[Congressional Record (Bound Edition), Volume 153 (2007), Part 18]
[Senate]
[Pages 24661-24667]
[From the U.S. Government Publishing Office, www.gpo.gov]




                    MENTAL HEALTH PARITY ACT OF 2007

  Mr. REID. I ask unanimous consent that the Senate proceed to the 
consideration of Calendar No. 93, S. 558.
  The PRESIDING OFFICER. The clerk will report the bill by title.
  The legislative clerk read as follows:

       A bill (S. 558) to provide parity between health insurance 
     coverage of mental health benefits and benefits for medical 
     and surgical services.

  There being no objection, the Senate proceeded to consider the bill, 
which had been reported from the Committee on Health, Education, Labor 
and Pensions with an amendment to strike all after the enacting clause 
and insert in lieu thereof the following:

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Mental Health Parity Act of 
     2007''.

     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) that provides both medical and surgical benefits and 
     mental health benefits, 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; or
       ``(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.--
       ``(1) 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, 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.
       ``(2) Clarification.--Nothing in paragraph (1) shall be 
     construed as requiring that a group health plan (or coverage 
     in connection with such a plan) eliminate, reduce, or provide 
     out-of-network coverage with respect to such plan (or 
     coverage).
       ``(d) Small Employer Exemption.--
       ``(1) In general.--This section shall not apply to any 
     group health plan (and group health insurance coverage 
     offered in connection with a group health plan) for any plan 
     year of any employer who employed an average of at least 2 
     (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) 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

[[Page 24662]]

     a plan (or coverage) for purposes of this section shall be 
     made by a qualified actuary who is a member in good standing 
     of the American Academy of Actuaries. Such determinations 
     shall be certified by the actuary and be made available to 
     the general public.
       ``(4) 6-month determinations.--If a group health plan (or a 
     health insurance issuer offering coverage in connections 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)(1) and shall be 
     subject to the applicable notice requirements under section 
     104(b)(1).
       ``(f) Rule of Construction.--Nothing in this section shall 
     be construed to require a group health plan (or health 
     insurance coverage offered in connection with such a plan) to 
     provide any mental health benefits.
       ``(g) Mental Health Benefits.--In this section, the term 
     `mental health benefits' means benefits with respect to 
     mental health services (including substance abuse treatment) 
     as defined under the terms of the group health plan or 
     coverage.''.
       (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, 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; or
       ``(3) be prohibited from 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.--
       ``(1) 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, 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.
       ``(2) Clarification.--Nothing in paragraph (1) shall be 
     construed as requiring that a group health plan (or coverage 
     in connection with such a plan) eliminate, reduce, or provide 
     out-of-network coverage with respect to such plan (or 
     coverage).
       ``(d) Small Employer Exemption.--
       ``(1) In general.--This section shall not apply to any 
     group health plan (and group health insurance coverage 
     offered in connection with a group health plan) for any plan 
     year of any employer who employed an average of at least 2 
     (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) 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 by a qualified actuary 
     who is a member in good standing of the American Academy of 
     Actuaries. Such determinations shall be certified by the 
     actuary and be made available to the general public.
       ``(4) 6-month determinations.--If a group health plan (or a 
     health insurance issuer offering coverage in connections 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)(1) and shall be 
     subject to the applicable notice requirements under section 
     104(b)(1).
       ``(f) Rule of Construction.--Nothing in this section shall 
     be construed to require a group health plan (or health 
     insurance coverage offered in connection with such a plan) to 
     provide any mental health benefits.
       ``(g) Mental Health Benefits.--In this section, the term 
     `mental health benefits' means benefits with respect to 
     mental health services (including substance abuse 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.''.

     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 2007.''.
       (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 2007.''.

     SEC. 4. SPECIAL PREEMPTION RULE.

