[Congressional Record Volume 153, Number 75 (Tuesday, May 8, 2007)]
[Senate]
[Pages S5737-S5740]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. KERRY (for himself, Mr. Smith, Mr. Kennedy, and Mr. 
        Domenici):
  S. 1337. A bill to amend title XXI of the Social Security Act to 
provide for equal coverage of mental health services under the State 
Children's Health Insurance Program; to the Committee on Finance.
  Mr. KERRY. Mr. President, it is my great hope that Congress will move 
this year to see that the successful, bipartisan State Children's 
Health Insurance Program is allowed the opportunity to fulfill its 
promise to the low-income children of this country. For 10 years it has 
provided, along with Medicaid, the type of meaningful and affordable 
health insurance coverage that should be ensured to each and every 
American. Yet there is much work to be done, and the reauthorization of 
S-CHIP gives us the opportunity to expand these successful programs to 
as many of the 9 million uninsured children in the country today, 
starting with the 6 million that are already eligible for public 
programs but not yet enrolled.
  But we must keep in mind that while expanding coverage to the 
uninsured is our top priority, it is equally important to ensure that 
the types of benefits offered to our Nation's children are quality 
services that are there for them when they need them. When it comes to 
mental health coverage, that unfortunately is not the case today. 
Therefore, I am introducing today, along with Senators Smith, Kennedy, 
and Domenici, the Children's Mental Health Parity Act which provides 
for equal coverage of mental health care for all children enrolled in 
the State Children's Health Insurance Plan, SCHIP.
  Mental illness is a critical problem for the young people in this 
country today. The numbers are startling: Mental disorders affect about 
one in five American children and up to 9 percent of kids experience 
serious emotional disturbances that severely impact their functioning. 
And low-income children, those the S-CHIP program is designed to cover, 
have the highest rates of mental health problems.
  Yet the sad reality is that an estimated two-thirds of all young 
people struggling with mental health disorders do not receive the care 
they need. We are failing our children when it comes to the treatment 
of mental health disorders and the consequences could not be more 
severe. Without early and effective intervention, affected children are 
less likely to do well in school and more likely to have compromised 
employment and earnings opportunities. Moreover, untreated mental 
illness may also increase a child's risk of coming into contact with 
the juvenile justice system, and children with mental disorders are at 
a much higher risk for suicide.
  Unfortunately, many States' S-CHIP programs are not providing the 
type of mental health care coverage that our most vulnerable children 
deserve. Many States impose discriminatory limits on mental health care 
coverage that do not apply to medical and surgical care. These can 
include caps on coverage of inpatient days and outpatient visits, as 
well as cost and testing restrictions that impair the ability of our 
physicians to make the best judgments for our kids.

[[Page S5738]]

  The Children's Mental Health Parity Act would prohibit discriminatory 
limits on mental health care in SCHIP plans by directing that any 
financial requirements or treatment limitations that apply to mental 
health or substance abuse services must be no more restrictive than the 
financial requirements or treatment limits that apply to other medical 
services. Your bill would also eliminate a harmful provision in current 
law that authorizes States to lower the amount of mental health 
coverage they provide to children in SCHIP down to 75 percent of the 
coverage provided in the benchmark plans listed in the statute as 
models for States to use in developing their SCHIP plans.
  The mental health community is gathered in Washington today to mark 
National Children's Mental Health Awareness Day and many of the leading 
advocacy groups have endorsed the Children's Mental Health Parity Act, 
including Mental Health America, the American Academy of Child & 
Adolescent Psychiatry, the Bazelon Center for Mental Health Law, Fight 
Crime: Invest in Kids, The National Association for Children's 
Behavioral Health, the National Association of Psychiatric Health 
Systems, and the National Council for Community Behavioral Health care.
  America's kids who are covered through SCHIP should be guaranteed 
that the mental health benefits they receive are just as comprehensive 
as those for medical and surgical care. It is no less important to care 
for our kids' mental health, and this unfair and unwise disparity 
should no longer be acceptable. As we debate many important features of 
the S-CHIP program during reauthorization, I look forward to working 
with Members on both sides of the aisle to see that this important, 
bipartisan measure receives the support that it deserves.
  I ask for unanimous consent that the text of the bill bill and 
letters of support be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                S. 1337

       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 ``Children's Mental Health 
     Parity Act''.

