[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 803 Introduced in Senate (IS)]







109th CONGRESS
  1st Session
                                 S. 803

   To amend the Employee Retirement Income Security Act of 1974, the 
  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

                             April 14, 2005

  Mr. Coleman (for himself and Mrs. Clinton) 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, the 
  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 2005'' 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 (42 U.S.C. 300gg-4 et 
                seq.) 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 2 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 (29 U.S.C. 1185 et seq.) 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 2 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), for 
purposes of assuring notice of such requirements under the plan; except 
that the summary description required to be provided under 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) Conforming amendments.--
                            (i) Section 731(c) of such Act (29 U.S.C. 
                        1191(c)) is amended by striking ``section 711'' 
                        and inserting ``sections 711 and 714''.
                            (ii) Section 732(a) of such Act (29 U.S.C. 
                        1191a(a)) is amended by striking ``section 
                        711'' and inserting ``sections 711 and 714''.
                            (iii) 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) In general.--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 2 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) Conforming amendments.--
                            (i) Section 4980D(d)(1) of such Code is 
                        amended by striking ``section 9811'' and 
                        inserting ``sections 9811 and 9813''.
                            (ii) 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) Amendment to the public health service act.--Part B of 
        title XXVII of the Public Health Service Act (42 U.S.C. 300gg-
        41 et seq.) 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) Conforming amendment.--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) Group health plans.--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, 
        2006.
            (2) Individual health insurance.--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, 2006.
            (3) Special rule.--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, 2006.
        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>