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Mental Health Liaison Group
Today Reps. Patrick Kennedy and Jim Ramstad introduced the Paul Wellstone Mental Health and Addiction Equity Act, designated as H.R. 1367, with 254 of their colleagues as original cosponsors. Their goal is to continue building support in the House and work towards committee action and Floor consideration this fall, and they welcome your assistance. At www.equitycampaign.net, any supporter of this legislation can sign up to become a "citizen cosponsor" of the bill. The sponsors thank organizations for continuing support of this important legislation.
To Endorse This Bill: To add your organization to the roster of supporters please send an email to firstname.lastname@example.org with that request. Include the organization name, contact person’s name, title, snail mail address, phone & fax and email address.
That support roster presently has the following organizations:
Press Release of March 7:
KENNEDY-RAMSTAD INTRODUCE HISTORIC MENTAL HEALTH PARITY BILL
Large Bipartisan Majority Support
FOR IMMEDIATE RELEASE March 7, 2007
Contacts: Robin Costello 401-729-5600 (Kennedy)
WASHINGTON: Congressmen Patrick J. Kennedy (D-RI) and Jim Ramstad (R-MN) today introduced "The Paul Wellstone Mental Health and Addiction Equity Act "(H.R. 1367), to improve the overall health of all Americans by granting greater access to mental health and addiction treatment and prohibiting health insurers from placing discriminatory restrictions on treatment.
Since February, the Congressmen have been crisscrossing the country touting the merits of the legislation with their "Campaign to Insure Mental Health and Addiction Equity". The response has been overwhelming with support surfacing from every corner of society. The legislation is cosponsored by an historic bipartisan majority of 256 Members of Congress, including House Leaders.
"This bill is really very simple," said Congressman Kennedy. "Millions of Americans pay their premiums every month, but when they or their children or family members get sick, their insurance isn't there for them. That's not fair and it's not smart. This is a public health crisis that in some way touches every family in America. It's time to break down the barriers to good mental health and addiction treatment."
"It's time to finish what we started in 1994 with our friend and colleague, the late Senator Paul Wellstone, and end the discrimination against people with addiction," said Congressman Ramstad. "This is not just another public policy issue. This is a life-or-death issue for millions of Americans."
The bill expands the Mental Health Parity Act of 1996 by requiring group health plans that offer benefits for mental health and addiction to do so on the same terms as care for other diseases. The legislation closes the loopholes that allow plans to charge higher copayments, coinsurance, deductibles, and maximum out-of-pocket limits and impose lower day and visit limits on mental health and addiction care.
According to the Government Accountability Office, nearly 90 percent of plans impose such financial limitations and treatment restrictions on mental health and addiction care despite voluminous scientific research documenting the biological, genetic, and chemical nature of these diseases, and the effectiveness of treatment. Both the House and Senate version of the bill applies to group health plans of 50 or more people.
Last month, The Senate Health, Education, Labor and Pensions Committee approved similar legislation, The Mental Health Parity Act of 2007, sponsored by Senators Kennedy (D-MA), Domenici (R-NM), and Enzi (R-WY). Among the differences is that the House bill, informed by the sponsors' forums across the country, requires health plans offering mental health benefits to cover the same mental health and addiction disorders that are included in the health plans Members of Congress use. The Senate bill has no such provision. The bills also differ in how they impact related state laws.
The Kennedy-Ramstad legislation is modeled after the Federal Employees Health Benefit Program, which covers Members of Congress and other federal workers and dependents and which implemented equality in mental health and addiction coverage in 2001. According to an exhaustive study published earlier this year by the Department of Health and Human Services, the federal employees' parity policy was implemented with "little or no increase in total MH/SA [mental health/substance abuse] spending".
A majority of respondents to a National Mental Health Association survey indicated that they would support parity legislation even if it meant a $1 per month increase to their premiums. The Congressional Budget Office has estimated that such legislation will increase health care costs less than that amount.
Background: The Paul Wellstone Mental Health and Addiction Equity Act of 2007 expands the Mental Health Parity Act of 1996 by prohibiting group health plans from imposing treatment or financial limitations on mental health benefits that are different from those applied to medical/surgical services. The legislation applies only to group health plans already providing mental health benefits and exempts plans sponsored by small businesses of under 50 employees.
Fact Sheet by Sponsors (2-15-07):
Paul Wellstone Mental Health and Addiction Equity Act of 2007
The bill amends the Mental Health Parity Act of 1996 to eliminate discriminatory provisions that erect obstacles to accessing care for Americans with mental health and addiction disorders. The 1996 Act required equality only for annual and lifetime limits. This bill requires equality across the terms of the health plan.
What the Bill Requires Plans To Do
The bill does not mandate group health plans provide any mental health coverage. However, if a plan does offer mental health coverage, then:
Equality in financial requirements. The plan or coverage must ensure that any financial requirements applied to mental health and addiction benefits are no more restrictive or costly than the financial requirements applied to substantially all comparable medical and surgical benefits that the plan covers. The categories for comparison are inpatient and outpatient, in-network and out-of-network. Financial requirements include deductibles, copayments, coinsurance, and out-of-pocket expenses. The plan may not establish separate cumulative cost-sharing requirements (such as deductibles) that are only applicable to mental health and addiction benefits.
Equality in treatment limits. The plan or coverage must also ensure that the treatment limitations applied to such benefits are no more restrictive than the treatment limitations applied to substantially all comparable medical and surgical benefits that the plan covers. Such treatment limitations include limits on the frequency of treatment, number of visits, days of coverage, or other similar limits on the scope and duration of treatment.
Coverage of all diseases covered by Congressional plans. The plan or coverage must cover the same range of mental illnesses and addiction disorders covered by the federal employee health plan that Members of Congress use.
Equality in out-of-network coverage. If the plan or coverage offers out-of-network benefits for medical and surgical benefits under the plan, then it must also offer out-of-network coverage for mental health and addiction benefits.
Scope of Coverage – Small Business and Individual Market Exemption
The mental health parity requirements apply to group health plans with 50 or more employees.
It does not apply to employers with less than 50 employees are exempt from this Act, nor does it affect the individual insurance market.
If a health plan experiences increased actual total costs of coverage as a result of the equity requirements that exceed 2% during the first plan year or 1% in subsequent years, it is exempt from the equity requirements for the following plan year. The exemption is good for one year, after which the plan would again need to comply.
Effect on State Mental Health Parity Laws
The bill would establish a federal floor, but not a ceiling. State laws would need to meet the standards in the bill as a minimum, but would not be prohibited from establishing stronger requirements. The bill would not preempt state laws mandating that mental health or addiction benefits be covered or governing medical management or other aspects of insurance regulation.
Transparency in Medical Management
Plans will be required to make information about criteria used for medical necessity determinations relating to mental health and addiction treatment available to current and potential beneficiaries and contracting providers, and to make available reasons for denials of benefits.
The bill amends an Internal Revenue Code provision that imposes a tax of $100 per day per beneficiary on employers who do not comply with the equity requirements of this bill.
Government Accountability Office Reports
The bill requires GAO to produce three reports:
A study of the bill’s impact on such things as health care costs, access to coverage, quality of care, government spending on mental health and addiction treatment and other public services, and use of medical management by plans.
A biannual assessment of obstacles beneficiaries face in obtaining appropriate care under their health plans.
A study of the availability and use of uniform patient placement criteria that can help guide health plans’ determinations of medical necessity.
The equity requirements of the bill will be effective in the first plan year that begins on or after January 1, 2008.
Resources: Fact sheets on parity may be found at http://www.mhlg.org/page18.html.