Order Code RL33820
The Mental Health Parity Act:
A Legislative History
Updated May 18, 2007
Ramya Sundararaman
Analyst in Public Health
Domestic Social Policy Division
C. Stephen Redhead
Specialist in Life Sciences
Domestic Social Policy Division

The Mental Health Parity Act: A Legislative History
Summary
This report provides a detailed history of mental health parity legislation,
including a discussion of bills introduced in each Congress and any accompanying
legislative action, including hearings, markups, and floor votes. The legislation is in
response to concerns about the coverage of mental health benefits in group health
plans, which is often more restricted than the coverage of physical illness.
Some advocates for people with mental illness strongly support legislation that
would require full parity, citing research that has shown the cost-effectiveness of
treating mental illnesses. On the other hand, health insurance plans and employers
offering self-insured plans contend that parity legislation will lead to significant
increases in the cost coverage.
Generally, the term full parity is used throughout the report to mean that the
treatment limitations and financial requirements on mental health coverage are the
same as those for coverage of physical illnesses. Treatment limitations include
restrictions on the number of visits or days of coverage, or other limits on the
duration and scope of treatment. Financial requirements include deductibles,
coinsurance, copayments, and other cost-sharing requirements, as well as annual and
lifetime dollar limits on coverage.
Mental health parity legislation was first introduced in 1992, and the Mental
Health Parity Act (MHPA) of 1996 was the first federal parity law. The MHPA
required partial parity by mandating only that annual and lifetime dollar limits in
coverage for mental health treatment under group health plans offering mental health
coverage be no less than that for physical illnesses. It also provided an exemption
to employers with 50 or fewer employees. Full parity legislation was first introduced
in the 107th Congress and reintroduced in the 108th and 109th Congresses, but failed
to pass.
In the 110th Congress, the Senate introduced the Mental Health Parity Act of
2007 (S. 558) on February 12, 2007. Unlike previous versions of parity legislation,
the bill has the support of insurance companies and employers. The Congressional
Budget Office (CBO) scored S. 558 and estimated that, if enacted, the bill would
increase premiums by 0.4%. On February 14, 2007, the Senate Health, Education,
Labor, and Pensions (HELP) Committee approved S. 558 (S.Rept. 110-53). The
House introduced similar legislation, the Paul Wellstone Mental Health and
Addiction Equity Act (H.R. 1424), on March 9, 2007. On May 8, 2007, the Senate
introduced the Children’s Mental Health Parity Act (S. 1337). The bill, which was
referred to the Committee on Finance, would amend Title XXI of the Social Security
Act to provide for equal coverage of mental health services under the State
Children’s Health Insurance Program.
The MHPA expires on December 31, 2007. About half of the states have passed
laws requiring full parity for mental health coverage.

Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
102nd Congress (1991-1992) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Bills and Resolutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Congressional Hearings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Roll Call Votes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
103rd Congress (1993-1994) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Congressional Hearings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Roll Call Votes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
104th Congress (1995-1996) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Bills and Resolutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Congressional Hearings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Roll Call Votes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
105th Congress (1997-1998) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Bills and Resolutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Congressional Hearings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Roll Call Votes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
106th Congress (1999-2000) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Bills and Resolutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Congressional Hearings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Roll Call Votes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
107th Congress (2001-2002) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Bills and Resolutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Congressional Hearings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Roll Call Votes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
108th Congress (2003-2004) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Bills and Resolutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Congressional Hearings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Roll Call Votes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
109th Congress (2005-2006) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Bills and Resolutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Congressional Hearings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
110th Congress (2007-2008) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Bills and Resolutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Congressional Hearings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Roll Call Votes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Appendix A. Medicare Mental Health Legislation . . . . . . . . . . . . . . . . . . . . . . . 13
95th Congress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
96th Congress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
104th Congress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
106th Congress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
107th Congress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
108th Congress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
109th Congress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
110th Congress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Appendix B. State Laws Mandating Parity
for Mental Health Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
List of Figures
Figure 1. Map of State Mental Health Parity Laws . . . . . . . . . . . . . . . . . . . . . . . 15
List of Tables
Table 1. Comparison of FEHB and State Parity Laws . . . . . . . . . . . . . . . . . . . . 17

