H.R. 1424, the “Paul Wellstone Mental Health and Addiction
Equity Act”
Introduced in House of
Representatives
In the House of Representatives, Rep. Patrick Kennedy
(D-RI) and Rep. Jim Ramstad (R-MN) introduced H.R. 1424, the “Paul Wellstone Mental Health and Addiction Equity Act” with 254 original
House cosponsors. H.R. 1424 would expand the Mental Health Parity Act of 1996 by requiring group health plans that offer benefits for mental health
and addiction to do so on the same terms as benefits for substantially all medical and surgical benefits. The Kennedy-Ramstad
legislation is modeled after the Federal Employees Health Benefit Program, which covers Members of Congress and other federal workers and dependents
and which implemented equality in mental health and addiction coverage in 2001. The legislation includes a provision that no State
laws that provide greater consumer protections, benefits, methods of access to benefits, rights or remedies would be preempted. In
regards to scope of coverage, H.R. 1424 applies to group health plans with 50 or more employees.
Key provisions of the legislation include:
Treatment Limits:
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If the plan or coverage does not include a
treatment limit (defined as a limitation on the frequency of treatment, number of visits or days of coverage, or other similar limit on the duration
or scope of treatment under the plan or coverage) on substantially all medical and surgical benefits, the plan or coverage may not impose any
treatment limit on mental health and substance-related disorder benefits that are classified in the same category. If the plan or
coverage does include a treatment limit on substantially all medical and surgical benefits, the plan or coverage may not impose such a treatment
limit on mental health and substance-related disorder benefits that is more restrictive than the limit that is applicable to the medical and surgical
benefits.
Financial Requirements:
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If the plan or coverage does not include a
financial requirement, such as a deductible, a limitation on out-of-pocket expenses, or similar financial requirement on medical and surgical
benefits, the plan or coverage may not impose such a requirement on mental health and substance-related disorder benefits.
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If the plan or coverage includes a deductible, a
limitation on out-of-pocket expenses, or similar financial requirement that does not apply separately to individual items and services on
substantially all medical and surgical benefits, it should be applied to both medical and surgical benefits and to mental health and
substance-related disorder benefits in the same manner. Financial requirements cannot be imposed on mental health and
substance-related disorder benefits in a way that is more costly than the requirement applicable to other comparable medical and surgical
benefits.
Availability of Plan Information:
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The criteria for medical necessity determinations
made under the plan with respect to mental health and substance-related disorder benefits shall be made available by the plan administrator (or the
health insurance issuer offering such coverage) to any current or potential participant, beneficiary, or contracting provider upon
request.
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The reason for any denial of reimbursement or payment for services with
respect to mental health and substance-related disorder benefits shall, upon request, be made available by the plan administrator (or the health
insurance issuer offering such coverage) to the participant or beneficiary.
Additional Key Provisions:
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spending on public services, such as the criminal justice system,
special education, and income assistance programs;
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the use of medical management of mental health and
substance-related disorder benefits and medical necessity determinations by group health plans (and health insurance issuers offering health
insurance coverage in connection with such plans) and timely access by participants and beneficiaries to clinically-indicated care for mental health
and substance-use disorders; and
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other matters as determined appropriate by the
Comptroller General.
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Within 18 months of the date of the enactment of
this Act, the Comptroller General shall submit to each House of the Congress a report on availability of uniform patient placement criteria for
mental health and substance-related disorders that could be used by group health plans and health insurance issuers to guide determinations of
medical necessity and the extent to which health plans utilize such criteria. If such criteria do not exist, the report shall include recommendations
on a process for developing such criteria.
H.R. 1424 was referred to the House Committee on
Energy and Commerce, and in addition to the House Committees on Education and Labor, and Ways and Means. More information regarding H.R. 1424,
including the complete text of the bill, can be found at http://thomas.loc.gov.
Legislation to Lift the Medicaid IMD Exclusion Introduced in the House
On February 16th, Congresswoman Eddie Bernice Johnson
(D-TX) introduced H.R. 1155, legislation that would expand Medicaid coverage for people with alcohol and drug addiction histories and mentally ill
people. Under current law, reimbursement for all Medicaid-covered services provided to recipients between 22 and 64 years of age in residential
treatment facilities known as Institutions for Mental Diseases (IMDs) are not allowed. IMDs are facilities with more than 16
treatment beds that provide care for individuals with "mental diseases," with substance abuse included in the definition of "mental
diseases." Although this exclusion was intended to prevent federal subsidies for large mental hospitals it has also been applied
to cover free-standing residential substance abuse treatment programs and mental health programs. Under H.R. 1155, Title XIX of
the Social Security Act would be amended to remove this exclusion from medical assistance under the Medicaid program.
Following its introduction, H.R. 1155 was referred to
the House Energy and Commerce Committee where the legislation awaits review. Members co-sponsoring H.R. 1155 are: Congressmen
Robert Brady (D-PA), Steve Cohen (D-TN), William Jefferson (D-LA), and Michael McNulty (D-NY). Text and status of H.R. 1155 can be
found at: http://thomas.loc.gov.
House Subcommittee Holds Hearing on Recent Chances to the TANF/Welfare Program; Subcommittee Members Express Concern over Changes
in Coverage for People Receiving Drug and Alcohol Addiction Treatment and Other Rehabilitative Services
On Tuesday, March 6th, the House Ways and Means
Subcommittee on Income Security and Family Support held a hearing that focused on the number of recent changes made to programs assisting low-income
families. Subcommittee Chairman Jim McDermott (D-WA) and Ranking Member Jerry Weller (R-IL) led the hearing.
