[Congressional Record Volume 154, Number 37 (Wednesday, March 5, 2008)]
[House]
[Pages H1309-H1315]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
PAUL WELLSTONE MENTAL HEALTH AND ADDICTION EQUITY ACT OF 2007--
Continued
Motion to Recommit Offered by Mr. Kline of Minnesota
Mr. KLINE of Minnesota. Mr. Speaker, I offer a motion to recommit.
The SPEAKER pro tempore. Is the gentleman opposed to the bill?
Mr. KLINE of Minnesota. In its current form I am.
The SPEAKER pro tempore. The Clerk will report the motion to
recommit.
The Clerk read as follows:
Mr. Kline of Minnesota moves to recommit the bill, H.R.
1424, to the Committee on Energy and Commerce with
instructions to report the same back to the House forthwith
with the following amendment:
Strike all after the enacting clause and insert the
following:
SEC. 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Mental
Health Parity Act of 2008''.
(b) Table of Contents.--The table of contents of this Act
is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Mental health parity.
Sec. 3. Effective date.
Sec. 4. Federal administrative responsibilities.
Sec. 5. Asset verification through access to information held by
financial institutions.
SEC. 2. MENTAL HEALTH PARITY.
(a) Amendments of ERISA.--Subpart B of part 7 of title I of
the Employee Retirement Income Security Act of 1974 is
amended by inserting after section 712 (29 U.S.C. 1185a) the
following:
``SEC. 712A. 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 ensure
that--
``(1) the financial requirements applicable to such mental
health benefits are no more restrictive than the financial
requirements applied to substantially all medical and
surgical benefits covered by the plan (or coverage),
including deductibles, copayments, coinsurance, out-of-pocket
expenses, and annual and lifetime limits, except that the
plan (or coverage) may not establish separate cost sharing
requirements that are applicable only with respect to mental
health benefits; and
``(2) the treatment limitations applicable to such mental
health benefits are no more restrictive than the treatment
limitations applied to substantially all medical and surgical
benefits covered by the plan (or coverage), including limits
on the frequency of treatment, number of visits, days of
coverage, or other similar limits on the scope or duration of
treatment.
``(b) Clarifications.--In the case of a group health plan
(or health insurance coverage offered in connection with such
a plan)
[[Page H1310]]
that provides both medical and surgical benefits and mental
health benefits, and complies with the requirements of
subsection (a), such plan or coverage shall not be prohibited
from--
``(1) negotiating separate reimbursement or provider
payment rates and service delivery systems for different
benefits consistent with subsection (a);
``(2) managing the provision of mental health benefits in
order to provide medically necessary services for covered
benefits, including through the use of any utilization
review, authorization or management practices, the
application of medical necessity and appropriateness criteria
applicable to behavioral health, and the contracting with and
use of a network of providers; and
``(3) applying the provisions of this section in a manner
that takes into consideration similar treatment settings or
similar treatments.
``(c) In- and Out-of-Network.--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, and that
provides such benefits on both an in- and out-of-network
basis pursuant to the terms of the plan (or coverage), such
plan (or coverage) shall ensure that the requirements of this
section are applied to both in- and out-of-network services
by comparing in-network medical and surgical benefits to in-
network mental health benefits and out-of-network medical and
surgical benefits to out-of-network mental health benefits.
``(d) Small Employer Exemption.--
``(1) In general.--Except as provided in paragraph (2),
this section shall not apply to any group health plan (or
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 (or 1 in the case of an
employer residing in a State that permits small groups to
include a single individual) but not more than 50 employees
on business days during the preceding calendar year.
``(2) No preemption of certain state laws.--Nothing in
paragraph (1) shall be construed to preempt any State
insurance law relating to employers in the State who employed
an average of at least 2 (or 1 in the case of an employer
residing in a State that permits small groups to include a
single individual) but not more than 50 employees on business
days during the preceding calendar year.
``(3) 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.
``(e) Cost Exemption.--
``(1) In general.--With respect to a group health plan (or
health insurance coverage offered in connections with such a
plan), if the application of this section to such plan (or
coverage) results in an increase for the plan year involved
of the actual total costs of coverage with respect to medical
and surgical benefits and mental health benefits under the
plan (as determined and certified under paragraph (3)) by an
amount that exceeds the applicable percentage described in
paragraph (2) of the actual total plan costs, the provisions
of this section shall not apply to such plan (or coverage)
during the following plan year, and such exemption shall
apply to the plan (or coverage) for 1 plan year. An employer
may elect to continue to apply mental health parity pursuant
to this section with respect to the group health plan (or
coverage) involved regardless of any increase in total costs.
``(2) Applicable percentage.--With respect to a plan (or
coverage), the applicable percentage described in this
paragraph shall be--
``(A) 2 percent in the case of the first plan year in which
this section is applied; and
``(B) 1 percent in the case of each subsequent plan year.
``(3) Determinations by actuaries.--Determinations as to
increases in actual costs under a plan (or coverage) for
purposes of this section shall be made and certified by a
qualified and licensed actuary who is a member in good
standing of the American Academy of Actuaries. All such
determinations shall be in a written report prepared by the
actuary. The report, and all underlying documentation relied
upon by the actuary, shall be maintained by the group health
plan or health insurance issuer for a period of 6 years
following the notification made under paragraph (6).
``(4) 6-month determinations.--If a group health plan (or a
health insurance issuer offering coverage in connection with
a group health plan) seeks an exemption under this
subsection, determinations under paragraph (1) shall be made
after such plan (or coverage) has complied with this section
for the first 6 months of the plan year involved.
``(5) Notification.--An election to modify coverage of
mental health benefits as permitted under this subsection
shall be treated as a material modification in the terms of
the plan as described in section 102(a) and shall be subject
to the applicable notice requirements under section
104(b)(1).
