Ask the Scholar
Document scope · 1 page
Scholar
Ask about this object, its catalog metadata, its source description, or the page inventory.
For page-specific OCR and visual context, open one of the page chats.
Scholar Source Context
Document identity
localId
34429040
label
Parity/48 Hours
core
doc
dtoType
document
citationUrl
pageCount
1
Source metadata
id
34429040
sourceUrl
contentType
document
title
Parity/48 Hours
citationUrl
collections
Records of the First Lady's Office (Clinton Administration)
Jennifer Klein's Files
imageCount
1
hasImages
yes
source
import
hasTranscription
no
Source extras
naId
34429040
levelOfDescription
fileUnit
otherTitles
42-t-7422560-20140536S-039-011-2016
recordType
description
ocrSource
nara-archive
Single page context
seq
1
pageIndex
0
type
document
mediaId
47a88a68803d9e72
ocrText
07/30/96
09:40
OMB AD HP
002
002
07/29/96
18:25
JLW-04-96 16:44 FROM.CBO/BAD/HRCEU
ID.202 226 2820
PAGE
1/3
TO:
Dean Rosen, Rebecca Jones
FROM:
Jeff Lemieux, CBO
SUBJ:
Preliminary Federal Cost Estimate: Limited Mental Health Parity Proposal
DATE:
6/4/96
I have attached a preliminary federal cost estimate of your proposal for a limited parity
for mental health parity. Over the ten years between 1997 and 2006, CBO and the Joint
Committee on Taxation (JCT) estimate that the revised proposal mental health parity
would increase the deficit by about $1.9 billion
The revised proposal is different from the proposal in the Senate-passed plan in several
ways.
Substance abuse benefits would not be subject to any mandates for parity,
Parity would apply only to two types of insurance items as specified in the
proposal:
1.
Aggregate lifetime limits
DRAFT
2.
Aggregate annual limits
Plans serving employers with 25 or fewer employees would be exempt,
Plans would be allowed to have separate insurance products for mental and
medical health coverage, with more stringent thresholds of management for mental
health care, and
Medicare and Medicaid would be exelopt
(In its previous estimate, CBO had assumed that these last two clarifications would be
made as the legislation progressed Therefore, they do not change the federal cost
estimate.)
The Congressional Research Service estimates that premiums for a typical fee-for-service
plan using customary management teclmiques to control costs would initially increase by
0.4 percent under this proposal. This estimate has not been adjusted for the impact the
proposal would have on certain managed care plans or the fact that employers with 25 or
fewer employees would be exempt. Both adjustments could lower the estimated cost of
06-04-96 04:55PM P001 #20
Mental Health Parity Compromise
1. PARITY FOR AGGREGATE LIFETIME AND ANNUAL PAYMENT LIMITS. If a
health plan has a lifetime or annual limit on what it will spend for medical or surgical services, that
plan must either include services for mental illness in that total, or have a separate limit for mental
illnesses that is no more restrictive than the medical/surgical limit. If a health plan does not have
either of these limits for medical/surgical services, it may not limit these aspects of mental health
services.
The compromise proposal:
- does not determine what a plan must charge for mental health services;
- does not require parity for copays and deductibles;
- does not require parity for inpatient hospital days or outpatient limits;
- excludes substance abuse and chemical dependency;
- excludes MEDICARE and MEDICAID;
- includes the Federal Employee Health Benefit Program;
- allows for managed care and mental health "carve-outs;"
- does not apply to individual health coverage;
- exempts small businesses with 25 or fewer employees.
Cost:
Relative to the original Domenici/Wellstone amendment passed by the Senate, the cost to
both private sector premiums and the federal government has been cut by 90%.
Initial Premium +
Employer
Loss Revenue
(Industry-wide)
Contribution
To Gov't
Original
4.0%
+1.6%
$16.17 billion
Compromise
0.4%
+0.16%
$ 1.8 billion
2, A COMMISSION ON MENTAL HEALTH PARITY. The Commission's purpose is to
review and analyze data and studies on the prevalence of mental illnesses, the efficacy and cost
effectiveness of treatment for mental illnesses and to develop strategies for implementation of fair
and equitable health coverage for individuals with mental illnesses. The Commission should
submit its final report no later than September 1, 1998. The final report should include strategies
and a timetable for implementing its recommendations.
MEMORANDUM
September 20, 1996
TO:
John Hilley
Jack Lew
Nancy-Ann Min
Jen Klein
Jack Ebeler
Christie Schmidt
Darrel Grinstead
FROM:
Chris Jennings
SUBJ:
48 Hour Rule
Following our conversation this morning, I have composed a draft statement/colloquy on the
48 hour rule for your review. It is my understanding that the conference report has already
been filed. Therefore, our most likely course of action may be drafting a colloquy between
the appropriate members to take place on the floor prior to a final vote.
Despite the initial positive reaction by Representative Jerry Lewis (R-CA), we have
subsequently learned this issue may create major problems for Representative Solomon and
other Republicans. It is our understanding that they explicitly made a decision not to refer to
Medicaid because they want to treat Medicaid separately and they do not want to bring
another committee into the discussion (e.g., Senate Finance Committee). Senator Bradley is
concerned that raising this issue may put the rest of the bill at risk. However, he will defer to
us, if we believe raising the issue can lead to successful resolution without undermining the
recently agreed to provision.
I would like to have a brief conference call on this issue before the end of the day.
DRAFT
DRAFT
DRAFT
DRAFT
DRAFT
DRAFT
Application of 48-Hour Rule to Medicaid Contracts with Certified Health Plans
It is our understanding that it is the intention of the statutory language (approved by the
VA/HUD conferees) for the 48-hour rule provisions to apply to State-certified health plans
that contract out with Medicaid. In other words, just as any other health plan in the nation
must comply with the 48-hour rule, so too shall any health plan that contracts out with
Medicaid. It is also our understanding that the statutory language was scored consistent with
this interpretation. We believe the language is somewhat vague on this point and believe, at
minimum, additional report language is necessary to clarify the intent of this provision.
Suggested Colloquy
Question:
It is my understanding that the intent of the statutory language for the 48-hour
rule requirements to be applied to any State-certified health plan that contracts with Medicaid.
Just as any other health plan in the nation must comply with the 48-hour rule, so too shall
any health plan that contracts with Medicaid. Is this correct?
Answer:
Yes it is.
Question:
It is also my understanding that the Congressional Budget Office has scored
this provision consistent with this interpretation. Is this correct?
Answer:
Yes it is.
OMB AD HP
5.
09/20/96
16:52
002
Application of 48-Hour Rule to Medicaid Contracts with Certified Health Plans
Background
It is our understanding that it is the intention of the statutory language (approved by VA/HUD
conferees) for the 48-hour rule provisions to apply to State-certified health plans that contract out
with Medicaid. In other words, just as any other health plan in the nation must comply with the
48-hour rule, so too shall any health plan that contracts out with Medicaid. It is our
understanding that the statutory language was scored consistent with this interpretation. We
believe the language is somewhat vague on this point and believe, at minimum, an explanatory
statement is necessary to clarify the intent of this provision.
Suggested Bill Managers' Statement
The intent of the statutory language is for the 48-hour rule requirements to be applied to any
State-certified plan that contracts with Medicaid. Just as any other health plan in the nation must
comply with the 48-hour rule, so too shall any health plan that contracts with a State to cover
Medicaid beneficiaries. This interpretation is consistent with CBO's scoring of the 48-hour rule
provisions.
Presidential Statements In Support of Mental Health Parity
"I am writing to express the President's strong support for the alternative that has
been proposed by Senator Domenici to prohibit health plans from establishing
separate lifetime and annual limits for mental health benefits. People with mental
illness have faced discrimination in health insurance coverage for far too long, and it
is time we take steps to end this inequity..."
Leon Panetta
July 30, 1996
"
I was disappointed that the mental health provision was taken out, [of the
Kennedy/Kassebaum bill] and I certainly hope we can get it as soon as possible in the
future. It should remain a high priority."
President Bill Clinton
August 1, 1996
"I wish this bill [Kennedy/Kassebaum] had contained the provision to eliminate the
differential treatment of mental health coverage, or at least taken some positive steps
in that direction."
President Bill Clinton
August 21, 1996
ush
Presidential Statements In Support of the 48 Hour Rule
"I urge members of Congress to move legislation forward as soon as possible that
makes this protection for mothers and their children the law of the land. No
insurance company should be free to make the final judgment about what is medically
best for newborns and their mothers. That decision should be left up to doctors,
nurses and mothers themselves."
President Bill Clinton
May 11, 1996
"We should protect mothers and newborn babies from being forced out of the hospital
in less than 48 hours."
President Bill Clinton
Democratic National Convention
August 30, 1996
"
the President is right to support a bill that would prohibit the practice of forcing
mothers and babies to leave the hospital in less than 48 hours."
Hillary Rodham Clinton
Democratic National Convention
August 28, 1996
"That's why I'm supporting the legislation I mentioned, dealing with not forcing new
mothers and their newborns out of the hospital."
President Bill Clinton
September 5, 1996
Sept 11th
FILE No. 637 09/18 '96 20:05 ID:
PAGE 1
Namt Gingrich
Sixth Bistrict
(202)225-0600
Georgia
Office of the Speaker
United States House of Representatives
Mashington, no 20515
FAX COVER LETTER
ATTENTION:
Chuck KIEFER
FROM:
Policy Office Staff
Karen Feaga
Fred Nutt
Jack Howard
Chris Scheve
Ed Kutler
Sue Yang
Gardner Peckham
DATE:
FAX NUMBER:
TOTAL NUMBER OF PAGES (INCLUDING COVER): 15
COMMENTS:
Mental health language as
agreed to by Domeniciard
Wellstone
:
Asued toby Kemerly /wellstore
All materials are confidential, to be delivered only to the party addressed above.
If there are any problems with this fax transmission, please contact (202) 225-0510.
FILE No. 637 09/18 '96 20:05 ID:
PAGE 2
SENT BY:53437
; 9-18-96 8:32PM : DEGISLATIVE COUNSEL-
:# 2/15
F:\EGG\HCR96\VAHUDCON\MNTLHLTH.004
[Final Draft]
Substitute for Senate Amendment #118 to H.R.
3666 (viz., title VII):
1 TITLE VII-PARITY IN THE AP-
2
PLICATION OF CERTAIN LIM-
3
ITS TO MENTAL HEALTH BEN-
4
EFITS
5 SEC. 701. SHORT TITLE.
6
This title may be cited as the "Mental Health Parity
7 Act of 1996".
8 SEC. 702. AMENDMENTS TO THE EMPLOYEE RETIREMENT
9
INCOME SECURITY ACT OF 1074.
10
(a) IN GENERAL.Subpart B of part 7 of subtitle
11 B of title I of the Employee Retirement Income Security
12 Act of 1974 (as added by section 603(a)) is amended by
13 adding at the end the following new section:
14 "SEC. 712. PARITY IN THE APPLICATION OF CERTAIN LIM-
15
ITS TO MENTAL HEALTH BENEFITS.
16
"(a) IN GENERAL.-
17
"(1) AGGREGATE LIFETIME LIMITS.-In the
18
case of a group health plan (or health insurance COV-
19
erage offered in connection with such a plan) that
20
provides both medical and surgical benefits and
21
mental health benefits—
22
"(A) No LIFETIME LIMIT.-If the plan or
23
coverage does not include an aggregate lifetime
September 18, 1996 (8:26 p.m.)
FILE No. 637 09/18 '96 20:05 ID:
PAGE 3
SENT BY:53437
: 9-18-96 : 8:33PM ; LEGISLATIVE COUNSEL-
:# 3/15
F:\EGG\HCR96\VAHUDCON\MNTLHITH.004
(Final Draft|
2
1
limit on substantially all medical and surgical
2
benefits, the plan or coverage may not impose
3
any aggregate lifetime limit on mental health
4
benefits.
5
"(B) LIFETIME LIMIT.-If the plan or cov-
6
erage includes an aggregate lifetime limit on
7
substantially all medical and surgical benefits
8
(in this paragraph referred to as the 'applicable
9
lifetime limit'), the plan or coverage shall ei-
10
ther—
11
"(i) apply the applicable lifetime limit
12
both to the medical and surgical benefits to
13
which it otherwise would apply and to
14
mental health benefits and not distinguish
15
in the application of such limit between
16
such medical and surgical benefits and
17
mental health benefits; or
18
"(ii) not include any aggregate life-
19
time limit on mental health benefits that is
20
less than the applicable lifetime limit.
21
"(C) RULE IN CASE OF DIFFERENT LIM-
22
ITS.-In the case of a plan or coverage that is
23
not described in subparagraph (A) or (B) and
24
that includes no or different aggregate lifctime
25
limits on different categorios of medical and
September 18. 1996 (8:20 p.m.)
FILE No. 637 09/18 '96 20:05 ID:
PAGE 4
SENT BY 53437
; 8-18-96 : 8:33PM : LEGISLATIVE COUNSEL-
:# 4/15
F:\EGG\HCR98\VAHUDCONVMNTLHLTH.006
|Final Draft]
3
1
surgical benefits, the Secretary shall establish
2
rules under which subparagraph (B) is applied
3
to such plan or coverage with respect to mental
4
health benefits by substituting for the applica-
5
ble lifetime limit an average aggregate lifetime
6
limit that is computed taking into account the
7
weighted average of the aggregate lifetime lim-
8
its applicable to such categories.
9
"(2) ANNUAL LIMITH.-In the case of A group
10
hoalth plan (or health insurance coverage offered in
11
connection with such a plan) that provides both
12
medical and surgical benefits and mental health ben-
13
efits—
14
"(A) No ANNUAL LIMIT.-If the plan or
15
coverage does not include an annual limit on
16
substantially all medical and surgical benefits,
17
the plan or coverage may not impose any an-
18
nual limit on mental health benefits.
19
"(B) ANNUAL LIMIT.-If the plan or COV-
20
erage includes an annual limit on substantially
21
all medical and surgical benefits (in this para-
22
graph referred to as the 'applicable annual
23
limit'), the plan or coverage shall cither—
24
"(i) apply the applicable annual limit
25
both to medical and surgical benefits to
September 18, 1996 (8:26 p.m.)
FILE No. 637 09/18 '96 20:06 ID:
PAGE 5
SENT BY 53437
; 9-18-96 8:34PM ; LEGISLATIVE COUNSEL-
:# 5/15
F:\EGG\HCR96\VAHUDOON\MNTLHI.TH.004
[Final Draft.]
4
1
which it otherwise would apply and to
2
mental health benefits and not distinguish
3
in the application of such limit between
4
such medical and surgical benefits and
5
mental health benefits; or
6
"(ii) not include any annual limit on
7
mental health benefits that is less than the
8
applicable annual limit.
9
"(C) RULE IN CASE OF DIFFERENT LIM-
10
ITS.-In the case of a plan or coverage that is
11
not described in subparagraph (A) or (B) and
12
that includes no or different annual limits on
13
different categories of medical and surgical ben-
14
efits, the Secretary shall establish rules under
15
which subparagraph (B) is applied to such plan
16
or coverage with respect to mental health bene-
17
fits by substituting for the applicable annual
18
limit an average annual limit that is computed
19
taking into account the weighted average of the
20
annual limits applicable to such categories.
21
"(b) CONSTRUCTION-Nothing in this section shall
22 be construed—
23
"(1) AS requiring a group health plan (or health
24
insurance coverage offered in connection with such a
25
plan) to provide any mental health benefits; or
September 18. 1998 (8:26 p.m.)
FILE No. 637 09/18 '96 20:06 ID:
PAGE 6
SENT BY 53437
; 9-18-96 : 8:35PM ; LEGISLATIVE COUNSEL-
:# 6/15
F:\EGG\HCR96\VAHUDCON\MNTLHLTH004
[Final Draft]
5
I
"(2) in the case of such a plan or coverage that
2
provides such mental health benefits, as affecting
3
the terms and conditions (including cost sharing,
4
limits on numbers of visits or days of coverage, and
5
requirements relating to medical necessity) relating
6
to the amount, duration, or scope of mental health
7
benefits under the plan or coverage, except as spe-
8
cifically provided in subsection (a) (in regard to par-
9
ity in the imposition of aggregate lifetime limits and
10
annual limits for mental health benefits).
11
"(c) EXEMPTIONS.-
12
"(1) SMALL EMPLOYER EXEMPTION.-
13
"(A) IN GENERAL.-This section shall not
14
apply to any group health plan (and group
15
health insurance coverage offered in connection
16
with a group health plan) for any plan year of
17
a small employer.
18
"(B) SMALL EMPLOYME.-For purposes of
19
subparagraph (A), the term 'small employer'
20
means, in connection with a group health plan
21
with respect to a calendar year and a plan year,
22
an employer who employed an average of at
23
least 2 but not more than 50 employees on
24
business days during the preceding calendar
September 18, 1998 (8:20 p.m.)
FILE No. 637 09/18 '96 20:06 ID:
PAGE 7
SENT BY:53437
i 9-18-96 : 8:35PM ; LEGISLATIVE COUNSEL-
;# 7/15
F:\EGG\HCR98\VAHUDCON\MNTLHLTH.004
[Final Draft]
6
1
year and who employs at least 2 employees on
2
the first day of the plan year.
3
"(2) INCREASED COST EXEMPTION.-This sec-
4
tion shall not apply with respect to a group health
5
plan (or health insurance coverage offered in connec-
6
tion with a group health plan) if the application of
7
this section under such plan (or to such coverage)
8
results in an increase in the cost under the plan (or
9
for such coverage) of at least 1 percent.
10
"(d) SEPARATE APPLICATION TO EACH OPTION OF-
11 FRRMD.-In the case of a group health plan that offers
12 a participant or beneficiary two or more benefit package
13 options under the plan, subsections (a) and (c) shall be
14 applied separately with respect to each such option.
15
"(e) DEFINITIONS-For purposes of this section:
16
"(1) AGGREGATE LIFETIME LIMIT-The term
17
'aggregate lifetime limit' means, with respect to ben-
18
efits under a group health plan or health insurance
19
coverage, a dollar limitation on the total amount
20
that may be paid with respect to such benefits under
21
the plan or health insurance covorage with respect to
22
an individual or other coverage unit.
23
"(2) ANNUAL LIMT.-The term 'annual limit'
24
means, with respect to benefits under a group health
25
plan or health insurance coverage, a dollar limitation
September 18, 1996 (8:28 p.m.)
FILE No, 637 09/18 '96 20:06 ID:
PAGE 8
SENT BY:53437
; 9-18-96 ; 8:36PM LEGISLATIVE COUNSEL-
:# 8/15
F:\EGG\HCR96\VAHUDOON\MNTLHLTH.004
[Final Dratt)
7
1
on the total amount of benefits that may be paid
2
with respect to such benefits in a 12-month period
3
under the plan or health insurance coverage with re-
4
speet to an individual or other coverage unit.
5
"(3) MEDICAL OR SURGICAL BENEFTTS.-The
6
term 'medical or surgical benefits' moans benefits
7
with respect to medical or surgical services, as de-
8
fined under the terms of the plan, but does not in-
9
clude mental health benefits.
10
"(4) MENTAL HEALTH HENEFITS.-The term
11
'mental health benefits' means benefits with respect
12
to mental health services, as defined under the terms
13
of the plan, but does not include benefits with re-
14
speet to treatment of substance abuse or chemical
15
dependency.
16
"(f) SUNSET.-This section shall not apply to bene-
17 fits for services furnished on or after September 30,
18 2001.".
19
(b) CLERICAL AMENDMENT.-The table of contents
20 in section 1 of such Act, an amended by section 602 of
21 this Act, is amended by inserting after the item relating
22 to section 711 the following new item:
"See. 712. Parity in the application of certain limits to mental health Lesse-
fits.".
September 16, 1896 (8:28 p.m.)
FILE No. 637 09/18 '96 20:07 ID:
PAGE 9
SENT BY :53437
: 9-18-86 ; 8:37PM i LEGISLATIVE COUNSEL-
i# 8/15
F:\EGG\HCR96\VAHUDCON\MNTLHLTH004
[Final Draft)
8
1
(e) EFFECTIVE DATE.-The amondments made by
2 this section shall apply with respect to group health plans
3 for plan years beginning on or after January 1, 1998.
4 SEC. 703. AMENDMENTS TO THE PUBLIC HEALTH SERVICE
5
ACT RELATING TO THE GROUP MARKET.
6
(a) IN GENERAL-Subpart 2 of part A of title
7 XXVII of the Public Health Service Act (as added by sec-
8 tion 604(a)) is amended by adding at the end the following
9 new section:
10 "SEC. 2705. PARITY IN THE APPLICATION OF CERTAIN LIM-
11
ITS TO MENTAL HEALTH RENEFITS.
12
"(a) IN GENERAL.-
13
"(1) AGGREGATE LIFETIME LIMITS.-In the
14
case of a group health plan (or health insurance cov-
15
crage offered in connection with such a plan) that
16
provides both medical and surgical benefits and
17
mental health benefits-
18
"(A) No LIFETIME LIMIT.-If the plan or
19
coverage does not include an aggregate lifetime
20
limit on substantially all medical and surgical
21
benefits, the plan or coverage may not impose
22
any aggregate lifetime limit on mental health
23
benefits.
24
"(B) LIFETIME LIMIT.-If the plan or cov-
25
erage includes an aggregate lifetime limit on
September 18, 1998 (8:26 p.m.)
FILE No. 637 09/18 '96 20:07 ID:
PAGE 10
SENT BY:53437
: 9-18-96 ; 8:37PM : LEGISLATIVE COUNSEL+
:#10/15
[Final Draft)
9
1
substantially all medical and surgical benefits
2
(in this paragraph referred to as the 'applicable
3
lifetime limit'), the plan or coverage shall ai-
4
thor—
5
"(i) apply the applicable lifetime limit
6
both to the medical and surgical benefits to
7
which it otherwise would apply and to
8
mental hcalth benefits and not distinguish
9
in the application of such limit between
10
such medical and surgical benefits and
11
mental health benefits; or
12
"(ii) not include any aggregate life-
13
time limit on mental health benefits that is
14
less than the applicable lifetime limit.