       (a) ERISA Preemption.--Section 731 of the Employee 
     Retirement Income Security Act of 1974 (29 U.S.C. 1191) is 
     amended--
       (1) by redesignating subsections (c) and (d) as subsections 
     (e) and (f), respectively; and
       (2) by inserting after subsection (b), the following:
       ``(c) Special Rule in Case of Mental Health Parity 
     Requirements.--
       ``(1) In general.--Notwithstanding any provision of section 
     514 to the contrary, the provisions of this part relating to 
     a group health plan or a health insurance issuer offering 
     coverage in connection with a group health plan shall 
     supercede any provision of State law that establishes, 
     implements, or continues in effect any standard or 
     requirement which differs from the specific standards or 
     requirements contained in subsections (a), (b), (c), or (e) 
     of section 712A.
       ``(2) Clarifications.--Nothing in this subsection shall be 
     construed to preempt State insurance laws relating to the 
     individual insurance market or to small employers (as such 
     term is defined for purposes of section 712A(d)).''.
       (b) PHSA Preemption.--Section 2723 of the Public Health 
     Service Act (42 U.S.C. 300gg-23) is amended--

[[Page 24663]]

       (1) by redesignating subsections (c) and (d) as subsections 
     (e) and (f), respectively; and
       (2) by inserting after subsection (b), the following:
       ``(c) Special Rule in Case of Mental Health Parity 
     Requirements.--
       ``(1) In general.--Notwithstanding any provision of section 
     514 of the Employee Retirement Income Security Act of 1974 to 
     the contrary, the provisions of this part relating to a group 
     health plan or a health insurance issuer offering coverage in 
     connection with a group health plan shall supercede any 
     provisions of State law that establishes, implements, or 
     continues in effect any standard or requirement which differs 
     from the specific standards or requirements contained in 
     subsections (a), (b), (c), or (e) of section 2705A.
       ``(2) Clarifications.--Nothing in this subsection shall be 
     construed to preempt State insurance laws relating to the 
     individual insurance market or to small employers (as such 
     term is defined for purposes of section 2705A(d)).''.
       (c) Effective Date.--The provisions of this section shall 
     take effect with respect to a State, on the date on which the 
     provisions of section 2 apply with respect to group health 
     plans and health insurance coverage offered in connection 
     with group health plans.

     SEC. 5. 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 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 abuse, the impact of any additional cost or 
     savings to the plan, the impact on out-of-network coverage 
     for mental health benefits (including substance abuse 
     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.

  Mr. KENNEDY. Mr. President, today is a landmark day in our nation's 
struggle to achieve access to mental health services for all Americans. 
The Mental Health Parity Act of 2007 reflects a major agreement by the 
mental health community, business leaders, and the insurance industry 
to guarantee that persons with mental health needs receive fair and 
equitable health insurance. Its passage will mean dramatic new help for 
113 million Americans who today are without mental health care and 
treatment.
  Access to such care and treatment is one of the most important and 
neglected civil rights issues facing the nation. For too long, persons 
living with mental disorders have suffered discriminatory treatment at 
all levels of society. They have been forced to pay more for the 
services they need and to worry about their job security if their 
employer learns of their condition. Sadly, in America today, patients 
with biochemical problems in their livers receive better care and 
greater compassion than patients with biochemical problems in their 
brains.
  This bill will help end such unacceptable discrimination. As we have 
seen in the recent bipartisan CHIP legislation, no one questions the 
need for affordable treatment of physical illnesses, but those who 
suffer from mental illnesses face serious barriers in obtaining the 
care they need at a cost they can afford.
  Like those suffering from physical illnesses, persons with mental 
disorders deserve the opportunity for quality care. The failure to 
obtain treatment can mean years of shattered dreams, unfulfilled 
potential and broken lives.
  The need is clear. One in five Americans will suffer some form of 
mental illness this year, but only a third of them will receive 
treatment. Millions of our fellow citizens are unnecessarily enduring 
the pain and sadness of seeing a family member, friend, or loved one 
suffer illnesses that seize the mind and break the spirit.
  Battling mental illness is a difficult process, but discrimination 
against persons with such illnesses is especially cruel, since the 
success rates for treatment often equal or surpass those for physical 
conditions. According to the National Institute of Mental Health, 
clinical depression treatment can be 70 percent successful, and 
treatment for schizophrenia can be 60 percent successful.
  Eleven years ago, a bipartisan majority in Congress approved the 
original Mental Health Parity Act. That legislation was an important 
first step in bringing attention to discriminatory practices against 
the mentally ill, but it did little to correct the injustices that so 
many Americans continue to face. This bill takes the actions needed to 
end the long-standing discrimination against persons with mental 
illness.
  Over the years we have heard compelling testimony from experts, 
activists, and patients about the need to equalize coverage of physical 
and mental illnesses. Some of the most forceful testimony came several 
years ago from Lisa Cohen, a hardworking American from New Jersey, who 
suffers from both physical and mental illnesses, and is forced to pay 
exorbitant costs for treating her mental disorder, while paying very 
little for her physical disorder. Lisa is typical of millions of 
Americans for whom the burden of mental illness is compounded by the 
burden of unfair discrimination.
  No Americans should be denied equal treatment for an illness because 
it involves the brain instead of the heart, the lungs, or other parts 
of their body. Mental health parity is a good investment for the 
Nation. The costs from lost worker productivity and extra physical care 
outweigh the costs of implementing parity for mental health treatment.
  Study after study has shown that parity makes good financial sense. 
Mental illness imposes a huge financial burden on the Nation. It costs 
us $300 billion each year in treatment expenses, lost worker 
productivity, and crime. This country can afford mental health parity. 
What we can't afford is to continue denying persons with mental 
disorders the care they need.
  But equal treatment of those affected by mental illness is not just 
an insurance issue. It is a civil rights issue. At its heart, mental 
health parity is a question of simple justice.
  Today is a turning point. We are finally moving toward ending this 
shameful form of discrimination in our society--discrimination against 
persons with mental illness. This bill is a true commitment by the 
insurance industry, business industry and the mental health community 
to bring fairness and dignity to the millions of Americans who have 
been second class patients for too long.
  The 1996 act was an important step towards ending health insurance 
discrimination against mental illness. This bill takes another large 
step to close the loopholes that remain.
  We would not be here without the strong commitment and skillful 
determination of the late Senator Paul Wellstone and Senator Pete 
Domenici. They deserve immense credit for their bipartisan leadership 
on mental health parity.
  I also commend the staff, both Democrat and Republican, who worked so

