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Friday, March 07, 2008

House Passes Paul Wellstone Mental Health and Addiction Equity Act

On Wednesday, the House passed the the Paul Wellstone Mental Health and Addiction Equity Act, H.R. 1424, which strives to end discrimination against those seeking mental health care. Speaker of the House Nancy Pelosi's comments in favor of the bill:

How will this bill benefit returning veterans?

Pelosi: “This legislation will be especially relevant for our returning veterans from Iraq and Afghanistan who later become employed in the private sector. This will be potentially lifesaving for those brave men and women who served in the National Guard and Reserves, but who don’t receive VA care for their entire lives.”

In educational interest, article(s) quoted from extensively.

From the Minneapolis-St. Paul Star Tribune:

Mental health advocates praised Wednesday's landmark vote by the U.S. House approving addiction and treatment legislation named for the late Sen. Paul Wellstone. The bill, which would require insurers to cover mental health in the same way as physical ailments, had long been championed by the Minnesota Democrat, who died in a 2002 plane crash.

"This is a very historic moment," said his son David Wellstone, who addressed a Capitol Hill rally that included former First Lady Rosalynn Carter and singer-turned-activist Carole King. "This legislation is very close to my heart."

The 268-148 House vote sets the stage for negotiations with the Senate, which passed a less stringent version of the bill last year. Key backers of the House bill, including Reps. Jim Ramstad, R-Minn., and Patrick Kennedy, D-R.I., say it provides greater access to treatment for people with addiction and mental health problems.

"This is not just another public policy issue," said Ram stad, a recovering alcoholic. "It's a matter of life and death for millions of Americans."

Industry groups that back the Senate version argue that the House bill would go too far in mandating expensive treatments and drive up health insurance premiums. They portray the Senate bill, which passed unanimously, as a better compromise among the business, insurance and mental health communities.

The Senate bill was sponsored by Kennedy's father, Massachusetts Democrat Edward Kennedy, along with GOP Sens. Pete Domenici of New Mexico and Mike Enzi of Wyoming. The younger Kennedy will negotiate with his father on a compromise.

Advocates of the Paul Wellstone Mental Health and Addiction Equity Act say it would end the stigma of mental illness by treating it on a par with physical maladies. "We're no longer going to allow people to languish in the shadows," said Kennedy, who has had his own bout with an addiction to painkillers.

While the congressional debate is far from over, champions of the Wellstone bill celebrated the House vote as the culmination of 12 years of activism on the issue.

Said Ramstad: "We know that Paul Wellstone is smiling down on us today."

Legislation specifics:

* Specifically, the bipartisan bill prohibits insurers and group health plans from imposing treatment or financial limitations when they offer mental health benefits that are more restrictive from those applied to medical and surgical services.

* The bill applies only to insurers and group health plans that provide mental health benefits. It also exempts businesses of 50 or fewer employees; and businesses that experience an overall premium increase of 2 percent or more in the first year and 1 percent in subsequent years.

* Over the last eight years, the Federal Employee Health Benefits Program (FEHBP) has made “parity” coverage for mental health care available to Members of Congress and 8.5 million other federal employees. Research has shown that there has been no significant cost increase attributable to this parity requirement in FEHBP.

* Furthermore, the nonpartisan Congressional Budget Office has estimated a miniscule impact on premiums for the mental health parity bill – just two-tenths of one percent.

* The two offsets in this bill were included in the CHAMP (Children’s Health and Medicare Protection) Act, which the House passed on August 1, 2007. One increases the rebate (or discount) that pharmaceutical companies are required to provide to State Medicaid programs for drugs provided to Medicaid beneficiaries. The second prohibits physicians from referring patients to hospitals in which they have an ownership interest (with a grandfather provision).

Following is an overview of some of the bill’s key provisions.

Requires equity in financial requirements. Under the bill, an insurer or group health plan must ensure that any financial requirements – such as deductibles, copayments, coinsurance, and out-of-pocket expenses – applied to mental health and addiction benefits are no more restrictive or costly than the financial requirements applied to comparable medical and surgical benefits that the plan covers.

Requires equity in treatment limits. Under the bill, a group health plan must ensure that the treatment limitations – such as frequency of treatment, number of visits, and days of coverage – applied to mental health and addiction benefits are no more restrictive than the treatment limitations applied to comparable medical and surgical benefits that the plan covers.

Does not mandate mental health benefits. The bill does not mandate insurers or group health plans to provide any mental health coverage. The bill’s provisions only apply to plans that choose to offer mental health coverage.

Exempts certain businesses. The bill exempts small businesses with 50 or fewer employees. It also exempts those businesses that experience an overall premium increase of 2 percent or more in the first year and 1 percent in subsequent years.

Covers same mental illnesses and addiction disorders as FEHBP. The bill ensures that group health plans cover the same range of mental illnesses and addiction disorders covered by the Federal Employees Health Benefits Program – i.e., the mental illnesses and addiction disorders included in the mental health practitioner’s guide, the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Does not mandate out-of-network benefits. The bill simply states that if a plan already offers out-ofnetwork benefits, it must offer out-of-network benefits on the same terms for mental health services as it does for medical and surgical services.

Does not pre-empt stronger state parity laws. The bill establishes a federal standard, a floor of protections that would apply to job-based health coverage, but allows states to be more protective of their
residents with stronger parity laws.

Explicitly permits medical management of health benefits. The bill allows the use of medical management tools that are based on valid medical evidence and pertinent to the patient’s medical condition so that specific coverage is not arbitrary in its application and more transparent to the patient.

Provides for enforcement. The bill provides remedies to protect beneficiaries’ rights and permits enforcement of the bill’s equity requirements by the Internal Revenue Service, the Department of Health and Human Services, and the Department of Labor.

More from the Wall Street Journal:

Now that Congressman Patrick Kennedy has won passage in the House for his mental health parity bill, he has to work out a compromise with the Senate, which has passed a much less restrictive version of the bill. Kennedy will be sitting across the negotiating table from one of the old lions of the Senate: his father, Ted Kennedy (pictured right), a driving force behind the Senate bill.

The Senate bill, backed by business and insurance groups, would give insurers that chose to cover mental health wide latitude in which conditions to cover. The House bill would require those that offered mental health coverage to cover all mental health and substance abuse disorders in the standard manual of mental illness, the WSJ reports. Both bills would forbid companies from charging higher copays or putting more stringent limits on mental health care than on other kinds of care.

Some Republican backers of the Senate bill have said the House version will never make it in the Senate. Kennedy the elder disagrees. “I don’t accept that,” he told the Providence Journal yesterday, just before walking over to the House to watch the debate over the bill. But he did say the differences are “something we’ll have to work on.”

Kennedy the younger, a Rhode Island Democrat, told the Boston Globe that he and his dad, a Massachusetts Dem, have been trying to figure out ways to bridge the legislation gap. “We’ve discussed strategies and ways we can try to move this,” he said.

Last year, the Diane Rehm Show had the elder Kennedy (and others) on to discuss the Mental Health Parity Act. Another piece of legislation, more specific to our troops, championed by the younger Kennedy is the Psychological Kevlar Act.

Personal note: I was honored to be questioned by Rep. Kennedy in a December House Veterans Affairs Committee hearing.

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