15
"(C) RULE IN CASE OF DIFFERENT LIM-
16
ITS.-In the case of a plan or coverage that is
17
not described in subparagraph (A) or (B) and
18
that includes no or different aggregate lifetime
19
limits on different categories of medical and
20
surgical benefits, the Secretary shall establish
21
rules under which subparagraph (B) is applied
22
to such plan or coverage with respect to mental
23
health benefits by substituting for the applica-
24
ble lifetime limit un average aggregate lifetime
25
limit that is computed taking into account the
September 18. 1998 (8:28 p.m.)
FILE No. 637 09/18 '96 20:07 ID:
PAGE 11
SENT 8Y:53437
; 9-18-86 ; 8:38PM i LEGISLATIVE COUNSEL-
:#11/15
[Final Draft)
10
1
weighted average of the aggregate lifetime lim-
2
its applicable to such categories.
3
"(2) ANNUAL LIMITS.-In the nase of a group
4
health plan (or health insurance coverage offered in
5
connection with such a plan) that provides both
6
medical and surgical benefits and mental health hen-
7
efits-
8
"(A) No ANNUAL LIMIT.-If the plan or
9
coverage does not include an annual limit on
10
substantially all medical and surgical benefits,
11
the plan or coverage may not impose any an-
12
nual limit on mental health benefits.
13
"(B) ANNUAL LIMIT.-If the plan or cov-
14
crage includes an annual limit on substantially
15
all medical and surgical benefits (in this para-
16
graph referred to as the 'applicable annual
17
limit'), the plan or coverage shall either-
18
"(i) apply the applicable annual limit
19
both to medical and surgical benefits to
20
which it otherwise would apply and to
21
mental health benefits and not distinguish
22
in the application of such limit between
23
such medical and surgical benefits and
24
mental health benefits; or
September 18, 1996 (6:26 p.m.)
FILE No. 637 09/18 '96 20:07 ID:
PAGE 12
SENT BY :53437
: 9-18-96 : 8:39PM ; LEGISLATIVE COUNSEL-
:#12/15
F:\EGG\HOR96\VAHUDCON\MNTLHLTH.004
[Final Draft]
11
1
"(ii) not include any annual limit on
2
mental health benefits that is less than the
3
applicable annual limit.
4
"(C) RULE IN CASE OF DIFFERENT LIM-
5
ITS.-In the case of a plan or coverage that is
6
not described in subparagraph (A) or (B) and
7
that includes no or different annual limits on
8
different categorics of medical and surgical ben-
9
efits, the Secretary shall establish rules under
10
which subparagraph (B) is applied to such plan
11
or coverage with respect to mental health bene-
12
fits by substituting for the applicable annual
13
limit an average annual limit that is computed
14
taking into account the weighted average of the
15
annual limits applicable to such categories.
16
"(b) CONSTRUCTION.-Nothing in this section shall
17 be construed—
18
"(1) as requiring a group health plan (or health
19
insurance coverage offered in connection with such a
20
plan) to provide any mental health benefits; or
21
"(2) in the case of such a plan or coverage that
22
provides such mental health benefits, as affecting
23
the terms and conditions (including cost sharing,
24
limits on numbers of visits or days of coverage, and
25
requirements relating to modical necessity) relating
September 18. 1998 (8:20 p.m.)
FILE No. 637 09/18 '96 20:08 ID:
PAGE 13
SENT BY:53437
; 8-18-96 ; 8:38PM ; LEGISLATIVE COUNSEL-
;#13/15
F:\EGG\HCR98\VAHUDCON\MNTLHLTH.004
[Final Draft|
12
1
to the amount, duration, or scope of mental health
2
benefits under the plan or coverage, except as spe-
3
cifically provided in subscction (a) (in regard to par-
4
ity in the imposition of aggregate lifetime limits and
5
annual limits for mental health benefits).
6
"(c) EXEMPTIONS.-
7
"(1) SMALL EMPLOYER EXEMPTION.-This SOO-
8
tion shall not apply to any group health plan (and
9
group health insurance coverage offered in connec-
10
tion with a group health plan) for any plan year of
11
a small employer.
12
"(2) INCREASED COST EXEMPTION.-This sec-
13
tion shall not apply with respect to & group health
14
plan (or health insurance coverage offered in connec-
15
tion with a group health plan) if the application of
16
this section under such plan (or to such coverage)
17
results in an increase in the cost under the plan (or
18
for such coverage) of at least 1 percent.
19
"(d) SEPARATE APPLICATION TO EACH OPTION OF-
20 FERED.-In the case of a group health plan that offers
21 a participant or beneficiary two or more benefit package
22 options under the plan, subsections (a) and (c) shall be
23 applied separately with respect to each such option.
24
"(e) DEFINITIONS.-For purposes of this section:
September 18, 1996 (8:26 p.m.)
FILE No. 637 09/18 '96 20:08 ID:
PAGE 14
SENT :53437
9-18-96 8:40PM : LEGISLATIVE COUNSEL-
:#14/15
F:\EGG\HCR96\VAHUDCON\MNTLHLTH.004
[Final Draft)
18
1
"(1) AGGREGATE LIFETIME LIMIT.-The term
2
'aggregate lifetime limit' means, with respect to ben-
3
efits under a group health plan or health insurance
4
coverage, a dollar limitation on the total amount
5
that may be paid with respect to such benefits under
6
the plan or health insurance coverage with respect to
7
an individual or other coverage unit.
8
"(2) ANNUAL LIMIT--The term 'annual limit'
9
mcans, with respect to benefits under a group health
10
plan or health insurance coverage, a dollar limitation
11
on the total amount of benefits that may be paid
12
with respect to such benefits in a 12-month period
13
under the plan or health insurance coverage with rc-
14
spcct to an individual or other coverage unit.
15
"(3) MEDICAL OR SURGICAL BENEFITS.-The
16
term 'medical or surgical benefits' means benefits
17
with respect to medical or surgical services, as de-
18
fined under the terms of the plan, but does not in-
19
clude mental health benefits.
20
"(4) MENTAL HEALTH BENEFITS.-The term
21
'mental health benefits' means benefits with respect
22
to mental health services, as defined under the terms
23
of the plan, but docs not include benefits with re-
24
spect to treatment of substance abusc or chemical
25
dependency.
September 18, 1996 (8:26 p.m.)
FILE No. 637 09/18 '96 20:08 ID:
PAGE 15
SENT BY 53437
: 8-18-86 ; 8:41PM ; LEGISLATIVE COUNSEL-
:#15/15
F:\EGG\HCR26\VAHUDCON\MNTLHLTH.004
(Final Draft)
14
1
"(f) SUNSET.-This section shall not apply to bene-
2 fits for services furnished on or after September 30,
3 2001.".
4
(b) EFFECTIVE DATE.-The amendments made by
5 this section shall apply with respect to group health plans
6 for plan years beginning on or after January 1, 1998.
September 18, 1996 (8:26 p.m.)
SEP-19-96 09:26 FROM:
ID:
PAGE
1/28
ONE HUNDRED FOURTH CONGRESS
THOMAS J. BLILEY, JR.. VIRGINIA CHAIRMAN
CARLOS J. MOORMEAD. CALIFORNIA,
JOHN D. DINGELL. MICHIGAN
VICE CHAIRMAN
MENRY A. WAXMAN, CALIFORNIA
W.J. "BILLY" TAUZIN. LOUISIANA
FOWARD J. MARKEY МАЗЅАСНИЗЕТТЅ
JACK FIELOS, TEXAS
U.S. house of Representatives
CARDISS COLLINS. ILLINOIS
MICHAEL G. OXLEY. OMIO
RALPK M. HALL. TEXAS
MICHAEL BILIRAKIS. FLORIDA
BILL RICHARDSON. NEW MEXICO
Committee on Commerce
DAN SCHAEFER, COLORADO
JOHN BRYANT. TEXAS
JOE BARTON. TEXAS
RICK BOUCHER, VIRGINIA
J. DENNIS MASTERT. ILLINOIS
THOMAS J MANTON. NEW YORK
FRED UPTON. MICHIGAN
EDOLPHUS TOWNS. NEW YORK
CLIFF STEARNS. FLORIDA
GERRYE STUDDS, MASSACHUSETTS
BILL PAXON. NEW YORK
FRANK PALLONE. JR., NEW JERSEY
Mashington, DC 20515-6115
PAUL E. GILLMOR. OMB
SHERROD BROWN. OMIO
SCOTT L KLUG, WISCONSIN
BLANCHE LAMBERT LINCOLN ARKANSAS
GARY A. FRANKS. CONNECTICUT
BART GORDON. TENNESSEE
JAMES C. GREENWOOD. PENNSYLVANIA
ELIZABETH FURSE. OPECON
MICHAEL 5. CRAPO. IDANO
PETER DEUTSCH. FLORIDA
CHRISTOPHER COX. CALIFORNIA
BOBBY L. RUSH. ILLINOIS
NATHAN DEAL GEORGIA
ANNA G. ESHOO. CALIFORNIA
RICHARD BURR, NORTH CAROLINA
RON KLINK PENNSYLVANIA
BRIAN F. BILBRAY, CALIFORNIA
PART STUPAK MICHIGAN
ED WHITFIELD. KENTUCKY
EUOT L ENGEL NEW YORK
GREG GANSKE. IOWA
DAN FRISA. NEW YORK
CHARLIE NORWOOD. GEORGIA
RICK WHITE. WASHINGTON
TOM COBURN. OKLAHOMA
DEMOCRATIC STAFF
JAMES E. DERDERIAN CHIEF OF STAFF
FAX COVER SHEET
DATE:
9-19-96
TO:
Chris Jennings
FROM:
Bridgett Taylor
FAX NUMBER:
456-7431
NUMBER OF PAGES:
(Including Cover)
27
COMMENTS:
Moms language/stetement VA/HUD
(If there are problems with this transmission,
please phone 202-226-3400, Democratic Staff, 564 FHOB.)
SEP-19-96 09:26 FROM:
ID:
PAGE
2/28
F:VEGG\HCR96\VAHUDCON\MNREPORT.001
Statement of Conferees on Senate Amendment #117 to
HR 3666 ("Newborns' and Mothers' Health Pro-
tection Act of 1996")
The conference agreement includes the Senate
amendment with modifications. It incorporates the re-
quirements of the provision and the authority to enforce
the requirements into the new part 7 of subtitle B of
ERISA and the new title XXVII of the Public Health
Service Act as established by P.L. 104-191. It does not
include the exception to the requirement for the 48-hour
or 96-hour minimum stay in the case that the plan pro-
vides for post-delivery follow-up care. It adds a prohibi-
tion that a health plan cannot restrict benefits for any
portion of the required minimum 48-hour or 96-hour stay
in a manner which is less favorable than the benefits pro-
viding for any preceding portion of such stay. In addi-
tion, the conference agreement provides that nothing in
this provision is intended to be construed as preventing
a group health plan or issuer from imposing coinsurance,
deductibles, or other cost-sharing in relation to benefits
for hospital lengths of stay in connection with childbirth
for a mother or newborn child under the plan (or under
health insurance coverage offered in connection with a
group health plan), except that such coinsurance or other
cost-sharing for any portion of a period within a hospital
September 19, 1996 (12:45 a.m.)
SEP 19-96 09:27 FROM:
ID:
PAGE
3728
F:\EGG\HCR96\VAHUDCON\MNREPORT001
2
length of stay required under subsection (a) may not be
greater than such coinsurance or cost-sharing for any
preceding portion of such stay. It is the intent of the con-
ferees that cost-sharing not be used in a manner that cir-
cumvents the objectives of this title. It provides for a
modification to the notice requirements by conforming
them to the summary of material modifications under
ERISA In general, it conforms the provision relating to
preemption to State laws to the Health Insurance Port-
ability and Accountability Act of 1996. Notwithstanding
section 731(a)(1) of ERISA and sections 2723(a)(1) and
2762 of the Public Health Service Act, the new provi-
sions shall not preempt a State law that requires health
insurance coverage to include coverage for maternity and
pediatric care in accordance with guidelines established
by the American College of Obstetricians and Gyne-
cologists, the American Academy of Pediatrics, or other
established professional medical associations. In addition,
those sections shall not be construed as superseding a
State law that leaves decisions regarding the appropriate
hospital length of stay in connection with childbirth en-
tirely to the attending provider in consultation with the
mother. In addition, it is the intent of the conferees that,
consistent with section 704 (redesignated as section 731)
of ERISA and section 2723 of the Public Health Service
September 19. 1996 (12:45 a.m.)
SEP: 19-96 09:27 FROM:
ID:
PAGE
4/28
F:VEGG\HCR96\VAHUDCON\MNREPORT.001
3
Act, the application of the preemption provision should
permit the operation of any State law or provision which
requires more favorable treatment of maternity coverage
under health insurance coverage than that required under
this title.
It is the intent of the conferees that health plans
have sufficient flexibility to encourage or specify that at-
tending providers follow nationally recognized guidelines
for maternal and perinatal care in determining when
early discharge is medically appropriate.
Throughout the title, the conferees have used the
term "hospital length of stay" to indicate that the re-
quirement for coverage of a 48-hour stay following vagi-
nal delivery and a 96-hour length of stay following a ce
sarean section delivery is triggered by any delivery in
connection with hospital care, regardless of whether the
delivery is in a hospital inpatient or outpatient setting.
It is the intent of the conferees that a detailed series
of conforming changes shall be made as soon as possible
to the Internal Revenue Code, specifically subtitle K of
the Internal Revenue Code of 1986 (as added by section
401(a) of the Health Insurance Portability and Account-
ability Act of 1996), in order to fully implement these
provisions as part of chapter 100 of the Code.
September 19. 1996 (12:45 a.m.)
SEP-19-96 09:27 FROM:
ID:
PAGE
5/28
F:\EGG\HCR96\VAHUDCON\NEWBORNS.06A
[Final Draft]
Substitute for Senate Amendment #117 to H.R.
3666 (viz., title VI):
1 TITLE
VI-NEWBORNS'
AND
2
MOTHERS' HEALTH PROTEC-
3
TION ACT OF 1996
4 SEC. 601. SHORT TITLE.
5
This title may be cited as the "Newborns' and Moth-
6 ers' Health Protection Act of 1996".
7 SEC. 602. FINDING.
8
Congress finds that-
9
(1) the length of post-delivery hospital stay
10
should be based on the unique characteristics of
11
each mother and her newborn child, taking into con-
12
sideration the health of the mother, the health and
13
stability of the newborn, the ability and confidence
14
of the mother and the father to care for their new-
15
born, the adequacy of support systems at home, and
16
the access of the mother and her newborn to appro-
17
priate follow-up health care; and
18
(2) the timing of the discharge of a mother and
19
her newborn child from the hospital should be made
20
by the attending provider in consultation with the
21
mother.
September 19. 1996 (12:30 a.m.)
SEP,-19-96 09:27 FROM:
ID:
PAGE
6/28
F:VEGG\HCR96\VAHUDCON\NEWBORNS.064
[Final Draft]
2
1 SEC. 603. AMENDMENTS TO THE EMPLOYEE RETIREMENT
2
INCOME SECURITY ACT OF 1974.
3
(a) IN GENERAL.-Part 7 of subtitle B of title I of
4 the Employee Retirement Income Security Act of 1974
5 (added by section 101(a) of the Health Insurance Port-
6 ability and Accountability Act of 1996) is amended-
7
(1) by amending the heading of the part to read
8
as follows:
9
"PART 7-GROUP HEALTH PLAN REQUIREMENTS";
10
(2) by inserting after the part heading the fol-
11
lowing.
12
"SUBPART A-REQUIREMENTS RELATING TO
13
PORTABILITY, ACCESS, AND RENEWABILITY";
14
(3) by redesignating sections 704 through 707
15
as sections 731 through 734, respectively;
16
(4) by inserting before section 731 (as SO redes-
17
ignated) the following new heading
18
"SUBPART C-GENERAL PROVISIONS":
19
and
20
(5) by inserting after section 703 the following
21
new subpart:
22
"SUBPART B-OTHER REQUIREMENTS
23 "SEC. 711. STANDARDS RELATING TO BENEFITS FOR MOTH-
24
ERS AND NEWBORNS.
25
"(a) REQUIREMENTS FOR MINIMUM HOSPITAL STAY
26 FOLLOWING BIRTH.-
September 19. 1996 (12:30 a.m.)
SEP-19-96 09:28 FROM:
ID:
PAGE
7/28
F:VEGG\HCR96\VAHUDCON\NEWBORNS064
[Final Draft]
3
1
"(1) IN GENERAL.-A group health plan, and a
2
health insurance issuer offering group health insur-
3
ance coverage, may not-
4
"(A) except as provided in paragraph
5
(2)-
6
"(i) restrict benefits for any hospital
7
length of stay in connection with childbirth
8
for the mother or newborn child, following
9
a normal vaginal delivery, to less than 48
10
hours, or
11
"(ii) restrict benefits for any hospital
12
length of stay in connection with childbirth
13.
for the mother or newborn child, following
14
a cesarean section, to less than 96 hours;
15
or
16
"(B) require that a provider obtain author-
17
ization from the plan or the issuer for prescrib-
18
ing any length of stay required under subpara-
19
graph (A) (without regard to paragraph (2)).
20
"(2) EXCEPTION.-Paragraph (1)(A) shall not
21
apply in connection with any group health plan or
22
health insurance issuer in any case in which the de-
23
cision to discharge the mother or her newborn child
24
prior to the expiration of the minimum length of
25
stay otherwise required under paragraph (1)(A) is
September 19. 1996 (12:30 a.m.)
SEP-19-96 09:28 FROM:
ID:
PAGE
8/28
F:\EGG\HCR96\VAHUDCON\NEWBORNS.06A
[Final Draft]
4
1
made by an attending provider in consultation with
2
the mother.
3
"(b) PROHIBITIONS.-A group health plan, and a
4 health insurance issuer offering group health insurance
5 coverage in connection with a group health plan, may
6 not-
7
"(1) deny to the mother or her newborn child
8
eligibility, or continued eligibility, to enroll or to
9
renew coverage under the terms of the plan, solely
10
for the purpose of avoiding the requirements of this
11
section;
12
"(2) provide monetary payments or rebates to
13
mothers to encourage such mothers to accept less
14
than the minimum protections available under this
15
section;
16
"(3) penalize or otherwise reduce or limit the
17
reimbursement of a provider because such provider
18
provided care in accordance with this section;
19
"(4) provide incentives (monetary or otherwise)
20
to a provider to induce such provider to provide care
21
to a participant or beneficiary in a manner inconsist-
22
ent with this section; or
23
"(5) subject to subsection (c)(3), restrict bene-
24
fits for any portion of a period within a hospital
25
length of stay required under subsection (a) in a
September 19, 1996 (12:30 a.m.)
SEP-19-96 09 : 28 FROM:
ID:
PAGE
9/28
F:VEGG\HCR96\VAHUDCON\NEWBORNS06A
[Final Draft)
5
1
manner which is less favorable than the benefits pro-
2
vided for any preceding portion of such stay.
3
"(c) RULES OF CONSTRUCTION.-
4
"(1) Nothing in this section shall be construed
5
to require a mother who is a participant or bene-
6
ficiary-
7
"(A) to give birth in a hospital; or
8
"(B) to stay in the hospital for a fixed pe-
9
riod of time following the birth of her child.
10
"(2) This section shall not apply with respect to
11
any group health plan, or any group health insur-
12
ance coverage offered by a health insurance issuer,
13
which does not provide benefits for hospital lengths
14
of stay in connection with childbirth for a mother or
15
her newborn thild.
16
"(3) Nothing in this section shall be construed
17
as preventing a group health plan or issuer from im-
18
posing deductibles, coinsurance, or other cost-shar-
19
ing in relation to benefits for hospital lengths of stay
20
in connection with childbirth for a mother or new-
21
born child under the plan (or under health insurance
22
coverage offered in connection with a group health
23
plan), except that such coinsurance or other cost-
24
sharing for any portion of a period within a hospital
25
length of stay required under subsection (a) may not
September 19. 1996 (12:30 a.m.)
SEP-19-96 09 : 28 FROM:
ID:
PAGE
10/28
F:\EGG\HCR96\VAHUDCONVNEWBORNS-06A
[Final Draft]
6
1
be greater than such coinsurance or cost-sharing for
2
any preceding portion of such stay.
3
"(d) NOTICE UNDER GROUP HEALTH PLAN.-The
4 imposition of the requirements of this section shall be
5 treated as a material modification in the terms of the plan
6 described in section 102(a)(1), for purposes of assuring
7 notice of such requirements under the plan; except that
8 the summary description required to be provided under the
9 last sentence of section 104(b)(1) with respect to such
10 modification shall be provided by not later than 60 days
11 after the first day of the first plan year in which such
12 requirements apply.
13
"(e) LEVEL AND TYPE OF REIMBURSEMENTS.-
14 Nothing in this section shall be construed to prevent a
15 group health plan or a health insurance issuer offering
16 group health insurance coverage from negotiating the level
17 and type of reimbursement with a provider for care pro-
18 vided in accordance with this section.
19
"(f) PREEMPTION-
20
"(1) IN GENERAL.-Notwithstanding section
21
731(a)(1), the provisions of this section shall not
22
preempt a State law (as defined in section
23
731(d)(1)) that requires health insurance coverage
24
to include coverage for maternity and pediatric care
25
in accordance with guidelines established by the
September 19. 1996 (12:30 a.m.)
SEP,-19-96 09:29 FROM:
ID:
PAGE 11/28
F:VEGG\HCR96\VAHUDCON\NEWBORNS06A
[Final Draft]
7
1
American College of Obstetricians and Gyne-
2
cologists, the American Academy of Pediatrics, or
3
other established professional medical associations.
4
"(2) CONSTRUCTION.-Section 731(a)(1) shall
5
not be construed as superseding a State law (as SO
6
defined) that leaves decisions regarding the appro-
7
priate hospital length of stay in connection with
8
childbirth entirely to the attending provider in con-
9
sultation with the mother.
10
(b) CONFORMING AMENDMENTS.--
11
(1) Section 731(c) of such Act (as added by
12
section 101 of the Health Insurance Portability and
13
Accountability Act of 1996 and redesignated by the
14
preceding provisions of this section) is amended by
15
striking "Nothing" and inserting "Except as pro-
16
vided in section 711, nothing".