     SEC. 2. PARITY FOR MENTAL HEALTH SERVICES IN SCHIP.

       (a) Assurance of Parity.--Section 2103(c) of the Social 
     Security Act (42 U.S.C. 1397cc(c)) is amended--
       (1) by redesignating paragraph (5) as paragraph (6); and
       (2) by inserting after paragraph (4), the following:
       ``(5) Mental health services parity.--
       ``(A) In general.--In the case of a State child health plan 
     that provides both medical and surgical benefits and mental 
     health or substance abuse benefits, such plan shall ensure 
     that the financial requirements and treatment limitations 
     applicable to such mental health or substance abuse benefits 
     are no more restrictive than the financial requirements and 
     treatment limitations applied to substantially all medical 
     and surgical benefits covered by the plan.
       ``(B) Deemed compliance.--To the extent that a State child 
     health plan includes coverage with respect to an individual 
     described in section 1905(a)(4)(B) and covered under the 
     State plan under section 1902(a)(10)(A) of the services 
     described in section 1905(a)(4)(B) (relating to early and 
     periodic screening, diagnostic, and treatment services 
     defined in section 1905(r)) and provided in accordance with 
     section 1902(a)(43), such plan shall be deemed to satisfy the 
     requirements of subparagraph (A).''.
       (b) Conforming Amendments.--Section 2103 of such Act (42 
     U.S.C. 1397cc) is amended--
       (1) in subsection (a), in the matter preceding paragraph 
     (1), by striking ``subsection (c)(5)'' and inserting 
     ``paragraphs (5) and (6) of subsection (c)''; and
       (2) in subsection (c)(2), by striking subparagraph (B) and 
     redesignating subparagraphs (C) and (D) as subparagraphs (B) 
     and (C), respectively.
       (c) Effective Date.--The amendments made by this section 
     take effect on October 1, 2007.
                                  ____

                                    National Council for Community


                                        Behavioral Healthcare,

                                                      May 8, 2007.
     Hon. Gordon H. Smith,
     Russell Senate Office Building, Washington, DC.
       Dear Senator Smith: On behalf of the National Council for 
     Community Behavioral Healthcare, I am writing to congratulate 
     you for the introduction of the Children's Mental Health 
     Parity Act, which will require a non-discriminatory mental 
     health benefit in the State Children's Health Insurance 
     (SCHIP) Program. The National Council strongly supports your 
     bill because it directly reflects the service needs of the 2 
     million children with mental and emotional disorders that our 
     members serve every year.
       The seminal document Mental Health: A Report of the Surgeon 
     General estimates that approximately one in five children and 
     adolescents experience the signs and symptoms of mental 
     disorders during the course of a year. Furthermore, 
     widespread conditions such as major clinical depression and 
     anxiety disorders are particularly prevalent in low-income 
     populations of children who are more likely to be enrolled in 
     the SCHIP Program. In many instances, these conditions 
     manifest themselves as physical complaints greatly 
     complicating the clinical management of both medical/surgical 
     conditions as well as mental disorders.
       With many states limiting outpatient mental health benefits 
     to 20 visits and inpatient hospital services to 30 days or 
     less, youngsters with more serious mental illnesses will not 
     receive the mental health care they need. Indeed, these 
     arbitrary limits make neither clinical nor fiscal sense. When 
     children reach their SCHIP mental health policy limits, 
     National Council members are often charged with qualifying 
     these same kids for Medicaid coverage. During the Medicaid 
     eligibility determination process, their clinical condition 
     may deteriorate leading to expensive placements in 
     psychiatric hospitals or residential treatment facilities.
       The Children's Mental Health Parity Act ends this 
     discriminatory treatment once and for all, while providing 
     additional mental health benefits for the kids who need them 
     most. Please count on the National Council to fight for this 
     important bill throughout the SCHIP reauthorization process.
           Sincerely,
                                                  Linda Rosenberg,
     Executive Director.
                                  ____