[[Page 24664]]

long and hard on this legislation. I particularly thank Carolyn Gluck 
of Senator Reid's office and all the Democratic staff who worked in 
recent weeks to help us produce the bill we have today.
  I also commend Ed Hild of Senator Domenici's staff and Andrew Patzman 
of Senator Enzi's staff for the many hours they spent with my staff to 
negotiate the bill.
  On my staff, I especially commend several who worked so long and hard 
and well on this legislation--Michael Myers, Carmel Martin, Kelsey 
Phipps, Daniel Dawes, Jennie Fay, Ches Garrison, and above all Connie 
Garner, whose passion, counsel and commitment I value so highly on this 
and many other issues. Without her dedicated guidance, we would not be 
at this important threshold today.
  My hope is that as we improve access to mental health services for 
all Americans, we will also help end the stigma and discrimination 
against those with mental illness. Mental illnesses are treatable and 
curable, and it is high time to bring relief to those who suffer from 
them.
  Mr. President, I yield the floor.
  Mr. ENZI. Mr. President, I rise to join my colleagues and sponsors of 
this legislation, Senators Domenici and Kennedy, for their long and 
tireless work bringing us to passage of this bill tonight.
  This legislation is literally years, if not decades in the making, 
and reflects countless hours of sweat and negotiation.
  With much effort and indispensable help, we managed to bring together 
long-opposed advocates from the mental health advocacy, provider, 
employer, and insurance communities around a solid, responsible, 
bipartisan, and long-overdue bill.
  Passage of this bill is a beacon example of what can be accomplished 
when people roll up their sleeves and work together in a bipartisan 
way.
  This legislation will bring fairness and relief to millions of 
Americans suffering from mental illness. The road is not yet over, but 
tonight is a tremendous step forward.
  Mr. REID. Mr. President, Passage of the Mental Health Parity Act of 
2007 is an important victory for individuals who are affected by mental 
illnesses. Over a decade has passed since we enacted the landmark 1996 
mental health parity law that was championed by my good friend, the 
late Senator Paul Wellstone, and Senator Domenici. Before his untimely 
death, Paul Wellstone was a tireless and eloquent advocate for 
legislation that would strengthen the 1996 law and achieve full parity 
in coverage between mental and physical illnesses.
  The Mental Health Parity Act of 2007 is the culmination of many years 
of work to build on and strengthen the 1996 Mental Health Parity Act. 
It is a good compromise that will ensure that plans covering mental 
health services cannot provide different financial requirements or 
treatment limitations than they would for medical or surgical benefits. 
This legislation is long overdue and I will continue to work to ensure 
it is enacted as soon as possible.
  Mr. DODD. Mr. President, I rise in support of S. 558, the Mental 
Health Parity Act of 2007. After many months of negotiations, I am 
pleased to call myself a strong supporter of this legislation. I thank 
the Chairman of the Health, Education, Labor and pensions Committee and 
the senior Senator from New Mexico for working with me and congratulate 
them on passage of S. 558. They and their staff have worked long hours 
to craft this compromise bill. Supporters of mental health parity, old 
and new, should commend the leadership of Senators Kennedy and Domenici 
for their years of commitment and struggle to pass expanded Federal 
mental health parity legislation.
  Millions of Americans are affected by mental illness. Each year, more 
than 50 million American adults will suffer from a mental disorder. All 
of us know a friend, a relative, a neighbor, a colleague whose life has 
been touched by mental illness, either their own or the illness of a 
loved one. Yet despite the compelling need, under many health plans, 
mental health benefits are much more limited than benefits for medical 