``(6) Notification to appropriate agency.--
``(A) In general.--A group health plan (or a health
insurance issuer offering coverage in connection with a group
health plan) that, based upon a certification described under
paragraph (3), qualifies for an exemption under this
subsection, and elects to implement the exemption, shall
notify the Department of Labor or the Department of Health
and Human Services, as appropriate, of such election.
``(B) Requirement.--A notification under subparagraph (A)
shall include--
``(i) a description of the number of covered lives under
the plan (or coverage) involved at the time of the
notification, and as applicable, at the time of any prior
election of the cost-exemption under this subsection by such
plan (or coverage);
``(ii) for both the plan year upon which a cost exemption
is sought and the year prior, a description of the actual
total costs of coverage with respect to medical and surgical
benefits and mental health benefits under the plan; and
``(iii) for both the plan year upon which a cost exemption
is sought and the year prior, the actual total costs of
coverage with respect to mental health benefits under the
plan.
``(C) Confidentiality.--A notification under subparagraph
(A) shall be confidential. The Department of Labor and the
Department of Health and Human Services shall make available,
upon request and on not more than an annual basis, an
anonymous itemization of such notifications, that includes--
``(i) a breakdown of States by the size and type of
employers submitting such notification; and
``(ii) a summary of the data received under subparagraph
(B).
``(7) Audits by appropriate agencies.--To determine
compliance with this subsection, the Department of Labor and
the Department of Health and Human Services, as appropriate,
may audit the books and records of a group health plan or
health insurance issuer relating to an exemption, including
any actuarial reports prepared pursuant to paragraph (3),
during the 6 year period following the notification of such
exemption under paragraph (6). A State agency receiving a
notification under paragraph (6) may also conduct such an
audit with respect to an exemption covered by such
notification.
``(f) Mental Health Benefits.--In this section, the term
`mental health benefits' means benefits with respect to
mental health services (including substance use disorder
treatment) as defined under the terms of the group health
plan or coverage, and when applicable as may be defined under
State law when applicable to health insurance coverage
offered in connection with a group health plan.
``(g) Abortion Clarification.--Nothing in this section
shall require a group health plan (or health insurance
coverage offered in connection with such a plan) to cover
abortion as a treatment.''.
(b) Public Health Service Act.--Subpart 2 of part A of
title XXVII of the Public Health Service Act is amended by
inserting after section 2705 (42 U.S.C. 300gg-5) the
following:
``SEC. 2705A. 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 ensure
that--
``(1) the financial requirements applicable to such mental
health benefits are no more restrictive than the financial
requirements applied to substantially all medical and
surgical benefits covered by the plan (or coverage),
including deductibles, copayments, coinsurance, out-of-pocket
expenses, and annual and lifetime limits, except that the
plan (or coverage) may not establish separate cost sharing
requirements that are applicable only with respect to mental
health benefits; and
``(2) the treatment limitations applicable to such mental
health benefits are no more restrictive than the treatment
limitations applied to substantially all medical and surgical
benefits covered by the plan (or coverage), including limits
on the frequency of treatment, number of visits, days of
coverage, or other similar limits on the scope or duration of
treatment.
``(b) Clarifications.--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, and complies with the requirements of
subsection (a), such plan or coverage shall not be prohibited
from--
``(1) negotiating separate reimbursement or provider
payment rates and service delivery systems for different
benefits consistent with subsection (a);
``(2) managing the provision of mental health benefits in
order to provide medically necessary services for covered
benefits, including through the use of any utilization
review, authorization or management practices, the
application of medical necessity
[[Page H1311]]
and appropriateness criteria applicable to behavioral health,
and the contracting with and use of a network of providers;
and
``(3) applying the provisions of this section in a manner
that takes into consideration similar treatment settings or
similar treatments.
``(c) In- and Out-of-Network.--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, and that
provides such benefits on both an in- and out-of-network
basis pursuant to the terms of the plan (or coverage), such
plan (or coverage) shall ensure that the requirements of this
section are applied to both in- and out-of-network services
by comparing in-network medical and surgical benefits to in-
network mental health benefits and out-of-network medical and
surgical benefits to out-of-network mental health benefits.
``(d) Small Employer Exemption.--
``(1) In general.--Except as provided in paragraph (2),
this section shall not apply to any group health plan (or
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 (or 1 in the case of an
employer residing in a State that permits small groups to
include a single individual) but not more than 50 employees
on business days during the preceding calendar year.
``(2) No preemption of certain state laws.--Nothing in
paragraph (1) shall be construed to preempt any State
insurance law relating to employers in the State who employed
an average of at least 2 (or 1 in the case of an employer
residing in a State that permits small groups to include a
single individual) but not more than 50 employees on business
days during the preceding calendar year.
``(3) 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.
``(e) Cost Exemption.--
``(1) In general.--With respect to a group health plan (or
health insurance coverage offered in connection with such a
plan), if the application of this section to such plan (or
coverage) results in an increase for the plan year involved
of the actual total costs of coverage with respect to medical
and surgical benefits and mental health benefits under the
plan (as determined and certified under paragraph (3)) by an
amount that exceeds the applicable percentage described in
paragraph (2) of the actual total plan costs, the provisions
of this section shall not apply to such plan (or coverage)
during the following plan year, and such exemption shall
apply to the plan (or coverage) for 1 plan year. An employer
may elect to continue to apply mental health parity pursuant
to this section with respect to the group health plan (or
coverage) involved regardless of any increase in total costs.
``(2) Applicable percentage.--With respect to a plan (or
coverage), the applicable percentage described in this
paragraph shall be--
``(A) 2 percent in the case of the first plan year in which
this section is applied; and
``(B) 1 percent in the case of each subsequent plan year.
``(3) Determinations by actuaries.--Determinations as to
increases in actual costs under a plan (or coverage) for
purposes of this section shall be made and certified by a
qualified and licensed actuary who is a member in good
standing of the American Academy of Actuaries. All such
determinations shall be in a written report prepared by the
actuary. The report, and all underlying documentation relied
upon by the actuary, shall be maintained by the group health
plan or health insurance issuer for a period of 6 years
following the notification made under paragraph (6).
