[Congressional Record Volume 149, Number 32 (Thursday, February 27, 2003)]
[Senate]
[Pages S2943-S2974]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DOMENICI (for himself, Mr. Kennedy, Mr. Coleman, Mr. 
        Dayton, Mr. Grassley, Mr. Reed, Mr. Cochran, Mr. Dodd, Mr. 
        Warner, Mr. Reid, Mr. Thomas, Mr. Johnson, Mr. Specter, Mr. 
        Harkin, Mr. Lugar, Mr. Daschle, Mr. Graham of South Carolina, 
        Mrs. Murray, Ms. Collins, Ms. Cantwell, Mr. Roberts, Mr. 
        Edwards, Mr. Chafee, Mrs. Lincoln, Mr. Bennett, and Mr. 
        Lautenberg):
  S. 486. 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; to the 
Committee on Health, Education, Labor, and Pensions.
  Mr. DOMENICI. Mr. President, I rise today with my friend Senator 
Kennedy to introduce the ``Senator Paul Wellstone Mental Health 
Equitable Treatment Act of 2003.''
  I have mixed emotions today, because, while we are once again 
fighting for parity, my long time partner, Paul Wellstone is not 
standing across the aisle from me. Unfortunately, my colleagues are to 
aware of Senator Wellstone's tragic passing last year. So, while I feel 
a profound sense of sadness, I also have a renewed determination to win 
a parity victory for the millions of Americans affected by these 
dreaded diseases.
  The time has come to end this blatant pattern of discrimination 
against people merely because they suffer from a mental illness. The 
human brain is the organ of the mind and just like the other organs of 
our body, it is subject to illness. And just as we must treat illnesses 
to our other organs, we must also treat illnesses of the brain.
  Building upon that, I would ask the following question: what if forty 
years ago our Nation had decided to exclude heart disease from health 
insurance coverage? Think about some of the wonderful things we would 
not be doing today like angioplasty, bypasses, and valve replacements 
and the millions of people helped because insurance covers these 
procedures.
  I would submit these medical advances have occurred because insurance 
dollars have followed the patient through the health care system. The 
presence of insurance dollars has provided an enticing incentive to 
treat those individuals suffering from heart disease. But sadly, those 
suffering from a mental illness do not enjoy those same benefits of 
treatment and medical advances because all too often insurance 
discriminates against illnesses of the brain.
  Individuals suffering from a mental illness face this discrimination 
even though medical science is in an era where we can accurately 
diagnosis mental illnesses and treat those afflicted so they can be 
productive. I simply do not understand, why with this evidence would we 
not cover these individuals and treat their illnesses like any other 
disease? There simply should not be a difference in the coverage 
provided by insurance companies for mental health benefits and medical 
benefits, merely because an individual suffers from a mental illness.
  The introduction of our Bill marks a historic opportunity for us to 
take the next step towards mental health parity. The timing of our Bill 
is even more important because the second consecutive one year 
extension of the landmark Mental Health Parity Act of 1996 will sunset 
later this year.
  As my colleagues know, this is an issue I have a long involvement 
with

[[Page S2972]]

