Rep. Patrick Kennedy (D-RI) introduced the Paul Wellstone Mental Health and Addiction Equity Act of 2008 on March 8, 2007: “To amend section 712 of the Employee Retirement Income Security Act of 1974, section 2705 of the Public Health Service Act, section 9812 of the Internal Revenue Code of 1986 to require equity in the provision of mental health and substance-related disorder benefits under group health plans, to prohibit discrimination on the basis of genetic information with respect to health insurance and employment, and for other purposes.”

Congressional Research Service Summary from Thomas.gov

3/5/2008--Passed House amended.

Division A - Paul Wellstone Mental Health and Addiction Equity Act of 2008

Paul Wellstone Mental Health and Addiction Equity Act of 2008 - Amends the Employee Retirement Income Security Act of 1974 (ERISA), the Public Health Service Act (PSHA), and the Internal Revenue Code to require group health plans to apply the same treatment limits on mental health or substance-related disorder benefits as they do for medical and surgical benefits (parity requirement). Extends such parity requirement to inpatient and outpatient services, whether in-network or out-of-network, and to emergency care services.

Defines "treatment limit" under a group health plan as a limitation on the number of visits or days of coverage, or other similar limit on the duration or scope of treatment.

Requires group health plans to apply the same beneficiary financial requirements to mental health or substance-related disorder benefits as they apply for medical and surgical benefits, including limits on deductibles, co-payments, and out-of-pocket expenses.

Revises the definition of "mental health benefits" to include substance-related disorder benefits.

Requires plan administrators to make the criteria for medical necessity determinations with respect to mental health and substance-related disorder benefits available to plan participants, beneficiaries, or providers upon request.

Sets forth the minimum scope of mental health and substance-related disorder benefits under a group health plan. Requires such plans offering out-of-network coverage to apply the same coverage offered for medical and surgical services to mental health and substance-related benefits.

Allows group health plans an increased exemption of 2% of the actual costs of coverage of mental health and substance-related disorder benefits in the first plan year after initiation or 1% in each subsequent year. Revises the similar exemption for small employers.

Makes the amendments made by this Act applicable to plan years beginning on or after January 1, 2009, and to group health plans under a collective bargaining agreement at the expiration of such agreement or by January 1, 2009.

Requires the Secretary of Labor to: (1) annually sample and conduct random audits of group health plans to determine compliance with this Act; and (2) provide assistance to plan participants and beneficiaries in complying with the requirements of this Act.

Declares that nothing in this Act preempts state laws that provide greater consumer protections and benefits than those provided by this Act.
Increases from 15.1% to 20.1% after December 31, 2008, and before January 1, 2015, the minimum Medicaid drug rebate percentage drug manufacturers must agree to for covered outpatient drugs.

Amends title XVIII (Medicare) of the Social Security Act to set forth new requirements for the hospital exception to the general prohibition against physician referral of Medicare patients for certain services to facilities in which such physicians or their immediate family members have financial interests (self-referral). Requires hospitals to develop procedures to prevent conflicts of interest, ensure bona fide investment, and safeguard patients. Requires the Secretary of Health and Human Services to establish policies and procedures to ensure compliance with such requirements and to conduct audits to determine if hospitals have violated such requirements.

Increases the amount available to the Physician Assistance and Quality Initiative Fund (PAQI Fund) in 2013.

Requires the Comptroller General to: (1) evaluate the effect of the implementation of this Act on the cost of health insurance coverage and related matters; (2) submit biannual reports to Congress on obstacles faced by individuals in obtaining mental health and substance-related disorder care under their health plans; and (3) report to Congress on the availability of uniform patient placement criteria for mental health and substance-related disorders for guiding determinations of medical necessity.

Division B - Genetic Information Nondiscrimination Act of 2008

Genetic Information Nondiscrimination Act of 2008 -

Title I - Genetic Nondiscrimination in Health Insurance

Section 101 -

Amends the Employee Retirement Income Security Act of 1974 (ERISA), the Public Health Service Act (PHSA), and the Internal Revenue Code to prohibit a group health plan from adjusting premium or contribution amounts for a group on the basis of genetic information.

Prohibits a group health plan from requesting or requiring an individual or family member of an individual from undergoing a genetic test. Provides that such prohibition does not: (1) limit the authority of a health care professional to request an individual to undergo a genetic test; or (2) preclude a group health plan from obtaining or using the results of a genetic test in making a determination regarding payment. Requires the plan to request only the minimum amount of information necessary to accomplish the intended purpose.

Allows a group health plan to request, but not require, a participant or beneficiary to undergo a genetic test for research purposes if certain requirements are met, including: (1) the plan clearly indicates that compliance is voluntary and that noncompliance will have no effect on enrollment status or premium or contribution amounts; (2) no genetic information collected or acquired is used for underwriting purposes; and (3) the plan notifies the Secretary of Health and Human Services that it is conducting activities pursuant to this exception and includes a description of the activities.

Prohibits a group health plan from requesting, requiring, or purchasing genetic information: (1) for underwriting purposes; or (2) with respect to any individual prior to such individual's enrollment in a plan. Applies such prohibitions to all group health plans, including small group health plans.