``(4) 6-month determinations.--If a group health plan (or a
health insurance issuer offering coverage in connection with
a group health plan) seeks an exemption under this
subsection, determinations under paragraph (1) shall be made
after such plan (or coverage) has complied with this section
for the first 6 months of the plan year involved.
``(5) Notification.--An election to modify coverage of
mental health benefits as permitted under this subsection
shall be treated as a material modification in the terms of
the plan as described in section 102(a) of the Employee
Retirement Income Security Act of 1974 and shall be subject
to the applicable notice requirements under section 104(b)(1)
of such Act.
``(6) Notification to appropriate agency.--
``(A) In general.--A group health plan (or a health
insurance issuer offering coverage in connection with a group
health plan) that, based upon a certification described under
paragraph (3), qualifies for an exemption under this
subsection, and elects to implement the exemption, shall
notify the Department of Labor or the Department of Health
and Human Services, as appropriate, of such election. A
health insurance issuer providing health insurance coverage
in connection with a group health plan shall provide a copy
of such notice to the State insurance department or other
State agency responsible for regulating the terms of such
coverage.
``(B) Requirement.--A notification under subparagraph (A)
shall include--
``(i) a description of the number of covered lives under
the plan (or coverage) involved at the time of the
notification, and as applicable, at the time of any prior
election of the cost-exemption under this subsection by such
plan (or coverage);
``(ii) for both the plan year upon which a cost exemption
is sought and the year prior, a description of the actual
total costs of coverage with respect to medical and surgical
benefits and mental health benefits under the plan; and
``(iii) for both the plan year upon which a cost exemption
is sought and the year prior, the actual total costs of
coverage with respect to mental health benefits under the
plan.
``(C) Confidentiality.--A notification under subparagraph
(A) shall be confidential. The Department of Labor and the
Department of Health and Human Services shall make available,
upon request and on not more than an annual basis, an
anonymous itemization of such notifications, that includes--
``(i) a breakdown of States by the size and type of
employers submitting such notification; and
``(ii) a summary of the data received under subparagraph
(B).
``(7) Audits by appropriate agencies.--To determine
compliance with this subsection, the Department of Labor and
the Department of Health and Human Services, as appropriate,
may audit the books and records of a group health plan or
health insurance issuer relating to an exemption, including
any actuarial reports prepared pursuant to paragraph (3),
during the 6 year period following the notification of such
exemption under paragraph (6). A State agency receiving a
notification under paragraph (6) may also conduct such an
audit with respect to an exemption covered by such
notification.
``(f) Mental Health Benefits.--In this section, the term
`mental health benefits' means benefits with respect to
mental health services (including substance use disorder
treatment) as defined under the terms of the group health
plan or coverage, and when applicable as may be defined under
State law when applicable to health insurance coverage
offered in connection with a group health plan.
``(g) Abortion Clarification.--Nothing in this section
shall require a group health plan (or health insurance
coverage offered in connection with such a plan) to cover
abortion as a treatment.''.
SEC. 3. EFFECTIVE DATE.
(a) In General.--The provisions of this Act shall apply to
group health plans (or health insurance coverage offered in
connection with such plans) beginning in the first plan year
that begins on or after January 1 of the first calendar year
that begins more than 1 year after the date of the enactment
of this Act.
(b) Termination of Certain Provisions.--
(1) Erisa.--Section 712 of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1185a) is amended by striking
subsection (f) and inserting the following:
``(f) Sunset--This section shall not apply to benefits for
services furnished after the effective date described in
section 3(a) of the Mental Health Parity Act of 2008.''.
(2) PHSA.--Section 2705 of the Public Health Service Act
(42 U.S.C. 300gg-5) is amended by striking subsection (f) and
inserting the following:
``(f) Sunset--This section shall not apply to benefits for
services furnished after the effective date described in
section 3(a) of the Mental Health Parity Act of 2008.''.
SEC. 4. FEDERAL ADMINISTRATIVE RESPONSIBILITIES.
(a) Group Health Plan Ombudsman.--
(1) Department of labor.--The Secretary of Labor shall
designate an individual within the Department of Labor to
serve as the group health plan ombudsman for the Department.
Such ombudsman shall serve as an initial point of contact to
permit individuals to obtain information and provide
assistance concerning coverage of mental health services
under group health plans in accordance with this Act.
(2) Department of health and human services.--The Secretary
of Health and Human Services shall designate an individual
within the Department of Health and Human Services to serve
as the group health plan ombudsman for the Department. Such
ombudsman shall serve as an initial point of contact to
permit individuals to obtain information and provide
assistance concerning coverage of mental health services
under health insurance coverage issued in connection with
group health plans in accordance with this Act.
(b) Audits.--The Secretary of Labor and the Secretary of
Health and Human Services shall each provide for the conduct
of random audits of group health plans (and health insurance
coverage offered in connection with such plans) to ensure
that such plans are in
[[Page H1312]]
compliance with this Act (and the amendments made by this
Act).
(c) Government Accountability Office Study.--
(1) 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, the impact on benefits and coverage for mental health
and substance use disorders, the impact of any additional
cost or savings to the plan, the impact on out-of-network
coverage for mental health benefits (including substance use
disorder treatment), the impact on State mental health
benefit mandate laws, other impact on the business community
and the Federal Government, and other issues as determined
appropriate by the Comptroller General.
(2) 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 paragraph
(1).
(d) Regulations.--Not later than 1 year after the date of
enactment of this Act, the Secretary of Labor and the
Secretary of Health and Human Services shall jointly
promulgate final regulations to carry out this Act.
SEC. 5. ASSET VERIFICATION THROUGH ACCESS TO INFORMATION HELD
BY FINANCIAL INSTITUTIONS.
