C) The table of sections of subchapter B of chapter 100 of 
        such Code is amended by adding at the end the following new 
        item:

``9813. Parity in the application of treatment limitations and 
                            financial requirements to substance abuse 
                            treatment benefits.''.
    (b) Individual Health Insurance.--(1) Part B of title XXVII of the 
Public Health Service Act is amended by inserting after section 2752 
the following new section:

``SEC. 2753. PARITY IN THE APPLICATION OF TREATMENT LIMITATIONS AND 
              FINANCIAL REQUIREMENTS TO SUBSTANCE ABUSE BENEFITS.

    ``(a) In General.--The provisions of section 2707 (other than 
subsection (e)) shall apply to health insurance coverage offered by a 
health insurance issuer in the individual market in the same manner as 
it applies to health insurance coverage offered by a health insurance 
issuer in connection with a group health plan in the small or large 
group market.
    ``(b) Notice.--A health insurance issuer under this part shall 
comply with the notice requirement under section 714(f) of the Employee 
Retirement Income Security Act of 1974 with respect to the requirements 
referred to in subsection (a) as if such section applied to such issuer 
and such issuer were a group health plan.''.
    (2) Section 2762(b)(2) of such Act (42 U.S.C. 300gg-62(b)(2)) is 
amended by striking ``section 2751'' and inserting ``sections 2751 and 
2753''.
    (c) Effective Dates.--(1) Subject to paragraph (3), the amendments 
made by subsection (a) apply with respect to group health plans for 
plan years beginning on or after January 1, 2004.
    (2) The amendments made by subsection (b) apply with respect to 
health insurance coverage offered, sold, issued, renewed, in effect, or 
operated in the individual market on or after January 1, 2004.
    (3) In the case of a group health plan maintained pursuant to 1 or 
more collective bargaining agreements between employee representatives 
and 1 or more employers ratified before the date of enactment of this 
Act, the amendments made by subsection (a) shall not apply to plan 
years beginning before the later of--
            (A) the date on which the last collective bargaining 
        agreements relating to the plan terminates (determined without 
        regard to any extension thereof agreed to after the date of 
        enactment of this Act), or
            (B) January 1, 2004.
For purposes of subparagraph (A), any plan amendment made pursuant to a 
collective bargaining agreement relating to the plan which amends the 
plan solely to conform to any requirement added by subsection (a) shall 
not be treated as a termination of such collective bargaining 
agreement.
    (d) Coordinated Regulations.--Section 104(1) of the Health 
Insurance Portability and Accountability Act of 1996 is amended by 
striking ``this subtitle (and the amendments made by this subtitle and 
section 401)'' and inserting ``the provisions of part 7 of subtitle B 
of title I of the Employee Retirement Income Security Act of 1974, and 
the provisions of parts A and C of title XXVII of the Public Health 
Service Act, and chapter 100 of the Internal Revenue Code of 1986''.
    (e) Preemption.--Nothing in the amendments made by this section 
shall be construed to preempt any provision of State law that provides 
protections to individuals that are greater than the protections 
provided under such amendments.
                                 <all>