17
(2) Section 732(a) of such Act (as added by
18
section 101 of the Health Insurance Portability and
19
Accountability Act of 1996 and redesignated by the
20
preceding provisions of this section) is amended by
21
inserting "(other than section 711)" after "part".
22
(3) Title I of such Act (as amended by section
23
101 of the Health Insurance Portability and Ac-
24
countability Act of 1996 and the preceding provi-
25
sions of this section) is further amended-
September 19. 1996 (12:30 a.m.)
SEP-19-96 09:29 FROM:
ID:
PAGE 12/28
F:\EGG\HCR96\VAHUDCON\NEWBORNS.06A
[Final Draft]
8
1
(A) in the last sentence of section 4(b), by
2
striking "section 706(b)(2)", "section
3
706(b)(1)", and "section 706(a)(1)" and insert-
4
ing "section 733(b)(2)", "section 733(b)(1)",
5
and "section 733(a)(1)", respectively;
6
(B) in section 101(g), by striking "section
7
706(a)(2)" and inserting "section 733(a)(2)";
8
(C) in section 102(b), by striking "section
9
706(a)(1)" each place it appears and inserting
10
"section 733(a)(1), and by striking "section
11
706(b)(2)" and inserting "section 733(b)(2)";
12
(D) in section 104(b)(1), by striking "sec-
13
tion 706(a)(1)" each place it appears and in-
14
serting "section 733(a)(1);
15
(E) in section 502(b)(3), by striking "sec-
16
tion 706(a)(1)" and inserting "section
17
733(a)(1)";
18
(F) in section 506(c), by striking "section
19
706(a)(2)" and inserting "section 733(a)(2)";
20
(G) in section 514(b)(9), by striking "sec-
21
tion 704" and inserting "section 731";
22
(H) in the last sentence of section
23
701(c)(1), by striking "section 706(c)" and in-
24
serting "section 733(c)";
September 19. 1996 (12:30 a.m.)
SEP-19-96 09:29 FROM:
ID:
PAGE 13/28
F:\EGG\HCR96\VAHUDCON\NEWBORNS.06A
[Final Draft]
9
1
(I) in section 732(b), by striking "section
2
706(c)(1)" and inserting "section 733(c)(1)";
3
(J) in section 732(c)(1), by striking "sec-
4
tion 706(c)(2)" and inserting "section
5
733(c)(2)";
6
(K) in section 732(c)(2), by striking "sec-
7
tion 706(c)(3)" and inserting "section
8
733(c)(3)"; and
9
(L) in section 732(c)(3), by striking "sec-
10
tion 706(c)(4)" and inserting "section
11
733(c)(4)".
12
(4) The table of contents in section 1 of such
13
Act is amended by striking the items relating to part
14
7 and inserting the following:
"PART 7-GROUP HEALTH PLAN REQUIREMENTS
"SUBPART A-REQUIREMENTS RELATING TO PORTABILITY. ACCESS, AND
RENEWABILITY
"Sec. 701. Increased portability through limitation on preexisting condition ex-
clusions.
"Sec. 702. Prohibiting discrimination against individual participants and bene-
ficiaries based on health status.
"Sec. 703. Guaranteed renewability in multiemployer plans and multiple em-
ployer welfare arrangements.
"SUBPART B-OTHER REQUIREMENTS
"Sec. 711. Standards relating to benefits for mothers and newborns.
"SUBPART C-GENERAL PROVISIONS
"Sec. 731. Preemption; State flexibility: construction.
"Sec. 732. Special rules relating to group health plans.
"Sec. 733. Definitions.
"Sec. 734 Regulations."
September 19. 1996 (12:30 a.m.)
SEP-19-96 09:29 FROM:
ID:
PAGE
14/28
F:\EGG\HCR96\VAHUDCON\NEWBORNS.06A
[Final Draft]
10
1
(c) EFFECTIVE DATE.-The amendments made by
2 this section shall apply with respect to group health plans
3 for plan years beginning on or after January 1, 1998.
4 SEC. 604. AMENDMENTS TO THE PUBLIC HEALTH SERVICE
5
ACT RELATING TO THE GROUP MARKET.
6
(a) IN GENERAL.-Title XXVII of the Public Health
7 Service Act (as added by section 102 of the Health Insur-
8 ance Portability and Accountability Act of 1996) is
9 amended-
10
(1) by amending the title heading to read as
11
follows:
12
"TITLE XXVII-REQUIREMENTS RELATING TO
13
HEALTH INSURANCE COVERAGE";
14
(2) by redesignating subparts 2 and 3 of part
15
A as subparts 3 and 4 of such part;
16
(3) by inserting after subpart 1 of part A the
17
following new subpart:
18
"Subpart 2-Other Requirements
19 "SEC. 2704. STANDARDS RELATING TO BENEFITS FOR
20
MOTHERS AND NEWBORNS.
21
"(a) REQUIREMENTS FOR MINIMUM HOSPITAL STAY
22 FOLLOWING BIRTH.-
23
"(1) IN GENERAL-A group health plan, and a
24
health insurance issuer offering group health insur-
25
ance coverage, may not-
September 19, 1996 (12:30 a.m.)
SEP-19-96 09:30 FROM:
ID:
PAGE
15/28
F:\EGG\HCR96\VAHUDCON\NEWBORNS.064
[Final Draft]
11
1
"(A) except as provided in paragraph
2
(2)-
3
(i) restrict benefits for any hospital
4
length of stay in connection with childbirth
5
for the mother or newborn child, following
6
a normal vaginal delivery, to less than 48
7
hours, or
8
"(ii) restrict benefits for any hospital
9
length of stay in connection with childbirth
10
for the mother or newborn child, following
11
a cesarean section, to less than 96 hours,
12
or
13
"(B) require that a provider obtain author-
14
ization from the plan or the issuer for prescrib-
15
ing any length of stay required under subpara-
16
graph (A) (without regard to paragraph (2)).
17
"(2) EXCEPTION.-Paragraph (1) (A) shall not
18
apply in connection with any group health plan or
19
health insurance issuer in any case in which the de-
20
cision to discharge the mother or her newborn child
21
prior to the expiration of the minimum length of
22
stay otherwise required under paragraph (1) (A) is
23
made by an attending provider in consultation with
24
the mother.
September 19. 1996 (12:30 a.m.)
SEP-19-98 09:30 FROM:
ID:
PAGE
16/28
F:VEGG\HCR96\VAHUDCON\NEWBORNS.064
[Final Draft]
12
1
"(b) PROHIBITIONS.-A group health plan, and a
2 health insurance issuer offering group health insurance
3 coverage in connection with a group health plan, may
4 not-
5
"(1) deny to the mother or her newborn child
6
eligibility, or continued eligibility, to enroll or to
7
renew coverage under the terms of the plan, solely
8
for the purpose of avoiding the requirements of this
9
section;
10
"(2) provide monetary payments or rebates to
11
mothers to encourage such mothers to accept less
12
than the minimum protections available under this
13
section;
14
"(3) penalize or otherwise reduce or limit the
15
reimbursement of a provider because such provider
16
provided care in accordance with this section;
17
"(4) provide incentives (monetary or otherwise)
18
to a provider to induce such provider to provide care
19
to a participant or beneficiary in a manner inconsist-
20
ent with this section: or
21
"(5) subject to subsection (c)(3), restrict bene-
22
fits for any portion of a period within a hospital
23
length of stay required under subsection (a) in a
24
manner which is less favorable than the benefits pro-
25
vided for any preceding portion of such stay.
September 19, 1996 (12:30 a.m.)
SEP-19-96 09:30 FROM:
ID:
PAGE 17/28
F:\EGG\HCR96\VAHUDCON\NEWBORNS06A
[Final Draft]
13
1
"(c) RULES OF CONSTRUCTION.-
2
"(1) Nothing in this section shall be construed
3
to require a mother who is a participant or bene-
4
ficiary-
5
"(A) to give birth in a hospital; or
6
"(B) to stay in the hospital for a fixed pe-
7
riod of time following the birth of her child.
8
"(2) This section shall not apply with respect to
9
any group health plan, or any group health insur-
10
ance coverage offered by a health insurance issuer,
11
which does not provide benefits for hospital lengths
12
of stay in connection with childbirth for a mother or
13
her newborn child.
14
"(3) Nothing in this section shall be construed
15
as preventing. a group health plan or issuer from im-
16
posing deductibles, coinsurance, or other cost-shar-
17
ing in relation to benefits for hospital lengths of stay
18
in connection with childbirth for a mother or new-
19
born child under the plan (or under health insurance
20
coverage offered in connection with a group health
21
plan), except that such coinsurance or other cost-
22
sharing for any portion of a period within a hospital
23
length of stay required under subsection (a) may not
24
be greater than such coinsurance or cost-sharing for
25
any preceding portion of such stay.
September 19, 1996 (12:30 a.m.)
SEP-19-96 09:30 FROM:
ID:
PAGE
18/28
F:\EGG\HCR96\VAHUDCON\NEWBORNS06A
[Final Draft]
14
1
"(d) NOTICE.-A group health plan under this part
2 shall comply with the notice requirement under section
3 711(d) of the Employee Retirement Income Security Act
4 of 1974 with respect to the requirements of this section
5 as if such section applied to such plan.
6
"(e) LEVEL AND TYPE OF REIMBURSEMENTS.
7 Nothing in this section shall be construed to prevent a
8 group health plan or a health insurance issuer offering
9 group health insurance coverage from negotiating the level
10 and type of reimbursement with a provider for care pro-
11 vided in accordance with this section.
12
"(f) PREEMPTION.-
13
"(1) IN GENERAL-Notwithstanding section
14
2723(a)(1), the provisions of this section shall not
15
preempt a State law (as defined in section
16
2723(d)(1)) that requires health insurance coverage
17
to include coverage for maternity and pediatric care
18
in accordance with guidelines established by the
19
American College of Obstetricians and Gyne-
20
cologists, the American Academy of Pediatrics, or
21
other established professional medical associations.
22
"(2) CONSTRUCTION.-Section 2723(a)(1) shall
23
not be construed as superseding a State law (as SO
24
defined) that leaves decisions regarding the appro-
25
priate hospital length of stay in connection with
September 19. 1996 (12:30 a.m.)
SEP-19-96 09:30 FROM:
ID:
PAGE 19/28
F:VEGG\HCR96\VAHUDCON\NEWBORNS.06A
[Final Draft]
15
1
childbirth entirely to the attending provider in con-
2
sultation with the mother.'
3
(b) CONFORMING AMENDMENTS.-
4
(1) Section 2721 of such Act (as added by sec-
5
tion 102 of the Health Insurance Portability and Ac-
6
countability Act of 1996) is amended-
7
(A) in subsection (a), by striking "subparts
8
1 and 2" and inserting "subparts 1 and 3",
9
and
10
(B) in subsections (b) through (d), by
11
striking "subparts 1 and 2" each place it ap-
12
pears and inserting "subparts 1 through 3".
13
(2) Section 2723(c) of such Act (as added by
14
section 102 of the Health Insurance Portability and
15
Accountability Act of 1996) is amended by inserting
16
"(other than section 2704)" after "part".
17
(c) EFFECTIVE DATE.-The amendments made by
18 this section shall apply with respect to group health plans
19 for plan years beginning on or after January 1, 1998.
20 SEC. 605. AMENDMENTS TO THE PUBLIC HEALTH SERVICE
21
ACT RELATING TO THE INDIVIDUAL MARKET.
22
(a) IN GENERAL.-Part B of title XXVII of the Pub-
23 lic Health Service Act (as added by section 111 of the
24 Health Insurance Portability and Accountability Act of
25 1996) is amended-
September 19. 1996 (12:30 a.m.)
SEP-19-96 09:31 FROM:
ID:
PAGE 20/28
F:\EGG\HCR96\VAHUDCON\NEWBORNS.06A
[Final Draft]
16
1
(1) by inserting after the part heading the fol-
2
lowing.
3
"Subpart 1-Portability, Access, and Renewability
4
Requirements";
5
(2) by redesignating sections 2745, 2746, and
6
2747 as sections 2761, 2762, and 2763, respectively;
7
(3) by inserting before section 2761 (as so re-
8
designated) the following:
9
"Subpart 3-General Provisions"; and
10
(4) by inserting after section 2744 the follow-
11
ing.
12
"Subpart 3-Other Requirements
13 "SEC. 2751. STANDARDS RELATING TO BENEFITS FOR
14
MOTHERS AND NEWBORNS.
15
"(a) IN GENERAL.-The provisions of section 2704
16 (other than subsections (d) and (f)) shall apply to health
17 insurance coverage offered by a health insurance issuer
18 in the individual market in the same manner as it applies
19 to health insurance coverage offered by a health insurance
20 issuer in connection with a group health plan in the small
21 or large group market.
22
"(b) NOTICE REQUIREMENT.-A health insurance is-
23 suer under this part shall comply with the notice require-
24 ment under section 711(d) of the Employee Retirement
25 Income Security Act of 1974 with respect to the require-
September 19. 1996 (12:30 a.m.)
SEP-19-96 09:31 FROM:
ID:
PAGE 21/28
F:VEGG\HCR96\VAHUDCON\NEWBORNS.06A
[Final Draft]
17
1 ments referred to in subsection (a) as if such section ap-
2 plied to such issuer and such issuer were a group health
3 plan.
4
"(c) PREEMPTION-
5
"(1) IN GENERAL-Notwithstanding section
6
2762(a)), the provisions of this section shall not pre-
7
empt a State law (as defined in section 2723(d)(1))
8
that requires health insurance coverage to include
9
coverage for maternity and pediatric care in accord-
10
ance with guidelines established by the American
11
College of Obstetricians and Gynecologists, the
12
American Academy of Pediatrics, or other estab-
13
lished professional medical associations.
14
"(2) CONSTRUCTION-Section 2762(a) shall
15
not be construed as superseding a State law (as SO
16
defined) that leaves decisions regarding the appro-
17
priate hospital length of stay in connection with
18
childbirth entirely to the attending provider in con-
19
sultation with the mother.'
20
(b) CONFORMING AMENDMENTS.-Such part (as SO
21 added) is further amended as follows:
22
(1) In section 2744(a)(1), strike "2746(b)" and
23
insert "2762(b)".
September 19. 1996 (12:30 a.m.)
SEP-19-96 09:31 FROM:
ID:
PAGE 22/28
F:\EGG\HCR96\VAHUDCON\NEWBORNS064
[Final Draft]
18
1
(2) In section 2745(a)(1) (before redesignation
2
under subsection (a)(1)), strike "2746" and insert
3
"2762".
4
(3) In section 2746(b) (before redesignation
5
under subsection (a)(1))-
6
(A) by inserting "(1)" after the dash, and
7
(B) by adding at the end the following:
8
"(2) Nothing in this part (other than section 2751)
9 shall be construed as requiring health insurance coverage
10 offered in the individual market to provide specific benefits
11 under the terms of such coverage.".
12
(c) EFFECTIVE DATE.-The amendments made by
13 this section shall apply with respect to health insurance
14 coverage offered, sold, issued, renewed, in effect, or oper-
15 ated in the individual market on or after January 1, 1998.
16 SEC. 606. REPORTS TO CONGRESS CONCERNING CHILD-
17
BIRTH
18
(a) FINDINGS.-Congress finds that-
19
(1) childbirth is one part of a continuum of ex-
20
perience that includes prepregnancy, pregnancy and
21
prenatal care, labor and delivery, the immediate
22
postpartum period, and a longer period of adjust-
23
ment for the newborn, the mother, and the family,
24
(2) health care practices across this continuum
25
are changing in response to health care financing
September 19. 1996 (12:30 a.m.)
SEP-19-96 09:31 FROM:
ID:
PAGE 23/28
F:\EGG\HCR96\VAHUDCON\NEWBORNS.06A
[Final Draft]
19
1
and delivery system changes, science and clinical re-
2
search, and patient preferences; and
3
(3) there is a need-
4
(4) to examine the issues and con-
5
sequences associated with the length of hospital
6
stays following childbirth;
7
(B) to examine the follow-up practices for
8
mothers and newborns used in conjunction with
9
shorter hospital stays;
10
(C) to identify appropriate health care
11
practices and procedures with regard to the
12
hospital discharge of newborns and mothers;
13
(D) to examine the extent to which such
14
care is affected by family and environmental
15
factors; and
16
(E) to examine the content of care during
17
hospital stays following childbirth.
18
(b) ADVISORY PANEL.-
19
(1) IN GENERAL.-Not later than 90 days after
20
the date of enactment of this Act, the Secretary of
21
Health and Human Services (in this section referred
22
to as the "Secretary") shall establish an advisory
23
panel (referred to in this section as the "advisory
24
panel")-
September 19, 1996 (12:30 a.m.)
SEP-19-96 09:32 FROM:
ID:
PAGE 24/28
F:VEGG\HCR96\VAHUDCON\NEWBORNS06A
[Final Draft]
20
1
(A) to guide and review methods, proce-
2
dures, and data collection necessary to conduct
3
the study described in subsection (c) in a man-
4
ner that is intended to enhance the quality,
5
safety, and effectiveness of health care services
6
provided to mothers and newborns;
7
(B) to develop a consensus among the
8
members of the advisory panel regarding the
9
appropriateness of the specific requirements of
10
this title; and
11
(C) to prepare and submit to the Sec-
12
retary, as part of the report of the Secretary
13
submitted under subsection (d), a report sum-
14
marizing the consensus (if any) developed under
15
subparagraph (B) or the reasons for not reach-
16
ing such a consensus.
17
(2) PARTICIPATION.-
18
(A) DEPARTMENT REPRESENTATIVES-
19
The Secretary shall ensure that representatives
20
from within the Department of Health and
21
Human Services that have expertise in the area
22
of maternal and child health or in outcomes re-
23
search are appointed to the advisory panel.
24
(B) REPRESENTATIVES OF PUBLIC AND
25
PRIVATE SECTOR ENTITIES.-
September 19. 1996 (12.30 a.m.)
SEP-19-96 09:32 FROM:
ID:
PAGE 25/28
F:VEGG\HCR96\VAHUDCON\NEWBORNS06A
[Final Draft]
21
1
(i) IN GENERAL-The Secretary shall
2
ensure that members of the advisory panel
3
include representatives of public and pri-
4
vate sector entities having knowledge or
5
experience in one or more of the following
6
areas:
7
(I) Patient care.
8
(II) Patient education.
9
(III) Quality assurance.
10
(IV) Outcomes research
11
(V) Consumer issues.
12
(ii) REQUIREMENT.-The panel shall
13
include representatives of each of the fol-
14
lowing categories:
15
(I) Health care practitioners.
16
(II) Health plans.
17
(III) Hospitals.
18
(IV) Employers.
19
(V) States.
20
(VI) Consumers.
21
(c) STUDIES.-
22
(1) IN GENERAL.-The Secretary shall conduct
23
a study of-
September 19. 1996 (12:30 a.m.)
SEP-19-96 09:32 FROM:
ID:
PAGE 26/28
F:VEGG\HCR96\VAHUDCON\NEWBORNS064
[Final Draft]
22
1
(A) the factors affecting the continuum of
2
care with respect to maternal and child health
3
care, including outcomes following childbirth;
4
(B) the factors determining the length of
5
hospital stay following childbirth:
6
(C) the diversity of negative or positive
7
outcomes affecting mothers, infants, and fami-
8
lies;
9
(D) the manner in which post natal care
10
has changed over time and the manner in which
11
that care has adapted or related to changes in
12
the length of hospital stay, taking into ac-
13
count-
14
(i) the types of post natal care avail-
15
able and the extent to which such care is
16
accessed; and
17
(ii) the challenges associated with pro-
18
viding post natal care to all populations,
19
including vulnerable populations, and solu-
20
tions for overcoming these challenges; and
21
(E) the financial incentives that may-
22
(i) impact the health of newborns and
23
mothers; and
24
(ii) influence the clinical decisionmak-
25
ing of health care providers.
September 19. 1996 (12:30 a.m.)
SEP-19-96 09:32 FROM:
ID:
PAGE 27/28
\EGG\HCR96\VAHUDCON\NEWBORNS.06A
[Final Draft]
23
1
(2) RESOURCES.-The Secretary shall provide
2
to the advisory panel the resources necessary to
3
carry out the duties of the advisory panel.
4
(d) REPORTS.-
5
(1) IN GENERAL-The Secretary shall prepare
6
and submit to the Committee on Labor and Human
7
Resources of the Senate and the Committee on Com-
8
merce of the House of Representatives a report that
9
contains—
10
(A) a summary of the study conducted
11
under subsection (c);
12
(B) a summary of the best practices used
13
in the public and private sectors for the care of
14
newborns and mothers;
15
(C) recommendations for improvements in
16
prenatal care, post natal care, delivery and fol-
17
low-up care, and whether the implementation of
18
such improvements should be accomplished by
19
the private health care sector, Federal or State
20
governments, or any combination thereof; and
21
(D) limitations on the databases in exist-
22
ence on the date of the enactment of this Act.
23
(2) DEADLINES.-The Secretary shall- prepare
24
and submit to the Committees referred to in para-
25
graph (1)-
September 19, 1996 (12:30 a.m.)
SEP-19-96 09:33 FROM:
ID:
PAGE 28/28
F:VEGG\HCR96\VAHUDCONVNEWBORNS064
[Final Draft]
24
1
(A) an initial report concerning the study
2
conducted under subsection (c) and elements
3
described in paragraph (1), not later than 18
4
months after the date of the enactment of this
5
Act;
6
(B) an interim report concerning such
7
study and elements not later than 3 years after
8
the date of the enactment of this Act; and
9
(C) a final report concerning such study
10
and elements not later than 5 years after the
11
date of the enactment of this Act.
12
(e) TERMINATION OF PANEL.-The advisory panel
13 shall terminate on the date that occurs 60 days after the
14 date on which the last report is submitted under sub-
15 section (d).
September 19, 1996 (12:30 a.m.)
MEMORANDUM
September 11, 1996
TO:
Carol Rasco
Laura Tyson
FROM:
Chris Jennings/Jen Klein
SUBJ:
President sends letter to Gingrich on health provisions
.