or surgical care. Even though a range of effective treatments exist for 
almost all mental disorders, those suffering from mental illness often 
face increased barriers to care and the stigma that underlies 
discriminatory practices in how we treat mental illness. These are the 
individuals that have insurance. It can only be worse for those without 
insurance. Mental health must not take a backseat to other health 
conditions.
  My own State of Connecticut recognized the disparity between 
insurance coverage for physical and mental illness and made significant 
steps to address it by enacting strong mental health parity and 
consumer protection laws. These laws far exceed what exists currently 
at the Federal level and I believe the bill being passed by the Senate 
today will allow my State to maintain those strong laws in the future.
  I was an original cosponsor of the original mental health parity bill 
in 1996 along with Senator Domenici and the late Senator Wellstone and 
have been a strong supporter of efforts to strengthen that bill since 
it was signed into law. But the legislation the HELP Committee marked 
up last February was different from what our late colleague Paul 
championed for so many years. The legislation our committee marked up 
contained preemption language which was broader in scope than what was 
in Federal mental health parity bills in the past.
  For that reason, I offered amendments during that markup to address 
preemption in a way I believed would have taken a major step toward 
protecting State insurance laws and ensuring that we do no harm to 
State-based consumer protections through passage of Federal mental 
health parity. At that markup, I voiced concerns about the impact the 
bill would have on States like Connecticut who have strong mental 
health parity laws, strong consumer protection laws, and strong benefit 
mandate laws.
  As a result of my continued concerns about the impact this bill would 
have on the residents of my State, I withheld cosponsorship of the 
legislation until the issues surrounding preemption could be resolved. 
Due to the hard work and dedication of members on both sides of the 
aisle, my concerns have been addressed and I can now support the 
legislation.
  Specifically, the bill being passed today removed the broad 
preemption language entirely. The bill now relies on the existing 
preemption of State law standard currently in the Employee Retirement 
Income Security Act and the Public Health Service Act, preserving 
States' laws relating to health insurance issuers. In many States, such 
issuers contract out the key insurance function of reviewing medical 
claims by their insureds to utilization review or medical management 
companies, which are licensed and regulated by the states. In fact, the 
legislation written by Chairman Kennedy, called the Health Insurance 
Portability and Accountability Act, HIPAA, was an innovative approach 
to Federal health care reform that has worked well in setting a minimum 
standard of protections while allowing stronger State-based consumer 
protections. It is my understanding that the bill passed today will 
operate in a very similar manner.
  I thank Senators Kennedy and Domenici for entering into a colloquy 
with me to further clarify the intent of this legislation. They have 
been open and willing to working with me since the HELP Committee 
markup occurred to address the concerns I had with this legislation. I 
would also like to acknowledge and thank the tremendous work and 
expertise of Mila Kofman, Associate Research Professor, Health Policy 
Institute, Georgetown University. She worked tirelessly to assist the 
members and staff through the complex issues of ERISA and preemption. 
From my own State of Connecticut, I would like to thank Kevin Lembo, 
Victoria Veltri, and Richard Kehoe who worked closely with my staff to 
ensure that Connecticut's strong mental health parity laws would be 
protected under this legislation.
  The bill we are passing today will not only mean new Federal 
protections for

