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Volume 12 Number 85 News: Mental Health Rep. Patrick J. Kennedy (D-R.I.) May 2 predicted mental health parity legislation he has introduced (H.R. 1424) would be marked up by the end of May and be on the House floor before the August congressional recess. Kennedy told reporters that the House Democratic leadership has promised him the Paul Wellstone Mental Health and Addiction Equity Act will be brought to the floor for a vote by the August recess, and predicted the bill would survive a House/Senate conference. As many as three House committees may claim jurisdiction over the bill, however, which could make it difficult to meet the schedule set out by Kennedy. Kennedy spoke following a Capitol Hill rally in which House Democratic leaders praised the bill, saying it would ensure millions of Americans have access to mental health care. The bill has a bipartisan majority of 265 House lawmakers, according to Kennedy. The measure is co-sponsored by Rep. Jim Ramstad (R-Minn.). Closing Loopholes The legislation would close loopholes in the Mental Health Parity Act of 1996 that mental health advocates say 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, compared with other medical services. By an 18-3 vote, the Senate Health, Education, Labor, and Pensions Committee Feb. 14 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 Senate bill is co-sponsored by Senate Health, Education, Labor, and Pensions Committee Chairman Edward M. Kennedy (D-Mass.), committee ranking minority member Michael B. Enzi (R-Wyo.), and Sen. Pete V. Domenici (R-N.M.). From January to March, Reps. Kennedy and Ramstad held field hearings in 14 cities to discuss mental health parity. They produced a report with five conclusions about the issue. The report said mental health parity is a statement of equality for those with mental illness; is cost-effective; must be carefully crafted to limit coverage loopholes implemented by insurers; requires strong enforcement; and equalizing benefits with other health care services is only part of the solution to providing parity. 'Onerous' Requirements The report said health plans "will seek every opportunity to avoid paying" mental health claims, including "onerous and repetitive preauthorization requirements, opaque medical necessity criteria, phantom networks, and arbitrary coverage denials." Speaking at the rally, Kennedy called mental illness "a public health crisis" and a "civil rights battle. " "This is not just another public policy issue," the congressman said in a May 2 press release. "This is a life-or-death issue for millions of Americans." Those appearing with Kennedy at the rally included House Speaker Nancy J. Pelosi (D-Calif.), and House Majority Leader Steny Hoyer (D-Md.). Business groups have rallied behind the Senate bill, saying it would be less costly than H.R. 1424. The House bill requires health plans offering medical health benefits to cover the same mental health diagnoses as does the Federal Employees Health Benefits Plan, according to Kennedy. The House bill also allows states to impose more comprehensive mental health parity laws than under H.R. 1424, while the Senate bill preempts state laws, he told reporters. Extensive Negotiations Supporters of the Senate bill say it is the result of extensive negotiations among parity advocates, businesses, insurers, lawmakers, and other stakeholders. Business groups also are concerned about provisions in the House bill in which the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), would be used to make coverage determinations and that FEHBP would be the basis for decisions about what mental health coverage should be offered. 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. Kennedy told reporters using DSM-IV would allow patients to be more quickly diagnosed and thus get quicker treatment. Kennedy also said the House is likely to try and build support for its bill by reaching out to Senate Republicans concerned that the Senate bill would preempt state parity laws. However, a mental health advocate told BNA May 2 that the preemption issue likely will be resolved in the Senate bill by the time it is brought to the floor. Senate floor action on S. 558 is expected within several months, the advocate said. The report is available.
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