Congress responds
As you know, early this morning the President sent a letter to Representative Gingrich
urging the House to "act quickly to enact three important health reform provisions." (See
attached)
Later today, the House passed a motion (392 to 17) offered by Representative Stokes
(D-OH) to instruct VA-HUD conferees to (1) assure new mothers and their babies the option
of a 48-hour post-delivery hospital stay, (2) move toward providing mental health coverage
parity, and (3) provide protections for the children of Vietnam veterans who are born with the
birth defect spina bifida. This motion contains all of the provisions referenced in the
President's letter. (Please see attached AP story).
This vote is likely to assure that the 48-hour rule and the spina bifida provisions will
be sent up in the final VA-HUD Appropriations bill. Notwithstanding this vote, the mental
health parity provision is still a long shot. We will keep you informed of developments.
THE WHITE HOUSE
WASHINGTON
September 11, 1996
The Honorable Newt Gingrich
Speaker of the House
of Representatives
Washington, D.C. 20515
Dear Mr. Speaker:
I am writing to urge the House to act quickly to enact three
important health reform provisions that were passed by the Senate
last week. I encourage you to work toward the speedy passage of
provisions that (1) assure new mothers and their babies the
option of a 48-hour post-delivery hospital stay, (2) move toward
providing mental health coverage parity, and (3) provide
protections for the children of Vietnam veterans who are born
with the birth defect spina bifida.
First, we should enact bipartisan legislation to require
health insurers to let all new mothers and their babies stay in
the hospital at least 48 hours following normal deliveries. Over
the past two decades, the average length of stay for an
uncomplicated childbirth has fallen sharply. A large and growing
"humber of health plans are refusing to pay for anything more than
a 24-hour stay, except in the most extreme circumstances, and
some have recommended releasing new mothers as early as eight
hours after delivery. Enactment of this measure would give peace
of mind to families who will no longer have to fear that new
mothers will be prematurely discharged from the hospital.
Second, we should ensure that the Domenici/Wellstone mental
health parity compromise becomes law. This legislation would
prohibit health plans from establishing separate lifetime and
annual limits for mental health benefits. People with mental
illness have faced discrimination in health insurance coverage
for far too long; it is time that we take steps to end this
inequity.
Finally, we should act now to give the Veterans'
Administration authority to help the children of Vietnam veterans
who are born with the birth defect spina bifida. Studies have
shown a positive link between this condition and parental
exposure to Agent Orange during service in Vietnam. This
legislation would provide health care, vocational training, and a
monthly monetary allowance to these children, fulfilling our
commitment to them.
-2-
I urge you to do all you can to ensure passage of these
important initiatives, either as part of the VA-HUD
appropriations bill, or in any other vehicle in which passage by
both Houses can be assured before Congress adjourns. In so
doing, we will improve the quality of health care for some of our
most vulnerable populations.
Sincerely,
n)
Date: 09/11/96 Time: 17:20
CClinton Urges Passage of Health-Related Legislation
WASHINGTON (AP) President Clinton urged the
Republican-controlled House on Wednesday to pass three
health-related pieces of legislation, including one that would
assure a two-day hospital stay for new mothers.
The House quickly concurred, voting 392-17 to endorse the three
measures approved by the Senate last week as amendments to a 1997
spending bill.
In addition to assuring that insurance companies pay for at
least 48 hours in the hospital for mothers after delivery, the
measures would close the gap between insurance coverage for mental
and physical illnesses and give benefits to veterans exposed to
Agent Orange during the Vietnam War whose offspring suffer from
spina bifida, a crippling birth defect.
The House vote instructed House members of a House-Senate
conference to accept the Senate-approved measures as they work out
differences on an $84 billion bill to fund veterans, housing, space
and other programs in fiscal 1997. The action is not binding, but
the size of the vote makes it almost certain the House conferees
will accept the Senate amendments.
In a letter to House Speaker Newt Gingrich, Clinton also pressed
for approval of the mental illness and Agent Orange bills.
The letter, which was released Wednesday at the White House
while the president campaigned in Colorado, said that by passing
the bills, ' 'we will improve the quality of health care for some of
our most vulnerable populations.
Referring to the time new mothers are allowed to remain in the
hospital after giving birth, Clinton said a large and growing
number of health plans now refuse to pay for anything more than a
4-hour stay except in extreme circumstances.
Some have recommended releasing new mothers as early as eight
hours after delivery, he said. 'Enactment of this measure would
give peace of mind to families who will no longer have to fear that
new mothers will be prematurely discharged from the hospital
Clinton also endorsed legislation sponsored by Sens. Pete
Domenici, R-N.M., and Paul Wellstone, D-Minn. that would prohibit
health insurers from setting separate lifetime and annual limits
for mental health benefits.
People with mental illness have faced discrimination in health
insurance coverage for far too long. It is time that we take steps
to end this inequity, the president said.
On the veterans measure, he wrote that studies have shown a
positive link between this condition (spina bifida) and parental
exposure to Agent Orange during service in Vietnam
'This legislation would provide health care, vocational
training, and a monthly monetary allowance to these children,
fulfilling our commitment to them, Clinton said.
The letter did not specify how much any these programs would
cost.
Republican leaders urged their members against hasty acceptance
of what they said were measures aimed at pleasing interest groups
just before the election, but all but 16 Republicans and one
Democrat voted to endorse the three measures.
Appropriations Committee Chairman Rep. Bob Livingston, R-La.
said lawmakers `risk a great danger that we in the haste of trying
to do good things in advance of an election all of a sudden adopt
measures in such a legislative domain that later on prove to be
ill -advised.
Keeping the three measures in the Veterans Affairs-Housing and
Urban Development spending bill would also put greater pressure on
Clinton to sign legislation he has indicated that he might veto.
The administration has objected to cuts in housing programs and
the House decision to eliminate all funding for AmeriCorps, the
president's national service program. The Senate allocated $400
million for AmeriCorps, still more than $100 million under the
administration request.
APNP-09-11-96 - 1730EDT
Statement by the President
I am pleased that the conferees on the VA-HUD appropriations bill have responded
to my challenge to pass two provisions that will give vital health care services and peace of
mind to American families.
As I wrote in my September 11 letter to Speaker Gingrich urging the House to pass
these measures, the first provision requires health insurers to let all new mothers and their
babies stay in the hospital at least 48 hours following normal deliveries. Over the past few
decades, the average length of stay for an uncomplicated childbirth has fallen sharply. A
large and growing number of health plans refuse to pay for anything more than a 24 hour
stay, except in the most extreme circumstances, and some release mothers as early as eight
hours after delivery. This can pose serious health risks for both mothers and newborns.
We owe all new mothers the assurance that when they bring a baby into this world, they
will not be rushed out of the hospital until they and their health care provider decide it is
medically safe for both mother and child.
The second provisions prohibits health plans from establishing separate lifetime and
annual limits for mental health benefits. People with mental illness have faced
discrimination in health insurance coverage for far too long; it is time that we take steps to
end this inequity.
I hope that the conferees will now pass the provision protecting the children of
Vietnam veterans who are born with spina bifida. I also look forward to prompt action by
the House and Senate on all of these measures.
THE WHITE HOUSE
WASHINGTON
July 30, 1996
Dear Mr. Chairman:
I am writing to express the President's strong support for the
alternative that has been proposed by Senator Domenici to prohibit
health plans from establishing separate lifetime and annual limits
for mental health benefits. People with mental illness have faced
discrimination in health insurance coverage for far too long, and it
is time we take steps to end this inequity by including the Domenici
alternative in the final version of the Health Insurance Portability
and Accountability Act (H.R. 3103) presented by the conference to the
Congress.
On April 23, 1996, by an overwhelmingly bipartisan vote of 68-
30, the Senate passed a Domenici/Wellstone amendment which would have
required health plans to treat mental health coverage on an equal
footing with other health benefits. The Domenici/Wellstone amendment
would have ended the most egregious inequities in coverage for mental
illness.
Despite this impressive vote, concerns about the potential cost
of this amendment were raised. In response, Senator Domenici dropped
all of the mental health parity requirements in the amendment except
equitable treatment of lifetime and annual limits. According to the
Congressional Budget Office (CBO), Senator Domenici's compromise
would cost 90 percent less than the original amendment ($966
million). CBO has also estimated that the proposal would increase
insurance premiums by 0.4 percent at most.
The President feels strongly that Senator Domenici's compromise
should be the acceptable bipartisan alternative to the Senate passed
amendment. I urge you and all conferees to incorporate his proposal
into the bill reported out by the conference. We look forward to
reaching prompt agreement on this and all the other important
provisions of H.R. 3103.
Sincerely,
Leon E Panetta
Chief of Staff
The Honorable Bill Archer
Chairman
Committee on Ways and Means
House of Representatives
Washington, D.C. 20515
THE WHITE HOUSE
WASHINGTON
July 30, 1996
Dear Mr. Chairman:
I am writing to express the President's strong support for the
alternative that has been proposed by Senator Domenici to prohibit
health plans from establishing separate lifetime and annual limits
for mental health benefits. People with mental illness have faced
discrimination in health insurance coverage for far too long, and it
is time we take steps to end this inequity by including the Domenici
alternative in the final version of the Health Insurance Portability
and Accountability Act (H.R. 3103) presented by the conference to the
Congress.
On April 23, 1996, by an overwhelmingly bipartisan vote of 68-
30, the Senate passed a Domenici/Wellstone amendment which would have
required health plans to treat mental health coverage on an equal
footing with other health benefits. The Domenici/Wellstone amendment
would have ended the most egregious inequities in coverage for mental
illness.
Despite this impressive vote, concerns about the potential cost
of this amendment were raised. In response, Senator Domenici dropped
all of the mental health parity requirements in the amendment except
equitable treatment of lifetime and annual limits. According to the
Congressional Budget Office (CBO), Senator Domenici's compromise
would cost 90 percent less than the original amendment ($966
million). CBO has also estimated that the proposal would increase
insurance premiums by 0.4 percent at most.
The President feels strongly that Senator Domenici's compromise
should be the acceptable bipartisan alternative to the Senate passed
amendment. I urge you and all conferees to incorporate his proposal
into the bill reported out by the conference. We look forward to
reaching prompt agreement on this and all the other important
provisions of H.R. 3103.
Sincerely,
G
Chief of Staff
The Honorable William M. Thomas
Chairman
Committee on House Oversight
House of Representatives
Washington, D.C. 20515
THE WHITE HOUSE
WASHINGTON
July 30, 1996
Dear Mr. Chairman:
I am writing to express the President's strong support for the
alternative that has been proposed by Senator Domenici to prohibit
health plans from establishing separate lifetime and annual limits
for mental health benefits. People with mental illness have faced
discrimination in health insurance coverage for far too long, and it
is time we take steps to end this inequity by including the Domenici
alternative in the final version of the Health Insurance Portability
and Accountability Act (H.R. 3103) presented by the conference to the
Congress.
On April 23, 1996, by an overwhelmingly bipartisan vote of 68-
30, the Senate passed a Domenici/Wellstone amendment which would have
required health plans to treat mental health coverage on an equal
footing with other health benefits. The Domenici/Wellstone amendment
would have ended the most egregious inequities in coverage for mental
illness.
Despite this impressive vote, concerns about the potential cost
of this amendment were raised. In response, Senator Domenici dropped
all of the mental health parity requirements in the amendment except
equitable treatment of lifetime and annual limits. According to the
Congressional Budget Office (CBO), Senator Domenici's compromise
would cost 90 percent less than the original amendment ($966
million). CBO has also estimated that the proposal would increase
insurance premiums by 0.4 percent at most.
The President feels strongly that Senator Domenici's compromise
should be the acceptable bipartisan alternative to the Senate passed
amendment. I urge you and all conferees to incorporate his proposal
into the bill reported out by the conference. We look forward to
reaching prompt agreement on this and all the other important
provisions of H.R. 3103.
Sincerely,
eon F Panetta
Chief of Staff
The Honorable Thomas J. Bliley, Jr.
Chairman
Committee on Commerce
House of Representatives
Washington, D.C. 20515
THE WHITE HOUSE
WASHINGTON
July 30, 1996
Dear Representative Bilirakis:
I am writing to express the President's strong support for the
alternative that has been proposed by Senator Domenici to prohibit
health plans from establishing separate lifetime and annual limits
for mental health benefits. People with mental illness have faced
discrimination in health insurance coverage for far too long, and it
is time we take steps to end this inequity by including the Domenici
alternative in the final version of the Health Insurance Portability
and Accountability Act (H.R. 3103) presented by the conference to the
Congress.
On April 23, 1996, by an overwhelmingly bipartisan vote of 68-
30, the Senate passed a Domenici/Wellstone amendment which would have
required health plans to treat mental health coverage on an equal
footing with other health benefits. The Domenici/Wellstone amendment
would have ended the most egregious inequities in coverage for mental
illness.
Despite this impressive vote, concerns about the potential cost
of this amendment were raised. In response, Senator Domenici dropped
all of the mental health parity requirements in the amendment except
equitable treatment of lifetime and annual limits. According to the
Congressional Budget Office (CBO), Senator Domenici's compromise
would cost 90 percent less than the original amendment ($966
million). CBO has also estimated that the proposal would increase
insurance premiums by 0.4 percent at most.
The President feels strongly that Senator Domenici's compromise
should be the acceptable bipartisan alternative to the Senate passed
amendment. I urge you and all conferees to incorporate his proposal
into the bill reported out by the conference. We look forward to
reaching prompt agreement on this and all the other important
provisions of H.R. 3103.
Sincerely,
Leon Panetta
Chief of Staff
The Honorable Michael Bilirakis
House of Representatives
Washington, D.C. 20515
THE WHITE HOUSE
WASHINGTON
July 30, 1996
Dear Mr. Chairman:
I am writing to express the President's strong support for the
alternative that has been proposed by Senator Domenici to prohibit
health plans from establishing separate lifetime and annual limits
for mental health benefits. People with mental illness have faced
discrimination in health insurance coverage for far too long, and it
is time we take steps to end this inequity by including the Domenici
alternative in the final version of the Health Insurance Portability
and Accountability Act (H.R. 3103) presented by the conference to the
Congress.
On April 23, 1996, by an overwhelmingly bipartisan vote of 68-
30, the Senate passed a Domenici/Wellstone amendment which would have
required health plans to treat mental health coverage on an equal
footing with other health benefits. The Domenici/Wellstone amendment
would have ended the most egregious inequities in coverage for mental
illness.
Despite this impressive vote, concerns about the potential cost
of this amendment were raised. In response, Senator Domenici dropped
all of the mental health parity requirements in the amendment except
equitable treatment of lifetime and annual limits. According to the
Congressional Budget Office (CBO), Senator Domenici's compromise
would cost 90 percent less than the original amendment ($966
million). CBO has also estimated that the proposal would increase
insurance premiums by 0.4 percent at most.
The President feels strongly that Senator Domenici's compromise
should be the acceptable bipartisan alternative to the Senate passed
amendment. I urge you and all conferees to incorporate his proposal
into the bill reported out by the conference. We look forward to
reaching prompt agreement on this and all the other important
provisions of H.R. 3103.
Sincerely,
Leon P Panetta
Chief of Staff
The Honorable William F. Goodling
Chairman
Committee on Economic and Educational Opportunity
House of Representatives
Washington, D.C. 20515
THE WHITE HOUSE
WASHINGTON
July 30, 1996
Dear Representative Fawell:
I am writing to express the President's strong support for the
alternative that has been proposed by Senator Domenici to prohibit
health plans from establishing separate lifetime and annual limits
for mental health benefits. People with mental illness have faced
discrimination in health insurance coverage for far too long, and it
is time we take steps to end this inequity by including the Domenici
alternative in the final version of the Health Insurance Portability
and Accountability Act (H.R. 3103) presented by the conference to the
Congress.
On April 23, 1996, by an overwhelmingly bipartisan vote of 68-
30, the Senate passed a Domenici/Wellstone amendment which would have
required health plans to treat mental health coverage on an equal
footing with other health benefits. The Domenici/Wellstone amendment
would have ended the most egregious inequities in coverage for mental
illness.
Despite this impressive vote, concerns about the potential cost
of this amendment were raised. In response, Senator Domenici dropped
all of the mental health parity requirements in the amendment except
equitable treatment of lifetime and annual limits. According to the
Congressional Budget Office (CBO), Senator Domenici's compromise
would cost 90 percent less than the original amendment ($966
million). CBO has also estimated that the proposal would increase
insurance premiums by 0.4 percent at most.
The President feels strongly that Senator Domenici's compromise
should be the acceptable bipartisan alternative to the Senate passed
amendment. I urge you and all conferees to incorporate his proposal
into the bill reported out by the conference. We look forward to
reaching prompt agreement on this and all the other important
provisions of H.R. 3103.
Sincerely,
G
Panetta
The Honorable Harris W. Fawell
House of Representatives
Washington, D.C. 20515
THE WHITE HOUSE
WASHINGTON
July 30, 1996
Dear Mr. Chairman:
I am writing to express the President's strong support for the
alternative that has been proposed by Senator Domenici to prohibit
health plans from establishing separate lifetime and annual limits
for mental health benefits. People with mental illness have faced
discrimination in health insurance coverage for far too long, and it
is time we take steps to end this inequity by including the Domenici
alternative in the final version of the Health Insurance Portability
and Accountability Act (H.R. 3103) presented by the conference to the
Congress.
On April 23, 1996, by an overwhelmingly bipartisan vote of 68-
30, the Senate passed a Domenici/Wellstone amendment which would have
required health plans to treat mental health coverage on an equal
footing with other health benefits. The Domenici/Wellstone amendment
would have ended the most egregious inequities in coverage for mental
illness.
Despite this impressive vote, concerns about the potential cost
of this amendment were raised. In response, Senator Domenici dropped
all of the mental health parity requirements in the amendment except
equitable treatment of lifetime and annual limits. According to the
Congressional Budget Office (CBO), Senator Domenici's compromise
would cost 90 percent less than the original amendment ($966
million). CBO has also estimated that the proposal would increase
insurance premiums by 0.4 percent at most.
The President feels strongly that Senator Domenici's compromise
should be the acceptable bipartisan alternative to the Senate passed
amendment. I urge you and all conferees to incorporate his proposal
into the bill reported out by the conference. We look forward to
reaching prompt agreement on this and all the other important
provisions of H.R. 3103.
Sincerely,
Leon DR Panetta
Chief of Staff
The Honorable Henry J. Hyde
Chairman
Committee on Judiciary
House of Representatives
Washington, D.C. 20515
THE WHITE HOUSE
WASHINGTON
July 30, 1996
Dear Representative McCollum:
I am writing to express the President's strong support for the
alternative that has been proposed by Senator Domenici to prohibit
health plans from establishing separate lifetime and annual limits
for mental health benefits. People with mental illness have faced
discrimination in health insurance coverage for far too long, and it
is time we take steps to end this inequity by including the Domenici
alternative in the final version of the Health Insurance Portability
and Accountability Act (H.R. 3103) presented by the conference to the
Congress.
On April 23, 1996, by an overwhelmingly bipartisan vote of 68-
30, the Senate passed a Domenici/Wellstone amendment which would have
required health plans to treat mental health coverage on an equal
footing with other health benefits. The Domenici/Wellstone amendment
would have ended the most egregious inequities in coverage for mental
illness.
Despite this impressive vote, concerns about the potential cost
of this amendment were raised. In response, Senator Domenici dropped
all of the mental health parity requirements in the amendment except
equitable treatment of lifetime and annual limits. According to the
Congressional Budget Office (CBO), Senator Domenici's compromise
would cost 90 percent less than the original amendment ($966
million). CBO has also estimated that the proposal would increase
insurance premiums by 0.4 percent at most.
The President feels strongly that Senator Domenici's compromise
should be the acceptable bipartisan alternative to the Senate passed
amendment. I urge you and all conferees to incorporate his proposal
into the bill reported out by the conference. We look forward to
reaching prompt agreement on this and all the other important
provisions of H.R. 3103.
Sincerely,
Leon F Panetta
Chief of Staff
The Honorable Bill McCollum
House of Representatives
Washington, D.C. 20515
THE WHITE HOUSE
WASHINGTON
July 30, 1996
Dear Representative Hastert:
I am writing to express the President's strong support for the
alternative that has been proposed by Senator Domenici to prohibit
health plans from establishing separate lifetime and annual limits
for mental health benefits. People with mental illness have faced
discrimination in health insurance coverage for far too long, and it
is time we take steps to end this inequity by including the Domenici
alternative in the final version of the Health Insurance Portability
and Accountability Act (H.R. 3103) presented by the conference to the
Congress.
On April 23, 1996, by an overwhelmingly bipartisan vote of 68-
30, the Senate passed a Domenici/Wellstone amendment which would have
required health plans to treat mental health coverage on an equal
footing with other health benefits. The Domenici/Wellstone amendment
would have ended the most egregious inequities in coverage for mental
illness.
Despite this impressive vote, concerns about the potential cost
of this amendment were raised. In response, Senator Domenici dropped
all of the mental health parity requirements in the amendment except
equitable treatment of lifetime and annual limits. According to the
Congressional Budget Office (CBO), Senator Domenici's compromise
would cost 90 percent less than the original amendment ($966
million). CBO has also estimated that the proposal would increase
insurance premiums by 0.4 percent at most.
The President feels strongly that Senator Domenici's compromise
should be the acceptable bipartisan alternative to the Senate passed
amendment. I urge you and all conferees to incorporate his proposal
into the bill reported out by the conference. We look forward to
reaching prompt agreement on this and all the other important
provisions of H.R. 3103.
Sincerely,
5
Chief of Staff
The Honorable Dennis Hastert
House of Representatives
Washington, D.C. 20515
THE WHITE HOUSE
WASHINGTON
July 30, 1996
Dear Representative Gibbons:
I am writing to express the President's strong support for the
alternative that has been proposed by Senator Domenici to prohibit
health plans from establishing separate lifetime and annual limits
for mental health benefits. People with mental illness have faced
discrimination in health insurance coverage for far too long, and it
is time we take steps to end this inequity by including the Domenici
alternative in the final version of the Health Insurance Portability
and Accountability Act (H.R. 3103) presented by the conference to the
Congress.
On April 23, 1996, by an overwhelmingly bipartisan vote of 68-
30, the Senate passed a Domenici/Wellstone amendment which would have
required health plans to treat mental health coverage on an equal
footing with other health benefits. The Domenici/Wellstone amendment
would have ended the most egregious inequities in coverage for mental
illness.