[[Page 24665]]

people in self-insured ERISA plans, but it will also protect workers 
and families in States with insurance laws that are stronger than the 
Federal ones by allowing those State laws to remain in effect. It 
reflects months and years of hard work and compromise. It is a victory 
for patients who need coverage for mental health services and I am 
pleased to stand in support of this legislation.
  Mr. DOMENICI. Mr. President, I want to start by thanking my 
colleagues, Senators Kennedy and Enzi, for all of their work and 
dedication on the Mental Health Parity Act of 2007. We would not be 
here this evening without them and a whole host of others both in and 
out of the Senate.
  Simply put, our legislation will ensure individuals with a mental 
illness have parity between mental health coverage and medical and 
surgical coverage. No longer will people with a mental illness have 
their mental health coverage treated differently than their coverage 
for other illnesses. That means parity between the coverage of mental 
illnesses and other medical conditions like cancer, heart disease, and 
diabetes.
  No longer will people be treated differently only because they suffer 
from a mental illness, and that means 113 million people in group 
health plans will benefit from our bill. We are here after years of 
hard work. We have worked with the mental health community and the 
business and insurance groups to carefully craft a compromise bill.
  No longer will a more restrictive standard be applied to mental 
health coverage and another more lenient standard be applied to medical 
and surgical coverage. What we are doing is a matter of simple 
fairness. I believe that becomes even more important when you consider 
the following: 26 percent of American adults, or nearly 58 million 
people, suffer from a diagnosable mental disorder each year, and 6 
percent of those adults suffer from a serious mental illness. More than 
30,000 people commit suicide each year in the United States, and 16 
percent of all inmates in State and local jails suffer from a mental 
illness.
  I would like to take a minute to talk about what we are doing with 
the passage of the Mental Health Parity Act of 2007. The bill provides 
mental health parity for about 113 million Americans who work for 
employers with 50 or more employees, ensures that 98 percent of 
businesses which provide a mental health benefit do so in a manner that 
is no more restrictive than the coverage of medical and surgical 
benefits, and ensures health plans do not place more restrictive 
conditions on mental health coverage than on medical and surgical 
coverage. The bill accomplishes this by providing parity for financial 
requirements like deductibles, copayments, and annual and lifetime 
limits and parity for treatment limitations, the number of covered 
hospital days and visits.
  Again, I want to thank everyone for their extraordinary efforts that 
have allowed us to achieve Senate passage of the Mental Health Parity 
Act of 2007.
  Mr. DURBIN. Mr. President, today the Senate takes a long overdue step 
in the right direction for the health of all Americans. The passage of 
the Mental Health Parity Act of 2007 recognizes the millions of people 
living with a mental illness and the millions of friends, family 
members, and communities who support them.
  Mental health parity legislation simply calls for health plans to 
provide comparable levels of coverage for mental health services as are 
provided for traditional medical services. It doesn't sound like a 
radical proposal, yet it has taken years to move this legislation 
through the Senate.
  We have made progress, though, and much of the leadership on this 
issue has been provided by Senator Kennedy and Senator Domenici in 
recent years. We started in 1992, when my good friend, the late Senator 
Paul Wellstone, and Senator Pete Domenici introduced the Mental Health 
Parity Act to correct the unfair burden placed on American families 
living with mental illness without access to mental health services.