The Mental Health Parity Act:
A Legislative History
Introduction
Private health insurers often provide less coverage of mental illnesses compared
to other medical conditions. Historically, health plans have imposed lower annual
or lifetime dollar limits on mental health coverage, limited treatment of mental health
illnesses by covering fewer hospital days and outpatient office visits, and increased
cost sharing for mental health care by raising deductibles and copayments. The lack
of parity (i.e., equivalence) in insurance coverage in part reflects insurers’ concerns
that mental disorders are difficult to diagnose, and that mental health care is
expensive and often ineffective. However, the 1999 Surgeon General’s report on
mental health concluded that mental illnesses are largely biologically based disorders
like many other medical conditions. It found that effective treatments exist for most
mental disorders.
In 1996, Congress enacted the Mental Health Parity Act (MHPA) to address
concerns about the more restrictive coverage of mental health benefits in employer-
sponsored group health plans. The MHPA, however, is limited in its scope. It does
not compel insurers to provide mental health coverage. For group plans that choose
to offer mental health benefits, the MHPA requires parity only for annual and lifetime
dollar limits on coverage. Group plans may still impose more restrictive treatment
limitations and cost sharing requirements on their mental health coverage. Congress
recently extended the MHPA through December 31, 2007.
Full-parity legislation was first introduced in the 107th Congress and
reintroduced in the 108th and 109th Congresses, but it has failed to pass despite
bipartisan support from lawmakers. Under full parity, a plan must use the same
treatment limitations and financial requirements in its mental health coverage as it
does in its medical and surgical coverage.1 Passage of full-parity legislation is a
priority for groups that advocate on behalf of the mentally ill, but is opposed by
employer and health insurance organizations because of concerns that it will drive
up costs.
In the 110th Congress, the Senate introduced the Mental Health Parity Act of
2007 (S. 558) on February 12, 2007. This bill was marked up in committee on
February 14, 2007. Unlike previous versions of parity legislation, the bill has the
1 Treatment limitations include restrictions on the number of visits or days of coverage, or
other limits on the duration and scope of treatment. Financial requirements include
deductibles, coinsurance, co-payments, and other cost sharing requirements, as well as
annual and lifetime limits on the total amount of coverage.

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support of insurance companies and employers. The Congressional Budget Office
(CBO) scored S. 558 and estimated that, if enacted, the bill would increase premiums
by 0.4%. The House introduced full parity legislation, the Paul Wellstone Mental
Health and Addiction Equity Act (H.R. 1424), on March 7, 2007. For a more
detailed analysis of these bills and the issues surrounding mental health parity, see
CRS Report RL31657, Mental Health Parity: Federal and State Action and
Economic Impact
, by Ramya Sundararaman and C. Stephen Redhead.
This report provides a legislative history of mental health parity, in anticipation
of activity on this issue during the 110th Congress. For each Congress, beginning
with the 102nd (1991 — 1992), there is a brief narrative summarizing the legislative
activity, followed by a list of bills and resolutions, hearings (if any), and roll call
votes (if any). Appendix A lists, by Congress, bills that focus solely on Medicare
mental health coverage. Appendix B includes a map and table that summarize the
state mental health parity laws.
102nd Congress (1991-1992)
Mental health parity legislation was first introduced in the Congress in 1992 by
Senators Domenici and Danforth (see below). That same year the Senate
Appropriations Committee instructed the National Advisory Mental Health Council
to prepare a report on the cost of mental health parity. The following language
appeared in the committee report to accompany the FY1993 Labor-HHS
appropriations bill:2
The Committee appreciates the report of the National Advisory
Mental Health Council entitled, “Mental Illness in America: A Series
of Public Hearings,” which includes a special recommendation on the
need to provide coverage for severely mentally ill Americans under
national health care reform. The Committee requests that the Council
prepare a report on the cost of covering medical treatment for severe
mental illness commensurate with other illnesses and an assessment
of the efficacy of treatment of severe mental illness....The Committee
further requests that this report be transmitted to the Committee prior
to next year’s hearings as authorized under section 406(g) of the
Public Health Service Act.
The Council’s report was published in the October 1993 issue of the American
Journal of Psychiatry. The report concluded that with advances in the field of
psychiatry, mental illnesses are now treatable, and that treatment of mental illness is
cost-effective. Those arguments continue to be used by advocates for the mentally
ill.
2 S.Rept. 102-397, p. 96.