Despite this impressive vote, concerns about the potential cost
of this amendment were raised. In response, Senator Domenici dropped
all of the mental health parity requirements in the amendment except
equitable treatment of lifetime and annual limits. According to the
Congressional Budget Office (CBO), Senator Domenici's compromise
would cost 90 percent less than the original amendment ($966
million). CBO has also estimated that the proposal would increase
insurance premiums by 0.4 percent at most.
The President feels strongly that Senator Domenici's compromise
should be the acceptable bipartisan alternative to the Senate passed
amendment. I urge you and all conferees to incorporate his proposal
into the bill reported out by the conference. We look forward to
reaching prompt agreement on this and all the other important
provisions of H.R. 3103.
Sincerely,
5 Panetta
Chief of Staff
The Honorable Sam M. Gibbons
Ranking Member
Committee on Ways and Means
House of Representatives
Washington, D.C. 20515
THE WHITE HOUSE
WASHINGTON
July 30, 1996
Dear Representative Stark:
I am writing to express the President's strong support for the
alternative that has been proposed by Senator Domenici to prohibit
health plans from establishing separate lifetime and annual limits
for mental health benefits. People with mental illness have faced
discrimination in health insurance coverage for far too long, and it
is time we take steps to end this inequity by including the Domenici
alternative in the final version of the Health Insurance Portability
and Accountability Act (H.R. 3103) presented by the conference to the
Congress.
On April 23, 1996, by an overwhelmingly bipartisan vote of 68-
30, the Senate passed a Domenici/Wellstone amendment which would have
required health plans to treat mental health coverage on an equal
footing with other health benefits. The Domenici/Wellstone amendment
would have ended the most egregious inequities in coverage for mental
illness.
Despite this impressive vote, concerns about the potential cost
of this amendment were raised. In response, Senator Domenici dropped
all of the mental health parity requirements in the amendment except
equitable treatment of lifetime and annual limits. According to the
Congressional Budget Office (CBO), Senator Domenici's compromise
would cost 90 percent less than the original amendment ($966
million). CBO has also estimated that the proposal would increase
insurance premiums by 0.4 percent at most.
The President feels strongly that Senator Domenici's compromise
should be the acceptable bipartisan alternative to the Senate passed
amendment. I urge you and all conferees to incorporate his proposal
into the bill reported out by the conference. We look forward to
reaching prompt agreement on this and all the other important
provisions of H.R. 3103.
Sincerely,
5 Panetta
Chief of Staff
The Honorable Pete Stark
House of Representatives
Washington, D.C. 20515
THE WHITE HOUSE
WASHINGTON
July 30, 1996
Dear Representative Dingell:
I am writing to express the President's strong support for the
alternative that has been proposed by Senator Domenici to prohibit
health plans from establishing separate lifetime and annual limits
for mental health benefits. People with mental illness have faced
discrimination in health insurance coverage for far too long, and it
is time we take steps to end this inequity by including the Domenici
alternative in the final version of the Health Insurance Portability
and Accountability Act (H.R. 3103) presented by the conference to the
Congress.
On April 23, 1996, by an overwhelmingly bipartisan vote of 68-
30, the Senate passed a Domenici/Wellstone amendment which would have
required health plans to treat mental health coverage on an equal
footing with other health benefits. The Domenici/Wellstone amendment
would have ended the most egregious inequities in coverage for mental
illness.
Despite this impressive vote, concerns about the potential cost
of this amendment were raised. In response, Senator Domenici dropped
all of the mental health parity requirements in the amendment except
equitable treatment of lifetime and annual limits. According to the
Congressional Budget Office (CBO), Senator Domenici's compromise
would cost 90 percent less than the original amendment ($966
million). CBO has also estimated that the proposal would increase
insurance premiums by 0.4 percent at most.
The President feels strongly that Senator Domenici's compromise
should be the acceptable bipartisan alternative to the Senate passed
amendment. I urge you and all conferees to incorporate his proposal
into the bill reported out by the conference. We look forward to
reaching prompt agreement on this and all the other important
provisions of H.R. 3103.
Sincerely,
eon E Panetta
Chief of Staff
The Honorable John D. Dingell
Ranking Member
Committee on Commerce
House of Representatives
Washington, D.C. 20515
THE WHITE HOUSE
WASHINGTON
July 30, 1996
Dear Representative Waxman:
I am writing to express the President's strong support for the
alternative that has been proposed by Senator Domenici to prohibit
health plans from establishing separate lifetime and annual limits
for mental health benefits. People with mental illness have faced
discrimination in health insurance coverage for far too long, and it
is time we take steps to end this inequity by including the Domenici
alternative in the final version of the Health Insurance Portability
and Accountability Act (H.R. 3103) presented by the conference to the
Congress.
On April 23, 1996, by an overwhelmingly bipartisan vote of 68-
30, the Senate passed a Domenici/Wellstone amendment which would have
required health plans to treat mental health coverage on an equal
footing with other health benefits. The Domenici/Wellstone amendment
would have ended the most egregious inequities in coverage for mental
illness.
Despite this impressive vote, concerns about the potential cost
of this amendment were raised. In response, Senator Domenici dropped
all of the mental health parity requirements in the amendment except
equitable treatment of lifetime and annual limits. According to the
Congressional Budget Office (CBO), Senator Domenici's compromise
would cost 90 percent less than the original amendment ($966
million). CBO has also estimated that the proposal would increase
insurance premiums by 0.4 percent at most.
The President feels strongly that Senator Domenici's compromise
should be the acceptable bipartisan alternative to the Senate passed
amendment. I urge you and all conferees to incorporate his proposal
into the bill reported out by the conference. We look forward to
reaching prompt agreement on this and all the other important
provisions of H.R. 3103.
Sincerely,
5 Panetta
Chief of Staff
The Honorable Henry A. Waxman
House of Representatives
Washington, D.C. 20515
THE WHITE HOUSE
WASHINGTON
July 30, 1996
Dear Representative Clay:
I am writing to express the President's strong support for the
alternative that has been proposed by Senator Domenici to prohibit
health plans from establishing separate lifetime and annual limits
for mental health benefits. People with mental illness have faced
discrimination in health insurance coverage for far too long, and it
is time we take steps to end this inequity by including the Domenici
alternative in the final version of the Health Insurance Portability
and Accountability Act (H.R. 3103) presented by the conference to the
Congress.
On April 23, 1996, by an overwhelmingly bipartisan vote of 68-
30, the Senate passed a Domenici/Wellstone amendment which would have
required health plans to treat mental health coverage on an equal
footing with other health benefits. The Domenici/Wellstone amendment
would have ended the most egregious inequities in coverage for mental
illness.
Despite this impressive vote, concerns about the potential cost
of this amendment were raised. In response, Senator Domenici dropped
all of the mental health parity requirements in the amendment except
equitable treatment of lifetime and annual limits. According to the
Congressional Budget Office (CBO), Senator Domenici's compromise
would cost 90 percent less than the original amendment ($966
million). CBO has also estimated that the proposal would increase
insurance premiums by 0.4 percent at most.
The President feels strongly that Senator Domenici's compromise
should be the acceptable bipartisan alternative to the Senate passed
amendment. I urge you and all conferees to incorporate his proposal
into the bill reported out by the conference. We look forward to
reaching prompt agreement on this and all the other important
provisions of H.R. 3103.
Sincerely,
Leon. E Panetta
Chief of Staff
The Honorable William (Bill) Clay
Ranking Member
Committee on Economic and Educational Opportunities
House of Representatives
Washington, D.C. 20515
THE WHITE HOUSE
WASHINGTON
July 30, 1996
Dear Representative Conyers:
I am writing to express the President's strong support for the
alternative that has been proposed by Senator Domenici to prohibit
health plans from establishing separate lifetime and annual limits
for mental health benefits. People with mental illness have faced
discrimination in health insurance coverage for far too long, and it
is time we take steps to end this inequity by including the Domenici
alternative in the final version of the Health Insurance Portability
and Accountability Act (H.R. 3103) presented by the conference to the
Congress.
On April 23, 1996, by an overwhelmingly bipartisan vote of 68-
30, the Senate passed a Domenici/Wellstone amendment which would have
required health plans to treat mental health coverage on an equal
footing with other health benefits. The Domenici/Wellstone amendment
would have ended the most egregious inequities in coverage for mental
illness.
Despite this impressive vote, concerns about the potential cost
of this amendment were raised. In response, Senator Domenici dropped
all of the mental health parity requirements in the amendment except
equitable treatment of lifetime and annual limits. According to the
Congressional Budget Office (CBO), Senator Domenici's compromise
would cost 90 percent less than the original amendment ($966
million). CBO has also estimated that the proposal would increase
insurance premiums by 0.4 percent at most.
The President feels strongly that Senator Domenici's compromise
should be the acceptable bipartisan alternative to the Senate passed
amendment. I urge you and all conferees to incorporate his proposal
into the bill reported out by the conference. We look forward to
reaching prompt agreement on this and all the other important
provisions of H.R. 3103.
Sincerely,
eon E Panetta
Chief of Staff
The Honorable John Conyers, Jr.
Ranking Member
Committee on Judiciary
House of Representatives
Washington, D.C. 20515
THE WHITE HOUSE
WASHINGTON
July 30, 1996
Dear Representative Bonior:
I am writing to express the President's strong support for the
alternative that has been proposed by Senator Domenici to prohibit
health plans from establishing separate lifetime and annual limits
for mental health benefits. People with mental illness have faced
discrimination in health insurance coverage for far too long, and it
is time we take steps to end this inequity by including the Domenici
alternative in the final version of the Health Insurance Portability
and Accountability Act (H.R. 3103) presented by the conference to the
Congress.
On April 23, 1996, by an overwhelmingly bipartisan vote of 68-
30, the Senate passed a Domenici/Wellstone amendment which would have
required health plans to treat mental health coverage on an equal
footing with other health benefits. The Domenici/Wellstone amendment
would have ended the most egregious inequities in coverage for mental
illness.
Despite this impressive vote, concerns about the potential cost
of this amendment were raised. In response, Senator Domenici dropped
all of the mental health parity requirements in the amendment except
equitable treatment of lifetime and annual limits. According to the
Congressional Budget Office (CBO), Senator Domenici's compromise
would cost 90 percent less than the original amendment ($966
million). CBO has also estimated that the proposal would increase
insurance premiums by 0.4 percent at most.
The President feels strongly that Senator Domenici's compromise
should be the acceptable bipartisan alternative to the Senate passed
amendment. I urge you and all conferees to incorporate his proposal
into the bill reported out by the conference. We look forward to
reaching prompt agreement on this and all the other important
provisions of H.R. 3103.
Sincerely,
5
Chief of Staff
The Honorable David E. Bonior
Democratic Whip
House of Representatives
Washington, D.C. 20515
THE WHITE HOUSE
WASHINGTON
July 30, 1996
Dear Mr. Leader:
I am writing to express the President's strong support for the
alternative that has been proposed by Senator Domenici to prohibit
health plans from establishing separate lifetime and annual limits
for mental health benefits. People with mental illness have faced
discrimination in health insurance coverage for far too long, and it
is time we take steps to end this inequity by including the Domenici
alternative in the final version of the Health Insurance Portability
and Accountability Act (H.R. 3103) presented by the conference to the
Congress.
On April 23, 1996, by an overwhelmingly bipartisan vote of 68-
30, the Senate passed a Domenici/Wellstone amendment which would have
required health plans to treat mental health coverage on an equal
footing with other health benefits. The Domenici/Wellstone amendment
would have ended the most egregious inequities in coverage for mental
illness.
Despite this impressive vote, concerns about the potential cost
of this amendment were raised. In response, Senator Domenici dropped
all of the mental health parity requirements in the amendment except
equitable treatment of lifetime and annual limits. According to the
Congressional Budget Office (CBO), Senator Domenici's compromise
would cost 90 percent less than the original amendment ($966
million). CBO has also estimated that the proposal would increase
insurance premiums by 0.4 percent at most.
The President feels strongly that Senator Domenici's compromise
should be the acceptable bipartisan alternative to the Senate passed
amendment. I urge you and all conferees to incorporate his proposal
into the bill reported out by the conference. We look forward to
reaching prompt agreement on this and all the other important
provisions of H.R. 3103.
Sincerely,
Jeon W. Panetta
Chief of Staff
The Honorable Trent Lott
Majority Leader
United States Senate
Washington, D.C. 20510
THE WHITE HOUSE
WASHINGTON
July 30, 1996
Dear Senator Kennedy:
I am writing to express the President's strong support for the
alternative that has been proposed by Senator Domenici to prohibit
health plans from establishing separate lifetime and annual limits
for mental health benefits. People with mental illness have faced
discrimination in health insurance coverage for far too long, and it
is time we take steps to end this inequity by including the Domenici
alternative in the final version of the Health Insurance Portability
and Accountability Act (H.R. 3103) presented by the conference to the
Congress.
On April 23, 1996, by an overwhelmingly bipartisan vote of 68-
30, the Senate passed a Domenici/Wellstone amendment which would have
required health plans to treat mental health coverage on an equal
footing with other health benefits. The Domenici/Wellstone amendment
would have ended the most egregious inequities in coverage for mental
illness.
Despite this impressive vote, concerns about the potential cost
of this amendment were raised. In response, Senator Domenici dropped
all of the mental health parity requirements in the amendment except
equitable treatment of lifetime and annual limits. According to the
Congressional Budget Office (CBO), Senator Domenici's compromise
would cost 90 percent less than the original amendment ($966
million). CBO has also estimated that the proposal would increase
insurance premiums by 0.4 percent at most.
The President feels strongly that Senator Domenici's compromise
should be the acceptable bipartisan alternative to the Senate passed
amendment. I urge you and all conferees to incorporate his proposal
into the bill reported out by the conference. We look forward to
reaching prompt agreement on this and all the other important
provisions of H.R. 3103.
Sincerely,
Leon Panetta
of Staff
The Honorable Edward M. Kennedy
Ranking Member
Committee on Labor and Human Resources
United States Senate
Washington, D.C. 20510
THE WHITE HOUSE
WASHINGTON
July 30, 1996
Dear Senator Moynihan:
I am writing to express the President's strong support for the
alternative that has been proposed by Senator Domenici to prohibit
health plans from establishing separate lifetime and annual limits
for mental health benefits. People with mental illness have faced
discrimination in health insurance coverage for far too long, and it
is time we take steps to end this inequity by including the Domenici
alternative in the final version of the Health Insurance Portability
and Accountability Act (H.R. 3103) presented by the conference to the
Congress.
On April 23, 1996, by an overwhelmingly bipartisan vote of 68-
30, the Senate passed a Domenici/Wellstone amendment which would have
required health plans to treat mental health coverage on an equal
footing with other health benefits. The Domenici/Wellstone amendment
would have ended the most egregious inequities in coverage for mental
illness.
Despite this impressive vote, concerns about the potential cost
of this amendment were raised. In response, Senator Domenici dropped
all of the mental health parity requirements in the amendment except
equitable treatment of lifetime and annual limits. According to the
Congressional Budget Office (CBO), Senator Domenici's compromise
would cost 90 percent less than the original amendment ($966
million). CBO has also estimated that the proposal would increase
insurance premiums by 0.4 percent at most.
The President feels strongly that Senator Domenici's compromise
should be the acceptable bipartisan alternative to the Senate passed
amendment. I urge you and all conferees to incorporate his proposal
into the bill reported out by the conference. We look forward to
reaching prompt agreement on this and all the other important
provisions of H.R. 3103.
Sincerely,
Leon E Panetta
Chlef-of Staff
The Honorable Daniel Patrick Moynihan
Ranking Member
Committee on Finance
United States Senate
Washington, D.C. 20510
THE WHITE HOUSE
WASHINGTON
July 30, 1996
Dear Mr. Chairman:
I am writing to express the President's strong support for the
alternative that has been proposed by Senator Domenici to prohibit
health plans from establishing separate lifetime and annual limits
for mental health benefits. People with mental illness have faced
discrimination in health insurance coverage for far too long, and it
is time we take steps to end this inequity by including the Domenici
alternative in the final version of the Health Insurance Portability
and Accountability Act (H.R. 3103) presented by the conference to the
Congress.
On April 23, 1996, by an overwhelmingly bipartisan vote of 68-
30, the Senate passed a Domenici/Wellstone amendment which would have
required health plans to treat mental health coverage on an equal
footing with other health benefits. The Domenici/Wellstone amendment
would have ended the most egregious inequities in coverage for mental
illness.
Despite this impressive vote, concerns about the potential cost
of this amendment were raised. In response, Senator Domenici dropped
all of the mental health parity requirements in the amendment except
equitable treatment of lifetime and annual limits. According to the
Congressional Budget Office (CBO), Senator Domenici's compromise
would cost 90 percent less than the original amendment ($966
million). CBO has also estimated that the proposal would increase
insurance premiums by 0.4 percent at most.
The President feels strongly that Senator Domenici's compromise
should be the acceptable bipartisan alternative to the Senate passed
amendment. I urge you and all conferees to incorporate his proposal
into the bill reported out by the conference. We look forward to
reaching prompt agreement on this and all the other important
provisions of H.R. 3103.
Sincerely,
Leon D. Panetta
Chief of Staff
The Honorable William V. Roth, Jr.
Chairman
Committee on Finance
United States Senate
Washington, D.C. 20510
THE WHITE HOUSE
WASHINGTON
July 30, 1996
Dear Madam Chair:
I am writing to express the President's strong support for the
alternative that has been proposed by Senator Domenici to prohibit
health plans from establishing separate lifetime and annual limits
for mental health benefits. People with mental illness have faced
discrimination in health insurance coverage for far too long, and it
is time we take steps to end this inequity by including the Domenici
alternative in the final version of the Health Insurance Portability
and Accountability Act (H.R. 3103) presented by the conference to the
Congress.
On April 23, 1996, by an overwhelmingly bipartisan vote of 68-
30, the Senate passed a Domenici/Wellstone amendment which would have
required health plans to treat mental health coverage on an equal
footing with other health benefits. The Domenici/Wellstone amendment
would have ended the most egregious inequities in coverage for mental
illness.
Despite this impressive vote, concerns about the potential cost
of this amendment were raised. In response, Senator Domenici dropped
all of the mental health parity requirements in the amendment except
equitable treatment of lifetime and annual limits. According to the
Congressional Budget Office (CBO), Senator Domenici's compromise
would cost 90 percent less than the original amendment ($966
million). CBO has also estimated that the proposal would increase
insurance premiums by 0.4 percent at most.
The President feels strongly that Senator Domenici's compromise
should be the acceptable bipartisan alternative to the Senate passed
amendment. I urge you and all conferees to incorporate his proposal
into the bill reported out by the conference. We look forward to
reaching prompt agreement on this and all the other important
provisions of H.R. 3103.
Sincerely,
Leon E Panetta
Chief of Staff
The Honorable Nancy Landon Kassebaum
Chairman
Committee on Labor and Human Resources
United States Senate
Washington, D.C. 20510
AMENDMENT NUMBERED
117
That the House recede from its disagreement to the amendment of the
Senate numbered 117, and agree to the same with an amendment, as follows:
In lieu of the matter proposed by said amendment, insert:
1 TITLE
VI-NEWBORNS
AND
2
MOTHERS' HEALTH PROTEC-
3
TION ACT OF 1996
4 SEC. 601. SHORT TITLE.
5
This title may be cited as the "Newborns' and Moth-
6 ers' Health Protection Act of 1996".
7 SEC. 602. FINDING.
8
Congress finds that—
9
(1) the length of post-delivery hospital stay
10
should be based on the unique characteristics of
11
each mother and her newborn child, taking into con-
12
sideration the health of the mother, the health and
13
stability of the newborn, the ability and confidence
14
of the mother and the father to care for their new-
15
born, the adequacy of support systems at home, and
16
the access of the mother and her newborn to appro-
17
priate follow-up health care; and
18
(2) the timing of the discharge of a mother and
19
her newborn child from the hospital should be made
20
by the attending provider in consultation with the
21
mother.
F
\EGG\HCR96\VAHUDCON\NEWBORNS.07A
(Finai Drait]
2
1 SEC. 603. AMENDMENTS TO THE EMPLOYEE RETIREMENT
2
INCOME SECURITY ACT OF 1974.
3
(a) IN GENERAL.-Part 7 of subtitle B of title I of
4 the Employee Retirement Income Security Act of 1974
5 (added by section 101(a) of the Health Insurance Port-
6 ability and Accountability Act of 1996) is amended—
7
(1) by amending the heading of the part to read
8
as follows:
9
"PART 7-GROUP HEALTH PLAN REQUIREMENTS";
10
(2) by inserting after the part heading the fol-
11
lowing:
12
"SUBPART A-REQUIREMENTS RELATING TO
13
PORTABILITY, ACCESS, AND RENEWABILITY";
ITAL
14
(3) by redesignating sections 704 through 707
15
as sections 731 through 734, respectively;
16
(4) by inserting before section 731 (as SO redes-
17
ignated) the following new heading:
18
"SUBPART C-GENERAL PROVISIONS";
19
and
20
(5) by inserting after section 703 the following
21
new subpart:
22
"SUBPART B-OTHER REQUIREMENTS
23 "SEC. 711. STANDARDS RELATING TO BENEFITS FOR MOTH-
24
ERS AND NEWBORNS.
25
"(a) REQUIREMENTS FOR MINIMUM HOSPITAL STAY
26 FOLLOWING BIRTH.-
(7:28
p.m.)
F:\EGG VAHUDCON EWBORNS 07A
[Final
3
1
"(1) IN GENERAL.- group health plan, and a
2
health insurance issuer offering group health insur-
3
ance coverage, may not-
4
"(A) except as provided in paragraph
5
(2)-
6
"(i) restrict benefits for any hospital
7
length of stay in connection with childbirth
8
for the mother or newborn child, following
9
a normal vaginal delivery, to less than 48
10
hours, or
11
"(ii) restrict benefits for any hospital
12
length of stay in connection with childbirth
ITAL
13
for the mother or newborn child, following
14
a cesarean section, to less than 96 hours;
15
or
16
"(B) require that a provider obtain author-
17
ization from the plan or the issuer for prescrib-
18
ing any length of stay required under subpara-
19
graph (A) (without regard to paragraph (2)).