  It took a while, but in 1996, the first mental health parity 
legislation was enacted into law. It wasn't a perfect bill. It fell far 
short of its goal in many respects, but it was a significant piece of 
legislation that acknowledged the longstanding bias against covering 
mental health services.
  Based on what we did in 1996, current law requires insurers that 
offer mental health care to offer comparable benefit caps for mental 
health and physical health. Unfortunately, that left a loophole that 
has allowed the common practice in which insurers set higher 
deductibles, charge higher copays, and cover fewer services for mental 
health care. As a result, millions of Americans are left without 
affordable mental health treatment. What they are left with is the 
often crushing aftermath--loss of employment, poor school performance, 
poverty, and even suicide.
  Every year since that 1996 law was enacted, the Senate has had a 
mental health parity bill to fix this problem, but to no avail. This 
year, for the first time in a decade, the Senate has passed a bill to 
address the loopholes in the mental health parity law. I commend 
Senators Kennedy and Domenici for their dedication to seeing this 
through. I only wish that Paul Wellstone could have lived to see this 
day.
  Paul Wellstone was a good friend of mine and an inspiration to me and 
to many others who served with him in the Chamber. Throughout his 
congressional career, Paul fought tirelessly for equal rights for all, 
regardless of their race, religion, socioeconomic status, or health 
status. He was a champion of many causes, but no cause was more dear, 
or more personal, to him than making sure that people with mental 
illness were treated fairly and with dignity.
  Paul Wellstone was touched personally by mental illness. His older 
brother lived and struggle with mental illness most of his life. Paul 
believed that for his brother, and for all Americans, mental health was 
as important as physical health. Senator Pete Domenici, too, 
understands the importance of having access to mental health services. 
His daughter also has struggled with mental illness.
  Fifteen years ago, Senators Wellstone and Domenici brought home a 
fact that is as true today as it was then--nearly everyone knows 
someone living with a mental illness. According to the National 
Institute of Mental Health, more than one in four adults in the United 
States--more than 57 million adults--suffer from a diagnosable mental 
disorder in a given year. One in seventeen Americans suffers from a 
serious mental illness.
  These two Senators were fiercely determined to end discrimination 
against people with mental illness. We all lost a spirited champion for 
mental health on October 25, 2002, when Paul Wellstone was in a fatal 
plane crash. But the fight for mental health parity has lived on. 
Senator Kennedy quickly took up the fight, and he and Senator Domenici 
have resolutely worked to strengthen common ground and supporters who 
would bring us to this day, the day of Senate passage of the mental 
health parity bill.
  Last year, the Senate passed a resolution I submitted that marked the 
fourth anniversary of Paul Wellstone's death. The resolution expresses 
the sense of the Senate that Congress should act ``to provide for equal 
coverage of mental health benefits with respect to health insurance 
coverage''--in other words, pass mental health parity.
  I am proud to note the Senate's action today. With the passage of the 
Mental Health Parity Act of 2007, we are assuring millions of Americans 
that mental illness deserves equal treatment as physical illness. We 
are telling millions of families that help is available and that they 
no longer have to feel excluded. And most importantly, we are opening 
doors to hope and closing doors to desperation.
  We may not live in a perfect world but we are closer to a more 
perfect union. It is in the spirit of Paul Wellstone and--thanks to 
Senators Kennedy and Domenici--the spirit of bipartisanship that we 
pass this historic piece of legislation. Senator Wellstone was quoted 
as saying:


