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Volume 13 Number 54 By Steve Teske News: Mental Health Sens. Edward M. Kennedy (D-Mass.) and Pete V. Domenici (R-N.M.) have offered the House a compromise proposal on mental health parity legislation (S. 558, H.R. 1424) that jettisons House language requiring employers to cover all illnesses listed in a provider manual and offers several other key changes, according to congressional aides and parity advocates. Domenici and Kennedy aides told BNA March 19 that the lawmakers had offered the compromise proposal to the House March 18, but declined to provide details. The Kennedy aide said the proposal was designed "to get the ball rolling" toward a compromise bill. A mental health parity advocate told BNA March 19 the offer does not include House language requiring employers to cover all illnesses listed in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) and embodies provisions on out-of-network coverage that move the Senate more toward language in the House parity bill. The House is not expected to react to the proposal until after lawmakers return March 31 from a two-week recess, the advocate said. House, Senate Action By a 268-148 vote, the House March 5 approved its parity bill (No. 44 HCDR 3/6/08 a0b6d7y5c7); the Senate approved parity legislation in September 2007 via unanimous consent. The offer made by Kennedy and Domenici did not include input from Sen. Michael B. Enzi (R-Wyo.), the advocate said, and his views of the proposal and those of other senators are not known. Enzi, Kennedy, and Domenici joined together to offer the parity bill more than a year ago. An Enzi spokesman declined comment on the issue. Both the House and Senate bills would require health plans offering mental health coverage to provide the same benefits for mental illness as they do for other medical conditions. Employers with fewer than 50 workers would be exempt under the bills. Significant Differences But there were significant differences between the measures that are the subject of the Kennedy/Domenici offer. The House DSM-IV provision has been vigorously opposed by business groups, which say it would impose a broad benefit mandate on employers. Business representatives, who support the Senate parity bill, have said they would oppose any final bill with the provision left intact (No. 47 HCDR 3/11/08 a0b6e2q4r6 The House bill provides for out-of-network benefits for mental health coverage if out-of-network benefits are offered for other surgical and medical conditions. The Senate bill requires parity for out-of-network mental health coverage only if a plan offers out-of-network mental health care coverage.
The proposal offered by Kennedy and Domenici on out-of-network coverage would allow an individual to seek out-of-network coverage if network coverage available is inadequate, and they would be liable only for in-network copayments, the advocate said.
The proposal also stipulates that, if out-of-network coverage is offered for physical treatments, it also must be available for out-of-network coverage for mental health treatments "according to the terms and conditions of [health] plans," the advocate said.
Out-of-Network Coverage
For example, an employee could opt for out-of-network coverage, but health plans still would be able to decide whether the coverage was medically necessary, the advocate added.
Another issue addressed by the Kennedy/Domenici proposal to the House involves medical management, the advocate said.
The House bill is silent on the issue of allowing health plans to use their own medical management and review criteria, although backers of H.R. 1424 say the bill would allow plans to use their own criteria. The Senate bill stipulates that plans be able to use their own medical management and review criteria.
Kennedy and Domenici have proposed that medical management criteria can be used, but they deleted a specific list of criteria from the compromise, the advocate told BNA.
But they included protections for medical management by allowing plans to operate as they currently do, as long as they comply with the parity requirements in the legislation, the advocate added.
The proposal also stipulates that any mental health benefits in force as a result of collective bargaining agreements would not have to be renegotiated as a result of congressional passage of parity legislation until the current contract expires, the advocate stated.
The House bill also would require plans to disclose medical necessity provisions upon request to consumers and providers, while the Senate bill does not. The Kennedy/Domenici proposal defers to the House on this issue, according to the advocate, who noted most health plans already provide such information to consumers.End of article graphic
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