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Bills and Resolutions
S. 2696 (Equitable Health Care for Severe Mental Illnesses Act of 1992).
Introduced by Senators Domenici and Danforth on May 12, 1992. S. 2696 stated that
“persons with severe mental illnesses must not be discriminated against in the health
care system; and health care coverage ... must provide for the treatment of severe
mental illnesses in a manner that is equitable and commensurate with that provided
for other major physical illnesses.” To be considered nondiscriminatory and
equitable, the bill mandated mental health coverage that “is not more restrictive than
coverage provided for other major physical illnesses, provides adequate financial
protection to the person requiring the medical treatment for a severe mental illness,
and is consistent with effective and common methods of controlling health care costs
for other major physical illnesses.”
H.Con.Res. 296. Introduced by Representative Mike Kopetski on March 19,
1992. Expressed the sense of the Congress that equitable mental health benefits must
be included in any health care reform legislation passed by the Congress.
S.Con.Res. 126. Introduced by Senator Shelby on June 24, 1992. Expressed
the sense of the Congress that equitable mental health care benefits must be included
in any health care reform legislation passed by the Congress.
Congressional Hearings
No hearings were conducted.
Roll Call Votes
No roll call votes were conducted.
103rd Congress (1993-1994)
Congressional lawmakers addressed mental health parity during the debate on
the Clinton Administration’s health care reform proposal in the 103rd Congress. The
Clinton plan (introduced as H.R. 3600 and S. 1757) provided for limited coverage
of mental illness as part of its benefit package, but included a phase-in of full parity
by January 1, 2001. The bills reported by the Senate Committee on Labor and
Human Resources (S. 2296) and the Senate Committee on Finance (S. 2351) both
included provisions for establishing full parity, as did legislation reported by the
House Committee on Education and Labor (H.R. 3600). Attempts to enact
comprehensive health care reform ended on the Senate floor in August 1994. The
full House did not debate health care reform legislation.
In 1993, Senator Domenici testified on discrimination in mental health coverage
before the Senate Committee on Labor and Human Resources.

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Congressional Hearings
Senate Committee on Labor and Human Resources, May 13, 1993, Coverage
of Mental and Addictive Disorders in Health Care Reform. Testimony by Tipper
Gore (Chairperson, Mental Health Working Group, President’s Health Care Reform
Task Force), Senator Domenici, and health insurance representatives. [S.Hrg.
103-211]. In addition, the following five hearings held during the congressional
debate on the Clinton health plan included testimony on mental health coverage and
parity.

House Committee on Ways and Means, October 26, 1993. Testimony by the
American Psychological Association. [Serial No. 103-90, pp. 245-294]

Senate Committee on Labor and Human Resources, November 8, 1993.
Testimony by Representative Mike Kopetski and mental health professionals. [S.Hrg.
103-216, Pt. 2, pp. 104-156]

House Committee on Energy and Commerce, December 8, 1993. Testimony
by mental health advocates and health insurance representatives. [Serial No. 103-91,
pp. 232-286]

House Committee on Education and Labor, February 3, 1994. Testimony by the
Bazelon Center for Mental Health Law. [Serial No. 103-62, pp. 22-73]