                                        Mental Health America,

                                Alexandria, Virginia, May 7, 2007.
     Hon. John F. Kerry,
     Hon. Edward M. Kennedy,
     Hon. Gordon Smith,
     Hon. Pete V. Domenici,
     U.S. Senate,
     Washington, DC.
       Dear Senators Kerry, Smith, Kennedy, and Domenici:  I 
     commend you for your leadership in introducing the 
     ``Children's Mental Health Parity Act'' to require equitable 
     coverage of mental health services in the State Children's 
     Health Insurance Program (SCHIP). As you know, providing 
     access to needed mental health care is a key component of 
     ensuring that SCHIP covers the full array of services needed 
     for healthy childhood development.
       As the Nation's oldest and largest advocacy organization 
     dedicated to addressing all aspects of mental health and 
     mental illness, we at Mental Health America greatly value the 
     importance of prevention and early identification of mental 
     illness. Thus, improving access to mental health care for 
     children and youth is one of our primary objectives, 
     particularly since some of the most serious mental illnesses 
     often first arise in adolescence.
       Many children need extensive mental health services in 
     order to progress socially and emotionally and to 
     successfully complete their education. Mental disorders 
     affect about one in five American children and five to nine 
     percent experience serious emotional disturbances that 
     severely impair their functioning. Moreover, low-income 
     children enrolled in Medicaid and SCHIP have the highest 
     rates of mental health problems.
       Unfortunately, over two-thirds of children struggling with 
     mental health disorders do not receive mental health care. 
     Without early and effective identification and interventions, 
     childhood mental disorders can lead to a downward spiral of 
     school failure, poor employment opportunities, and poverty in 
     adulthood. Untreated mental illness may also increase a 
     child's risk of coming into contact with the juvenile justice 
     system, and children with mental disorders are at a much 
     higher risk for suicide.
       Discriminatory limits on mental health care are a primary 
     cause of this widespread lack of access to necessary mental 
     health services. And sadly, many state SCHIP plans impose 
     these restrictive limits on mental health care, including 
     caps on coverage of inpatient days and outpatient visits. 
     These limits are not based on the medical needs of children 
     enrolled in SCHIP or on practitioners' best practice 
     guidelines. They are far too restrictive for ensuring access 
     to adequate care for children with mental disorders. In fact, 
     research has shown that children with complex mental health 
     needs have access to full coverage for needed services in not 
     more than 40 percent of states due to the limited benefit 
     package in their state's SCHIP plan.
       Thus, we greatly appreciate your introduction of the 
     ``Children's Mental Health Parity Act'' that would prohibit 
     discriminatory limits on mental health care in SCHIP plans by 
     directing that any financial requirements or treatment 
     limitations that apply to mental health or substance abuse 
     services must be no more restrictive than the financial 
     requirements or treatment limits that apply to other medical 
     services. Your bill would also eliminate a harmful provision 
     in current law that authorizes states to lower the amount of 
     mental health coverage they provide to children in SCHIP down 
     to 75 percent of the coverage provided in the benchmark plans 
     listed in the statute as models for states to use in 
     developing their SCHIP plans.

[[Page S5739]]

       We look forward to working with you to ensure enactment of 
     this important legislation.
           Sincerely,
                                            David L. Shern, Ph.D.,
     President and CEO.
                                  ____

                                         American Academy of Child


                                     and Adolescent Psychiatry

                                      Washington, DC, May 3, 2007.
     Hon. Senator Gordon Smith,
     Russell Senate Office Building,
     Washington, DC.
     Hon. Senator John Kerry,
     Russell Senate Office Building,
     Washington, DC.
       Dear Senators Smith and Kerry: on behalf of the American 
     Academy of Child and Adolescent Psychiatry (AACAP), we would 
     like to express our support for the ``The Children's Mental 
     Health Parity Act.''
       The American Academy of Child and Adolescent Psychiatry 
     (AACAP) is a medical membership association established by 
     child and adolescent psychiatrists in 1953. Now over 7,600 
     members strong, the AACAP is the leading national medical 
     association dedicated to treating and improving the quality 
     of life for the estimated 7-12 million American youth under 
     18 years of age who are affected by emotional, behavioral, 
     developmental and mental disorders.
       Mental health is integral to the health and well-being of 
     all children. Children coping with emotional and mental 
     disorders must be identified, diagnosed, and treated to avoid 
     the loss of critical developmental years that can never be 
     recaptured. Currently, under the State Children's Health 
     Insurance Program (SCHIP) mental health coverage is left up 
     to the states. This act will amend Title XXI of the Social 
     Security Act to provide for equal mental health coverage 
     under SCRIP and allow for millions of children to receive the 
     preventive care they need to live healthy productive lives.
       We appreciate your leadership on this important issue. 
     Please contact Kristin Kroeger Ptakowski, Director of 
     Government Affairs, at 202.966.7300, x. 108, if you have any 
     questions concerning children's mental health issues.
           Sincerely,
                                              Thomas Anders, M.D.,
     President.
                                  ____