[[Page 24666]]

       I don't think politics has anything to do with left, right, 
     or center. It has to do with trying to do right by the 
     people.

  Today, I think Paul would agree that the Senate has done right.


                  PREEMPTION AND PROTECTING STATE LAWS

  Mr. DOMENICI. Mr. President, as someone who has worked to bring a 
greater understanding of mental illness and to end all forms of 
discrimination against people who suffer from a mental illness, I am 
pleased to report that the Senate has passed a monumental mental health 
parity bill that could bring hope and greater measure of fairness in 
mental health insurance care coverage to as many as 113 million 
Americans and nearly 500,000 New Mexicans. This legislation, the Mental 
Health Parity Act of 2007, builds on the 1996 Mental Health Parity law 
that I authored with the late Senator Paul Wellstone. It is supported 
by more than 230 organizations and has been a bipartisan effort from 
the beginning. I thank Senator Kennedy, the chairman of the Health, 
Education, Labor and Pensions Committee, for his vision, his leadership 
and his support for this legislation.
  Mr. KENNEDY. I thank the Senator from New Mexico for his tremendous 
leadership on this bill. He has fought for this legislation for many 
years, and I am grateful for his commitment to getting this bill 
passed. This legislation represents the culmination of more than a 
year's negotiations involving lawmakers, mental health, insurance and 
business organizations to craft compromise legislation. During the 
markup of the bill last February, my colleague Senator Dodd raised very 
important issues regarding the effects of the preemption language in 
the legislation. Since then, he was joined by several other Senators, 
attorneys general, and State insurance commissioners who have voiced 
concerns about unintended consequences of the bill. It was never the 
intent of the bill to harm or weaken State insurance laws but in 
response to concerns raised by several of my colleagues and insurance 
experts, the language pertaining to preemption was stricken from the 
legislation.
  Mr. DODD. I thank the chairman of the HELP Committee and the 
distinguished senior Senator from New Mexico and congratulate them on 
passage of S. 558, the Mental Health Parity Act. They and their staff 
have worked long hours to craft this compromise bill, and I 
congratulate them on this victory for individuals with mental illness 
throughout the country. Supporters of mental health parity, old and 
new, should commend the leadership of Senators Domenici and Kennedy for 
their years of commitment and struggle to pass Federal mental health 
parity legislation.
  I was an original cosponsor of the original mental health parity bill 
in 1996, along with Senator Domenici and the late Senator Wellstone, 
and have been a strong supporter of efforts to strengthen that bill 
since it was signed into law. But, as my colleagues may know, the 
legislation the HELP Committee marked up last February which is now 
before the Senate is different from what our late colleague Paul 
championed for so many years. The legislation our committee marked up 
contained preemption language which was broader in scope than what was 
in Federal mental health parity bills in the past. For that reason, I 
filed amendments during that markup to address preemption in a way I 
believed would have taken a major step toward protecting State 
insurance laws and ensuring that we do no harm to State-based consumer 
protections through Federal mental health parity. At that markup, I 
voiced concerns about the impact the bill would have on States like 
Connecticut who have strong mental health parity laws, strong consumer 
protection laws, and strong benefit mandate laws.
  As a result of my continued concerns about the impact this bill would 
have on the residents of my State, I withheld cosponsorship of the 
legislation until the issues surrounding preemption could be resolved. 
I am pleased to say that because of the hard work and dedication of 
Members on both sides of the aisle, my concerns have been addressed and 
I can now support the legislation.
  Mr. KENNEDY. I thank the senior Senator from Connecticut and 
appreciate his leadership on this issue. He raised a number of 
important issues during the consideration of this bill. I believe we 
have addressed those concerns in the legislation and I am pleased that 
he is now a strong supporter of the legislation.
  Mr. DODD. The bill passing the Senate today relies on the existing 
preemption of State law standard currently in ERISA and the Public 
Health Service Act, preserving States laws relating to health insurance 
issuers. In many States, such issuers contract out the key insurance 
function of reviewing medical claims by their insurers to utilization 
review or medical management companies, which are licensed and 
regulated by the States. In fact, the legislation written by the 
Senator from Massachusetts, called HIPAA, was an innovative approach to 
Federal health care reform that has worked so well in setting a minimum 
standard of protections while allowing stronger State-based consumer 
protections. Is it the distinguished senior Senator from Massachusetts' 
belief that S. 558 preserves the States' ability to regulate such 
companies?
  Mr. KENNEDY. Yes, nothing in this bill affects any State law or State 
regulation of any company or issuer who performs utilization review or 
other medical management services. The changes made to the preemption 
section of S. 558 mean that the current HIPAA standard would apply to 
this legislation, just like it applies to existing law passed in 1996. 
By using existing preemption language, we mean only the narrowest 
preemption of State laws. A minimum standard of Federal protection 
allows States to provide additional protection for their citizens. 
State laws designed to regulate medical management or utilization 
review to protect plan participants are not preempted under the bill 
because they do not ``prevent the application'' of the substantive 
provisions of this bill.
  Mr. DODD. Is it also the understanding of the senior Senator from New 
Mexico that this legislation will not only mean new Federal protections 
for people in self-insured ERISA plans, but it will also protect 
workers and families in States with insurance laws that are stronger 
than the Federal ones by allowing those State laws to remain in effect?
  Mr. DOMENICI. Yes, the senior Senator from Connecticut is correct.
  Mr. DODD. I thank the Senator and want to thank the Senator from 
Massachusetts for allowing my concerns about preemption and protecting 
State laws to be heard in the committee and for working tirelessly with 
me to address those concerns. The bill we are passing reflects months 
and years of hard work and compromise, and I am pleased to voice my 
strong support for S. 558. It is a victory for patients who need 
coverage for mental health services.
  Mr. REID. I ask unanimous consent that the amendment at the desk be 
considered and agreed to; the committee-reported amendment, as amended, 
be agreed to; the motions to reconsider be laid upon the table, en 
bloc; the bill, as amended, be read three times and passed; the motion 
to reconsider be laid upon the table; and that any statements be 
printed in the Record.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment (No. 2908) was agreed to.
  (The amendment is printed in today's Record under ``Text of 
Amendments.'')
  The committee amendment in the nature of a substitute, as amended, 
was agreed to.
  The bill (S. 558), as amended, was ordered to be engrossed for a 
third reading, was read the third time, and passed.
  Mr. REID. Mr. President, I congratulate Senators Kennedy, Enzi, and 
others who worked on this legislation for such a long time. They are to 
be commended. Senator Wellstone, I am sure, is smiling on us today.

[[Page 24667]]



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