[Congressional Record Volume 154, Number 155 (Saturday, September 27, 2008)]
[Extensions of Remarks]
[Pages E2078-E2079]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




 H.R. 6983: THE PAUL WELLSTONE AND PETE DOMENICI MENTAL HEALTH PARITY 
                    AND ADDICTION EQUITY ACT OF 2008

                                 ______
                                 

                               speech of

                           HON. GEORGE MILLER

                             of california

                    in the house of representatives

                      Tuesday, September 23, 2008

  Mr. GEORGE MILLER of California. Mr. Speaker, I rise today in support 
of the Paul Wellstone and Pete Domenici Mental Health Parity and 
Addiction Equity Act of 2008.
   Over the years, there have been numerous hearings in DC and around 
the country at which individuals and their family members testified 
about the need for parity in the treatment of mental health and 
addiction conditions.
   The final bill being considered today will eliminate most if not all 
of the abuses that families across the country have testified about. 
The following are examples of many of the major inequities that the 
bill is designed to eliminate:
   Emergency Care:
   Dr. Gerry Clancy described seeking prior authorization for a 
suicidal patient. Wanting to confirm that this was a serious suicide 
attempt, the health plan reviewer asked whether the patient had a plan 
to take his own life. Dr. Clancy answered that the patient planned to 
shoot himself. He said the reviewer then went farther and said, ``Does 
that person have a gun?'' and Dr. Clancy answered ``yes.'' Dr. Clancy 
said he could not believe the next question: ``does the person have 
bullets?''
   No family in America should have to face having to justify why a 
suicide attempt is a real medical emergency. The final bill would 
require plans to have the same requirements for prior authorization, 
terms and financial limitations, co-pays, deductibles and day and visit 
limits on emergency benefits for mental health and addiction treatment 
services as the plan has on medical and surgical emergency services 
covered under the plan.
   Medical Necessity:
   Michael Noonan, the father of a college-enrolled daughter who 
suffered from chemical dependence, testified about the struggle his 
family faced to access inpatient addiction treatment for his daughter. 
After his daughter encountered a series of escalating problems and 
relapses, her clinician recommended inpatient rehabilitation for her 
alcohol dependence. He contacted his insurance company and was told 
that his contract included a benefit for inpatient rehabilitation for 
substance use disorders with a $200 deductible and 30 day coverage. In 
spite of confirming these benefits with his managed behavioral health 
care company, the authorization of his daughters' inpatient care was 
suspended after only five days of care. Mr. Noonan endured repeated 
denials, took out a home equity loan of $23,000 to pay for treatments 
while processing appeals, and requested the assistance of his 
congressional representative in order to secure payment for the 
treatment of his daughter. His experience was echoed in the testimony 
of many others, like Xavier Ascanio, whose daughter Samantha was 
hospitalized for an eating disorder. ``During the inpatient stay, the 
insurance company doled out pre-approval two or three days at a time. 
Imagine that hanging over you, both as a parent and as a patient.''
   Under the final bill, health plans are required to disclose upon 
request the criteria for medical necessity determinations and the 
reason for any denial made under the plan with respect to mental health 
and substance use disorder benefits to the participant or beneficiary.
   Out of Network:
   Xavier Ascanio testified how difficult it was to find a qualified 
provider in-network to treat his daughter for an eating disorder. He 
said that after dealing with a parade of providers who were not 
helpful, they finally found some who were knowledgeable and could 
really help. Unfortunately, the providers were not on any insurance 
company's PPO list.
   Ms. Melinda Lemos-Jackson whose young son was diagnosed with an 
autism spectrum disorder when he was 3 years of age testified, ``Would 
you go to an internist for a heart condition or would you go to a 
cardiologist? I have placed the calls to the clinicians, who upon 
interview, don't meet my son's needs, I have tried some of the in-
network clinicians who clearly are not suitable. I've sometimes spoken 
to highly regarded folks who are actually on the list, only to find out 
that their practices are closed or they can't take a child like my son 
at this time, so we get the services our son needs and we learn to 
bring our checkbook and our Visa. Our health insurance is not 
accepted.''
   What Mr. Ascanio and Ms. Lemos-Jackson described are ``phantom 
networks.'' ``Phantom networks'' are networks offered by plans that 
lack an acceptable number and array of providers that offer real 
options for help or hope for people with mental illness or addiction.
   Ensuring equitable access to out-of-network benefits for mental 
health and addiction benefits is critical for making sure patients 
receive the care they need. A February 2007 RAND Corporation study 
looked at one health plan and found only 11.8% of patients accessing 
mental health benefits under the plan received care out-of-network. 
Moreover, a December 2007 study in Health Affairs on parity in the 
FEHBP found that parity legislation that does not extend parity to out-
of-network benefits may have the unintended consequence of decreasing 
access to mental health and addiction treatment services altogether.
   The final bill requires health plans to have the same terms and 
financial limitations on out-of-network benefits for mental health and 
addiction treatment services as the plan has on medical and surgical 
services covered under the plan. Plans must provide out-of-network 
benefits for mental health and substance use disorders in exactly the 
same manner as out-of-network medical and surgical benefits provided 
under the plan in order to be in compliance with this Act.
   Wellness Plans:
   Wellness plans can include information about diet, exercise, stress 
management and other forms of chronic disease management tools, but 
they are no substitute for mental health and addiction benefits. 
Increasingly, we have seen employee assistance programs that provide 
drug and alcohol treatment move to providing family counseling, stress 
management and other extremely helpful resources--but they are not a 
substitute for addiction treatment.
   The final bill would prohibit a plan from changing its benefit 
design to a ``wellness plan'' to avoid compliance with the parity 
requirements of this Act.
   The Diagnostic and Statistical Manual DSM:
   Kitty Westin, the President of the Eating Disorder Coalition, spoke 
movingly about the need for full diagnostic coverage of mental 
illnesses. Anna Westin, Kitty's daughter, died at the age of 21 due to 
lack of access to care for her severe eating disorder. Despite having 
the ``Cadillac'' of insurance policies, Anna was repeatedly denied the 
treatment she needed. Eating disorders, like other diagnoses affecting 
children and youth, are often singled out for denial, a form of 
discrimination that led to the strong push in this legislation to 
require insurers to use the widely-accepted Diagnostic and Statistical 
Manual (DSM), rather than allowing plans to pick and choose diagnostic 
coverage based on cost or bias.
   The DSM is a diagnostic manual developed by the American Psychiatric 
Association, through an open process involving more than 1,000 national 
and international mental health researchers and clinicians. It is used 
by virtually all private insurance companies, along

[[Page E2079]]

with Medicaid, OPM for the Federal Employees Health Benefit Program, 
Tricare, and Medicare, which all require DSM criteria for the 
submission of claims. All NIH grant submissions, FDA drug indications 
for treatment, and legal indications for mental competency require the 
use of DSM codes and guidelines.
   Despite this status as a recognized authority, the DSM itself became 
the focal point for many heated debates during the parity negotiations, 
launched by opponents of parity. However, in the end, language to 
require the DSM as the basis for coverage was not included in this 
bill. The final bill requires the Government Accountability Office 
(GAO) to monitor and report to Congress on the extent to which health 
plans comply with the requirements of this Act to provide meaningful 
parity to the millions of families who experience mental health or 
substance abuse conditions.

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