(a) Addition of Authority.--Title XIX of the Social
Security Act is amended by inserting after section 1939 the
following new section:
``asset verification through access to information held by financial
institutions
``Sec. 1940. (a) In General.--Subject to the provisions of
this section, each State shall implement an asset
verification program described in subsection (b), for
purposes of determining or redetermining the eligibility of
an individual for medical assistance under the State plan
under this title.
``(b) Asset Verification Program.--
``(1) In general.--For purposes of this section, an asset
verification program means a program described in paragraph
(2) under which--
``(A) a State requires each applicant for, or recipient of,
medical assistance under the State plan under this title to
provide authorization by such applicant or recipient (and any
other person whose income or resources are material to the
determination of the eligibility of the applicant or
recipient for such assistance) for the State to obtain
(subject to the cost reimbursement requirements of section
1115(a) of the Right to Financial Privacy Act) from any
financial institution (within the meaning of section 1101(1)
of such Act) any financial record (within the meaning of
section 1101(2) of such Act) held by the institution with
respect to the applicant or recipient (and such other person,
as applicable), whenever the State determines the record is
needed in connection with a determination with respect to
such eligibility for (or the amount or extent of) such
medical assistance;
``(B) each such applicant or recipient (or other person)
shall provide such authorization directly to the financial
institution involved as a condition of eligibility for such
medical assistance; and
``(C) the State uses such authorization to verify the
financial resources of such applicant or recipient (and such
other person, as applicable), in order to determine or
redetermine the eligibility of such applicant or recipient
for medical assistance under the State plan.
``(2) Program described.--A program described in this
paragraph is a program for verifying individual assets in a
manner consistent with the approach used by the Commissioner
of Social Security under section 1631(e)(1)(B)(ii).
``(c) Duration of Authorization.--An authorization provided
to a State under subsection (b)(1) shall remain effective
until the earliest of--
``(1) the rendering of a final adverse decision on the
applicant's application for medical assistance under the
State's plan under this title;
``(2) the cessation of the recipient's eligibility for such
medical assistance; or
``(3) the express revocation by the applicant or recipient
(or such other person described in subsection (b)(1), as
applicable) of the authorization, in a written notification
to the State.
``(d) Required Disclosure.--The State shall inform any
person who provides authorization pursuant to subsection
(b)(1) of the duration and scope of the authorization.
``(e) Refusal or Revocation of Authorization.--If an
applicant for, or recipient of, medical assistance under the
State plan under this title (or such other person described
in subsection (b)(1), as applicable) refuses to provide, or
revokes, any authorization made by the applicant or recipient
(or such other person, as applicable) under subsection
(a)(1)(B) for the State to obtain from any financial
institution any financial record, the State may, on that
basis, determine that the applicant or recipient is
ineligible for medical assistance.
``(f) Use of Contractor.--For purposes of implementing an
asset verification program under this section, a State may
select and enter into a contract with a public or private
entity meeting such criteria and qualifications as the State
determines appropriate.
``(g) Technical Assistance.--The Secretary shall provide
States with technical assistance to aid in implementation of
an asset verification program under this section.
``(h) Reports.--A State implementing an asset verification
program under this section shall furnish to the Secretary
such reports concerning the program, at such times, in such
format, and containing such information as the Secretary
determines appropriate.''.
(b) State Plan Requirements.--Section 1902(a) of the Social
Security Act (42 U.S.C. 1396a(a)) is amended--
(1) in paragraph (69) by striking ``and'' at the end;
(2) in paragraph (70) by striking the period at the end and
inserting ``; and''; and
(3) by inserting after paragraph (70), as so amended, the
following new paragraph:
``(71) provide that the State will implement an asset
verification program under such section.''.
(c) Withholding of Federal Matching Payments for
Noncompliant States.--Section 1903(i) (42 U.S.C. 1396b(i)) is
amended--
(1) in paragraph (21) by striking ``or'' at the end;
(2) in paragraph (22) by striking the period at the end and
inserting ``; or''; and
(3) by adding after paragraph (22) the following new
paragraph:
``(23) if a State is required to implement an asset
verification program under section 1940 and fails to comply
with the requirements of such section, with respect to
amounts expended by such State for medical assistance for
individuals subject to asset verification under such
section.''.
(d) Repeal.--Section 4 of Public Law 110-90 is repealed.
(e) Adjustment to PAQI Fund.--Section 1848(l)(2) of the
Social Security Act (42 U.S.C. 1395w-4(l)(2)), as amended by
section 101(a)(2) of the Medicare, Medicaid, and SCHIP
Extension Act of 2007 (Public Law 110-73), is amended--
(1) in subparagraph (A)(i)--
(A) in subclause (III), by striking ``$4,960,000,000'' and
inserting ``$4,360,000,000''; and
(B) by adding at the end the following new subclause:
``(IV) For expenditures during 2014, an amount equal to
$1,000,000,000.'';
(2) in subparagraph (A)(ii), by adding at the end the
following new subclause:
``(IV) 2014.--The amount available for expenditures during
2014 shall only be available for an adjustment to the update
of the conversion factor under subsection (d) for that
year.''; and
(3) in subparagraph (B)--
(A) in clause (ii), by striking ``and'' at the end;
(B) in clause (iii), by striking the period at the end and
inserting ``; and''; and
(C) by adding at the end the following new clause:
``(iv) 2014 for payment with respect to physicians'
services furnished during 2014.''.
Mr. KLINE of Minnesota (during the reading). Mr. Speaker, I ask
unanimous consent to waive the reading of the amendment.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Minnesota?
There was no objection.
The SPEAKER pro tempore. The gentleman from Minnesota is recognized
for 5 minutes.
Mr. KLINE of Minnesota. Mr. Speaker, I rise today to offer this
motion to recommit on H.R. 1424 with instructions forthwith, to
substitute the Kline amendment for the underlying bill.
