Close Close
Popular Financial Topics Discover relevant content from across the suite of ALM legal publications From the Industry More content from ThinkAdvisor and select sponsors Investment Advisor Issue Gallery Read digital editions of Investment Advisor Magazine Tax Facts Get clear, current, and reliable answers to pressing tax questions
Luminaries Awards

Life Health > Health Insurance

How a U.S. House mental health bill could affect insurers

Your article was successfully shared with the contacts you provided.

Update: After this article was published, members of the House Energy and Commerce Committee voted 53-0 to approve the version of H.R. 2646 offered by Rep. Fred Upton and Rep. Frank Pallone. Look for full coverage of the vote tomorrow.

Members of the U.S. House have rounded up broad, bipartisan support for a bill that could set new federal rules for how the United States handles people believed to have serious mental illness.  

Related: Kennedy’s mental health vision still not realized

The full House Energy and Commerce Committee is preparing to meet at 10 a.m. Wednesday to review and vote on H.R. 2646, the Helping Families in Mental Health Crisis Act bill. The committee plans to stream video of the bill markup live on the Web.

The committee could look at two versions of the bill.

One version, which was introduced by Rep. Tim Murphy (R-Pa.) in June, has attracted 140 Republican and 53 Democratic co-sponsors.

Rep. Fred Upton (R-Mich.), the chairman of the House Energy committee, and Rep. Frank Pallone (D-N.J.), the highest-ranking Democrat on the committee, have proposed a second version of the bill.

The authors of the bill have tried to come up with strategies to help families and communities be more active in managing the care of patients who are believed to be unable to make sound decisions about treatment for serious mental health conditions.

Many civil rights groups and other groups have opposed at least some versions of the Murphy bill, arguing that it could reduce privacy protections for some people and alienate some patients by forcing those patients into involuntary outpatient treatment programs.

In the past, other groups, especially for mental health care providers and the families of people with conditions such as schizophrenia, have argued that the current federal and state rules in effect in many communities do too little to accommodate the needs of patients, families and communities struggling with conditions that limit people’s ability to care for themselves.

If legislation based on the Upton-Pallone draft or the current version of the Murphy bill became law, some provisions could have a direct effect on public and private health insurance issuers and group health plan sponsors and administrators.

For more about some of those provisions, read on:


The current version of the Murphy bill includes a stand-alone “Definitions” section. (Photo: Allison Bell)

1. Definitions

The current version of the Murphy bill could explicitly create formal definitions of terms such as “caregiver,” “individual with a serious mental illness or serious emotional disturbance,” and “persistently or acutely disabled” in connection with serious mental illness.

The definition for “individual with a serious mental illness or serious emotional disturbance,” for example, would define that individual to be someone who was 18 years of age or older, had a diminished capacity to understand or follow a treatment plan, and had a condition meeting diagnostic criteria given in the Diagnostic Statistical Manual of Mental Disorders.

The Upton-Pallone draft does not include the same formal definitions of terms. The drafters state, however, in a section on what members of Congress think about the interaction between mental health care needs and the health information privacy provisions in the Health Insurance Portability and Accountability Act of 1996, that “serious mental illness” includes “schizophrenia spectrum, bipolar disorders and major depressive disorder.”

Related: Calif. bill may set mental health disability cover standards


The current version of the Murphy bill includes new Medicaid prescription drug benefits standards. (Photo: Allison Bell)

2. Drugs

Murphy’s current version of H.R. 2646 would require a state Medicaid plan to cover “all “drugs that are being used for the treatment of a diagnosis of major depression, bipolar (manic-depressive) disorder, panic disorder, obsessive-compulsive disorder, schizophrenia and schizoaffective disorder.” The private administrator of a managed Medicaid plan would have to cover all outpatient drugs used to treat a mental health disorder.

A Medicaid plan could require a patient to go through a preauthorization process to use the drugs. 

Related: Alkermes rises on U.S. approval of schizophrenia drug

Doctor with a patient

The current version of the Murphy bill includes a section on psychiatrist participation in health plan provider networks. (Photo: iStock)

3. Psychiatrists

Both Murphy and the drafters of the Upton-Pallone version talk about the need to increase the supply of mental health services providers.

Murphy includes a provision noting that, from 2009 through 2010, 73 percent of physicians other than psychiatrists and just 43 percent of psychiatrists were accepting Medicaid.

“It is the sense of Congress that … psychiatrists should accept private health insurance, Medicare and Medicaid,” to ensure that individuals with mental illness have adequate access to mental health services, according to a provision at the end of the Murphy version.

Related: America’s mental health care crisis: A story in numbers


The Upton-Pallone version of H.R. 2646 and the current Murphy version include different group health plan mental health services parity provisions. (Photo: iStock)

4. Group health plan parity 

The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) already requires group health plans that offer both mental health services coverage and other types of health benefits to provide mental health benefits that are substantially the same as the non-mental-health benefits, both in terms of quantitative and nonquantitative treatment limits.

The current version of the Murphy bill would have the Government Accountability Office, a congressional research unit, analyze how well group health plans are complying with the MHPAEA standards.

The Upton-Pallone version would require the U.S. Department of Health and Human Services, the U.S. Labor Department and the U.S. Treasury Department to give employers explicit examples showing what kinds of arrangements would meet MHPAEA parity standards or violate MHPAEA parity standards.

The Upton-Pallone version would also require the departments to give health insurers and group health plan sponsors advice about how they can meet the needs of outsiders for the kind of information that can be used to monitor compliance with the parity standards.

The MHPAEA and federal regulations require insurers and plans to give patients, providers and others information about parity compliance. Coverage providers have been looking for practical ideas about how to meet that requirement.

See also: 

5 new parity traps that could ruin your benefits clients

‘Mental Health Parity’ Provision Furor

Have you followed us on Facebook?


© 2024 ALM Global, LLC, All Rights Reserved. Request academic re-use from All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.