and I would like to begin with a few observations.
  I believe that we have made great strides in providing parity for the 
coverage of mental illness. However, mental illness continues to exact 
a heavy toll on many, many lives.
  Even though we know so much more about mental illness, it can still 
bring devastating consequences to those it touches; their families, 
their friends, and their loved ones. These individuals and families not 
only deal with the societal prejudices and suspicions hanging on from 
the past, but they also must contend with unequal insurance coverage.
  I would submit the Mental Health Parity Act of 1996 is a good first 
start, but the Act is also not working. While there may adherence to 
the letter of the law, there are certainly violations of the spirit of 
the law. For instance, ways are being found around the law by placing 
limits on the number of covered hospital days and outpatient visits.
  That is why I believe it is time for a change.
  Some will immediately say we cannot afford it or that inclusion of 
this treatment will cost too much. But, the facts simply do not support 
that conclusion. First, I would direct them to the Congressional Budget 
Office's, CBO, score of the bill. CBO scored the cost of the bill as 
0.9 percent or less than one percent. Second, I would point out the 
Mental Health Parity Act of 1996 contains a provision allowing 
companies to no longer comply with the law if their costs increase by 
more than one percent. And do you know how many companies have opted 
out because their costs have increased by more than one percent? Less 
than ten companies throughout our entire country.
  With that in mind I would like to share a couple of facts about 
mental illness with my colleagues: within the developed world, 
including the United States, 4 of the 10 leading causes of disability 
for individuals over the age of five are mental disorders; in the order 
of prevalence the disorders are major depression, schizophrenia, 
bipolar disorder, and obsessive compulsive disorder; one in every five 
people--more than 40 million adults--in this Nation will be afflicted 
by some type of mental illness; and schizophrenia alone is 50 times 
more common than cystic fibrosis, 60 times more common than muscular 
dystrophy and will strike between 2 and 3 million Americans.
  Let us also look at the efficacy of treatment for individuals 
suffering from certain mental illnesses, especially when compared with 
the success rates of treatments for other physical ailments. For a long 
time, many who are in this field--especially on the insurance side--
have behaved as if you get far better results for angioplasty than you 
do for treatments for bipolar illness.
  Treatment for bipolar disorders--that is, those disorders 
characterized by extreme lows and extreme highs--have an 80 percent 
success rate if you get treatment, both medicine and care. 
Schizophrenia, the most dreaded of mental illnesses, has a 60-percent 
success rate in the United States today if treated properly. Major 
depression has a 65 percent success rate.
  Let's compare those success rates to several important surgical 
procedures that everybody thinks we ought to be doing: Angioplasty has 
a 41-percent success rate and Atherectomy has a 52-percent success 
rate.
  I would now like to take a minute to discuss the Senator Paul 
Wellstone Mental Health Equitable Treatment Act of 2003. The Bill seeks 
a very simple goal: provide the same mental health benefits already 
enjoyed by Federal employees.
  The Bill is modeled after the mental health benefits provided through 
the Federal Employees Health Benefits Program, FEHBP, and expands the 
Mental Health Parity Act of 1996 to prohibit a group health plan from 
imposing treatment limitations or financial requirements on the 
coverage of mental health benefits unless comparable limitations are 
imposed on medical and surgical benefits.
  Our Bill provides full parity for all categories of mental health 
conditions listed in the Diagnostic and Statistical Manual of Mental 
Disorders, Fourth Edition, DSM IV, with coverage being contingent on 
the mental health condition being included in an authorized treatment 
plan, the treatment plan is in accordance with standard protocols, and 
the treatment plan meets medical necessity determination criteria.
  Like the Mental Health Parity Act of 1996, the Bill does not require 
a health plan to provide coverage for alcohol and substance abuse 
benefits. Moreover, the Bill does not mandate the coverage of mental 
health benefits, but rather the Bill only applies if the plan already 
provides coverage for mental health benefits.
  In conclusion, the Bill provides mental heath benefits on par with 
those already enjoyed by Federal employees and members of Congress and 
I would urge my colleagues to support this important piece of 
legislation.
  I ask unanimous consent that the text of the Bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                 S. 486

       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 ``Senator Paul Wellstone 
     Mental Health Equitable Treatment Act of 2003''.

     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.--
       ``(1) In general.--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.
       ``(2) Medical management of mental health benefits.--
     Consistent with subsection (a), nothing in this section shall 
     be construed to prevent the medical management of mental 
     health benefits, including through concurrent and 
     retrospective utilization review and utilization management 
     practices, preauthorization, and the application of medical 
     necessity and appropriateness criteria applicable to 
     behavioral health and the contracting and use of a network of 
     participating providers.
       ``(3) No requirement of specific services.--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 coverage for specific mental health 
     services, except to the extent that the failure to cover such 
     services would result in a disparity between the coverage of 
     mental health and medical and surgical 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 50 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) In-Network and Out-of-Network Rules.--In the case of 
     a plan or coverage option that provides in-network mental 
     health benefits, out-of-network mental health benefits may be 
     provided using treatment limitations or financial 
     requirements that are not comparable to the limitations and 
     requirements applied to medical and surgical benefits if the 
     plan or coverage provides such in-

[[Page S2973]]

     network mental health benefits in accordance with subsection 
     (a) and provides reasonable access to in-network providers 
     and facilities.
       ``(f) 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 by a participant or beneficiary with respect to 
     benefits under the plan or health insurance coverage and 
     shall include the application of 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, as defined 
     under the terms and conditions of the plan or coverage (as 
     the case may be), 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, if such 
     services are included as part of an authorized treatment plan 
     that is in accordance with standard protocols and such 
     services meet the plan or issuer's medical necessity 
     criteria. Such term 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 similar 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, 2004.

