Senate Committee Backs Stronger Mental Health Parity Mandate

A federal parity bill that would require health plans covering mental illnesses to remove discriminatory treatment limits and financial requirements sailed through the Senate Health, Education, Labor, and Pensions (HELP) Committee last month.

APA Medical Director Steven Mirin, M.D., praised the committee’s swift and unanimous passage of the improved parity bill. “APA looks forward to passing S 543 into law to ensure psychiatric patients receiving the quality mental health treatment they need and deserve. This is a giant step towards ending insurance industry practices that discriminate against mental illness,” Mirin told Psychiatric News.

He attended the committee mark-up with representatives of mental health advocacy groups and Rep. Patrick Kennedy (D-R.I.), a key cosponsor of a House parity bill (HR 162) introduced by Rep. Marge Roukema (R-N.J.) in March.

The group demonstrated its support for parity legislation by walking together from Kennedy’s office to the committee session, where they were greeted by cosponsors Sen. Paul Wellstone (D-Minn.) and HELP committee chair Sen. Edward Kennedy (D-Mass.). Along with Wellstone, Sen. Pete Domenici (R-N.M.) is a lead sponsor of S 543.

The bill passed unanimously with one amendment, which changed the language that exempts small employers from those with 25 or fewer employees to those with 50 or fewer, which is consistent with the 1996 law.

The bill requires health plans that provide mental illness coverage to apply the same treatment limitations and financial requirements that are imposed on physical illnesses. That means the same limits on the frequency of treatment, number of visits or days covered, and the same deductibles, coinsurance amounts, copayments, and other-cost sharing requirements, according to the legislation.

The 1996 parity law prohibited only discriminatory annual and lifetime dollar limits for mental health care. The fact that the 1996 law, also cosponsored by Domenici and Wellstone, is scheduled to sunset at the end of this month has provided an impetus for passing S 543 quickly. A floor vote had not been scheduled as of press time.

The version approved by the committee allows mental health benefits to be managed through utilization review and applying medical-necessity criteria, according to the bill.

The bill defines mental illnesses as all categories of mental health conditions listed in the current edition of the DSM but excludes substance abuse disorders.

Before the mark-up, some committee members including Sen. Bill Frist (R-Tenn.) suggested limiting the definition of mental disorders to “biologically based illnesses” (Psychiatric News, August 3). However, they were educated by APA staff about the importance of covering all DSM mental disorders in the legislation, according to Michael Strazzella, deputy director for congressional relations in APA’s Division of Government Relations.

Ranking Republican committee member Judd Gregg (R-N.H.) said at the mark-up, that he voted for the bill with the intent of offering an amendment during the floor debate to exempt employers from the parity mandate if their insurance costs increase more than 1 percent. The cost exemption language is also in the 1996 parity law.

APA is opposed to adding a cost exemption to the parity bills. The Congressional Budget Office recently estimated that the Senate bill would only increase insurance premiums by 1 percent, according to Ellen Gerrity, Wellstone’s legislative assistant for mental health and addiction issues.

“This is negligible compared with the $79 billion in indirect costs in 1990 due mainly to lost productivity caused by mental illness, and the $69 billion in direct treatment costs in 1996 reported by the Surgeon General in his 1999 report on mental health,” remarked Wellstone at the committee’s session.

The bill, which had 54 cosponsors at press time, would not preempt stronger provisions in state parity laws.

APA supports parity for substance abuse disorders, which is included in House parity bill HR 162. Differences between the House and Senate parity bills would have to be worked out in conference, if they pass their respective chambers.

The House bill, which had 155 cosponsors at press time, was still in committee.

The status and summaries of the House and Senate bills are available on the Thomas legislative Web site at thomas.loc.gov by searching on the bill number, HR 162/S 543. ▪