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Volume 12 Number 182 News: Mental Health The Senate by unanimous consent late Sept. 18 approved legislation (S. 558) requiring businesses with 50 or more workers to offer the same medical benefits for mental health care as they do for other medical conditions. The Mental Health Parity Act of 2007 would not require businesses to offer mental health benefits, but if they do, such benefit packages must embody parity with other medical benefits in the areas of patient deductibles, copayments, and annual and lifetime coverage limits, as well as in covered hospital days and visits. Meanwhile, the House Ways and Means Health Subcommittee Sept. 19, by a 10 to 3 vote, approved the House version of parity legislation (H.R. 1424) . The House measure has been approved by the House Education and Labor Committee, but must still go through the full Way and Means Committee and the Energy and Commerce Committee. Among the differences with the Senate bill is that the House bill requires health plans offering mental health benefits to cover the same mental health and addiction disorders that are included in the health plans used by members of Congress. However, the final version of the Senate bill moved closer to the House version in that it would no longer pre-empt stronger state mental health parity laws. Senate Health, Education, Labor, and Pensions Committee Chairman Edward M. Kennedy (D-Mass.) told reporters Sept. 19 that the Senate was holding conversations with the House about how to proceed with parity legislation. But he said no deal with the House had been reached for that chamber to take the Senate's parity bill. The Senate bill was approved by the HELP committee in February. An industry source told BNA Sept. 19 that, while there was no official agreement for the House to take the Senate bill, "I think there's a hope that something will happen" in which the House would cede to the Senate. Business Support for Senate Bill Business groups have rallied behind the Senate bill, saying it would be less costly than H.R. 1424. Mental health advocates also have signaled their support for the legislation, saying it has the best chance of becoming law. The Senate bill is the result of extensive bipartisan negotiations in the Senate and among business, insurers, and advocates. One of its sponsors, Sen. Pete Domenici (R-N.M.), told reporters Sept. 19 President Bush would sign parity legislation if it reaches his desk. "The bill we passed represents an agreement, after 10 long years of stalemate, not only between Democrats and Republicans, but also with the mental health community, businesses and the insurance industry," Kennedy said at a press briefing. Mental health parity legislation approved by Congress in 1996 requires group health plans that offer mental health benefits to set the same annual and lifetime caps on mental health coverage as for other medical/surgical services. Mental health advocacy groups say the 1996 law has loopholes that need to be closed by barring group health plans from requiring higher copayments, deductibles, and coinsurance payments for mental health services, compared to other health benefits. The Senate bill includes a cost exemption for businesses. Health plans can be exempted from the parity requirements if they are projected to have increased health care costs exceeding 2 percent of total plan costs during the first year or exceeding 1 percent of the total plan costs each subsequent year, according to a summary of the legislation provided by lawmakers. The Congressional Budget Office has estimated that mental health parity will increase employers' health care costs by less than 1 percent. House Bill The House Ways and Means Health Subcommittee approved H.R. 1424, the Paul Wellstone Mental Health and Addiction Equity Act, after defeating several Republican amendments, including turning back by a 3 to 9 vote an amendment by subcommittee ranking minority member Dave Camp (R-Mich.) to adopt the Senate bill. GOP opponents of the House bill said it would impose costly, new burdensome requirements on health plans and businesses, driving up the cost of health and insurance and causing employers to drop coverage. In particular, Republicans criticized a provision in H.R. 1424 under which the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), would be used to make coverage determinations. The provision is not in the Senate bill. DSM-IV is published by the American Psychiatric Association and covers what in the association's view are all mental health disorders for both children and adults. It also lists causes of disorders, statistics in terms of gender, age at onset, and prognosis, as well as treatment research. Supporters of the bill said DSM-IV is used by many health care programs, including Medicare, Medicaid, TRICARE and the Federal Employees Health Benefits Program. "The Senate bill is not true parity," said bill co-sponsor Jim Ramstad (R-Minn.). Camp said using the DSM-IV would force employers to provide coverage for individuals with illnesses such as jet lag and caffeine addiction. But he said the issue most likely is moot, because the bill is not likely to become law. "This bill as written isn't going to go much further than the House," he said, adding he could support the Senate bill. "The Senate has made clear which direction it wants to go in." The Senate bill is available online.
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