                                          National Association for


                                 Children's Behavioral Health,

                                      Washington, DC, May 6, 2007.
     Senator John Kerry,
     Senate Russell,
     Washington, DC.
       Dear Senator Kerry: On behalf of the National Association 
     for Children's Behavioral Health, we want to thank you for 
     your leadership in introducing the Children's Mental Health 
     Parity Act. Allowing persistent discriminatory coverage in 
     mental health benefits in any health insurance policies is an 
     indignity which no longer can be tolerated. Correcting this 
     injustice in the State Children's Health Insurance Program, 
     recognizing the particular and multiple needs of low income 
     and disabled children, is an appropriate beginning.
       The reauthorization of this program offers a critical 
     opportunity to rectify discriminatory limits on mental health 
     care that exist in SCHIP plans across the nation. Children in 
     SCHIP plans deserve comprehensive coverage for their mental 
     health needs. Not only does existing law not require parity 
     for mental health services in benchmark plans, it allows for 
     discriminatory lower actuarial values in benchmark equivalent 
     plans. This outrage must be corrected. Your bill takes the 
     courageous steps necessary to correct these injustices. We 
     stand ready to assist you any way to assure swift passage.
       The National Association for Children's Behavioral Health 
     (NACBH) is a nonprofit trade association representing multi-
     service treatment and social service agencies. Members 
     provide a wide array of behavioral health and related 
     services to children, youth and families. Services provided 
     by NACBH members include assessment, crisis intervention, 
     residential treatment, group homes, family-based treatment 
     homes, foster care, independent living, family services, 
     alternative educational services and programs, in-home 
     respite, outpatient counseling and a plethora of community 
     outreach programs and resources. Providers serve clients from 
     the mental health, social service, juvenile justice, welfare, 
     and educational systems. Serving over 50,000 clients 
     annually, NACBH members are firmly rooted in their local 
     communities. They provide a link to the full array of 
     services designed to restore the child and family to as 
     normal, involved and functioning a life as possible.
       NACBH's mission is to promote the availability and delivery 
     of appropriate and relevant services to children and youth, 
     with or at risk of, serious emotional or behavioral 
     disturbances and their families. We thank you for your 
     commitment to children and youth, with or at risk of 
     emotional disturbances, and their families and look forward 
     to working with you to pass this critically important bill.
                                                       Joy Midman,
     Executive Director.
                                  ____

                                                      Fight Crime:


                                               Invest in Kids,

                                      Washington, DC, May 8, 2007.
       Dear Senator Kerry: The 3,000 police chiefs, sheriffs, 
     district attorneys and violence survivors of Fight Crime: 
     Invest in Kids know from the front lines--and the research--
     that targeted investments in children are critical to our 
     nation's public safety. The State Children's Health Insurance 
     Program (SCHIP) can provide coverage for many effective 
     interventions that are proven to help treat kids with 
     behavioral or emotional problems--preventing later violence 
     and saving taxpayers money. However, to maximize its crime 
     reduction impact, current law regarding mental health 
     coverage must be strengthened to ensure that mental health 
     benefits are equivalent in scope to benefits for other 
     physician and health services. We are pleased that you, along 
     with Senators Smith, Kennedy and Domenici, are working to 
     amend the State Children's Health Insurance Program to 
     provide mental health parity.
       SCHIP coverage can help provide evidenced-based, intensive 
     individual and family therapy programs for troubled youth 
     such as Multi-Systemic Therapy (MST). A study of MST followed 
     juvenile offenders until they were, on average, 29-years-old. 
     Individuals who had not received MST were 62 percent more 
     likely to have been arrested for an offense, and more than 
     twice as likely to have been arrested for a violent offense. 
     Unfortunately, a number of states limit the amount or 
     duration of mental health services coverage so that, in many 
     states, effective delinquency intervention treatments like 
     MST could not be covered.
       Mental health benefits under SCHIP should be strengthened 
     to ensure that mental health benefits are equivalent in scope 
     to benefits for other physician and health services. The 
     Children's Mental Health Parity Act would amend SCHIP to 
     ensure that states' children's health plans include no 
     financial requirements and treatment limitations for mental 
     health care that are more restrictive than those of other 
     medical benefits of the plan.
       We look forward to working with you to ensure that a strong 
     SCHIP reauthorization bill, which incorporates these mental 
     health parity provisions, moves to enactment. This will help 
     kids get off to a good start and make our communities safer.
           Sincerely,
                                                    David S. Kass,
                                                        President.
                                                 Miriam A. Rollin,
     Vice President.
                                  ____

