ACT NOW to Push for Mental Health Parity!
June 25, 2007
U.S. Senators Pete Domenici (R-NM), Edward M. Kennedy (D-MA) and Mike Enzi (R-WY), Senate sponsors of federal parity legislation (S 558), are expected to quickly press for action on a revised version of their bill to provide equivalent health plan coverage for the treatment of mental illness.
Contact both of your U.S. Senators and urge them to support immediate passage of S 558 and oppose any amendments to weaken the legislation.
Call or Email your Senators today! A special toll-free Parity Hotline has been set up 1-866-parity4 (1-866-727-4894). The hotline reaches the U.S. Capitol switchboard, which can connect you to your Senators. To reach your Senators via email, go to NAMI's Legislative Action Center.
Mental illness is real – just like cancer, diabetes and heart disease.
Treatment works, yet most go without.
There is no justification – either medical or economic – for health plans to cover mental illness on different terms or conditions than other illnesses.
The time has come to end insurance discrimination against people with mental illness and their families.
Special Note for Senate cosponsors of S 558:
If your Senator is a cosponsor of S 558, please thank him/her for supporting parity and urge them to help move the bill forward this week. A list of cosponsors of S 558 can be found here.
A helpful Q&A guide on S 558 can be found here.
Previous NAMI alerts on S 558 can be found here and here.
Background on Revised Version of S 558:
The Senate parity bill passed through the Senate Health, Education, Labor and Pensions (HELP) Committee on a strong bipartisan vote on February 12th. Since then, Senate sponsors have been preparing changes to address concerns about how the bill would interact with existing state parity laws and are expected to offer a "Manager’s Amendment" to the full Senate as a revised version of S 558.
Description of the "Manager’s Amendment" to S 558:
As part of the "Manager’s Amendment," the Senate sponsors have replaced references to "substance abuse" with "substance use disorder" and have made the following key changes to the special preemption rule in S 558:
The word "parity" is inserted into the special preemption rule to clarify that only state parity laws are impacted by the preemption provisions. State parity laws remain in place, with the exception that state financial and treatment requirements are replaced by subsection (a) and any cost exemption (or lack of one) is replaced by (e).
The letter "(b)" is dropped from the preemption rule. This clarifies that state laws or provisions of state laws that regulate the management of the delivery of care are not preempted by S 558. This change ensures that important state consumer protection laws are preserved.
A clarification has been added to the preemption rule to provide that state out-of-network requirements are not preempted.
The preemption rule is further clarified to specifically preserve state laws that require coverage of "specific items, benefits, or services."
A severability clause has been added making clear that all provisions of state laws that are not specifically preempted by S 558 would be preserved if a state court were to preempt part of a state law.
The revised version of S 558 not only makes it clear that the scope of any preemption is very narrow, but additional changes in language make clearer what is NOT preempted, including:
- state insurance laws relating to the individual market or to employers with 50 or fewer employees;
- state insurance laws that require coverage of specific items, benefits, or services (including for specific mental health conditions);
- state insurance laws relating to the provision of out-of-network mental health coverage; and
- state laws regarding the management of mental health benefits and reimbursement or provider payment rates.
Other provisions of S 558:
S 558 creates a national standard that would require that treatment limitations and financial requirements be no more restrictive than they are for substantially all medical and surgical benefits. This would set a no-discrimination standard in lieu of state laws or standards setting different duration of treatment and/or financial requirements. While this would remove minimum durational requirements for treatment in some states, it would set a uniformly fair standard that provides for coverage that is equivalent to that provided for other illnesses.
S 558 sets a national standard under which a health plan can become exempt from compliance with parity because of increased costs. Unlike many state laws under which initial cost-experience enables a plan to escape compliance indefinitely, S 558 establishes a mechanism for an exemption for a single year at a time based on actuarially-certified experiential data. A plan is first required to implement the parity law before seeking an exemption and subsequent one-year exemptions are possible only after reinstating compliance with parity requirements. Given the administrative costs of shifting in and out of compliance, experts believe it unlikely that many plans will seek an exemption.