MH Groups Applaud Changes in Senate Parity Bill

Senate negotiations led in June to a draft of a mental health parity insurance coverage bill that has the backing of a mental health coalition, which includes APA and an influential group of business leaders.

The measure would amend the Mental Health Parity Act of 1996, which required insurance equality only for annual and lifetime dollar limits. The bill (S 558) and a similar House measure (HR 1424) would require health plans that offer mental health coverage to provide mental health benefits at parity with benefits for other types of health care.

Although the Senate Health, Education, Labor, and Pensions (HELP) Committee approved the Senate bill sponsored by Sen. Pete Domenici (R-N.M.) in March, other senators raised concerns that threatened to stall the bill before it reached the Senate floor. During subsequent negotiations on the Senate bill, APA pushed for changes that would expand protections for existing state parity laws that are more stringent than those proposed in the federal legislation. District branches in states with strong mental health parity laws raised concerns about the impact of preemption wording in the Senate legislation (Psychiatric News, May 4).

The negotiations changed the bill's controversial provisions that would preempt the state laws that mandated coverage of specific “minimum benefits packages,” including those for specific mental health conditions. Although the new measure does not explicitly preempt those laws, the broader federal parity measure would “wrap around and most likely render such state laws moot,” according to APA's Department of Government Relations.

The new language would require health plans to provide equal coverage for out-of-network mental health services as they provide for out-of-network services for other types of health care. However, they would not be required to offer an out-of-network benefit for mental health services, if they did not already do so. The added language also clarified that insurance plans are not required to drop any out-of-network mental health benefits they already offer.

The negotiated changes, expected to be offered as an amendment to the bill, also would drop an earlier preemption of state laws that regulate the practice of managed care.

In addition, the negotiated changes add language that specifies that if any part of state law is explicitly preempted by federal law, remaining provisions of state law would remain in effect.

“We worked very hard to get these changes to the Senate bill,” said Nicholas Meyers, director of APA's Department of Government Relations, about recent negotiations between congressional staff, mental health advocates, and representatives of the business community and the insurance industry.

Other negotiated changes include language specifying that the bill would not preempt state parity laws that applied to employers with 50 or fewer employees. The bill's language that referenced “substance abuse treatment” was changed to “substance use disorder treatment,” due to psychiatrists' concerns that the old language could limit the bill's scope becauseit varies from the field's terminology.

Although similar parity bills were introduced in both the House and Senate, supporters said the differing rules in the two chambers require a greater degree of compromise in the Senate measure. The House bill includes no preemption language regarding state laws and a more-inclusive definition of mental illness linked to DSM-IV.

Meyers said that the Senate would not, however, pass a parity measure similar to the House version.

Representatives of several New York state district branches sent APA a letter in April outlining their concerns about the Senate bill. In June, Vermont's Department of Banking, Insurance, Securities, and Health Care Administration sent House Speaker Nancy Pelosi (D-Calif.) an analysis that also outlined areas of its state parity law that the Senate bill might override. Vermont officials called for federal legislation that would establish a base level of mental health parity requirements and allow states to add onto that with their own laws.

An analysis of the proposed changes by the Coalition for Fairness in Mental Illness Coverage—to which APA belongs—concluded that the modified preemption provisions will not disrupt state parity coverage.

Meyers said that it is possible that some patients in a few states would lose specific state-mandated benefits, such as coverage for a minimum number of inpatient days, if the Senate bill passes. Those losses would be balanced, he pointed out, with a historic requirement that plans provide mental health coverage at parity.

“APA is, of course, very sensitive to unintended effects of a federal parity law but in the Senate I don't see the removal of all preemption language is in the cards,” Meyers said.

He noted that the current draft has led to the first-ever public support of key business and insurance groups of parity legislation that increases the coverage available to workers.

“If we squander this opportunity to pass a very good bill, I don't believe we will have another opportunity for the foreseeable future,” Meyers said.

Parity advocates hope the full Senate will consider the bill in July, although that has not been confirmed, with passage in one chamber expected to spur action in the other. ▪