                                           National Association of


                                   Psychiatric Health Systems,

                                      Washington, DC, May 7, 2007.
     Hon. John F. Kerry,
     Hon. Gordon Smith,
     Hon. Edward M. Kennedy,
     Hon. Pete V. Domenici,
     U.S. Senate,
     Washington, DC.
       Dear Senators Kerry, Smith, Kennedy, and Domenici: On 
     behalf of the more than 600 members of the National 
     Association of Psychiatric Health Systems (NAPHS) and the 
     individuals and families that our members serve, we want to 
     thank you for your leadership in introducing the ``Children's 
     Mental Health Parity Act'' to require equitable coverage of 
     mental health services in the State Children's Health 
     Insurance Program (SCHIP).
       Low-income children enrolled in Medicaid and SCHIP have the 
     highest rates of mental health problems. Unfortunately, over 
     two-thirds of children struggling with mental health 
     disorders do not receive mental health care. Untreated mental 
     illness may increase a child's risk of coming into contact 
     with the juvenile justice system, and children with mental 
     disorders are at a much higher risk for suicide.
       Discriminatory limits on mental health care are a primary 
     cause of this widespread lack of access to necessary mental 
     health services. And sadly, many state SCHIP plans impose 
     these restrictive limits on mental health care, including 
     caps on coverage of inpatient days and outpatient visits. 
     These limits are far too restrictive for ensuring access to 
     adequate care for children with mental disorders. In fact, 
     research has shown that children with complex mental health 
     needs have access to full coverage for needed services in not 
     more than 40 percent of states due to the limited benefit 
     package in their state's SCHIP plan.
       Thus, we greatly appreciate your introduction of the 
     ``Children's Mental Health Parity Act'' that would prohibit 
     discriminatory limits on mental health care in SCHIP plans by 
     directing that any financial requirements or treatment 
     limitations that apply to mental health or substance abuse 
     services must be no more restrictive than the financial 
     requirements or treatment limits that apply to other medical 
     services. Your bill would also eliminate a harmful provision 
     in current law that authorizes states to lower the amount of 
     mental health coverage they provide to children in SCHIP down 
     to 75 percent of the coverage provided in the benchmark plans 
     listed in the statute as models for states to use in 
     developing their SCHIP plans.
       Again, thank you for all you have done to improve the lives 
     of millions of children with psychiatric disorders. We 
     enthusiastically support your bill and look forward to 
     continuing to work with you to pass this very important 
     legislation.
           Sincerely,
                                                      Mark Covall,
                                               Executive Director.

[[Page S5740]]

