As negotiations on a Senate mental health parity bill are under way, APA
has continued to push for changes expanding the bill's protections for
existing state parity laws that are more stringent. District branches in
states with strong mental health parity laws also raised concerns about the
impact of preemption wording in the Senate legislation.
Although APA supports the Senate measure, it is working to strengthen the
parity provisions within it, while keeping district branches and state
associations informed of provisions—as approved by a Senate
committee—that could affect the parity laws in their states.
Although similar parity bills were introduced in both the House (HR 1424)
and Senate (S 558) recently, supporters said the differing rules in the two
chambers require a greater degree of compromise in the Senate measure.
The Senate Health, Education, Labor, and Pensions (HELP) Committee approved
the Senate bill sponsored by Sen. Pete Domenici (R-N.M.) in March, but other
senators raised concerns that supporters worry could stall the bill before it
reaches the Senate floor.
Both measures would amend the Mental Health Parity Act of 1996, which
requires insurance equality only for annual and lifetime dollar limits. They
would also require health plans that offer mental health coverage to provide
mental health benefits at parity with benefits for other types of health
One aspect of the Senate bill that concerns parity advocates is that it
does not require health plans to provide an out-of-network benefit for mental
health services, even if they provide such benefits for other illnesses.
However, plans that do provide out-of-network mental health benefits must do
so at the same level as for other medical and surgical out-of-network
"Under this bill, in some states patients would lose coverage,"
Seth Stein, executive director and general counsel of the New York State
Psychiatric Association, told Psychiatric News, "although it
may be that more people, as a whole, would gain coverage in the
Representatives of several New York state district branches sent APA
leaders a letter in April outlining their concerns about the Senate bill, such
as its preemption of the state's law that mandates coverage of specific
minimum hospital days and outpatient visits.
"These limitations and restrictions in the [Senate bill] would not be
fundamentally problematic if the federal provisions were a floor for
benefits," the letter noted. "However, the Senate bill provides
that the provisions of the federal law would preempt state laws that provide
more extensive coverage or that do not provide a cost exemption included in
Nicholas Meyers, director of APA's Department of Government Relations
(DGR), said that overall even the limited Senate bill would have a strongly
positive impact. He agreed that it is possible some patients in a few states
would lose specific mandated benefits, such as a coverage for a minimum number
of inpatient days. Those loses would be balanced with a historic requirement
that plans provide coverage at parity.
"You have to balance [some losses] against the fact that far more
states covering far more individuals would see a net significant improvement
in mental health coverage," Meyers said. "And, of course, for the
first time tens of millions of individuals in ERISA plans would also have a
parity coverage requirement that is not possible under current law."
The New York letter called on APA leaders to reach out to district branches
and state associations for input and recommendations and to help assess the
impact of the bills on the 41 states with parity laws.
Meyers said his office is working to keep APA members informed of the
legislation, although he noted that the ongoing Senate negotiations make it
unclear what final shape the measure will take.
A weekly legislative e-mail update is sent to district branch officials,
which APA members can access at the "Advocacy" section of the
Association's Web site. Also, DGR has issued a special report on parity and
plans to issue more reports when the House and Senate pass their respective
bills and go to conference. Also under consideration are conference calls
between DGR staff and district branch officials concerned about the federal
parity legislation's impact on their state laws.
"We understand the concern of district branches that might find some
specific provision of state parity laws preempted by provisions in the Senate
parity bill, but the language is still under consideration," Meyers told
He encouraged APA members who have questions or concerns to feel free to
contact the DGR staff.
Stein agreed that "judgments have to be made" during the give
and take of legislative negotiations and emphasized that the letter was
intended to ensure good communication between APA leaders and district
Some good news for parity supporters is that the Senate bill includes
parity coverage for substance abuse treatment. Negotiators turned back an
attempt by Sen. Tom Coburn (R-Okla.) to remove addiction-treatment language,
which also is included in the House bill.
Nonetheless, members of A PA's Council on Addiction Psychiatry have raised
concerns that the Senate bill's use of the term "substance abuse
treatment" could limit its strength because it varies from the field's
terminology of "substance use disorders." APA is working through
Senate parity supporters to change the original language.
Negotiators also agreed to a change in the bill that would allow companies
that temporarily drop parity coverage if costs spike to not report that
decision publicly. Business advocates said such public reports could hurt
businesses by revealing the status of their finances to competitors.
Although APA prefers that no measure preempt state laws that are stronger
than a federal measure, parity advocates acknowledge that the Senate measure
will not advance without some preemption provision. APA urged Senate
negotiators to clarify the preemption language so that only treatment and
financial areas are included. The bill would replace the treatment and
financial parity laws in most states with the first national standard for
financial requirements and treatment limitations. The House bill would only
set a floor state laws could build on.
Parity advocates hope to resolve the major areas of contention in the
Senate bill and to have the chamber pass it soon. Passage in one chamber makes
it more likely that the other chamber will take action on its version of the
APA leaders continue to testify on the need for parity before various
legislative committees. Steven Sharfstein, M.D., immediate past president of
APA, testified before the House Ways and Means Subcommittee on Health in March
that implementing parity in 2001 did not significantly increase services or
health costs in the managed care plans of the Federal Employees Health
Benefits Program (see APA Tells Congress: End Medicare's Higher Copay for MH Treatment).
Parity received another endorsement when the American Psychological
Association joined APA in mid-March in calling for enactment of a federal
parity law. ▪