Senate Committee on Labor and Human Resources, March 8, 1994. Testimony
by former First Ladies Betty Ford and Rosalynn Carter. [S.Hrg. 103-216, Pt. 4, pp.
562-581]
Roll Call Votes
No roll call votes were conducted.
104th Congress (1995-1996)
Senators Domenici and Wellstone reintroduced the Equitable Health Care for
Severe Mental Illnesses Act (S. 298) on January 31, 1995. Similar language was
approved by the Senate on April 18, 1996, as an amendment to S. 1028, the Health
Insurance Reform Act. The amendment was later dropped in conference. The
conferees also rejected a partial parity amendment offered by Senators Domenici and
Wellstone covering only annual and lifetime dollar limits. The legislation was signed
into law, without any mental health parity provisions, as the Health Insurance
Portability and Accountability Act (HIPAA, P.L. 104-191).
On August 2, 1996, Senators Domenici and Wellstone introduced the Mental
Health Parity Act (MHPA, S. 2031), which required parity only for annual and
lifetime dollar limits. The bill, which included an exemption for employers with 25
or fewer employees, did not mandate mental health coverage. The parity provisions
applied only to those group health plans that chose to provide mental health

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coverage. On September 5, 1996, Senators Domenici and Wellstone offered the
MHPA as an amendment to the FY1997 VA-HUD appropriations bill (H.R. 3666).
By voice vote, the Senate approved a second degree amendment offered by Senator
Gramm, which exempted health plans from the MHPA parity requirement if the cost
of compliance exceeded the original cost of coverage by 1%. The Senate approved
the Domenici-Wellstone amendment, as amended, on a 82-15 vote. During
conference, the House conferees agreed to the parity amendment. MHPA became
Title VII of the FY1997 VA-HUD appropriation bill, which was signed into law on
September 26, 1996 (P.L. 104-204). MHPA amended both the Employee Retirement
Income Security Act (ERISA) and the Public Health Service (PHS) Act.3 During the
105th Congess (discussed below), the MHPA provisions were added to the Internal
Revenue Code (IRC) by the Taxpayer Relief Act of 1997. By amending all three
federal statutes (i.e., ERISA, the PHS Act, and the IRC), the MHPA standards apply
to a broad range of group health plans, as well as state-licensed health insurance
organizations. More details on the parity legislation and related roll call votes in the
104th Congress are provided below.
Bills and Resolutions
S. 298 (Equitable Health Care for Severe Mental Illnesses Act of 1995).
Introduced by Senators Domenici and Wellstone on January 31, 1995. Required that
“persons with severe mental illnesses must not be discriminated against in the health
care system, and health care coverage ... must provide for the treatment of severe
mental illnesses in a manner that is equitable and commensurate with that provided
for other major physical illnesses.”
S. 2031 (Mental Health Parity Act of 1996). Introduced by Senators Domenici
and Wellstone on August 2, 1996. Required parity for annual and lifetime dollar
limits on coverage in group health plans that offer mental health benefits.
H.R. 4045 (National Mental Health Parity Act of 1996). Introduced by
Representative Pete Stark on September 10, 1996. Amended the IRC to require
group health plans to provide full parity for coverage of all conditions listed in the
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).4
Amended the Medicare statute to restructure the mental health benefit.
H.R. 4058 (Mental Health Parity Act of 1996). Introduced by Representative
Marge Roukema on September 11, 1996. Same provisions as S. 2031, plus the 1%
compliance cost exemption.
H.R. 4135 (Newborns and Mothers Health Protection and Mental Health Parity
Implementation Amendments of 1996). Introduced by Representatives Bill Thomas
and Pete Stark, September 24, 1996. Amended the IRC to incorporate the MHPA
provisions.
3 P.L. 104-204, Title VII, codified at 29 U.S.C. 1185a and 42 U.S.C. 300gg-5.
4 The DSM, produced by the American Psychiatric Association, is a comprehensive system
of diagnosis for psychiatric conditions. The fourth and current edition was published in
1995 and is available at [http://www.psych.org/research/dor/dsm/index.cfm].