Last night the Rules Committee issued its 50th closed rule of this
Congress and did not allow consideration of the Wilson-Kline-Camp
substitute amendment. This motion to recommit gives us the opportunity
to pass a mental health parity bill that has both bipartisan and
bicameral support, and it does so immediately, allowing the House to
approve a real mental health parity bill this very night.
My motion is a viable, commonsense alternative that, contrary to H.R.
1424, achieves real parity in the treatment of employer-sponsored
coverage for mental and behavioral illnesses. The motion to recommit
substitutes H.R. 1424 with the version similar to the mental health
parity legislation S. 558 that passed the U.S. Senate last year under
unanimous consent.
During the markup of H.R. 1424 before the Committee on Education and
Labor, I offered a version of the compromise Senate bill as an
amendment, believing that if Congress intends to move forward with
mental health parity legislation, this compromise language is the most
sensible alternative and our best chance of enacting legislation on
this issue this year.
Unlike H.R. 1424, this motion is a product of over 2 years of
bipartisan negotiations between mental health advocates, health care
providers, and business groups representing virtually all sides in this
debate. The motion accomplishes what it sets out to do. It
[[Page H1313]]
provides parity for mental health and substance abuse benefits. It
provides parity while preserving the foundation of the ERISA benefit
structure, protecting the ability of group health plans to medically
manage their claims and providing plans with the flexibility to
determine and administer on a voluntary basis the benefits provided to
working men and women and their families. By steering clear of the
benefit mandates and litigation traps contained in H.R. 1424, this
motion makes it possible for employers to continue to provide high-
quality affordable benefits, and it does so while responsibly
offsetting the cost.
This motion to recommit includes an important provision that will
save the American taxpayers billions of dollars by reducing the fraud
in the Medicaid system by requiring all States to implement an
electronic asset verification program within their Medicaid eligibility
systems. Many States have balanced budget requirements and thus have
limited dollars to allocate for the Medicaid programs. These new State-
level Medicaid asset verification systems would ensure that Medicaid
applicants are not intentionally hiding significant amounts of funds in
undisclosed bank accounts in order to fraudulently enroll in a State's
Medicaid program. This is a responsible way to pay for mental health
parity benefits.
Finally, this motion to recommit includes language to clarify that
the bill does not require a group health plan to cover abortion as a
treatment. For these reasons, I strongly urge my colleagues to support
this motion to recommit and vote in favor of this commonsense
alternative.
I yield to the gentlewoman from New Mexico (Mrs. Wilson).
{time} 1930
Mrs. WILSON of New Mexico. Mr. Speaker, I would ask my colleagues to
remember only three things about this motion to recommit:
First, it happens immediately. This is ``forthwith'' so we can do
this tonight. Don't send it back to committee. We can do it right now.
Second, it substitutes the Senate bill that is supported by 245
different organizations, including the National Alliance for the
Mentally Ill, the American Psychological Association and numerous
others. It's a bipartisan bill that passed unanimously in the United
States Senate. It has the parity provisions very similar to the ones
that Mr. Kennedy and Mr. Ramstad have brought forward, but an important
policy difference. The Ramstad-Kennedy bill does not require employers
to cover mental health care. It says, if they do offer it, it must
include every diagnosis in the DSM-IV manual, everything. No other,
including the Federal employees health plan, goes that far. I think
that the likely result of that will be what we all don't want to see,
which is employers drop mental health coverage completely. That's why
organizations like the National Alliance on Mental Illness support the
Senate bill and not the House bill. They want to see an expansion of
coverage for the mentally ill, not a loss of coverage for 18 million
seriously ill Americans.
The third thing that I want you to remember is this: There's been a
lot of discussion about the pay-for in the bill we're asked to vote on
here on the floor tonight. This motion to recommit would defeat the
provision that will close physician-owned hospitals, including a lot of
them in rural areas of America as a different pay-for that extends a
successful pilot project for electronic verification of assets for
Medicaid eligibility.
So three things. We can do it tonight, it doesn't go back to
committee. It is better policy which will extend greater coverage for
those who are mentally ill. And the pay-for doesn't hurt our rural,
physician-owned hospitals.
Mr. PALLONE. Mr. Speaker, I rise in opposition to the motion.
The SPEAKER pro tempore. The gentleman from New Jersey is recognized
for 5 minutes.
Mr. PALLONE. Mr. Speaker, I would yield initially to the gentleman
from Rhode Island (Mr. Langevin).
Mr. LANGEVIN. I thank the gentleman for yielding.
Mr. Speaker, I rise in strong support of the Paul Wellstone Mental
Health and Addiction Equity Act and against this motion to recommit.
My friends, this is a cynical attempt by the Republican leadership to
kill a bill that they never liked from the start. Too many people
worked too hard and for too long on this legislation to let it be
derailed now.
274 Members have cosponsored the bill. Three committees have passed
it. And my two good friends, Patrick Kennedy and Jim Ramstad, have
worked for years to reach this vote today. I will not let their hard
work be for nothing.
Mr. Speaker, I know what it's like to live every day with a
disability and how important it is to have the care and the resources
that allow me to live a normal life. See, you can see my disability.
It's obvious. But with a wheelchair, with adaptive equipment, it really
levels the playing field. With other support I can live a very
fulfilling and normal life.
But, Mr. Speaker, there are millions of people across this country
who live with a silent disability, a hidden disability, struggling day
in and day out with substance abuse, mental illness, chemical
imbalance, other mental illness challenges, and they don't have the
support that they need, and they struggle day in and day out. They
don't have the support they need because they don't have mental health
parity. We have the opportunity to change that and give them the care
and the support that they need to live a normal life.
Patrick Kennedy, my good friend, has had the courage to speak for all
those suffering from the hidden disability of mental illness. He's been
a champion and a leader, and millions of people across this country are
looking to him right now and they will be looking at all of us to pass
this bill and allow them the access and the care and the treatment that
they deserve. We can't let them down.