Additional members participating included: Representatives Fortney “Pete” Stark (D-CA), Artur Davis (D-AL), John Lewis (D-GA),
Shelley Berkley (D-NV), Chris Van Hollen (D-MD), Wally Herger (R-CA), Dave Camp (R-MI) and Jon Porter (R-NV).
Ms. Sidonie Squier, Director of the Office of Family
Assistance, Department of Health and Human Services, provided testimony to the Subcommittee on the first witness panel. Witnesses
presenting on the second panel were: Robin Arnold-Williams, Ph.D., Secretary of the Washington State Department of Social and Health Services; David
A. Hansell, Esq., Acting Commissioner of the New York State Department of Temporary Disability Assistance; Nancy K. Ford, Administrator of the
Division of Welfare and Supportive Services in Nevada; Mary Dean Harvey, Director of the Georgia Department of Human Resources Division of Family and
Children; and Bruce Wagstaff, Director of the Sacramento County Department of Human Assistance.
Following Ms. Squier’s testimony
on recent changes to the TANF (Temporary Assistance to Needy Families) program, Subcommittee Chairman McDermott discussed the importance of removing
barriers to employment, in particular raising the issue of people in need of alcohol and drug addiction treatment. Chairman
McDermott alluded to recent changes to the regulations governing the TANF program that restrict the amount of time that activities such as alcohol
and drug treatment count as work participation under TANF. Under the new regulations, alcohol and drug addiction treatment is now
classified as a job readiness/job search activity under TANF and the regulations impose a six-week time limit, with four consecutive weeks allowed,
on the amount of addiction treatment that now counts toward the TANF work requirement.
Chairman McDermott expressed concern about placing
drug and alcohol addiction treatment in the job readiness category and the accompanying time limitation for coverage. Ms. Squier
responded that addiction treatment fit best in the job readiness category and expressed that the Bush Administration thought that TANF coverage for
drug treatment would actually expand under the new regulations. Under the old law, Ms. Squier asserted, only 14 States counted
drug treatment and mental health services toward the work requirement, including 5 States that counted those services as job readiness
activities. Under the new regulations, Ms. Squier expressed that 36 additional States would count these rehabilitative services
toward their work requirement. Ms. Squier further said that she agreed that if an individual needed more time in addiction
treatment, that the State should allow the individual to continue getting treatment. However, Ms. Squier did emphasize that fifty
percent of the State’s individuals don’t have to be included in the participation rate and expressed that States could choose to not
count individuals in treatment for addiction within their participation rate.
A number of other witnesses and
Subcommittee members expressed concerns about the changes to the TANF program, including how parents would be able to secure high quality child care
and whether the child poverty rate would continue to increase. Congressman Chris Van Hollen expressed concern about how the changes would affect
people with disabilities. Ms. Ford, Administrator of the Nevada Division of Welfare and Supportive Services, and Mr. Wagstaff,
Director of the Sacramento County Department of Human Assistance, both cited that they were worried that changes to the program would result in
families losing critical assistance. Mr. Wagstaff also spoke about the time limitation on job readiness programs, including drug
and alcohol addiction treatment services. Speaking of methamphetamine addiction, Mr. Wagstaff asserted that people addicted to
methamphetamine often need additional time in treatment and that limiting the amount of time that can be covered to four to six weeks was a source of
great concern.
Additional information about the Subcommittee hearing
on changes to the TANF program, including full witness statements, can be found at: http://waysandmeans.house.gov/hearings.asp?formmode=detail&hearing=533.
U.S.
Surgeon General Issues Call to Action on Underage Drinking
On March 6th, the United States Acting Surgeon
General issued his first Call to Action on underage drinking. Kenneth Mortisugu, M.D., M.P.H. made recommendations for local
governments, schools, parents, other adults and young people themselves aimed at helping decrease drinking among youth. The six
goals that the Surgeon General developed in collaboration with the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the Substance Abuse
Mental Health Services Administration (SAMHSA) are:
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Fostering changes in society that facilitate health
adolescent development and that help prevent and reduce underage
drinking
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Engaging parents, schools, communities, all levels
of government, all social systems that interface with youth, and youth themselves in a coordinated national effort to prevent and reduce underage
drinking and its consequences
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Promoting an understanding of underage alcohol
consumption in the context of human development and maturation that takes into account individual adolescent characteristics as well as environmental, ethnic, cultural, and gender differences
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Conducting additional research on adolescent
alcohol use and its relationship to development
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Working to improve public health surveillance on
underage drinking and on population-based risk factors for this behavior; and
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Working to ensure that policies at all levels are
consistent with the national goal of preventing and reducing underage alcohol consumption.
Following a decline in tobacco and illicit drug use,
the 2005 National Survey on Drug Use and Health estimates there are eleven million underage drinkers in the United States; more than 7.2 million are
considered binge drinkers. Emphasizing the importance of early intervention, in the underage drinking Call to Action the U.S.
Surgeon General stressed that young people who start drinking before the age of fifteen are five times more likely to have alcohol-related problems
later in life. Dr. Mortisugu also cited new research that looks at the harms of alcohol to the developing adolescent brain and
reiterated that alcohol is the most heavily used substance by American youth.
More information about the Surgeon General’s
Call to Action, including an accompanying report with additional information about underage drinking, can be found at:
http://www.surgeongeneral.gov/topics/underagedrinking/.
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