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Congressional Hearings
No hearings were conducted.
Roll Call Votes
April 18, 1996. On a vote of 30-68 the Senate rejected an amendment by
Senator Kassebaum to table the Domenici parity amendment to S. 1028. The
Domenici amendment was subsequently adopted by voice vote.
September 5, 1996. The Senate voted 82-15 to adopt the Domenici parity
amendment to the FY1997 VA-HUD appropriations bill (H.R. 3666). Note:
immediately prior to this vote the Senate had voted 75-22 to table a second-degree
amendment to the Domenici amendment offered by Senator Brown.
August 1, 1996. On a vote of 198-228 the House rejected a motion by
Representative Pete Stark to recommit the conference report for H.R. 3103 (i.e.,
HIPAA) to the committee, with instructions to the House managers to improve
mental health coverage while minimizing the impact on the cost or availability of
insurance.
September 11, 1996. The House voted 392-17 to adopt a motion by
Representative Louis Stokes to instruct the House conferees for H.R. 3666 (i.e.,
FY1997 VA-HUD appropriations), among other things, to agree to the Senate mental
health parity provisions.
105th Congress (1997-1998)
On June 24, 1997, during the Senate floor debate on the Balanced Budget Act
of 1997 (P.L. 105-33; August 5, 1997), Senators Wellstone and Domenici introduced
an amendment requiring State Childrens’ Health Insurance Plan (SCHIP) plans that
offer mental health benefits to provide full-parity coverage. The amendment was
agreed to by voice vote, but later rejected in conference. However, the conferees
accepted language requiring all SCHIP plans and Medicaid managed care plans to
meet the requirements of the MHPA.5
Section 1531(a)(4) of the Taxpayer Relief Act of 1997 (P.L. 105-34; August 5,
1997) added the MHPA provisions to the Internal Revenue Code (IRC).6 Two parity
bills were introduced in the House (see below), but there was no further legislative
activity nor any hearings on mental health parity during the 105th Congress.
5 P.L. 105-33, Sections 4704(a) and 4901, codified at 42 U.S.C. 1396u-2(b)(8) and 42 U.S.C.
1397cc(f)(2), respectively.
6 P.L. 105-34, Section 1531(a)(4), codified at 26 U.S.C. 9812.

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Bills and Resolutions
H.R. 621 (National Mental Health Parity Act of 1997). Introduced by
Representative Pete Stark on February 5, 1997. Same language as H.R 4045 in the
104th Congress.
H.R. 3568 (Mental Health and Substance Abuse Parity Amendments of 1998).
Introduced by Representative Marge Roukema on March 26, 1998. Amended the
MHPA provisions in ERISA, the IRC and the PHS Act to require full parity for
mental health and substance abuse benefits in group health plans that offer such
coverage.
Congressional Hearings
No hearings were conducted.
Roll Call Votes
No roll call votes were conducted.
106th Congress (1999-2000)
Four mental health parity bills were introduced (or reintroduced) during the
106th Congress, but none saw any legislative action. In 1999, President Clinton
directed the Office of Personnel Management (OPM) to implement full parity for
mental health benefits in health plans offered under the Federal Employees Health
Benefits Program (FEHBP). This required plans participating in FEHBP to cover
medically necessary treatment for all categories of mental illness listed in the DSM-
IV. The Senate Committee on Health, Education, Labor, and Pensions held a parity
hearing on May 18, 2000.
Bills and Resolutions
S. 796 (Mental Health Equitable Treatment Act of 1999). Introduced by
Senators Domenici and Wellstone on April 14, 1999. Amended the MHPA
provisions in ERISA and the PHS Act to require parity with respect to the number
of inpatient days and outpatient visits covered for mental illness, but to require full
parity for a categorical list of severe biologically based mental illnesses.
H.R. 1515 (Mental Health and Substance Abuse Parity Amendments of 1999).
Introduced by Representative Marge Roukema on April 21, 1999. Same language
as H.R. 3568 in the 105th Congress.
H.R. 2445 (Mental Health Parity Enhancement Act of 1999). Introduced by
Representative Carolyn Maloney on July 1, 1999. Amended the MHPA provisions
in ERISA, the IRC and the PHS Act to require parity with respect to treatment
limitations.