I urge my colleagues to support this bill and reject this cynical
attempt and specious motion to recommit.
Mr. PALLONE. Mr. Speaker, I reclaim my time and I want to thank the
gentleman from Rhode Island for what he said.
I yield the balance of my time to the gentleman from Michigan (Mr.
Stupak).
Mr. STUPAK. I thank the gentleman for yielding.
Mr. Speaker, I urge my colleagues, and I ask them to vote ``no'' on
this motion to recommit.
The House bill is stronger than the Senate bill. The House bill
provides stronger parity protections than the Senate bill for the same
cost. The House bill requires parity in out-of-network benefits. The
Senate bill does not. Out-of-network care is important where plans
cover a limited number of providers and there are long waiting lists to
access the care.
The House bill requires coverage for all clinically significant
disorders if the insurer chooses to provide coverage for mental
illness. The Senate bill lets health plans pick and choose which
diseases they will cover, so they could deny care for autism, eating
disorders, alcoholism and more.
And also, on this motion to recommit, when it comes to protecting
human life, I stand with my colleagues on both sides of the aisle. But
this abortion provision in this legislation is a red herring. If this
abortion provision was a problem, why would my colleagues, our
colleagues, our friends in the Senate like Senator Coburn, Senator
Brownback, Senator DeMint vote for it?
I sit on the Energy and Commerce Committee where this bill came from.
The abortion issue never was raised.
Under the House bill, health care plans retain the right to make
decisions about medical necessity, and nothing in this bill would
overturn the ability of health care plans to impose a conscience clause
and not cover certain services due to religious or moral objections.
This was made part of Federal law in 2005 under the Abortion
Nondiscrimination Act authored by Congressman Dave Weldon. That is the
law today. Nothing in this bill would affect the Weldon amendment as we
know it. Nothing in this bill would affect the ability of a plan to
prohibit coverage of abortion either on medically necessary grounds or
on a conscience clause.
The bill provides for treating mental health services and physical
services with parity. It doesn't address how plans cover physical,
i.e., abortion
[[Page H1314]]
services. The bill addresses the diagnoses plans must cover, but does
not tell plans what specific benefits they have to provide for those
diagnoses.
The SPEAKER pro tempore. All time has expired.
Without objection, the previous question is ordered on the motion to
recommit.
There was no objection.
The SPEAKER pro tempore. The question is on the motion to recommit.
The question was taken; and the Speaker pro tempore announced that
the noes appeared to have it.
Recorded Vote
Mr. KLINE of Minnesota. Mr. Speaker, I demand a recorded vote.
A recorded vote was ordered.
The SPEAKER pro tempore. Pursuant to clause 8 and clause 9 of rule
XX, this 15-minute vote on the motion to recommit will be followed by
5-minute votes on passage of the bill, if ordered, and suspending the
rules with regard to H.R. 5400.
The vote was taken by electronic device, and there were--ayes 196,
noes 221, not voting 11, as follows:
[Roll No. 100]
AYES--196
Aderholt
Akin
Alexander
Altmire
Bachmann
Bachus
Barrett (SC)
Bartlett (MD)
Barton (TX)
Biggert
Bilbray
Bilirakis
Bishop (UT)
Blackburn
Blunt
Bonner
Boozman
Boren
Boustany
Brady (TX)
Broun (GA)
Brown (SC)
Buchanan
Burgess
Burton (IN)
Buyer
Calvert
Camp (MI)
Campbell (CA)
Cannon
Cantor
Capito
Carter
Chabot
Coble
Cole (OK)
Conaway
Crenshaw
Cubin
Cuellar
Culberson
Davis (KY)
Davis, David
Davis, Lincoln
Deal (GA)
Dent
Diaz-Balart, L.
Diaz-Balart, M.
Donnelly
Doolittle
Drake
Dreier
Duncan
Ehlers
Ellsworth
Emerson
English (PA)
Everett
Fallin
Feeney
Ferguson
Flake
Forbes
Fortenberry
Fossella
Foxx
Franks (AZ)
Gallegly
Garrett (NJ)
Gerlach
Gingrey
Gohmert
Goode
Goodlatte
Granger
Graves
Green, Gene
Hall (TX)
Hastings (WA)
Hayes
Heller
Hensarling
Herger
Hinojosa
Hobson
Hoekstra
Hulshof
Hunter
Inglis (SC)
Issa
Johnson (IL)
Johnson, Sam
Jones (NC)
Jordan
King (IA)
King (NY)
Kingston
Kline (MN)
Knollenberg
Kuhl (NY)
Lamborn
Lampson
Latham
LaTourette
Latta
Lewis (CA)
Lewis (KY)
Linder
LoBiondo
Lucas
Lungren, Daniel E.