Provides that any reference to genetic information concerning an individual or family member includes genetic information of: (1) a fetus carried by a pregnant woman; and (2) an embryo legally held by an individual or family member utilizing an assisted reproductive technology.

Authorizes a penalty against any sponsor of a group health plan for any failure to meet requirements of this Act. Allows a waiver or limitation of penalties if such failure was not discovered after exercising reasonable diligence or was due to reasonable cause.

Section 102 -

Amends the PHSA to prohibit: (1) a health insurance issuer offering health insurance coverage in the individual market from establishing eligibility rules for enrollment based on genetic information; (2) discrimination on the basis of genetic information for health insurance offered in the individual market in the same manner as such discrimination is prohibited for group coverage; and (3) the imposition by a health insurance issuer offering health insurance coverage in the individual market of a preexisting condition exclusion on the basis of genetic information.

Applies such requirements to nonfederal governmental plans.

Section 104 -

Amends title XVIII (Medicare) of the Social Security Act (SSA) to prohibit an issuer of a Medicare supplemental policy, on the basis of genetic information, from: (1) denying or conditioning the issuance or effectiveness of the policy, including the imposition of any exclusion of benefits based on a preexisting condition; or (2) discriminating in the pricing of the policy, including the adjustment of premium rates.

Prohibits an issuer of a Medicare supplemental policy from: (1) requesting or requiring an individual or a family member to undergo a genetic test; or (2) requesting, requiring, or purchasing genetic information for underwriting purposes or for any individual prior to enrollment.

Section 105 -

Amends title XI (General Provisions, Peer Review, and Administrative Simplification) of SSA to require the Secretary of Health and Human Services to revise Health Insurance Portability and Accountability Act of 1996 (HIPAA) privacy regulations to: (1) treat genetic information as health information; and (2) prohibit the use or disclosure by a group health plan, health insurance coverage, or Medicare supplemental policy of genetic information about an individual for underwriting purposes.

Section 106 -

Requires the Secretaries of Health and Human Services, Labor, and the Treasury to ensure that their regulations, rulings, and interpretations under this title are administered to have the same effect at all times and that they adopt a coordinated enforcement strategy.

Title II - Prohibiting Employment Discrimination on the Basis of Genetic Information

Section 202 -

Prohibits, as an unlawful employment practice, an employer, employment agency, labor organization, or joint labor-management committee from discriminating against an employee, individual, or member because of genetic information, including: (1) for an employer, by failing to hire or discharging an employee or otherwise discriminating against an employee with respect to the compensation, terms, conditions, or privileges of employment; (2) for an employment agency, by failing or refusing to refer an individual for employment; (3) for a labor organization, by excluding or expelling a member from the organization; (4) for an employment agency, labor organization, or joint labor-management committee, by causing or attempting to cause an employer to discriminate against a member in violation of this Act; or (5) for an employer, labor organization, or joint labor-management committee, by discriminating against an individual in admission to, or employment in, any program established to provide apprenticeships or other training or retraining.

Prohibits, as an unlawful employment practice, an employer, employment agency, labor organization, or joint labor-management committee from limiting, segregating, or classifying employees, individuals, or members because of genetic information in any way that would deprive or tend to deprive such individuals of employment opportunities or otherwise adversely affect their status as an employee.

Prohibits, as an unlawful employment practice, an employer, employment agency, labor organization, or joint labor-management committee from requesting, requiring, or purchasing an employee's genetic information, except for certain purposes, which include where: (1) such information is requested or required to comply with certification requirements of family and medical leave laws; (2) the information involved is to be used for genetic monitoring of the biological effects of toxic substances in the workplace; and (3) the employer conducts DNA analysis for law enforcement purposes as a forensic laboratory.

Section 206 -

Requires an employer, employment agency, labor organization, or joint labor-management committee that possesses any genetic information about an employee or member to maintain such information in separate files and treat such information as a confidential medical record.

Prohibits an employer, employment agency, labor organization, or joint labor-management committee from disclosing such genetic information, except: (1) to the employee or member upon request; (2) to an occupational or other health researcher; (3) in response to a court order; (4) to a government official investigating compliance with this Act if the information is relevant to the investigation; or (5) in connection with the employee's compliance with the certification provisions of the Family and Medical Leave Act of 1993 or such requirements under State family and medical leave laws.

Section 207 -

Sets forth provisions regarding enforcement of this Act.

Section 208 -

Provides that disparate impact on the basis of genetic information does not establish a cause of action under this Act.

Establishes the Genetic Nondiscrimination Study Commission six years after enactment of this Act to review the developing science of genetics and to make recommendations to Congress regarding whether to provide a disparate impact cause of action under this Act. Authorizes appropriations to the Equal Employment Opportunity Commission (EEOC) to carry out this section.

Section 212 -

Authorizes appropriations.

Title III - Miscellaneous Provisions

Section 301 -

Amends the Higher Education Act of 1965 to lower the percentage of a borrower's student loan payment made under the Federal Family Education Loan program subsequent to default that a guaranty agency may retain for deposit in its operating fund if the Secretary of Education has already reimbursed it for such default.

Section 302 -

Provides that if any provision of this Act, an amendment made by this Act, or the application of such provision or amendment to any person or circumstance is held to be unconstitutional, the remainder of this Act shall not be affected.

MIWatch Related Entries

• S. 558 (May 23, 2008)