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H.R. 2593 (National Mental Health Parity Act of 1999). Introduced by
Representative Pete Stark on July 22. 1999. Same language as H.R. 621 in the 105th
Congress.
Congressional Hearings
Senate Committee on Health, Education, Labor, and Pensions, May 18, 2000,
Mental Health Parity. Witnesses included Senator Wellstone, Government
Accountability Office (Report GAO/HEHS-00-95), and the National Institute of
Mental Health. [S.Hrg. 106-582]
Roll Call Votes
No roll call votes were conducted.
107th Congress (2001-2002)
With MHPA due to sunset on September 30, 2001, Senators Domenici and
Wellstone reintroduced the Mental Health Equitable Treatment Act (S. 543) on
March 15, 2001. S. 543 amended the MHPA provisions in ERISA and the PHS Act,
requiring full parity for all DSM-IV diagnoses. The Senate HELP Committee held
a hearing on mental health parity on July 11, 2001, at which Senator Wellstone
testified. On August 1, 2001, the Committee approved unanimously a substitute
version of S. 543 that included compromise language protecting the ability of health
plans to use managed care techniques and raising the small-employer exemption from
25 to 50 workers (same as MHPA). On October 30, 2001, Senators Domenici and
Wellstone offered S. 543, as reported, as an amendment (S.Amdt. 2020) to the
FY2002 Labor-HHS appropriations bill (H.R. 3061), which the Senate approved by
voice vote.
The House version of H.R. 3061 did not include any parity language. On
December 18, 2001, the House conferees rejected on a party-line vote Representative
Patrick Kennedy’s motion to accept the Domenici-Wellstone mental health parity
amendment. However, the conference approved a motion by Representative Duke
Cunningham to include language in the bill reauthorizing the MHPA through
December 31, 2002. Conferees added language to the conference report (H.Rept.
107-342; December 19, 2001) “strongly urging the committees of jurisdiction in the
House and Senate to convene early hearings and undertake swift consideration of
legislation to extend and improve mental health parity protections during the second
session of the 107th Congress.”
During 2002, both the House Committee on Education and the Workforce and
the Committee on Energy and Commerce held hearings on mental health parity, but
there was no further action taken on the three parity bills introduced in the House (see
below). In two separate legislative actions, Congress reauthorized the MHPA
through December 31, 2003. Section 610 of the Job Creation and Worker Assistance
Act of 2002 (H.R. 3090, P.L. 107-147) amended the MHPA provisions in the IRC,
and the Mental Health Parity Reauthorization Act of 2002 (H.R. 5716, P.L. 107-313)

CRS-9
reauthorized the MHPA provisions in ERISA and the PHS Act. H.R. 5716 was
introduced by Representative John Boehner on November 13, 2002, and approved
without objection by the full House on November 15, 2002. That same day the
Senate received and passed the measure by unanimous consent.
Bills and Resolutions
S. 543 (Mental Health Equitable Treatment Act of 2001). Introduced by
Senators Domenici and Wellstone on March 15, 2001. Senate HELP Committee
hearing on July 11, 2001. Committee markup, August 1, 2001, at which the
committee approved a substitute version of the bill by a vote of 21-0 (S.Rept. 107-61,
September 6, 2001).
H.R. 162 (Mental Health and Substance Abuse Parity Amendments of 2001).
Introduced by Representative Marge Roukema on January 3, 2001. Same language
as H.R. 1515 in the 106th Congress.
H.R. 2992 (Mental Health Parity Enhancement Act of 2001). Introduced by
Representative Carolyn Maloney on October 2, 2001. Same language as H.R. 2445
in the 106th Congress.
H.R. 4066 (Mental Health Equitable Treatment Act of 2002). Introduced by
Representative Marge Roukema on March 20, 2002. Same language as S. 543, as
reported by committee.
Congressional Hearings
Senate Committee on Health, Education, Labor, and Pensions, July 11, 2001,
Achieving Parity for Mental Health Treatment. Witnesses included the American
Psychiatric Association, Magellan Health Services, and the Office of Personnel
Management. [S.Hrg. 107-184]
House Committee on Education and the Workforce, Subcommittee on
Employer-Employee Relations, March 13, 2002, Assessing Mental Health Parity:
Implications for Patients and Employers. Witnesses included Representatives Marge
Roukema and Patrick Kennedy, the American Managed Behavioral Healthcare
Association, and the ERISA Industry Committee (ERIC). [Serial No. 107-51]
House Committee on Energy and Commerce, Subcommittee on Health, July 23,
2002, Insurance Coverage of Mental Health Benefits. Witnesses included the
American Psychiatric Association, the American Association of Health Plans, and
the National Association of Manufacturers. [Serial No. 107-118]
Roll Call Votes
No roll call votes were conducted.