Mack
Manzullo
Marchant
Marshall
Matheson
McCarthy (CA)
McCaul (TX)
McCotter
McCrery
McHenry
McHugh
McIntyre
McKeon
McMorris Rodgers
Mica
Miller (FL)
Miller (MI)
Miller, Gary
Moran (KS)
Musgrave
Myrick
Neugebauer
Nunes
Ortiz
Paul
Pearce
Pence
Peterson (PA)
Petri
Pickering
Pitts
Porter
Price (GA)
Pryce (OH)
Putnam
Radanovich
Regula
Rehberg
Reichert
Reyes
Reynolds
Rogers (AL)
Rogers (KY)
Rogers (MI)
Rohrabacher
Ros-Lehtinen
Roskam
Royce
Ryan (WI)
Sali
Saxton
Schmidt
Sensenbrenner
Sessions
Shadegg
Shimkus
Shuler
Shuster
Simpson
Smith (NE)
Smith (NJ)
Smith (TX)
Souder
Stearns
Tancredo
Terry
Thornberry
Tiahrt
Tiberi
Turner
Upton
Walberg
Walden (OR)
Walsh (NY)
Wamp
Weldon (FL)
Weller
Westmoreland
Whitfield (KY)
Wilson (NM)
Wilson (SC)
Wittman (VA)
Wolf
Young (AK)
Young (FL)
NOES--221
Abercrombie
Ackerman
Allen
Andrews
Arcuri
Baca
Baird
Baldwin
Barrow
Bean
Becerra
Berkley
Berman
Berry
Bishop (GA)
Bishop (NY)
Blumenauer
Bono Mack
Boswell
Boucher
Boyd (FL)
Boyda (KS)
Brady (PA)
Braley (IA)
Brown, Corrine
Butterfield
Capps
Capuano
Cardoza
Carnahan
Carney
Castle
Castor
Chandler
Clarke
Clay
Cleaver
Clyburn
Cohen
Conyers
Cooper
Costa
Costello
Courtney
Cramer
Crowley
Cummings
Davis (AL)
Davis (CA)
Davis (IL)
Davis, Tom
DeFazio
DeGette
Delahunt
DeLauro
Dicks
Dingell
Doggett
Doyle
Edwards
Ellison
Emanuel
Engel
Eshoo
Etheridge
Farr
Fattah
Filner
Frank (MA)
Frelinghuysen
Giffords
Gilchrest
Gillibrand
Gordon
Green, Al
Grijalva
Gutierrez
Hall (NY)
Hare
Harman
Hastings (FL)
Herseth Sandlin
Higgins
Hill
Hinchey
Hirono
Hodes
Holden
Holt
Honda
Hooley
Hoyer
Inslee
Israel
Jackson (IL)
Jackson-Lee (TX)
Jefferson
Johnson (GA)
Jones (OH)
Kagen
Kanjorski
Kaptur
Kennedy
Kildee
Kilpatrick
Kind
Kirk
Klein (FL)
Kucinich
LaHood
Langevin
Larsen (WA)
Larson (CT)
Lee
Levin
Lewis (GA)
Lipinski
Loebsack
Lofgren, Zoe
Lowey
Lynch
Mahoney (FL)
Maloney (NY)
Markey
Matsui
McCarthy (NY)
McCollum (MN)
McDermott
McGovern
McNerney
McNulty
Meek (FL)
Meeks (NY)
Melancon
Michaud
Miller (NC)
Miller, George
Mitchell
Mollohan
Moore (KS)
Moore (WI)
Moran (VA)
Murphy (CT)
Murphy, Patrick
Murphy, Tim
Murtha
Nadler
Napolitano
Neal (MA)
Oberstar
Obey
Olver
Pallone
Pascrell
Pastor
Payne
Perlmutter
Peterson (MN)
Platts
Pomeroy
Price (NC)
Rahall
Ramstad
Richardson
Rodriguez
Ross
Rothman
Roybal-Allard
Ruppersberger
Ryan (OH)
Salazar
Sanchez, Linda T.
Sanchez, Loretta
Sarbanes
Schakowsky
Schiff
Schwartz
Scott (GA)
Scott (VA)
Serrano
Sestak
Shays
Shea-Porter
Sherman
Sires
Skelton
Slaughter
Smith (WA)
Snyder
Solis
Space
Spratt
Stark
Stupak
Sullivan
Sutton
Tanner
Tauscher
Taylor
Thompson (CA)
Thompson (MS)
Tierney
Towns
Tsongas
Udall (CO)
Udall (NM)
Van Hollen
Velazquez
Visclosky
Walz (MN)
Wasserman Schultz
Waters
Watson
Watt
Waxman
Weiner
Welch (VT)
Wexler
Wilson (OH)
Wu
Yarmuth
NOT VOTING--11
Boehner
Brown-Waite, Ginny
Gonzalez
Johnson, E. B.
Keller
Poe
Rangel
Renzi
Rush
Woolsey
Wynn
Announcement by the Speaker Pro Tempore
The SPEAKER pro tempore (during the vote). Members are advised there
are 2 minutes remaining on the vote.
{time} 1956
Mr. SESTAK changed his vote from ``aye'' to ``no.''
So the motion was rejected.
The result of the vote was announced as above recorded.
The SPEAKER pro tempore. The question is on the passage of the bill.
The question was taken; and the Speaker pro tempore announced that
the ayes appeared to have it.
Mr. PALLONE. Mr. Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. This will be a 5-minute vote.
The vote was taken by electronic device, and there were--yeas 268,
nays 148, not voting 13, as follows:
[Roll No. 101]
YEAS--268
Abercrombie
Ackerman
Allen
Altmire
Andrews
Arcuri
Baca
Baird
Baldwin
Barrow
Bean
Becerra
Berkley
Berman
Berry
Biggert
Bishop (GA)
Bishop (NY)
Blumenauer
Bono Mack
Boren
Boswell
Boucher
Boustany
Boyd (FL)
Boyda (KS)
Brady (PA)
Braley (IA)
Brown, Corrine
Buchanan
Butterfield
Capito
Capps
Capuano
Cardoza
Carnahan
Carney
Castle
Castor
Chandler
Clarke
Clay
Cleaver
Clyburn
Cohen
Conyers
Cooper
Costa
Costello
Courtney
Cramer
Crowley
Cuellar
Cummings
Davis (AL)
Davis (CA)
Davis (IL)
Davis, Lincoln
Davis, Tom
DeFazio
DeGette
Delahunt
DeLauro
Dent
Diaz-Balart, L.
Diaz-Balart, M.
