Review: Paul Wellston Mental Health and Addiction Equity Act of 2007

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Changes are underway to create equity in group health plan policies for the treatment of mental health and substance abuse diagnosis. On March 6th the House of Representatives passed the Paul Wellston Mental Health and Addiction Equity Act of 2007. Support for the legislation was overwhelming at 268 for, and 148 against. The bill requires group health insurers and health plans to create parity between coverage for substance abuse and mental health treatment and medical / surgical benefits. In particular, the bill ensures that out-of-network mental health costs will be covered just as out-of-network medical and surgical services are. Additionally, the bill ensures that diagnosis for mental health and substance abuse, which have been given by the medical community, are covered. Charles B. Rangel, Ways and Means Committee Chairman, said, “This bill rights an unconscionable wrong… Today we have made a great stride toward eliminating discrimination against people with mental illness and addiction, and I am proud of the House for working to correct this great injustice.” Obviously, the bill has the overwhelming support of advocates as well as organizations that treat mental illness and addiction. The following is an excerpt from Speaker Nancy Pelosi’s website, a forum that discusses current legislation, which gives an overview of the bill:

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).

Click here to read more from Speaker Nancy Pelosi’s website

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