Mental health parity bill provides flexibility for insurers

March 1, 2007

Legislation encouraging more equitable coverage of mental illness is moving forward in Congress following important modification of previous requirements. The Senate Health, Education, Labor and Pensions (HELP) Committee recently approved a bill that requires health plans to offer similar benefits for mental and physical illness in terms of deductibles, copayments and treatment limitations. But the new measure no longer mandates that group health plans cover mental illness.

WASHINGTON, D.C.-Legislation encouraging more equitable coverage of mental illness is moving forward in Congress following important modification of previous requirements. The Senate Health, Education, Labor and Pensions (HELP) Committee recently approved a bill that requires health plans to offer similar benefits for mental and physical illness in terms of deductibles, copayments and treatment limitations. But the new measure no longer mandates that group health plans cover mental illness.

Instead, the bill eliminates more restrictive standards for mental health coverage compared with medical and surgical benefits. Plans have to provide comparable treatment limitations, such as the number of covered hospital days and visits. Insurers would still be able to negotiate separate provider rates and to manage mental health benefits to ensure that treatment is medically necessary. The bill was expanded to include substance abuse as a mental health condition. Businesses with 50 or fewer employees are exempt from its requirements, and group plans can opt out if expenses for mental health coverage exceed a certain level.

As a result of lengthy negotiations to reach agreement on these issues, the measure gained support from health plans, employers and mental health advocates. Senator Pete Domenici (R-N.M.), who has led the fight for mental health parity for more than a decade, welcomed this progress toward extending a much more modest mental health parity bill that was enacted in 1996. Strong support from Senate HELP panel leaders, Senators Edward Kennedy (D-Mass.) and Mike Enzi (R-Wyo.), led to speedy committee approval of this "carefully crafted, balanced compromise bill," as Enzi described it.