Dicks
Dingell
Doggett
Donnelly
Doyle
Edwards
Ellison
Ellsworth
Emanuel
Emerson
Engel
English (PA)
Eshoo
Etheridge
Farr
Fattah
Ferguson
Filner
Fossella
Frank (MA)
Frelinghuysen
Gallegly
Gerlach
Giffords
Gilchrest
Gillibrand
Gordon
Green, Al
Green, Gene
Grijalva
Gutierrez
Hall (NY)
Hare
Harman
Hastings (FL)
Hayes
Herseth Sandlin
Higgins
Hill
Hinchey
Hirono
Hobson
Hodes
Holden
Holt
Honda
Hooley
Hoyer
Inslee
Israel
Jackson (IL)
Jackson-Lee (TX)
Jefferson
Johnson (GA)
Johnson (IL)
Jones (OH)
Kagen
Kanjorski
Kaptur
Kennedy
Kildee
Kilpatrick
Kind
King (NY)
Kirk
Klein (FL)
Knollenberg
Kucinich
LaHood
Langevin
Larsen (WA)
Larson (CT)
LaTourette
Lee
Levin
Lewis (GA)
Lipinski
LoBiondo
Loebsack
Lofgren, Zoe
Lowey
Lynch
Mahoney (FL)
Maloney (NY)
Markey
Matheson
Matsui
McCarthy (NY)
McCollum (MN)
McDermott
McGovern
McHugh
McIntyre
McNerney
McNulty
Meek (FL)
Meeks (NY)
Melancon
Michaud
Miller (MI)
Miller (NC)
Miller, George
Mitchell
Mollohan
Moore (KS)
Moore (WI)
Moran (VA)
Murphy (CT)
Murphy, Patrick
Murphy, Tim
Murtha
Nadler
Napolitano
Neal (MA)
Oberstar
Obey
Olver
Ortiz
Pallone
Pascrell
Pastor
Payne
Pelosi
Perlmutter
Peterson (MN)
Pickering
Platts
Pomeroy
Price (NC)
Pryce (OH)
Rahall
Ramstad
Regula
Reyes
Richardson
Rodriguez
Ros-Lehtinen
Ross
Rothman
Roybal-Allard
Ruppersberger
Ryan (OH)
Salazar
Sanchez, Linda T.
Sanchez, Loretta
[[Page H1315]]
Sarbanes
Saxton
Schakowsky
Schiff
Schwartz
Scott (GA)
Scott (VA)
Sensenbrenner
Serrano
Sestak
Shays
Shea-Porter
Sherman
Shuler
Sires
Skelton
Slaughter
Smith (TX)
Smith (WA)
Snyder
Solis
Space
Spratt
Stark
Stupak
Sullivan
Sutton
Tanner
Tauscher
Taylor
Thompson (CA)
Thompson (MS)
Tiahrt
Tierney
Towns
Tsongas
Udall (CO)
Udall (NM)
Upton
Van Hollen
Velazquez
Visclosky
Walsh (NY)
Walz (MN)
Wamp
Wasserman Schultz
Waters
Watson
Watt
Waxman
Weiner
Weller
Wexler
Wilson (OH)
Wu
Yarmuth
Young (AK)
NAYS--148
Aderholt
Akin
Alexander
Bachmann
Bachus
Barrett (SC)
Bartlett (MD)
Barton (TX)
Bilbray
Bilirakis
Bishop (UT)
Blackburn
Blunt
Boehner
Bonner
Boozman
Brady (TX)
Broun (GA)
Brown (SC)
Burgess
Burton (IN)
Buyer
Calvert
Camp (MI)
Campbell (CA)
Cannon
Cantor
Carter
Chabot
Coble
Cole (OK)
Conaway
Crenshaw
Cubin
Culberson
Davis (KY)
Davis, David
Deal (GA)
Doolittle
Drake
Dreier
Duncan
Ehlers
Everett
Fallin
Feeney
Flake
Forbes
Fortenberry
Foxx
Franks (AZ)
Garrett (NJ)
Gingrey
Gohmert
Goode
Goodlatte
Granger
Graves
Hall (TX)
Hastings (WA)
Heller
Hensarling
Herger
Hinojosa
Hoekstra
Hulshof
Hunter
Inglis (SC)
Issa
Johnson, Sam
Jones (NC)
Jordan
King (IA)
Kingston
Kline (MN)
Kuhl (NY)
Lamborn
Lampson
Latham
Latta
Lewis (CA)
Lewis (KY)
Linder
Lucas
Lungren, Daniel E.
Mack
Manzullo
Marchant
Marshall
McCarthy (CA)
McCaul (TX)
McCotter
McCrery
McHenry
McKeon
McMorris Rodgers
Mica
Miller (FL)
Miller, Gary
Moran (KS)
Myrick
Neugebauer
Nunes
Paul
Pearce
Pence
Peterson (PA)
Petri
Pitts
Porter
Price (GA)
Putnam
Radanovich
Rehberg
Reichert
Reynolds
Rogers (AL)
Rogers (KY)
Rogers (MI)
Rohrabacher
Roskam
Royce
Ryan (WI)
Sali
Schmidt
Sessions
Shadegg
Shimkus
Shuster
Simpson
Smith (NE)
Smith (NJ)
Souder
Stearns
Tancredo
Terry
Thornberry
Tiberi
Turner
Walden (OR)
Weldon (FL)
Westmoreland
Whitfield (KY)
Wilson (NM)
Wilson (SC)
Wittman (VA)
Wolf
Young (FL)
NOT VOTING--13
Brown-Waite, Ginny
Gonzalez
Johnson, E. B.
Keller
Musgrave
Poe
Rangel
Renzi
Rush
Walberg
Welch (VT)
Woolsey
Wynn
Announcement by the Speaker Pro Tempore
The SPEAKER pro tempore (during the vote). Members are advised there
are 2 minutes remaining on the vote.
{time} 2003
So the bill was passed.
The result of the vote was announced as above recorded.
A motion to reconsider was laid on the table.
The SPEAKER pro tempore. Pursuant to section 2 of House Resolution
1014, the text of H.R. 493, as passed by the House, will be appended to
the engrossment of H.R. 1424.
____________________