20
"(2) EXCEPTION.-Paragrap (1)(A) shall not
21
apply in connection with any group health plan or
22
health insurance issuer in any case in which the de-
23
cision to discharge the mother or her newborn child
24
prior to the expiration of the minimum length of
25
stay otherwise required under paragraph (1)(A) is
1996
F:\EGG\HCR96\ VAHUDCON NEWBORNS.07A
[Fimar
4
1
made by an attending provider in consultation with
2
the mother.
3
"(b) PROHIBITIONS.-A group health plan, and a
4 health insurance issuer offering group health insurance
5 coverage in connection with a group health plan, may
6 not-
7
"(1) deny to the mother or her newborn child
8
eligibility, or continued eligibility, to enroll or to
9
renew coverage under the terms of the plan, solely
10
for the purpose of avoiding the requirements of this
11
section;
12
"(2) provide monetary payments or rebates to
13
mothers to encourage such mothers to accept less
14
than the minimum protections available under this
15
section;
16
"(3) penalize or otherwise reduce or limit the
17
reimbursement of an attending provider because
18
such provider provided care to an individual partici-
19
pant or beneficiary in accordance with this section;
20
"(4) provide incentives (monetary or otherwise)
21
to an attending provider to induce such provider to
22
provide care to an individual participant or bene-
23
ficiary in a manner inconsistent with this section; or
24
"(5) subject to subsection (c)(3), restrict bene-
25
fits for any portion of a period within a hospital
Potember
F: EGG HCR96\ VAHUDCON
[Final Draft]
5
1
length of stay required under subsection (a) in a
2
manner which is less favorable than the benefits pro-
3
vided for any preceding portion of such stay.
4
"(c) RULES OF CONSTRUCTION.-
5
"(1) Nothing in this section shall be construed
6
to require a mother who is a participant or bene-
7
ficiary-
8
"(A) to give birth in a hospital; or
9
"(B) to stay in the hospital for a fixed pe-
10
riod of time following the birth of her child.
11
"(2) This section shall not apply with respect to
12
any group health plan, or any group health insur-
13
ance coverage offered by a health insurance issuer,
14
which does not provide benefits for hospital lengths
15
of stay in connection with childbirth for a mother or
16
her newborn child.
17
"(3) Nothing in this section shall be construed
18
as preventing a group health plan or issuer from im-
19
posing deductibles, coinsurance, or other cost-shar-
20
ing in relation to benefits for hospital lengths of stay
21
in connection with childbirth for a mother or new-
22
born child under the plan (or under health insurance
23
coverage offered in connection with a group health
24
plan), except that such coinsurance or other cost-
25
sharing for any portion of a period within a hospital
September
19
p.m.)
[Final Draftl
6
1
length of stay required under subsection (a) may not
2
be greater than such coinsurance or cost-sharing for
3
any preceding portion of such stay.
4
"(d) NOTICE UNDER GROUP HEALTH PLAN.-The
5 imposition of the requirements of this section shall be
6 treated as a material modification in the terms of the plan
7 described in section 102(a)(1), for purposes of assuring
8 notice of such requirements under the plan; except that
9 the summary description required to be provided under the
10 last sentence of section 104(b)(1) with respect to such
11 modification shall be provided by not later than 60 days
12 after the first day of the first plan year in which such
13 requirements apply.
14
"(e) LEVEL AND TYPE OF REIMBURSEMENTS.-
15 Nothing in this section shall be construed to prevent a
16 group health plan or a health insurance issuer offering
17 group health insurance coverage from negotiating the level
18 and type of reimbursement with a provider for care pro-
19 vided in accordance with this section.
20
"(f) PREEMPTION; EXCEPTION FOR HEALTH INSUR-
21 ANCE COVERAGE IN CERTAIN STATES.-
22
"(1) IN GENERAL.-The requirements of this
23
section shall not apply with respect to health insur-
24
ance coverage if there is a State law (as defined in
25
section 731(d)(1)) for a State that regulates such
September 10
AMUDCON
[Final Draft]
7
1
coverage that is described in any of the following
2
subparagraphs:
3
"(A) Such State law requires such cov-
4
erage to provide for at least a 48-hour hospital
5
length of stay following a normal vaginal deliv-
6
ery and at least a 96-hour hospital length of
7
stay following a cesarean section.
8
"(B) Such State law requires such cov-
9
erage to provide for maternity and pediatric
10
care in accordance with guidelines established
11
by the American College of Obstetricians and
12
Gynecologists, the American Academy of Pedi-
13
atrics, or other established professional medical
14
associations.
15
"(C) Such State law requires, in connec-
16
tion with such coverage for maternity care, that
17
the hospital length of stay for such care is left
18
to the decision of (or required to be made by)
19
the attending provider in consultation with the
20
mother.
21
"(2) CONSTRUCTION.-Section 731(a)(1) shall
22
not be construed as superseding a State law de-
23
scribed in paragraph (1).".
24
(b) CONFORMING AMENDMENTS.-
September 19, 1996 (7:28 p.m.)
\EGG\HCRes
Final Draft]
8
1
(1) Section 731(c) of such Act (as added by
2
section 101 of the Health Insurance Portability and
3
Accountability Act of 1996 and redesignated by the
4
preceding provisions of this section) is amended by
5
striking "Nothing" and inserting "Except as pro-
6
vided in section 711, nothing".
7
(2) Section 732(a) of such Act (as added by
8
section 101 of the Health Insurance Portability and
9
Accountability Act of 1996 and redesignated by the
10
preceding provisions of this section) is amended by
11
inserting "(other than section 711)" after "part".
12
(3) Title I of such Act (as amended by section
13
101 of the Health Insurance Portability and Ac-
14
countability Act of 1996 and the preceding provi-
15
sions of this section) is further amended—
16
(A) in the last sentence of section 4(b), by
17
striking
"section
706(b)(2)",
"section
18
706(b)(1)", and "section 706(a)(1)" and insert-
19
ing "section 733(b)(2)", "section 733(b)(1)",
20
and "section 733(a)(1)", respectively;
21
(B) in section 101(g), by striking "section
22
706(a)(2)" and inserting "section 733(a)(2)";
23
(C) in section 102(b), by striking "section
24
706(a)(1)" each place it appears and inserting
VAHUDOON
WBORNS.07A
(Final Draft]
9
1
"section 733(a)(1), and by striking "section
2
706(b)(2)" and inserting "section 733(b)(2)";
3
(D) in section 104(b)(1), by striking "sec-
4
tion 706(a)(1)" each place it appears and in-
5
serting "section 733(a)(1);
6
(E) in section 502(b)(3), by striking "sec-
7
tion 706(a)(1)" and inserting "section
8
733(a)(1)";
9
(F) in section 506(c), by striking "section
10
706(a)(2)" and inserting "section 733(a)(2)";
11
(G) in section 514(b)(9), by striking "sec-
12
tion 704" and inserting "section 731";
13
(H) in the last sentence of section
14
701(c)(1), by striking "section 706(c)" and in-
15
serting "section 733(c)";
16
(I) in section 732(b), by striking "section
17
706(c)(1)" and inserting "section 733(c)(1)";
18
(J) in section 732(c)(1), by striking "sec-
19
tion 706(c)(2)" and inserting "section
20
733(c)(2)";
21
(K) in section 732(c)(2), by striking "sec-
22
tion 706(c)(3)" and inserting "section
23
733(c)(3)"; and
September
19
FAEGG HCR96 VAHUDCON NEWBORNS.07A
[Final Draft]
10
1
(L) in section 732(c)(3), by striking "sec-
2.
tion 706(c)(4)" and inserting "section
3
733(c)(4)".
4
(4) The table of contents in section 1 of such
5
Act is amended by striking the items relating to part
6
7 and inserting the following:
"PART 7-GROUP HEALTH PLAN REQUIREMENTS
"SUBPART A-REQUIREMENTS RELATING TO PORTABILITY, ACCESS, AND
RENEWABILITY
"Sec. 701. Increased portability through limitation on preexisting condition ex-
clusions.
"Sec. 702. Prohibiting discrimination against individual participants and bene-
ficiaries based on health status.
"Sec. 703. Guaranteed renewability in multiemployer plans and multiple em-
ployer welfare arrangements.
"SUBPART B-OTHER REQUIREMENTS
ITAL
"Sec. 711. Standards relating to benefits for mothers and newborns.
"SUBPART C-GENERAL PROVISIONS
"Sec. 731. Preemption; State flexibility; construction.
"Sec. 732. Special rules relating to group health plans.
"Sec. 733. Definitions.
"Sec. 734. Regulations.".
7
(c) EFFECTIVE DATE.-The amendments made by
8 this section shall apply with respect to group health plans
9 for plan years beginning on or after January 1, 1998.
10 SEC. 604. AMENDMENTS TO THE PUBLIC HEALTH SERVICE
11
ACT RELATING TO THE GROUP MARKET.
12
(a) IN GENERAL.-Title XXVII of the Public Health
13 Service Act (as added by section 102 of the Health Insur-
14 ance Portability and Accountability Act of 1996) is
15 amended-
F: EGG HCR96
[Final Draft]
11
1
(1) by amending the title heading to read as
2
follows:
3
"TITLE XXVI-REQUIREMENTS RELATING TO
4
HEALTH INSURANCE COVERAGE";
5
(2) by redesignating subparts 2 and 3 of part
6
A as subparts 3 and 4 of such part;
7
(3) by inserting after subpart 1 of part A the
8
following new subpart:
9
"Subpart 2-Other Requirements
10 "SEC. 2704. STANDARDS RELATING TO BENEFITS FOR
11
MOTHERS AND NEWBORNS.
12
"(a) REQUIREMENTS FOR MINIMUM HOSPITAL STAY
13 FOLLOWING BIRTH.-
14
"(1) IN GENERAL.-A group health plan, and a
15
health insurance issuer offering group health insur-
16
ance coverage, may not-
17
"(A) except as provided in paragraph
18
(2)-
19
"(i) restrict benefits for any hospital
20
length of stay in connection with childbirth
21
for the mother or newborn child, following
22
a normal vaginal delivery, to less than 48
23
hours, or
24
"(ii) restrict benefits for any hospital
25
length of stay in connection with childbirth
F:\EGG HCR96 VAHUDGON NEWDORNS.07A
[Final Draft]
12
1
for the mother or newborn child, following
2
a cesarean section, to less than 96 hours,
3
or
4
"(B) require that a provider obtain author-
5
ization from the plan or the issuer for prescrib-
6
ing any length of stay required under subpara-
7
graph (A) (without regard to paragraph (2)).
8
"(2) EXCEPTION.-Paragraph (1)(A) shall not
9
apply in connection with any group health plan or
10
health insurance issuer in any case in which the de-
11
cision to discharge the mother or her newborn child
12
prior to the expiration of the minimum length of
13
stay otherwise required under paragraph (1) (A) is
14
made by an attending provider in consultation with
15
the mother.
16
"(b) PROHIBITIONS.-A group health plan, and a
17 health insurance issuer offering group health insurance
18 coverage in connection with a group health plan, may
19 not-
20
"(1) deny to the mother or her newborn child
21
eligibility, or continued eligibility, to enroll or to
22
renew coverage under the terms of the plan, solely
23
for the purpose of avoiding the requirements of this
24
section;
Septembe 1996 (7:28 p.m.)
FAEGG HCR96 VAHUDSONANEWBORNS.07
[Final Draft]
13
1
"(2) provide monetary payments or rebates to
2
mothers to encourage such mothers to accept less
3
than the minimum protections available under this
4
section;
5
"(3) penalize or otherwise reduce or limit the
6
reimbursement of an attending provider because
7
such provider provided care to an individual partici-
8
pant or beneficiary in accordance with this section;
9
"(4) provide incentives (monetary or otherwise)
10
to an attending provider to induce such provider to
11
provide care to an individual participant or bene-
12
ficiary in a manner inconsistent with this section; or
(TAL
13
"(5) subject to subsection (c)(3), restrict bene-
14
fits for any portion of a period within a hospital
15
length of stay required under subsection (a) in a
16
manner which is less favorable than the benefits pro-
17
vided for any preceding portion of such stay.
18
"(c) RULES OF CONSTRUCTION.-
19
"(1) Nothing in this section shall be construed
20
to require a mother who is a participant or bene-
21
ficiary-
22
"(A) to give birth in a hospital; or
23
"(B) to stay in the hospital for a fixed pe-
24
riod of time following the birth of her child.
September
FGG
VAHUDOON
NEWBORNS.07A
Draft]
14
1
"(2) This section shall not apply with respect to
2
any group health plan, or any group health insur-
3
ance coverage offered by a health insurance issuer,
4
which does not provide benefits for hospital lengths
5
of stay in connection with childbirth for a mother or
6
her newborn child.
7
"(3) Nothing in this section shall be construed
8
as preventing a group health plan or issuer from im-
9
posing deductibles, coinsurance, or other cost-shar-
10
ing in relation to benefits for hospital lengths of stay
11
in connection with childbirth for a mother or new-
12
born child under the plan (or under health insurance
13
coverage offered in connection with a group health
14
plan), except that such coinsurance or other cost-
15
sharing for any portion of a period within a hospital
16
length of stay required under subsection (a) may not
17
be greater than such coinsurance or cost-sharing for
18
any preceding portion of such stay.
19
"(d) NOTICE.-A group health plan under this part
20 shall comply with the notice requirement under section
21 711(d) of the Employee Retirement Income Security Act
22 of 1974 with respect to the requirements of this section
23 as if such section applied to such plan.
24
"(e) LEVEL AND TYPE OF REIMBURSEMENTS.-
25 Nothing in this section shall be construed to prevent a
September 19, 1990
EGG HCR96\ VAHUDCON
NEWDORNS.07A
[Final Draftl
15
1 group health plan or a health insurance issuer offering
2 group health insurance coverage from negotiating the level
3 and type of reimbursement with a provider for care pro-
4 vided in accordance with this section.
5
"(f) PREEMPTION; EXCEPTION FOR HEALTH INSUR-
6 ANCE COVERAGE IN CERTAIN STATES.-
7
"(1) IN GENERAL-The requirements of this
8
section shall not apply with respect to health insur-
9
ance coverage if there is a State law (as defined in
10
section 2723(d)(1)) for a State that regulates such
11
coverage that is described in any of the following
12
subparagraphs:
13
"(A) Such State law requires such cov-
14
erage to provide for at least a 48-hour hospital
15
length of stay following a normal vaginal deliv-
16
ery and at least a 96-hour hospital length of
17
stay following a cesarean section.
18
"(B) Such State law requires such cov-
19
erage to provide for maternity and pediatric
20
care in accordance with guidelines established
21
by the American College of Obstetricians and
22
Gynecologists, the American Academy of Pedi-
23
atrics, or other established professional medical
24
associations.
EGG' HCR96 VAHUDCO
[Final Draft]
16
1
"(C) Such State law requires, in connec-
2
tion with such coverage for maternity care, that
3
the hospital length of stay for such care is left
4
to the decision of (or required to be made by)
5
the attending provider in consultation with the
6
mother.
7
"(2) CONSTRUCTION.-Section 2723(a)(1) shall
8
not be construed as superseding a State law de-
9
scribed in paragraph (1).'
10
(b) CONFORMING AMENDMENTS.-
11
(1) Section 2721 of such Act (as added by sec-
12
tion 102 of the Health Insurance Portability and Ac-
13
countability Act of 1996) is amended-
14
(A) in subsection (a), by striking "subparts
15
1 and 2" and inserting "subparts 1 and 3",
16
and
17
(B) in subsections (b) through (d), by
18
striking "subparts 1 and 2" each place it ap-
19
pears and inserting "subparts 1 through 3".
20
(2) Section 2723(c) of such Act (as added by
21
section 102 of the Health Insurance Portability and
22
Accountability Act of 1996) is amended by inserting
23
"(other than section 2704)" after "part".
September
p.m.)
HORSO
[Final Draft]
17
1
(c) EFFECTIVE DATE.-The amendments made by
2 this section shall apply with respect to group health plans
3 for plan years beginning on or after January 1, 1998.
4 SEC. 605. AMENDMENTS TO THE PUBLIC HEALTH SERVICE
5
ACT RELATING TO THE INDIVIDUAL MARKET.
6
(a) IN GENERAL.-Part B of title XXVII of the Pub-
7 lic Health Service Act (as added by section 111 of the
8 Health Insurance Portability and Accountability Act of
9 1996) is amended-
10
(1) by inserting after the part heading the fol-
11
lowing:
12
"Subpart 1-Portability, Access, and Renewability
13
Requirements";
14
(2) by redesignating sections 2745, 2746, and
ITAL
15
2747 as sections 2761, 2762, and 2763, respectively;
16
(3) by inserting before section 2761 (as so re-
17
designated) the following:
18
"Subpart 3-General Provisions"; and
19
(4) by inserting after section 2744 the follow-
20
ing:
21
"Subpart 3-Other Requirements
22 "SEC. 2751. STANDARDS RELATING TO BENEFITS FOR
23
MOTHERS AND NEWBORNS.
24
"(a) IN GENERAL.-The provisions of section 2704
25 (other than subsections (d) and (f)) shall apply to health
1996
(7:28
n.m
VAHUDCON \NE WBORNS.07A
[Final Draftl
18
1 insurance coverage offered by a health insurance issuer
2 in the individual market in the same manner as it applies
3 to health insurance coverage offered by a health insurance
4 issuer in connection with a group health plan in the small
5 or large group market.
6
"(b) NOTICE REQUIREMENT.-A health insurance is-
7 suer under this part shall comply with the notice require-
8 ment under section 711(d) of the Employee Retirement
9 Income Security Act of 1974 with respect to the require-
10 ments referred to in subsection (a) as if such section ap-
11 plied to such issuer and such issuer were a group health
12 plan.
13
"(c) PREEMPTION; EXCEPTION FOR HEALTH INSUR-
14 ANCE COVERAGE IN CERTAIN STATES:-
15
"(1) IN GENERAL-The requirements of this
16
section shall not apply with respect to health insur-
17
ance coverage if there is a State law (as defined in
18
section 2723(d)(1)) for a State that regulates such
19
coverage that is described in any of the following
20
subparagraphs:
21
"(A) Such State law requires such cov-
22
erage to provide for at least a 48-hour hospital
23
length of stay following a normal vaginal deliv-
24
ery and at least a 96-hour hospital length of
25
stay following a cesarean section.
EGG HCR96 VAHUDCON
[Final Draft]
19
1
"(B) Such State law requires such cov-
2
erage to provide for maternity and pediatric
3
care in accordance with guidelines established
4
by the American College of Obstetricians and
5
Gynecologists, the American Academy of Pedi-
6
atrics, or other established professional medical
7
associations.
8
"(C) Such State law requires, in connec-
9
tion with such coverage for maternity care, that
10
the hospital length of stay for such care is left
11
to the decision of (or required to be made by)
12
the attending provider in consultation with the
ITAL
13
mother.
14
"(2) CONSTRUCTION.-Section 2762(a) shall
15
not be construed as superseding a State law de-
16
scribed in paragraph (1).
17
(b) CONFORMING AMENDMENTS.-Such part (as SO
18 added) is further amended as follows:
19
(1) In section 2744(a)(1), strike "2746(b)" and
20
insert "2762(b)".
21
(2) In section 2745(a)(1) (before redesignation
22
under subsection (a)(1)), strike "2746" and insert
23
"2762".
24
(3) In section 2746(b) (before redesignation
25
under subsection (a)(1))-
September
WAILUDCON
NEWDORNO.07A
[Final Draft]
20
1
(A) by inserting "(1)" after the dash, and
2
(B) by adding at the end the following:
3
"(2) Nothing in this part (other than section 2751)
4 shall be construed as requiring health insurance coverage
5 offered in the individual market to provide specific benefits
6 under the terms of such coverage.".
7
(c) EFFECTIVE DATE.-The amendments made by
8 this section shall apply with respect to health insurance
9 coverage offered, sold, issued, renewed, in effect, or oper-
10 ated in the individual market on or after January 1, 1998.
11 SEC. 606. REPORTS TO CONGRESS CONCERNING CHILD-
12
BIRTH.
13
(a) FINDINGS.-Congress finds that-
14
(1) childbirth is one part of a continuum of ex-
ITAL
15
perience that includes prepregnancy, pregnancy and
16
prenatal care, labor and delivery, the immediate
17
postpartum period, and a longer period of adjust-
18
ment for the newborn, the mother, and the family;
19
(2) health care practices across this continuum
20
are changing in response to health care financing
21
and delivery system changes, science and clinical re-
22
search, and patient preferences; and
23
(3) there is a need—
EGG
HCR96
VAHUDCON
[Final Draft]
21
1
(A) to examine the issues and con-
2
sequences associated with the length of hospital
3
stays following childbirth;
4
(B) to examine the follow-up practices for
5
mothers and newborns used in conjunction with
6
shorter hospital stays;
7
(C) to identify appropriate health care
8
practices and procedures with regard to the
9
hospital discharge of newborns and mothers;
10
(D) to examine the extent to which such
11
care is affected by family and environmental
12
factors; and
13
(E) to examine the content of care during
14
hospital stays following childbirth.
15
(b) ADVISORY PANEL.-
16
(1) IN GENERAL.-Not later than 90 days after
17
the date of enactment of this Act, the Secretary of
18
Health and Human Services (in this section referred
19
to as the "Secretary") shall establish an advisory
20
panel (referred to in this section as the "advisory
21
panel")-
22
(A) to guide and review methods, proce-
23
dures, and data collection necessary to conduct
24
the study described in subsection (c) in a man-
25
ner that is intended to enhance the quality,
FAEGG HCR96 VAHUDCON (NEWBORNS.U7A
[Final Draft]
22
1
safety, and effectiveness of health care services
2
provided to mothers and newborns;
3
(B) to develop a consensus among the
4
members of the advisory panel regarding the
5
appropriateness of the specific requirements of
6
this title; and
7
(C) to prepare and submit to the Sec-
8
retary, as part of the report of the Secretary
9
submitted under subsection (d), a report sum-
10
marizing the consensus (if any) developed under
11
subparagraph (B) or the reasons for not reach-
12
ing such a consensus.