     
                                  ____
                                     Judge David L. Bazelon Center


                                        for Mental Health Law,

                                                      May 7, 2007.
     Hon. John Kerry,
     Hon. Gordon Smith
     Hon. Pete Domenici,
     U.S. Senate,
     Washington, DC.
       Dear Senators Kerry, Smith and Domenici:  On behalf of the 
     Judge David L. Bazelon Center for Mental Health Law--the 
     national leading legal-advocacy organization representing 
     children and adults with mental disabilities--I would like to 
     offer our strong support for the Children's Mental Health 
     Parity Act. We fully share your goal of eliminating 
     discriminatory limits placed on mental health services within 
     the State Children's Health Insurance Program (SCHIP).
       As you well know, many states have imposed discriminatory 
     and restrictive limits on mental health services that would 
     not be permissible in Medicaid, including caps on both 
     inpatient and outpatient care, annual cost restrictions, and 
     limits on diagnostic services. As a result, many enrolled 
     children do not receive essential mental health care as an 
     important component of the range of services needed by 
     children for healthy development. Without access to needed 
     mental health care, children are placed at risk for a host of 
     adverse outcomes, including school failure, contact with 
     juvenile justice and even suicide.
       It is vital that SCHIP plans provide mental health coverage 
     that is equivalent to the coverage provided for general 
     health care. The goal of SCHIP--to provide children with the 
     health insurance coverage they need--must be realized for all 
     eligible children. We look forward to working with you to 
     ensure enactment of this important legislation.
           Sincerely,
                                                 Robert Bernstein,
                                               Executive Director.

  Mr. SMITH. Mr. President, I rise today with my colleagues Senator 
Kerry, Senator Domenici and Senator Kennedy to introduce a The 
Children's Mental Health Parity Act that will have tremendous impact on 
millions of low-income children who are living with a mental illness. 
This bill will ensure mental health parity exists in the State 
Children's Health Insurance Program, SCHIP, which provides health care 
to our Nation's low-income children.
  Mental illness affects about one in 5 American children, yet an 
estimated \2/3\ of all young people with mental health problems are not 
getting the help they need. Moreover, children in Medicaid and SCHIP 
have the highest rates of mental health problems. Despite the 
prevalence of mental illness among our Nation's children, a large 
majority of children struggling with these difficulties do not receive 
mental health care. Without early and effective identification and 
interventions, childhood mental illnesses can lead to school failure, 
poor employment opportunities and poverty in adulthood. We also ow that 
suicide is the sixth leading cause of death among 5 to 15 year olds and 
the third leading cause of death for 15 to 24 year olds. Moreover, in 
1999, more teenagers and young adults died as a result of suicide than 
cancer, heart disease, HIV/AIDS, birth defects, stroke and chronic lung 
disease combined. Currently, between 500,000 and one million young 
people attempt suicide each year.
  A parent with a son who struggled with a mental illness, I know all 
too well the indiscriminate nature of the illness and the frightening 
statistics of its regular occurrence for those we love. That is why 
ensuring access to care is so vitally important. Yet, our Nation's 
health care program dedicated to delivering care to children is falling 
behind. Many States have imposed restrictive limits on mental health 
services that would not be permissible in Medicaid, including caps on 
both inpatient and outpatient care, annual cost restrictions, and 
limits on diagnostic services. These limits are not based on the 
medical needs of beneficiaries or best practice guidelines and result 
in coverage that is wholly inadequate for a child with a mental 
illness.
  This is why the introduction of this legislation is so critical. The 
Children's Mental Health Parity Act would prohibit discriminatory 
limits on mental health care in SCHIP plans by directing that any 
financial requirements or treatment limitations that apply to mental 
health or substance abuse services must be no more restrictive than the 
financial requirements or treatment limits that apply to other medical 
services. The bill also would eliminate a harmful provision in current 
law that authorizes states to lower the amount of mental health 
coverage they provide to children in SCHIP down to 75 percent of the 
coverage provided in the benchmark plans listed in the statute as 
models for States to use in developing their SCHIP plans.
  My home State of Oregon had the wisdom and foresight to see that 
mental health parity was necessary. The Oregon Health Plan, through 
which SCHIP kids are covered, offers parity with physical health 
services and a very comprehensive mental health benefit package, A 2004 
report by the Governor of Oregon's Mental Health Taskforce found that 
in any given year, 75,000 children under the age of 18 are in need of 
mental health services. It also listed as one of the major problems 
facing the Oregon mental health system is the fact that mental health 
parity was not, at that time, in effect. That is no longer the case and 
I look forward to seeing significant improvements in the mental health 
system in Oregon as a result of the hard work done there.
  Although we are fortunate to have mental health parity in Oregon, 
there are millions children across the Nation that are in critical need 
of similar care. That is why the introduction of this Federal 
legislation is so important, and I urge my colleagues on both sides of 
the aisle to support this bill and work towards its swift passage.
                                 ______