[Congressional Record Volume 151, Number 44 (Thursday, April 14, 2005)]
[Senate]
[Pages S3680-S3682]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. COLEMAN (for himself and Mrs. Clinton):
  S. 803. 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; to the 
Committee on Health, Education, Labor, and Pensions.
  Mr. COLEMAN. Mr. President, I am pleased to introduce the Help Expand 
Access to Recovery and Treatment (HEART) Act of 2005 with my friend and 
colleague, Senator Clinton of New York.
  By passing this life-saving legislation, Congress would provide 
equitable access to substance abuse treatment services for 23 million 
adults and children who need treatment for the disease of alcoholism 
and other drug dependencies.
  HEART would put the decision of whether or not consumers are granted 
substance abuse treatment services in the hands of doctors and trained 
addiction professionals, and patients. At least 75 percent of 
individuals who suffer from alcoholism have access to private health 
insurance. However, fewer than 70 percent of employer-provided health 
plans cover alcoholism and drug treatment at the same level as other 
medical conditions.
  Our bill eliminates this inequitable coverage of medical conditions 
so those who need treatment receive it.
  I look forward to working with my colleagues to pass this legislation 
that is not just important to our nation's economy and the health of 
our workforce but to the quality of life for millions of Americans and 
their families.
  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. 803

       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

[[Page S3681]]

     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

[[Page S3682]]

     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.
                                 ______