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

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)