Targets: All Members of the House of Representatives.

Action: Use the toll-free Parity Hotline, 1-866-parity4 (1-866-727-4894), to call your U.S. Representative.  (The Parity Hotline reaches the Capitol switchboard, which can connect callers to their members of Congress).

Message: “I am calling to ask that the Representative vote for H.R. 1424, the Paul Wellstone Mental Health & Addiction Equity Act.  Parity is a fair and affordable solution to insurance discrimination that will save lives and families.”

We have been pushing hard since 2001 to enact full mental health parity, and victory is finally within reach.  Following the Senate’s historic passage of the Mental Health Parity Act (S. 558) by unanimous consent in September, the House is poised to take up H.R. 1424 on Wednesday, March 5.  Parity supporters across America should contact their Representative NOW to urge his or her vote for H.R. 1424.  Senate and House leaders should continue to work together to reconcile differences between the versions and produce a bill that can pass in both chambers.

Support Letters Needed: National organizations are urged to fax their own letter supporting passage of H.R. 1424 ASAP to the sponsors: Rep. Kennedy at 202-225-3290 and Rep. Ramstad at 202-225-6351.

            Sample Letter:
Honorable Patrick J. Kennedy    Honorable Jim Ramstad
U.S. House of Representatives  U.S. House of Representatives
Washington, DC  20515             Washington, DC  20515

Dear Representatives Kennedy and Ramstad:

I am writing on behalf of the _________________ Association to urge House Members to vote YES on your bill H.R. 1424, the Paul Wellstone Mental Health & Addiction Equity Act.

Millions of American families who face structural discrimination against the mental health benefits in their health coverage will welcome passage of this legislation.  It is designed to close loopholes in the 1996 Federal parity law that has too often been evaded.  By requiring group health plans that provide mental health or substance use benefits to include them without different duration limits and financial requirements, this legislation will help people with mental disorders without a costly burden on employers.

We hope that House passage of your strong bipartisan bill will spur to completion the negotiations with the Senate on a bill that can become law this year.  Further delay is not acceptable.

Thank you for your leadership on this important issue.

Background: Reps. Patrick Kennedy (D-RI) and Jim Ramstad (R-MN) introduced the Paul Wellstone Mental Health and Addiction Equity Act, H.R. 1424, which now has 271 additional House Members as cosponsors.  Following approval of H.R. 1424 by the Ways & Means Health Subcommittee on Sept. 19, the sponsors issued this press statement: http://www.patrickkennedy.house.gov/index.asp?Type=B_PR&SEC={D13F97BD-4913-484F-AC33-664303B6CE91}&DE={CADC5567-963B-45C4-8516-85E09BCCF24C} 
The full Ways & Means Committee approved the bill on Sept. 26.  See http://waysandmeans.house.gov/legis.asp?formmode=item&number=588 for the text and analyses.
 
At www.equitycampaign.net, any supporter of this legislation can sign up to become a "citizen cosponsor" of the bill. 

The Legislation: The Paul Wellstone Mental Health and Addiction Equity Act of 2007 expands the Mental Health Parity Act of 1996 by prohibiting group health plans from imposing treatment or financial limitations on mental health benefits that are different from those applied to medical/surgical services.  The legislation applies only to group health plans already providing mental health benefits and exempts plans sponsored by small businesses of under 50 employees.

Fact Sheet by Sponsors (2-15-07):
Paul Wellstone Mental Health and Addiction Equity Act of 2007

Context
The bill amends the Mental Health Parity Act of 1996 to eliminate discriminatory provisions that erect obstacles to accessing care for Americans with mental health and addiction disorders.  The 1996 Act required equality only for annual and lifetime limits.  This bill requires equality across the terms of the health plan.

What the Bill Requires Plans To Do
The bill does not mandate group health plans provide any mental health coverage. However, if a plan does offer mental health coverage, then:

Equality in financial requirements.  The plan or coverage must ensure that any financial requirements applied to mental health and addiction benefits are no more restrictive or costly than the financial requirements applied to substantially all comparable medical and surgical benefits that the plan covers.  The categories for comparison are inpatient and outpatient, in-network and out-of-network.  Financial requirements include deductibles, copayments, coinsurance, and out-of-pocket expenses. The plan may not establish separate cumulative cost-sharing requirements (such as deductibles) that are only applicable to mental health and addiction benefits.

Equality in treatment limits.  The plan or coverage must also ensure that the treatment limitations applied to such benefits are no more restrictive than the treatment limitations applied to substantially all comparable medical and surgical benefits that the plan covers. Such treatment limitations include limits on the frequency of treatment, number of visits, days of coverage, or other similar limits on the scope and duration of treatment.

Coverage of all diseases covered by Congressional plans.  The plan or coverage must cover the same range of mental illnesses and addiction disorders covered by the federal employee health plan that Members of Congress use.

Equality in out-of-network coverage.  If the plan or coverage offers out-of-network benefits for medical and surgical benefits under the plan, then it must also offer out-of-network coverage for mental health and addiction benefits.

Scope of Coverage – Small Business and Individual Market Exemption
The mental health parity requirements apply to group health plans with 50 or more employees.

It does not apply to employers with less than 50 employees are exempt from this Act, nor does it affect the individual insurance market.

                              
Cost Exemption
If a health plan experiences increased actual total costs of coverage as a result of the equity requirements that exceed 2% during the first plan year or 1% in subsequent years, it is exempt from the equity requirements for the following plan year.  The exemption is good for one year, after which the plan would again need to comply.

Effect on State Mental Health Parity Laws
The bill would establish a federal floor, but not a ceiling.  State laws would need to meet the standards in the bill as a minimum, but would not be prohibited from establishing stronger requirements.  The bill would not preempt state laws mandating that mental health or addiction benefits be covered or governing medical management or other aspects of insurance regulation.

Transparency in Medical Management
Plans will be required to make information about criteria used for medical necessity determinations relating to mental health and addiction treatment available to current and potential beneficiaries and contracting providers, and to make available reasons for denials of benefits.

Enforcement
The bill amends an Internal Revenue Code provision that imposes a tax of $100 per day per beneficiary on employers who do not comply with the equity requirements of this bill.

Government Accountability Office Reports
The bill requires GAO to produce three reports:
A study of the bill’s impact on such things as health care costs, access to coverage, quality of care, government spending on mental health and addiction treatment and other public services, and use of medical management by plans.
A biannual assessment of obstacles beneficiaries face in obtaining appropriate care under their health plans.
A study of the availability and use of uniform patient placement criteria that can help guide health plans’ determinations of medical necessity.

Effective Date
The equity requirements of the bill will be effective in the first plan year that begins on or after January 1, 2008.

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Resources: Fact sheets on parity and rosters of organizations supporting the House and Senate bills may be found at http://www.mhlg.org/page18.html.

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