April 16, 1999

As the United States Senate prepared to go into recess in late March, parity champions Paul Wellstone (D-Minn.) and Pete Domenici (R-N.M.) were drafting legislation to close some of the loopholes in the 1996 Mental Health Parity Act (MHPA).

APA's Division of Government Relations (DGR) has worked with Wellstone and Domenici for years on parity legislation. In particular, DGR played an important role in ensuring that a 1 percent opt-out exemption required affected health plans to comply with the law before opting out rather than opting out based on anticipated cost increases, observed Shelley Stewart, DGR's deputy director for federal relations.

The Senate went into recess March 29 and was scheduled to return at press time. Domenici's press secretary, Chris Gallegos, said he anticipated that a parity bill would be introduced some time this spring (likely prior to APA's annual meeting).

The proposed bill, if introduced as anticipated, would tighten up the 1996 MHPA. That law conditionally equalized annual and lifetime aggregate limits for treatment of mental illness and physical illness in group health plans. But it exempted businesses with 50 or fewer employees and did not require parity with respect to copays and inpatient-day or outpatient-visit limits. It also provided an opt-out provision for any health plan that experienced a cost increase of 1 percent or more as a result of the increased mental health coverage.

According to a working draft of the bill circulated by Domenici's office, the proposed bill would

• provide full parity for specified adult and child mental illnesses;


• prohibit limits on the number of covered hospital days and outpatient visits for all mental illnesses;


• alter the exemption so that only businesses with 25 or fewer employees would be exempt; and


• eliminate the September 30, 2001, sunset provision in the MHPA, making the law permanent.

The bill would still permit an opt-out if a company's insurance costs increased by more than 1 percent as a result of implementing the law's provisions. And it would still apply only to group health plans already providing mental health benefits and would continue to exclude coverage for benefits relating to alcohol and drug abuse treatment.

The bill would provide full parity for the following "severe biologically based mental illnesses":

• schizophrenia,


• bipolar disorder,


• major depression,


• autism,


• obsessive-compulsive and "severe panic disorders," and


• "other severe and disabling mental disorders such as severe anorexia and severe attention-deficit-hyperactivity disorder."

The draft notes that the term "severe biologically based mental illness" refers to the listed illnesses "as defined by current medical science in conjunction with the DSM IV."

Ronald Shellow, M.D., chair of APA's Joint Commission on Government Relations, hailed the effort to broaden parity.

"Senators Pete Domenici and Paul Wellstone have courageously led the fight for parity for people suffering from mental disorders," said Shellow. "This proposed legislation [if introduced] will be one more step along the way for full parity for our patients suffering from mental disorders."

Referring to the bipartisan nature of the two Senators' collaboration, Shellow added that "any time that the two of them can get together and bridge the Republican-Democratic gap, we are certainly in favor of it. APA is in favor of anything it can do to close the loopholes in the 1996 MHPA for the benefit of our patients.-R.B.K.