13
(2) PARTICIPATION.-
14
(A) DEPARTMENT REPRESENTATIVES.-
15
The Secretary shall ensure that representatives
16
from within the Department of Health and
17
Human Services that have expertise in the area
18
of maternal and child health or in outcomes re-
19
search are appointed to the advisory panel.
20
(B) REPRESENTATIVES OF PUBLIC AND
21
PRIVATE SECTOR ENTITIES.-
22
(i) IN GENERAL.-The Secretary shall
23
ensure that members of the advisory panel
24
include representatives of public and pri-
25
vate sector entities having knowledge or
September
HCR96\VAHUDCON\NEWBORNS.07A
Draft]
23
1
experience in one or more of the following
2
areas:
3
(I) Patient care.
4
(II) Patient education.
5
(III) Quality assurance.
6
(IV) Outcomes research.
7
(V) Consumer issues.
8
(ii) REQUIREMENT.-The panel shall
9
include representatives of each of the fol-
10
lowing categories:
11
(I) Health care practitioners.
12
(II) Health plans.
13
(III) Hospitals.
14
(IV) Employers.
15
(V) States.
16
(VI) Consumers.
17
(c) STUDIES.-
18
(1) IN GENERAL-The Secretary shall conduct
19
a study of-
20
(A) the factors affecting the continuum of
21
care with respect to maternal and child health
22
care, including outcomes following childbirth;
23
(B) the factors determining the length of
24
hospital stay following childbirth;
AHUDCON
[Final Draft]
24
1
(C) the diversity of negative or positive
2
outcomes affecting mothers, infants, and fami-
3
lies;
4
(D) the manner in which post natal care
5
has changed over time and the manner in which
6
that care has adapted or related to changes in
7
the length of hospital stay, taking into ac-
8
count—
9
(i) the types of post natal care avail-
10
able and the extent to which such care is
11
accessed; and
12
(ii) the challenges associated with pro-
13
viding post natal care to all populations,
78"
14
including vulnerable populations, and solu-
15
tions for overcoming these challenges; and
16
(E) the financial incentives that may-
17
(i) impact the health of newborns and
18
mothers; and
19
(ii) influence the clinical decisionmak-
20
ing of health care providers.
21
(2) RESOURCES.-The Secretary shall provide
22
to the advisory panel the resources necessary to
23
carry out the duties of the advisory panel.
24
(d) REPORTS.-
EGG HCR96 VAHUDCOT
25
1
(1) IN GENERAL-The Secretary shall prepare
2
and submit to the Committee on Labor and Human
3
Resources of the Senate and the Committee on Com-
4
merce of the House of Representatives a report that
5
contains—
6
(A) a summary of the study conducted
7
under subsection (c);
8
(B) a summary of the best practices used
9
in the public and private sectors for the care of
10
newborns and mothers;
11
(C) recommendations for improvements in
12
prenatal care, post natal care, delivery and fol-
13
low-up care, and whether the implementation of
14
such improvements should be accomplished by
15
the private health care sector, Federal or State
16
governments, or any combination thereof; and
17
(D) limitations on the databases in exist-
18
ence on the date of the enactment of this Act.
19
(2) DEADLINES.-The Secretary shall prepare
20
and submit to the Committees referred to in para-
21
graph (1)-
22
(A) an initial report concerning the study
23
conducted under subsection (c) and elements
24
described in paragraph (1), not later than 18
September
19,
1996
p.m.)
TITLE VI - NEWBORNS' AND MOTHERS' HEALTH PROTECTION ACT OF 1996
Amendment No. 117:
The conference agreement includes the Senate
, including the deletion of 0 ffsets,
amendment with modifications It incorporates the re-
quirements of the provision and the authority to enforce
the requirements into the new part 7 of subtitle B of
ERISA and the new title XXVII of the Public Health
Service Act as established by P.L. 104-191. It does not
include the exception to the requirement for the 48-hour
or 96-hour minimum stay in the case that the plan pro-
vides for post-delivery follow-up care. It adds a prohibi-
tion that a health plan cannot restrict benefits for any
portion of the required minimum 48-hour or 96-hour stay
in a manner which is less favorable than the benefits pro-
viding for any preceding portion of such stay. In addi-
tion, the conference agreement provides that nothing in
this provision is intended to be construed as preventing
a group health plan or issuer from imposing coinsurance,
deductibles, or other cost-sharing in relation to benefits
for hospital lengths of stay in connection with childbirth
for a mother or newborn child under the plan (or under
health insurance coverage offered in connection with a
group health plan), except that such coinsurance or other
cost-sharing for any portion of a period within a hospital
75
length of stay required under subsection (a) may not be
greater than such coinsurance or cost-sharing for any
preceding portion of such stay. It is the intent of the con-
ferees that cost-sharing not be used in a manner that cir-
cumvents the objectives of this title. It provides for a
modification to the notice requirements by conforming
them to the summary of material modifications under
ERISA In general, it conforms the provision relating to
preemption to State laws to the Health Insurance Port-
ability and Accountability Act of 1996. Notwithstanding
section 731(a)(1) of ERISA and sections 2723(a)(1) and
2762 of the Public Health Service Act, the new provi-
sions shall not preempt a State law that requires health
insurance coverage to include coverage for maternity and
pediatric care in accordance with guidelines established
by the American College of Obstetricians and Gyne-
cologists, the American Academy of Pediatrics, or other
established professional medical associations. In addition,
those sections shall not be construed as superseding a
State law that leaves decisions regarding the appropriate
hospital length of stay in connection with childbirth en-
tirely to the attending provider in consultation with the
mother. In addition, it is the intent of the conferees that,
consistent with section 704 (redesignated as section 731)
of ERISA and section 2723 of the Public Health Service
76
Act, the application of the preemption provision should
permit the operation of any State law or provision which
requires more favorable treatment of maternity coverage
under health insurance coverage than that required under
this title.
It is the intent of the conferees that health plans
have sufficient flexibility to encourage or specify that at-
tending providers follow nationally recognized guidelines
for maternal and perinatal care in determining when
early discharge is medically appropriate.
Throughout the title, the conferees have used the
term "hospital length of stay" to indicate that the re-
quirement for coverage of a 48-hour stay following vagi-
nal delivery and a 96-hour length of stay following a ce-
sarean section delivery is triggered by any delivery in
connection with hospital care, regardless of whether the
delivery is in a hospital inpatient or outpatient setting.
It is the intent of the conferees that a detailed series
of conforming changes shall be made as soon as possible
to the Internal Revenue Code, specifically subtitle K of
the Internal Revenue Code of 1986 (as added by section
401(a) of the Health Insurance Portability and Account-
ability Act of 1996), in order to fully implement these
provisions as part of chapter 100 of the Code.
77
TITLE VII - PARITY IN THE APPLICATION OF CERTAIN LIMITS TO MENTAL
HEALTH BENEFITS
Amendment No. Inserts language proposed by- the Sonate egarding montal
health parity |amended to delete the offsets and make other modifications.
The conference agreement includes the Senate
amendment with modifications. It incorporates the re-
quirement into the new part 7 of subtitle B of title I of
ERISA and the new title XXVII of the Public Health
Service Act as established by Public Law 104-191. The
construction clause has been modified to state that noth-
ing in this section shall be construed as-
(1) requiring a group health plan (or health in-
surance coverage offered in connection with such a
plan) to provide any mental health benefits; or
(2) in the case of such a plan or coverage that
provides such mental health benefits, as affecting
the terms and conditions (including cost sharing, the
limits on numbers of visits or days of coverage, and
requirements relating to medical necessity) relating
to the amount, duration, or scope of mental health
benefits under the plan or coverage, except as spe-
cifically provided in regard to parity in the imposi-
tion of aggregate lifetime limits and annual limits
for mental health benefits.
This language affirms the intent of conferees that group
health plans and issuers retain the flexibility, consistent
with the requirements of the Act, to define the scope of
70
benefits, establish cost-sharing requirements, and to im-
pose limits on hospital days and out-patient visits. Parity
of mental health services with medical and surgical serv-
ices defined under a group health plan is limited solely
to any aggregate dollar life-time limit and any annual
dollar limit under such a plan. The conference agreement
clarifies that the requirements apply to each group health
plan, and, in the case of a group health plan that offers
two or more benefit packages, the parity requirements
shall be applied separately with respect to each such op-
tion. In addition, the conference agreement applies an ex-
emption to small employers as defined in the Health In-
surance Portability and Accountability Act; adds certain
definitions; and applies the requirements of the provision
to group health plan years beginning on or after January
1, 1998. The agreement does not include the Senate lan-
guage relating to effective dates for the Federal Em-
ployee Health Benefit Plan.
It is the intent of the conferees that a detailed series
of conforming changes shall be made as soon as possible
to the Internal Revenue Code, specifically subtitle K of
the Internal Revenue Code of 1986 (as added by section
401(a) of the Health Insurance Portability and Account-
ability Act of 1996), in order to fully implement these
provisions as part of chapter 100 of the Code.
79
The conferees intend that a limit be considered to
apply to "substantially all medical and surgical benefits"
if it applies to at least two-thirds of all the medical and
surgical benefits covered under the group health plan's
benefit package.
It is the intent of the conferees that, consistent with
section 704 (redesignated as section 731) of ERISA and
section 2723 of the Public Health Service Act, the appli-
cation of the preemption provision should permit the op-
eration of any State law or provision which requires more
favorable treatment of mental health benefits under
health insurance coverage than that required under this
section.
80
CONFERENCE TOTAL--WITH COMPARISONS
The total new budget (obligational) authority for the fiscal year 1997
recommended by the Committee of Conference, with comparisons to the fiscal
year 1996 amount, the 1997 budget estimates, and the House and Senate bills
for 1997 follow:
New budget (obligational) authority, fiscal year 1996
$ 82,442,966,000
Budget estimates of new (obligational) authority,
fiscal year 1997
87,820,371,000
House bill, fiscal year 1997
83,995,260,000
Senate bill, fiscal year 1997
84,810,153,000
Conference agreement, fiscal year 1997
84,800,283,000
Conference agreement compared with:
New budget (obligational) authority, fiscal year 1996
+2,357,317,000
Budget estimates of new (obligational) authority,
fiscal year 1997
-3,020,088,000
House bill, fiscal year 1997
+805,023,000
Senate bill, fiscal year 1997
-9,870,000
81
Managers on the Part of the
HOUSE
JERRY LEWIS Lews
Managers on the Part of the
Juny
SENATE
CHRISTOPHERS. BOND
Barhara 2. Vercananich
CONRAD BURNS
BARBARA F. VUCANOVICH
Webh
TED STEVENS
JAMES T. David WALSH
Hoh
RICHARD Richard C. SHELBY C. Hulby
Lakulledse DAVID L. HOBSON
)
Robert ROBERT F. 7 BENNETT Summy
JOE KNOLLENBERG
TURP. Juling
BEN NIGHTHORSE CAMPBELL
RODNEY P. FRELINGHUYSEN
MARK O. HATFIELD
BARBARA A. MIKULSKI
BOB IVINGSTON
PATRICK Patient J LEAHY Lenhy
LOUIS STOKES
/Ola B Molloha
ALAN B. MOLLOHAN
J. FRANK BENNETT R. LAUTENBERG JOHNS ON
JIM CHAPMAN
marcy MARCY Kaptur
J. ROBERT KERREY
ROBERT C. BYRD
DAVID
AMENDMENT NUMBERED
118
That the House recede from its disagreement to the amendment of the
Senate numbered 118, and agree to the same with an amendment, as follows:
In lieu of the matter proposed by said amendment, insert:
1 TITLE VII-PARITY IN THE AP-
2
PLICATION OF CERTAIN LIM-
3
ITS TO MENTAL HEALTH BEN-
4
EFITS
5 SEC. 701. SHORT TITLE.
6
This title may be cited as the "Mental Health Parity
7 Act of 1996".
8 SEC. 702. AMENDMENTS TO THE EMPLOYEE RETIREMENT
9
INCOME SECURITY ACT OF 1974.
10
(a) IN GENERAL.-Subpart B of part 7 of subtitle
11 B of title I of the Employee Retirement Income Security
7+1
12 Act of 1974 (as added by section 603(a)) is amended by
13 adding at the end the following new section:
14 "SEC. 712. PARITY IN THE APPLICATION OF CERTAIN LIM-
15
ITS TO MENTAL HEALTH BENEFITS.
16
"(a) IN GENERAL.-
17
"(1) AGGREGATE LIFETIME LIMITS.-In the
18
case of a group health plan (or health insurance cov-
19
erage offered in connection with such a plan) that
20
provides both medical and surgical benefits and
21
mental health benefits-
22
"(A) No LIFETIME LIMIT.-If the plan or
23
coverage does not include an aggregate lifetime
[Final Draft]
2
1
limit on substantially all medical and surgical
2
benefits, the plan or coverage may not impose
3
any aggregate lifetime limit on mental health
4
benefits.
5
"(B) LIFETIME LIMIT.-If the plan or cov-
6
erage includes an aggregate lifetime limit on
7
substantially all medical and surgical benefits
8
(in this paragraph referred to as the 'applicable
9
lifetime limit'), the plan or coverage shall ei-
10
ther—
11
"(i) apply the applicable lifetime limit
12
both to the medical and surgical benefits to
13
which it otherwise would apply and to
14
mental health benefits and not distinguish
15
in the application of such limit between
ITAL
16
such medical and surgical benefits and
17
mental health benefits; or
18
"(ii) not include any aggregate life-
19
time limit on mental health benefits that is
20
less than the applicable lifetime limit.
21
"(C) RULE IN CASE OF DIFFERENT LIM-
22
ITS.-In the case of a plan or coverage that is
23
not described in subparagraph (A) or (B) and
24
that includes no or different aggregate lifetime
25
limits on different categories of medical and
September
F:\EGG
MNTLHLTH.005
[Final Draft]
3
1
surgical benefits, the Secretary shall establish
2
rules under which subparagraph (B) is applied
3
to such plan or coverage with respect to mental
4
health benefits by substituting for the applica-
5
ble lifetime limit an average aggregate lifetime
6
limit that is computed taking into account the
7
weighted average of the aggregate lifetime lim-
8
its applicable to such categories.
9
"(2) ANNUAL LIMITS.-In the case of a group
10
health plan (or health insurance coverage offered in
11
connection with such a plan) that provides both
12
medical and surgical benefits and mental health ben-
ITAL
13
efits-
14
"(A) No ANNUAL LIMIT.-If the plan or
15
coverage does not include an annual limit on
16
substantially all medical and surgical benefits,
17
the plan or coverage may not impose any an-
18
nual limit on mental health benefits.
19
"(B) ANNUAL LIMIT.-If the plan or cov-
20
erage includes an annual limit on substantially
21
all medical and surgical benefits (in this para-
22
graph referred to as the 'applicable annual
23
limit'), the plan or coverage shall either-
24
"(i) apply the applicable annual limit
25
both to medical and surgical benefits to
September 19
WTLHLTH.005
[Final
4
1
which it otherwise would apply and to
2
mental health benefits and not distinguish
3
in the application of such limit between
4
such medical and surgical benefits and
5
mental health benefits; or
6
"(ii) not include any annual limit on
7
mental health benefits that is less than the
8
applicable annual limit.
9
"(C) RULE IN CASE OF DIFFERENT LIM-
10
ITS.-In the case of a plan or coverage that is
11
not described in subparagraph (A) or (B) and
12
that includes no or different annual limits on
13
different categories of medical and surgical ben-
14
efits, the Secretary shall establish rules under
15
which subparagraph (B) is applied to such plan
16
or coverage with respect to mental health bene-
17
fits by substituting for the applicable annual
18
limit an average annual limit that is computed
19
taking into account the weighted average of the
20
annual limits applicable to such categories.
21
"(b) CONSTRUCTION.-Nothing in this section shall
22 be construed—
23
"(1) as requiring a group health plan (or health
24
insurance coverage offered in connection with such a
25
plan) to provide any mental health benefits; or
September
19,
1996
p.m.)
VAHUBCO.
111.00
Draftl
5
1
"(2) in the case of a group health plan (or
2
health insurance coverage offered in connection with
3
such a plan) that provides mental health benefits, as
4
affecting the terms and conditions (including cost
5
sharing, limits on numbers of visits or days of cov-
6
erage, and requirements relating to medical neces-
7
sity) relating to the amount, duration, or scope of
8
mental health benefits under the plan or coverage,
9
except as specifically provided in subsection (a) (in
10
regard to parity in the imposition of aggregate life-
11
time limits and annual limits for mental health bene-
12
fits).
13
"(c) EXEMPTIONS.-
14
"(1) SMALL EMPLOYER EXEMPTION.-
15
"(A) IN GENERAL.-This section shall not
16
apply to any group health plan (and group
17
health insurance coverage offered in connection
18
with a group health plan) for any plan year of
19
a small employer.
20
"(B) SMALL EMPLOYER.-For purposes of
21
subparagraph (A), the term 'small employer'
22
means, in connection with a group health plan
23
with respect to a calendar year and a plan year,
24
an employer who employed an average of at
25
least 2 but not more than 50 employees on
[Final Draft]
6
1
business days during the preceding calendar
2
year and who employs at least 2 employees on
3
the first day of the plan year.
4
"(C) APPLICATION OF CERTAIN RULES IN
5
DETERMINATION OF EMPLOYER SIZE.-For
6
purposes of this paragraph-
7
"(i) APPLICATION OF AGGREGATION
8
RULE FOR EMPLOYERS.-Rules similar to
9
the rules under subsections (b), (c), (m),
10
and (o) of section 414 of the Internal Rev-
11
enue Code of 1986 shall apply for purposes
12
of treating persons as a single employer.
13
"(ii) EMPLOYERS NOT IN EXISTENCE
14
IN PRECEDING YEAR.-In the case of an
15
employer which was not in existence
16
throughout the preceding calendar year,
17
the determination of whether such em-
18
ployer is a small employer shall be based
19
on the average number of employees that
20
it is reasonably expected such employer
21
will employ on business days in the current
22
calendar year.
23
"(iii) PREDECESSORS.-Any reference
24
in this paragraph to an employer shall in-
September 19 1996
F: EGG HCR96 MNTLHLTH.005
[Final Draft]
7
1
clude a reference to any predecessor of
2
such employer.
3
"(2) INCREASED COST EXEMPTION.-This sec-
4
tion shall not apply with respect to a group health
5
plan (or health insurance coverage offered in connec-
6
tion with a group health plan) if the application of
7
this section to such plan (or to such coverage) re-
8
sults in an increase in the cost under the plan (or
9
for such coverage) of at least 1 percent.
10
"(d) SEPARATE APPLICATION TO EACH OPTION OF-
11 FERED.-In the case of a group health plan that offers
12 a participant or beneficiary two or more benefit package
13 options under the plan, the requirements of this section
14 shall be applied separately with respect to each such op-
15 tion.
16
"(e) DEFINITIONS.-For purposes of this section:
17
"(1) AGGREGATE LIFETIME LIMIT.-The term
18
'aggregate lifetime limit' means, with respect to ben-
19
efits under a group health plan or health insurance
20
coverage, a dollar limitation on the total amount
21
that may be paid with respect to such benefits under
22
the plan or health insurance coverage with respect to
23
an individual or other coverage unit.
24
"(2) ANNUAL LIMIT.-The term 'annual limit'
25
means, with respect to benefits under a group health
September 19, 1996 (7:18 p.m.)
FAUGG
111.003
[Final
8
1
plan or health insurance coverage, a dollar limitation
2
on the total amount of benefits that may be paid
3
with respect to such benefits in a 12-month period
4
under the plan or health insurance coverage with re-
5
spect to an individual or other coverage unit.
6
"(3) MEDICAL OR SURGICAL BENEFITS.-The
7
term 'medical or surgical benefits' means benefits
8
with respect to medical or surgical services, as de-
9
fined under the terms of the plan or coverage (as the
10
case may be), but does not include mental health
11
benefits.
12
"(4) MENTAL HEALTH BENEFITS.-The term
13
'mental health benefits' means benefits with respect
14
to mental health services, as defined under the terms
15
of the plan or coverage (as the case may be), but
16
does not include benefits with respect to treatment
17
of substance abuse or chemical dependency.
18
"(f) SUNSET.-This section shall not apply to bene-
19 fits for services furnished on or after September 30,
20 2001."
21
(b) CLERICAL AMENDMENT.-The table of contents
22 in section 1 of such Act, as amended by section 602 of
23 this Act, is amended by inserting after the item relating
24 to section 711 the following new item:
"Sec. 712. Parity in the application of certain limits to mental health bene-
fits.".
F: EGG HCR96 VAHUDCON MNTLHLTH.005
[Final Draft]
9
1
(c) EFFECTIVE DATE.-The amendments made by
2 this section shall apply with respect to group health plans
3 for plan years beginning on or after January 1, 1998.
4 SEC. 703. AMENDMENTS TO THE PUBLIC HEALTH SERVICE
5
ACT RELATING TO THE GROUP MARKET.
6
(a) IN GENERAL.-Subpart 2 of part A of title
7 XXVII of the Public Health Service Act (as added by sec-
8 tion 604(a)) is amended by adding at the end the following
9 new section:
10 "SEC. 2705. PARITY IN THE APPLICATION OF CERTAIN LIM-
11
ITS TO MENTAL HEALTH BENEFITS.
12
"(a) IN GENERAL.-
13
"(1) AGGREGATE LIFETIME LIMITS.-In the
14
case of a group health plan (or health insurance cov-
15
erage offered in connection with such a plan) that
16
provides both medical and surgical benefits and
17
mental health benefits—
18
"(A) No LIFETIME LIMIT.-If the plan or
19
coverage does not include an aggregate lifetime
20
limit on substantially all medical and surgical
21
benefits, the plan or coverage may not impose
22
any aggregate lifetime limit on mental health
23
benefits.
24
"(B) LIFETIME LIMIT.-If the plan or cov-
25
erage includes an aggregate lifetime limit on
10
1
substantially all medical and surgical benefits
2
(in this paragraph referred to as the 'applicable
3
lifetime limit'), the plan or coverage shall ei-
4
ther—
5
"(i) apply the applicable lifetime limit
6
both to the medical and surgical benefits to
7
which it otherwise would apply and to
8
mental health benefits and not distinguish
9
in the application of such limit between
10
such medical and surgical benefits and
11
mental health benefits; or
(
12
"(ii) not include any aggregate life-
13
time limit on mental health benefits that is
14
less than the applicable lifetime limit.