     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.--
       ``(1) In general.--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.
       ``(2) Medical management of mental health benefits.--
     Consistent with subsection (a), nothing in this section shall 
     be construed to prevent the medical management of mental 
     health benefits, including through concurrent and 
     retrospective utilization review and utilization management 
     practices, preauthorization, and the application of medical 
     necessity and appropriateness criteria applicable to 
     behavioral health and the contracting and use of a network of 
     participating providers.
       ``(3) No requirement of specific services.--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 coverage for specific mental health 
     services, except to the extent that the failure to cover such 
     services would result in a disparity between the coverage of 
     mental health and medical and surgical 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 50 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) In-Network and Out-of-Network Rules.--In the case of 
     a plan or coverage option that provides in-network mental 
     health benefits, out-of-network mental health benefits may be 
     provided using treatment limitations or financial 
     requirements that are not comparable to the limitations and 
     requirements applied to medical and surgical benefits if the 
     plan or coverage provides such in-network mental health 
     benefits in accordance with subsection (a) and provides 
     reasonable access to in-network providers and facilities.
       ``(f) 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 by a participant, beneficiary or enrollee with 
     respect to benefits under the plan or health insurance 
     coverage and shall include the application of 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, as defined 
     under the terms and conditions of the plan or coverage (as 
     the case may be), 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, if such 
     services are included as part of an authorized treatment plan 
     that is in accordance with standard protocols and such 
     services meet the plan or issuer's medical necessity 
     criteria. Such term 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 similar 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, 2004.

     SEC. 4. PREEMPTION.

       Nothing in the amendments made by this Act shall be 
     construed to preempt any provision of State law, with respect 
     to health insurance coverage offered by a health insurance 
     issuer in connection with a group health plan, that provides 
     protections to enrollees that are greater than the 
     protections provided under such amendments. Nothing in the 
     amendments made by this Act shall be construed to affect or 
     modify section 514 of the Employee Retirement Income Security 
     Act of 1974 (29 U.S.C. 1144).

     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. Such study shall also include an 
     estimate of the cost that would be incurred if such 
     amendments were extended in a manner so as to provide 
     coverage for the treatment of substance abuse and chemical 
     dependency.
       (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).
  Mr. KENNEDY. Mr. President, it is an honor to be here today with 
Senator Domenici to renew the battle in the Senate to end one of the 
most shameful forms of discrimination in our society discrimination 
against mental illness. We renew the battle in the name of our friend 
and colleague Paul Wellstone who did so much to advance this cause we 
share and whom we miss so dearly now.
  Senator Pete Domenici and Senator Paul Wellstone led us with great 
skill in the Senate in this bipartisan battle in the past, and I'm 
proud to join Senator Domenici today to carry on this very important 
effort in the Senate.
  This bill brings first class medicine to millions of Americans who 
have been second class patients for too long.
  We know that millions of Americans across the country with mental 
illness faced stigma and misunderstanding. Even worse, they have been 
denied treatment that can cure or ease their cruel afflictions. Too 
often, they are the victims of discrimination by health insurance 
companies. It is unacceptable that the nation continues to tolerate 
actions by insurers that deny medical care for mental illnesses even 
though the very same insurers fully cover the treatment of physical 
illnesses that are often more costly, less debilitating and less 
curable. Mental illnesses are treatable and curable, and

[[Page S2974]]

it's high time to bring relief to those who experience them.
  Equal treatment of the mentally ill is not just an insurance issue, 
it is a civil rights issue. At its heart, mental health parity is a 
question of simple justice.
  The need is clear. One in five Americans will suffer some form of 
mental illness this year--but only one-third of them will receive 
treatment. According to a report of the Surgeon General, at least 4 
million children suffer from a major mental illness that results in 
significant impairments at home, at school, and with their peers. 
Families must often make painful choices about how to pay for the care 
their child needs to live a normal life.
  The cost is low. As we have seen in state after state and in the 
Federal Employees Health Benefits Program, insurance parity does not 
cause soaring insurance premiums. When parity for both mental health 
coverage and substance abuse coverage was provided for federal 
employees, they paid only $1 a month more for individual coverage and 
$2 for family coverage. The Congressional Budget Office has estimated 
that this bill will raise insurance rates by less than one percent a 
small cost that will bring health care and financial security to many 
families.
  It is tragic when a child is diagnosed with any illness. It is heart 
wrenching for parents to watch their children suffer. The tragedy is 
even greater when an insurance company denies treatment for a child 
solely because the illness is a mental illness. It's wrong for 
insurance companies to promote modern medicine for physical diseases, 
but leave mental health in the dark ages.
  It is wrong to force parents to choose between the care their child 
needs and the other financial needs of the family. I have heard 
countless stories from mothers and fathers whose children desperately 
needed the care that their insurance companies refused to provide.
  There is hope for the future. Today we were presented with 30,000 
petitions signed by young people asking Congress to provide affordable 
coverage for mental health services. The petitions were signed in 
concerts held across the country to raise awareness for suicide 
prevention. Pete Domenici and I are here today to bring hope to these 
parents and to these young people. It is long past time to end 
insurance discrimination, and guarantee all people with mental 
illnesses the coverage they deserve.
                                 ______