Mental Health Equitable Treatment Act of 2001 (Introduced in the Senate)
S 543 IS
107th CONGRESS
1st Session
S. 543

To provide for equal coverage of mental health benefits with respect to health insurance coverage unless comparable limitations are imposed on medical and surgical benefits.
IN THE SENATE OF THE UNITED STATES
March 15, 2001

Mr. DOMENICI (for himself, Mr. WELLSTONE, Mr. SPECTER, Mr. KENNEDY, Mr. CHAFEE, Mr. DODD, Mr. COCHRAN, Mr. REED, Mr. REID, Mr. WARNER, Mr. GRASSLEY, Mr. ROBERTS, Mr. DURBIN, and Mr. JOHNSON) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions

A BILL To provide for equal coverage of mental health benefits with respect to health insurance coverage unless comparable limitations are imposed on medical and surgical benefits. Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE. This Act may be cited as the `Mental Health Equitable Treatment Act of 2001'.
SEC. 2. AMENDMENT TO THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974.
(a) IN GENERAL- Section 712 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1185a) is amended to read as follows: `SEC. 712. 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 not impose any treatment limitations or financial requirements with respect to the coverage of benefits for mental illnesses unless comparable treatment limitations or financial requirements are imposed on medical and surgical benefits. `
(b) CONSTRUCTION- Nothing in this section shall be construed as requiring a group health plan (or health insurance coverage offered in connection with such a plan) to provide any mental health benefits. `
(c) 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 but not more than 25 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. `
(d) SEPARATE APPLICATION TO EACH OPTION OFFERED- In the case of a group health plan that offers a participant or beneficiary two or more benefit package options under the plan, the requirements of this section shall be applied separately with respect to each such option. `(e)
DEFINITIONS- For purposes of this section-- `
(1) FINANCIAL REQUIREMENTS- The term `financial requirements' includes deductibles, coinsurance, co-payments, other cost sharing, and limitations on the total amount that may be paid with respect to benefits under the plan or health insurance coverage with respect to an individual or other coverage unit (including annual and lifetime limits). `
(2) MEDICAL OR SURGICAL BENEFITS- The term `medical or surgical benefits' means benefits with respect to medical or surgical services, as defined under the terms of the plan or coverage (as the case may be), but does not include mental health benefits. `
(3) MENTAL HEALTH BENEFITS- The term `mental health benefits' means benefits with respect to services for all categories of mental health conditions listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM IV-TR), or the most recent edition if different than the Fourth Edition, as defined under the terms of the plan or coverage (as the case may be), if such services are included as part of an authorized treatment plan that is in accordance with standard protocols and such services meet applicable medical necessity criteria, but does not include benefits with respect to the treatment of substance abuse or chemical dependency. `
(4) TREATMENT LIMITATIONS- The term `treatment limitations' means limitations on the frequency of treatment, number of visits or days of coverage, or other limits on the duration or scope of treatment under the plan or coverage.'.
(b) EFFECTIVE DATE- The amendment made by this section shall apply with respect to plan years beginning on or after January 1, 2002. SEC. 3. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT RELATING TO THE GROUP MARKET. (a) IN GENERAL- Section 2705 of the Public Health Service Act (42 U.S.C. 300gg-5) is amended to read as follows: `SEC. 2705. 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 not impose any treatment limitations or financial requirements with respect to the coverage of benefits for mental illnesses unless comparable treatment limitations or financial requirements are imposed on medical and surgical benefits. `
(b) CONSTRUCTION- Nothing in this section shall be construed as requiring a group health plan (or health insurance coverage offered in connection with such a plan) to provide any mental health benefits. `
(c) 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 but not more than 25 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. `
(d) SEPARATE APPLICATION TO EACH OPTION OFFERED- In the case of a group health plan that offers a participant or beneficiary two or more benefit package options under the plan, the requirements of this section shall be applied separately with respect to each such option. `
(e) DEFINITIONS- For purposes of this section-- `
(1) FINANCIAL REQUIREMENTS- The term `financial requirements' includes deductibles, coinsurance, co-payments, other cost sharing, and limitations on the total amount that may be paid with respect to benefits under the plan or health insurance coverage with respect to an individual or other coverage unit (including annual and lifetime limits). `
(2) MEDICAL OR SURGICAL BENEFITS- The term `medical or surgical benefits' means benefits with respect to medical or surgical services, as defined under the terms of the plan or coverage (as the case may be), but does not include mental health benefits. `
(3) MENTAL HEALTH BENEFITS- The term `mental health benefits' means benefits with respect to services for all categories of mental health conditions listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM IV), or the most recent edition if different than the Fourth Edition, as defined under the terms of the plan or coverage (as the case may be), if such services are included as part of an authorized treatment plan that is in accordance with standard protocols and such services meet applicable medical necessity criteria, but does not include benefits with respect to the treatment of substance abuse or chemical dependency. `
(4) TREATMENT LIMITATIONS- The term `treatment limitations' means limitations on the frequency of treatment, number of visits or days of coverage, or other limits on the duration or scope of treatment under the plan or coverage.'.
(b) EFFECTIVE DATE- The amendment made by this section shall apply with respect to plan years beginning on or after January 1, 2002. SEC. 4. PREEMPTION. Nothing in the amendments made by this Act shall be construed to preempt any provision of State law that provides protections to enrollees that are greater than the protections provided under such amendments. SEC. 5. GENERAL ACCOUNTING OFFICE STUDY.
(a) 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, and other issues as determined appropriate by the Comptroller General.
(b) 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 subsection (a).

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