15
"(C) RULE IN CASE OF DIFFERENT LIM-
16
ITS.-In the case of a plan or coverage that is
17
not described in subparagraph (A) or (B) and
18
that includes no or different aggregate lifetime
19
limits on different categories of medical and
20
surgical benefits, the Secretary shall establish
21
rules under which subparagraph (B) is applied
22
to such plan or coverage with respect to mental
23
health benefits by substituting for the applica-
24
ble lifetime limit an average aggregate lifetime
25
limit that is computed taking into account the
F:
MNTLHLTH.005
[Final Draft]
11
1
weighted average of the aggregate lifetime lim-
2
its applicable to such categories.
3
"(2) ANNUAL LIMITS.-In the case of a group
4
health plan (or health insurance coverage offered in
5
connection with such a plan) that provides both
6
medical and surgical benefits and mental health ben-
7
efits-
8
"(A) No ANNUAL LIMIT.-If the plan or
9
coverage does not include an annual limit on
10
substantially all medical and surgical benefits,
11
the plan or coverage may not impose any an-
1
12
nual limit on mental health benefits.
13
"(B) ANNUAL LIMIT.-If the plan or cov-
14
erage includes an annual limit on substantially
15
all medical and surgical benefits (in this para-
16
graph referred to as the 'applicable annual
17
limit'), the plan or coverage shall either-
18
"(i) apply the applicable annual limit
19
both to medical and surgical benefits to
20
which it otherwise would apply and to
21
mental health benefits and not distinguish
22
in the application of such limit between
23
such medical and surgical benefits and
24
mental health benefits; or
F:\EGG
HCR96
12
1
"(ii) not include any annual limit on
2
mental health benefits that is less than the
3
applicable annual limit.
4
"(C) RULE IN CASE OF DIFFERENT LIM-
5
ITS.-In the case of a plan or coverage that is
6
not described in subparagraph (A) or (B) and
7
that includes no or different annual limits on
8
different categories of medical and surgical ben-
9
efits, the Secretary shall establish rules under
10
which subparagraph (B) is applied to such plan
11
or coverage with respect to mental health bene-
12
fits by substituting for the applicable annual
13
limit an average annual limit that is computed
14
taking into account the weighted average of the
15
annual limits applicable to such categories.
16
"(b) CONSTRUCTION.-Nothing in this section shall
17 be construed—
18
"(1) as requiring a group health plan (or health
19
insurance coverage offered in connection with such a
20
plan) to provide any mental health benefits; or
21
"(2) in the case of a group health plan (or
22
health insurance coverage offered in connection with
23
such a plan) that provides mental health benefits, as
24
affecting the terms and conditions (including cost
25
sharing, limits on numbers of visits or days of cov-
MNTLHLTH.005
[Final Draft)
13
1
erage, and requirements relating to medical neces-
2
sity) relating to the amount, duration, or scope of
3
mental health benefits under the plan or coverage,
4
except as specifically provided in subsection (a) (in
5
regard to parity in the imposition of aggregate life-
6
time limits and annual limits for mental health bene-
7
fits).
8
"(c) EXEMPTIONS.-
9
"(1) SMALL EMPLOYER EXEMPTION.-This sec-
10
tion shall not apply to any group health plan (and
11
group health insurance coverage offered in connec-
12
tion with a group health plan) for any plan year of
ITAL
13
a small employer.
14
"(2) INCREASED COST EXEMPTION.-This sec-
15
tion shall not apply with respect to a group health
16
plan (or health insurance coverage offered in connec-
17
tion with a group health plan) if the application of
18
this section to such plan (or to such coverage) re-
19
sults in an increase in the cost under the plan (or
20
for such coverage) of at least 1 percent.
21
"(d) SEPARATE APPLICATION TO EACH OPTION OF-
22 FERED.-In the case of a group health plan that offers
23 a participant or beneficiary two or more benefit package
24 options under the plan, the requirements of this section
HI 005
[Final Draft]
14
1 shall be applied separately with respect to each such op-
2 tion.
3
"(e) DEFINITIONS.-For purposes of this section:
4
"(1) AGGREGATE LIFETIME LIMIT.-The term
5
'aggregate lifetime limit' means, with respect to ben-
6
efits under a group health plan or health insurance
7
coverage, a dollar limitation on the total amount
8
that may be paid with respect to such benefits under
9
the plan or health insurance coverage with respect to
10
an individual or other coverage unit.
11
"(2) ANNUAL LIMIT.-The term 'annual limit'
12
means, with respect to benefits under a group health
13
plan or health insurance coverage, a dollar limitation
14
on the total amount of benefits that may be paid
15
with respect to such benefits in a 12-month period
16
under the plan or health insurance coverage with re-
17
spect to an individual or other coverage unit.
18
"(3) MEDICAL OR SURGICAL BENEFITS.-The
19
term 'medical or surgical benefits' means benefits
20
with respect to medical or surgical services, as de-
21
fined under the terms of the plan or coverage (as the
22
case may be), but does not include mental health
23
benefits.
24
"(4) MENTAL HEALTH BENEFITS.-The term
25
'mental health benefits' means benefits with respect
HCR96 VAHUDCON MNTLHLTH.005
Final Draft]
15
1
to mental health services, as defined under the terms
2
of the plan or coverage (as the case may be), but
3
does not include benefits with respect to treatment
4
of substance abuse or chemical dependency.
5
"(f) SUNSET.-This section shall not apply to bene-
6 fits for services furnished on or after September 30,
7 2001.".
8
(b) EFFECTIVE DATE.-The amendments made by
9 this section shall apply with respect to group health plans
10 for plan years beginning on or after January 1, 1998
i and the Senate agree to the same.
48 HOUR RULE
I.
48 HOUR RULE
The "Newborns' and Mothers' Protection Act of 1996" will require health plans to allow all
new mothers of newborns, at their option, to remain in the hospital for at least 48 hours
following most normal deliveries.
II.
PURPOSE
Over the past two decades, the average length of stay for an uncomplicated childbirth has
declined sharply. Today, a growing number of insurance companies are refusing to pay for
anything more than a 24-hour stay, and as few as 8 hours.
III.
IMPACT
This initiative will bring "peace of mind" to new mothers because they know they
will not be discharged prematurely from the hospital.
IV.
SPECIFIC PROVISIONS
Requires health plans to let mothers and newborns remain in the hospital for a
minimum of 48 hours after a normal delivery and 96 hours after a Caesarean section.
Shorter stays may be allowed if the attending health care provider, in consultation
with the new mother, determines such a stay is appropriate.
Requires follow-up care within 72 hours of discharge, if discharge occurs earlier
than 48 hours after birth.
The initiative will not pre-empt state legislation if states already require a minimum
of 48 hour stays for normal deliveries (96 hours for Caesarean section) or meet
guidelines established by the American College of Obstetricians or Gynecologists, the
American Academy of Pediatrics, or certain other medical professional organizations.
V.
BACKGROUND
Senators Bradley, Frist and Kassebaum and Representative Dingell introduced the
"Newborns' and Mothers' Health Protection Act" to allow all new mothers a minimum of 48
hours of care following most normal deliveries. The President, First Lady and members of
the Administration challenged Congress to pass this legislation before they adjourned. In
September, Congress responded to their challenge and included this legislation on the
VA/HUD appropriations bill that they sent to the President for his signature.
September 25, 1996
Statements In Support of the 48 Hour Rule
"I urge members of Congress to move legislation forward as soon as possible that
makes this protection for mothers and their children the law of the land. No
insurance company should be free to make the final judgment about what is medically
best for newborns and their mothers. That decision should be left up to doctors,
nurses and mothers themselves."
President Bill Clinton
May 11, 1996
"We should protect mothers and newborn babies from being forced out of the hospital
in less than 48 hours."
President Bill Clinton
Democratic National Convention
August 30, 1996
"
the President is right to support a bill that would prohibit the practice of forcing
mothers and babies to leave the hospital in less than 48 hours."
Hillary Rodham Clinton
Democratic National Convention
August 28, 1996
"That's why I'm supporting the legislation I mentioned, dealing with not forcing new
mothers and their newborns out of the hospital."
President Bill Clinton
September 5, 1996
"We should enact bipartisan legislation to require health insurers to let all new
mothers and their babies stay in the hospital at least 48 hours following normal
deliveries."
President Bill Clinton
September 11, 1996
September 25, 1996
MENTAL HEALTH PARITY
I.
MENTAL HEALTH PARITY
This provision will prohibit insurers from setting separate lifetime and annual coverage
limits for mental and physical illnesses.
II.
PURPOSE
In insurance plans today, there is widespread variation in lifetime and annual caps and
in other aspects of mental health care coverage. Many of these plans discriminates
against individuals diagnosed with mental illness. President Clinton believes that
individuals with mental illness should be treated in the same manner as those with
other medical disorders.
III.
IMPACT
This provision will provide more equitable treatment of mental health benefits under
private health insurance plans.
IV.
SPECIFIC PROVISIONS
This provision will require health plans that have a lifetime or annual limit on
spending for medical or surgical services to include either mental health
services in that total or have a separate limit for mental illnesses that is no
more restrictive than the medical-surgical limit.
The provision applies to health plans under the Federal Employee Benefit
Health Plan (FEBHP) and the Employee Retirement Income Security Act
(ERISA).
Businesses with 50 or fewer employees are exempt from this provision.
The provision does not require health plans to cover mental illness.
The provision allows for separate co-payment, deductible and visit limits from
mental health treatment.
The provision will take effect January 1, 1998.
V.
BACKGROUND
The President has been a strong proponent of moving toward mental health parity.
The President endorses reforms that will provide more equitable treatment of mental
health benefits under private health insurance plans. The President stated his support
for the Domenici/Wellstone compromise and expressed his disappointment that it was
not included in the Kennedy/Kassebaum health insurance reform legislation. He also
made a public commitment to work toward the passage of such legislation.
September 25, 1996
Statements In Support of Mental Health Parity
"I am writing to express the President's strong support for the alternative that has
been proposed by Senator Domenici to prohibit health plans from establishing
separate lifetime and annual limits for mental health benefits. People with mental
illness have faced discrimination in health insurance coverage for far too long, and it
is time we take steps to end this inequity..."
Leon Panetta
July 30, 1996
"
I was disappointed that the mental health provision was taken out, [of the
Kennedy/Kassebaum bill] and I certainly hope we can get it as soon as possible in the
future. It should remain a high priority."
President Bill Clinton
August 1, 1996
"I wish this bill [Kennedy/Kassebaum] had contained the provision to eliminate the
differential treatment of mental health coverage, or at least taken some positive steps
in that direction."
President Bill Clinton
August 21, 1996
"We also have to find a way to provide access to mental health benefits and health
insurance. It's a very important thing for our country."
President Bill Clinton
August 27, 1996
"We should ensure that the Domenici/Wellstone mental health parity compromise
becomes law.' "
President Bill Clinton
September 11, 1996
September 25, 1996
CHILDREN OF VIETNAM VETERANS BORN WITH SPINA BIFIDA
I.
CHILDREN OF VIETNAM VETERANS BORN WITH SPINA BIFIDA
This legislation will authorize the Veterans' Administration to provide medical and
rehabilitative training for children of Vietnam veterans who are born with the birth
defect spina bifida.
II.
PURPOSE
Research has shown a positive link between spina bifida exposure to Agent Orange
during service in Vietnam. The President strongly believes it is appropriate that we
help children whose birth defects may be a result of their father's or mother's service
to this country.
III.
IMPACT
This initiative will provide assistance to at least 2,000 spina-bifida afflicted
children of Vietnam veterans.
This initiative will provide about $35 million in 1997 for treatment and
vocational rehabilitation, with additional funding made available in the future.
IV.
SPECIFIC PROVISIONS
Requires the Department of Veterans Affairs to furnish needed health care to a
Vietnam veteran's child who is suffering from spina bifida.
Provides treatment and vocational rehabilitation to eligible children.
V.
BACKGROUND
On May 20, 1996 you announced your intent to propose legislation to meet the needs
of veterans' children afflicted with spina bifida -- the first time the offspring of
American soldiers will receive benefits for combat-related health problems. The
Congress responded to your challenge, through the leadership of Senator Daschle,
Senator Rockefeller and Representative Evans, to pass legislation to authorize the
Veterans' Administration to provide medical and rehabilitative training for children of
Vietnam veterans who are born with the birth defect spina bifida.
September 25, 1996
Statements In Support of Children of Vietnam Veterans
Born with Spina Bifida
"Our administration will also propose legislation to meet the needs of veterans'
children afflicted with the birth defect, spina bifida -- the first time the offspring of
American solders will receive benefits for combat-related health problems."
President Bill Clinton
May 20, 1996
"The President and I firmly believe that VA needs to be on the side of veterans and
their children."
Secretary Jesse Brown
May 25, 1996
"It seems appropriate, therefore, and in the best interests of these children, that the
same benefit of the doubt as is required to be given Vietnam veterans be given to their
offspring, whose birth defects may be a result of their father's or mother's service to
this country."
Secretary Jesse Brown
July 25, 1996
"We should act now to give the Veterans' Administration authority to help the children
of Vietnam veterans who are born with the birth defect spina bifida."
President Bill Clinton
September 11, 1996
September 25, 1996
SEP-19-1996 20:11 FROM
TO
94567431
P.01/08
NANCY LANDON KASSEBAUM. KANSAS. CHAIRMAN
JAMES fort JESSORDS. VERMONT
EDWARD M. KENNEDY. MASSACHUSCTTS
DAN COATS. INDIANA
CLAISORNE PELL RHODE ISLAND
JUDD GREGG. NEW MAMPSHIRE
CHRISTOPHER I DODD. CONNECTICUT
BILL FRIST. ENNESSEE
PAUL SIMON. ILLINOIS
MIKE DEWINE. OHIO
TOM HARKIN, IOWA
JOWN ASHCROFT, MISSOURI
BARBARA A, MIKULSRI, MARYLAND
SPENCER ABRAHAM, MICHIGAN
PAUL WELLSTONE, MINNESOTA
SLADE GORTON, WASHINGTON
United States Senate
SUSAN < MATTAN, STAFF DIRECTOR
NICK LITTLEFIELD. MINORITY STAFF DIRECTOR AND CHIEF COUNSEL
COMMITTEE ON LABOR AND
HUMAN RESOURCES
WASHINGTON, DC 20510-6300
TO:
Chris Jennings
FR:
David Nexon
DATE & TIME:
9/19 8:20 pm
NUMBER OF PAGES:
COVER + 7
RETURN FAX NUMBER:
(202) 224-3533
IF THERE IS TROUBLE RECEIVING THIS FAX, PLEASE CALL
(202) 224-7675.
MESSAGE:
Changes.
FAX NUMBER: 456-7431
SEP-19-1996 20:11 FROM
TO
94567431
P.02/08
F:\EGG\HCR96\VAHLDCON\MHREPORT.001
Find
Statement of Conferees on Senate Amendment #118 to
H.R. 3666 ("Mental Health Parity Act of 1996")
The conference agreement includes the Senate
amendment with modifications. It incorporates the re-
quirement into the new part 7 of subtitle B of title I of
ERISA and the new title XXVII of the Public Health
Service Act as established by Public Law 104-191. The
construction clause has been modified to state that noth-
ing in this section shall be construed as-
(1) requiring a group health plan (or health in-
surance coverage offered in connection with such a
plan) to provide any mental health benefits; or
(2) in the case of such a plan or coverage that
provides such mental health benefits, as affecting
the terms and conditions (including cost sharing, the
limits on numbers of visits or days of coverage, and
requirements relating to medical necessity) relating
to the amount, duration, or scope of mental health
benefits under the plan or coverage, except as spe-
cifically provided in regard to parity in the imposi-
tion of aggregate lifetime limits and annual limits
for mental health benefits.
This language affirms the intent of conferees that group
health plans and issuers retain the flexibility, consistent
with the requirements of the Act, to define the scope of
September 19. 1996 (12:37 a.m.)
SEP-19-1996 20:11 FROM
TO
94567431
P.03/08
2
benefits, establish cost-sharing requirements, and to im-
pose limits on hospital days and out-patient visits. Parity
of mental health services with medical and surgical serv-
ices defined under a group health plan is limited solely
to any aggregate dollar life-time limit and any annual
dollar limit under such a plan. The conference agreement
clarifies that the requirements apply to each group health
plan, and, in the case of a group health plan that offers
two or more benefit packages, the parity requirements
shall be applied separately with respect to each such op-
tion. In addition, the conference agreement applies an ex-
emption to small employers as defined in the Health In-
surance Portability and Accountability Act; adds certain
definitions; and applies the requirements of the provision
to group health plan years beginning or or after January
1, 1998. The agreement does not include the Senate lan-
guage relating to effective dates for the Federal Em-
ployee Health Benefit Plan.
It is the intent of the conferees that a detailed series
of conforming changes shall be made as soon as possible
to the Internal Revenue Code, specifically subtitle K of
the Internal Revenue Code of 1986 (as added by section
401(a) of the Health Insurance Portability and Account-
ability Act of 1996), in order to fully implement these
provisions as part of chapter 100 of the Code.
September 19. 1996 (12:37 a.m.)
SEP-19-1996 20:12 FROM
TO
94567431
P.04/08
F:\EGG\HCR96VVAHUDCON\MHREPORT.001
3
The conferees intend that a limit be considered to
apply to "substantially all medical and surgical benefits"
if it applies to at least two-thirds of all the medical and
surgical benefits covered under the group health plan's
benefit package.
It is the intent of the conferees that, consistent with
section 704 (redesignated as section 731) of ERISA and
section 2723 of the Public Health Service Act, the appli-
cation of the preemption provision should permit the op-
eration of any State law or provision which requires more
favorable treatment of mental health benefits under
health insurance coverage than that required under this
section.
September 19. 1996 (12:37 a.m.)
TO
94567431
P.05/08
SEP-19-1996 20:12 FROM
ID:
PAGE
85P-18-96 18:51 FROM.
2/6
F:\EGG\HCE96\VAHUDCON\PEEEMPT02
wringebt
Filer
HARMP
55288
NEWBORNS: Substitute for page 6, line 19
through page 7 line 9 the following (and also in PHSA
provisions):
1
"(f) PREEMPTION; EXCEPTION FOR HEALTH INSUR-
2 ANCE COVERAGE IN CHETAIN STATES-
3
"(1) IN GHNERAL-The requirements of this
4
section shall not apply with respect to health insur-
5
snce coverage if there is a State law (as defined in
6
section 731(d)(1)) for a State that regulates such
7
coverage that is described in any of the following
8
subperagraphs:
9
"(A) Such State law requires such COV-
10
erage to provide coverage for at least 48 hours
11
of hospital length of stay following & normal
12
vaginal delivery and at least 96 hours of how-
13
pital length of stay following a cesarian section.
14
"(B) Such State law requires such cov-
15
erage to provide coverage for maternity and pe-
16
diatric care in accordance with guidelines estab-
17
lished by the American College of Obstetricians
18
and Gynecologists, the American Academy of
19
Pediatrics, or other established professional
20
medical associations.
21
"(C) Such State law requires that such
22
coverage for the hospital length of stay for ma-
September 19. 1996 (Print p.m.)
09-19-96 06:39PM P002 #22
SEP-19-1996 20:13 FROM
TO
94567431
P.06/08
BEP-18-96 18.51 FROM.
ID.
PAGE 3/5
F:\EGG\HCR96\VAHUDCON\PFEEMPT.003
2
1
ternity and pediatric care may not be less than
2
the coverage provided for in such guidelines un-
3
less such shorter coverage is at the rec-
4
ommendation of the attending provider in con-
5
sultation with the mother.
6
"(2) CONSTRUCTION.-Section 731(a)(1) shall
7
not be construed as superseding a State law de-
8
scribed in paragraph (1).
September 19, 1998 (SVP p.m.)
09-19-96 08:39PM P003 #22
SEP-19-1996 20:13 FROM
TO
94567431
P.07/08
ID:
PAGE 4/6
SEP-18-96 18.51 FROM:
FAEGG\HCR96\VAHUDCON\PREEMPT.008
8
Additional technical changes:
(1) MENTAL HEALTH PARITY (page 6, end of
line 2): Aggregation rule should be applied to ERISA
small employer provision. Add a new subparagraph (C):
"(C) APPLICATION OF CHETAIN RULES IN
DETERMINATION or EMPLOYER SIZE.-For
purposes of this paragraph-
"(i) APPLICATION OF AGGREGATION
EULE FOR EMPLOYERS.-all persons treat-
ed as 8 single employer under subsection
(b), (e), (m), or (o) of section 414 of the
Internal Revenue Code of 1986 shall be
treated as 1 employer.
"(ii) EMPLOYERS NOT IN EXISTENCE
IN PRECEDING YEAR-In the case of an
employer which was not in existence
throughout the preceding calendar year,
the determination of whether such em-
player is a small employer shall be based
on the average number of employees that
it is reasonably expected such employer
will employ on business days in the current
calendar year.
"(iii) PREDECESSORS.-Any reference
in this paragraph to an employer shall in-
September 10, 1998 (LAT p.m.)
09-19-96 06:39PM P004 #22
89%
SEP-19-1996 20:14 FROM
TO
94567431
P.08/08
SEP-19 96 18:51 FROM:
ID:
PAGE 5/5
\EGG\ECR96\VAHUDOON\PREEMPT.002
4
clude & reference to any predecessor of
such employer.
(2) MENTAL HEALTH PARITY (page 6, line 13),
should refer to "(c)(2)" reather than "(c)" [or should
refer to "the requirements of this section" rather than
"subsections (a) and (c)".]
(3) NEWBORNS. Strike page 7 lices 17 through
21 and conform succeeding provisions. [This would strike
the following Section 732(a) of such Act (as added by
section 101 of the Health Insurance Portability and Ac-
countability Act of 1996 and redesignated by the preced-
ing provisions of this section) is amended by inserting
"(other than section 711)" after "part"
September 18, 1995 (5:47 am)
09-19-96 06:39PM P005 #22