[Congressional Record Volume 142, Number 123 (Tuesday, September 10, 1996)]
[Extensions of Remarks]
[Pages E1554-E1555]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




         INTRODUCTION OF SENATE-PASSED MENTAL HEALTH PARITY ACT

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                      Tuesday, September 10, 1996

  Mr. STARK. Mr. Speaker, I am introducing today the identical bill the 
Senate passed on September 5 by 82-15, offered by Senator Domenici, 
Wellstone, and many others, to provide mental health lifetime and 
annual cap parity.
  I would like to see much more extensive mental health legislation 
passed. I would like to see an elimination of all caps, in both 
physical and mental health, but this bill is a step forward, has 
widespread support, and is the least we can and should do in this 
Congress.
  If the House can pass identical legislation this month, this 
incremental health reform could become law this year and begin to help 
innumerable families who face the crisis of paying for mental health 
needs.

                                H.R. --

       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 ``National Mental Health 
     Parity Act of 1996''.

     SEC. 2. PLAN PROTECTIONS FOR INDIVIDUALS WITH A MENTAL 
                   ILLNESS.

       (a) Permissible Coverage Limits Under a Group Health 
     Plan.--
       (1) Aggregate lifetime limits.--
       (A) In general.--With respect to a group health plan 
     offered by a health insurance issuer, that applies an 
     aggregate lifetime limit to plan payments for medical or 
     surgical services covered under the plan, if such plan also 
     provides a mental health benefit such plan shall--
       (i) include plan payments made for mental health services 
     under the plan in such aggregate lifetime limit; or
       (ii) establish a separate aggregate lifetime limit 
     applicable to plan payments for mental health services under 
     which the dollar amount of such limit (with respect to mental 
     health services) is equal to or greater than the dollar 
     amount of the aggregate lifetime limit on plan payments for 
     medical or surgical services.
       (B) No lifetime limit.--With respect to a group health plan 
     offered by a health insurance issuer, that does not apply an 
     aggregate lifetime limit to plan payments for medical or 
     surgical services covered under the plan, such plan may not 
     apply an aggregate lifetime limit to plan payments for mental 
     health services covered under the plan.
       (2) Annual limits.--
       (A) In general.--With respect to a group health plan 
     offered by a health insurance issuer, that applies an annual 
     limit to plan payments for medical or surgical services 
     covered under the plan, if such plan also provides a mental 
     health benefit such plan shall--
       (i) include plan payments made for mental health services 
     under the plan in such annual limit; or
       (ii) establish a separate annual limit applicable to plan 
     payments for mental health services under which the dollar 
     amount of such limit (with respect to mental health services) 
     is equal to or greater than the dollar amount of the annual 
     limit on plan payments for medical or surgical services.
       (B) No annual limit.--With respect to a group health plan 
     offered by a health insurance issuer, that does not apply an 
     annual limit to plan payments for medical or surgical 
     services covered under the plan, such plan may not apply an 
     annual limit to plan payments for mental health services 
     covered under the plan.
       (b) Rule of Construction.--
       (1) In general.--Nothing in this section shall be construed 
     as prohibiting a group health plan offered by a health 
     insurance issuer, from--
       (A) utilizing other forms of cost containment not 
     prohibited under subsection (a); or
       (B) applying requirements that make distinctions between 
     acute care and chronic care.
       (2) Nonapplicability.--This section shall not apply to--
       (A) substance abuse or chemical dependency benefits; or
       (B) health benefits or health plans paid for under title 
     XVIII or XIX of the Social Security Act.
       (3) State law.--Nothing in this section shall be construed 
     to preempt any State law that provides for greater parity 
     with respect to mental health benefits than that required 
     under this section.
       (c) Small Employer Exemption.--
       (1) In general.--This section shall not apply to plans 
     maintained by employers that employ less than 26 employees.
       (2) Application of certain rules in determination of 
     employer size.--For purposes of this subsection--
       (A) Application of aggregation rule for employers.--All 
     persons treated as a single employer under subsection (b), 
     (c), (m), or (o) of section 414 of the Internal Revenue Code 
     of 1986 shall be treated as 1 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 subsection to an 
     employer shall include a reference to any predecessor of such 
     employer.

     SEC. 3. DEFINITIONS.

       For purposes of this title:
       (1) Group health plan.--
       (A) In general.--The term ``group health plan'' means an 
     employee welfare benefit plan (as defined in section 3(1) of 
     the Employee Retirement Income Security Act of 1974) to the 
     extent that the plan provides medical care (as defined in 
     paragraph (2)) and including items and services paid for as 
     medical care) to employees or their dependents (as defined 
     under the terms of the plan) directly or through insurance, 
     reimbursement, or otherwise.
       (B) Medical care.--The term ``medical care'' means amounts 
     paid for--
       (i) the diagnosis, cure, mitigation, treatment, or 
     prevention of disease, or amounts paid for the purpose of 
     affecting any structure or function of the body.
       (ii) amounts paid for transportation primarily for and 
     essential to medical care referred to in clause (i), and
       (iii) amounts paid for insurance covering medical care 
     referred to in clauses (i) and (ii).
       (2) Health insurance coverage.--The term ``health insurance 
     coverage'' means benefits consisting of medical care 
     (provided directly, through insurance or reimbursement, or 
     otherwise and including items and services paid for as 
     medical care) under any hospital or medical service policy or 
     certificate, hospital or medical service plan contract, or 
     health maintenance organization contract offered by a health 
     insurance issuer.
       (3) Health insurance issuer.--The term ``health insurance 
     issuer'' means an insurance company, insurance service, or 
     insurance organization (including a health maintenance 
     organization, as defined in paragraph (4)) which is licensed 
     to engage in the business of insurance in a State and which 
     is subject to State law which regulates insurance (within the 
     meaning of section 514(b)(2) of the Employee Retirement 
     Income Security Act of 1974), and includes a plan sponsor 
     described in section 3(16)(B) of the Employee Retirement 
     Income Security Act of 1974 in the case of a group health 
     plan which is an employee welfare benefit plan (as defined in 
     section 3(1) of such Act). Such term does not include a group 
     health plan.
       (4) Health maintenance organization.--The term ``health 
     maintenance organization'' means--
       (A) a federally qualified health maintenance organization 
     (as defined in section 1301(a) of the Public Health Service 
     Act).
       (B) an organization recognized under State law as a health 
     maintenance organization, or
       (C) a similar organization regulated under State law for 
     solvency in the same manner

[[Page E1555]]

     and to the same extent as such a health maintenance 
     organization.
       (5) State.--The term ``State'' means each of the several 
     States, the District of Columbia, Puerto Rico, the Virgin 
     Islands, Guam, American Samoa, and the Northern Mariana 
     Islands.

     SEC. 4. SUNSET.

       Sections 1 through 3 shall cease to be effective on 
     September 30, 2001.

     Sec. 5. Federal Employee Health Benefit Program.

       For the Federal Employee Health Benefit Program, sections 1 
     through 3 will take effect on October 1, 1997.

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