CRS-10
108th Congress (2003-2004)
The 108th Congress extended the MHPA through the end of 2005. First, the
Mental Health Parity Reauthorization Act of 2003 (S. 1929, P.L. 108-197)
reauthorized the MHPA through December 31, 2004. The bill was introduced by
Senator Gregg on November 21, 2003, approved in the Senate by unanimous consent
the same day, and passed the House without objection on December 8, 2003. It
amended the MHPA provisions in ERISA and the PHS Act, but not the IRC.
Secondly, Section 302 of the Working Families Tax Relief Act of 2004 (H.R. 1308,
P.L. 108-311) reauthorized the MHPA through December 31, 2005. P.L. 108-311
amended the MHPA provisions in all three statutes.
Bills and Resolutions
S. 10 (Health Care Coverage Expansion and Quality Improvement Act of 2003).
Introduced by Senator Daschle on January 7, 2003. Title II incorporated the Mental
Health Equitable Treatment Act (same language as S. 543, as reported by committee,
in the 107th Congress).
H.R. 953/S. 486 (Senator Paul Wellstone Mental Health Equitable Treatment
Act of 2003). Introduced by Representatives Patrick Kennedy and Jim Ramstad and
by Senators Domenici and Kennedy on February 27, 2003. Same language as S. 543,
as reported by committee, in the 107th Congress.
S. 1832 (Senator Paul Wellstone Mental Health Equitable Treatment Act of
2003). Introduced by Senator Daschle on November 6, 2003. Same language as S.
486.
Congressional Hearings
Senate Committee on Health, Education, Labor, and Pensions, May 18, 2000,
Mental Health Parity. Witnesses included Senator Wellstone, Government
Accountability Office (Report GAO/HEHS-00-95), and the National Institute of
Mental Health. [S.Hrg. 106-582]
Roll Call Votes
No roll call votes were conducted.

CRS-11
109th Congress (2005-2006)
The 109th Congress further extended the MPHA through the end of 2007. In
the first session of the 109th Congress, the Employee Retirement Preservation Act
(H.R. 4579, P.L. 109-151) extended the provisions requiring mental health parity in
ERISA, the PHS Act, and the IRC through 2006. H.R. 4579 passed the House by
voice vote on December 17, 2005, and passed the Senate by unanimous consent on
December 22, 2005. In the second session, Section 115 of the Tax Relief and Health
Care Act of 2006 (H.R. 6111, P.L. 109-432) extended the MPHA provisions in all
three statutes through 2007.
Bills and Resolutions
H.R. 1402 (Paul Wellstone Mental Health Equitable Treatment Act of 2005).
Reintroduced by Representatives Patrick Kennedy and Jim Ramstad on March 17,
2005. No legislative action was taken on this bill, and no corresponding legislation
was introduced in the Senate.
Congressional Hearings
No hearings were conducted.
Roll Call Votes
No roll call votes were conducted.
110th Congress (2007-2008)
The Senate has introduced the Mental Health Parity Act of 2007 (S. 558). This
bill would amend ERISA and the PHS Act. The House has introduced the Paul
Wellstone Mental Health and Addiction Equity Act (H.R. 1424), which would amend
ERISA, the PHS Act, and the IRC. The Senate has also introduced a bill (S. 1337)
to ensure parity for mental health coverage under the State Children’s Health
Insurance Program.
Bills and Resolutions
S. 558 (Mental Health Parity Act of 2007). Introduced by Senator Domenici on
February 12, 2007. The bill was referred to the Senate Health, Education, Labor, and
Pensions Committee, which approved the measure with an amendment on February
14, 2007 (S.Rept. 110-53). The Mental Health Parity Act of 2007 is very similar to
the Paul Wellstone Mental Health Equitable Treatment Act of 2005.
H.R. 1424 (Paul Wellstone Mental Health and Addiction Equity Act).
Introduced by Representatives Kennedy and Ramstad on March 7, 2007. Unlike the
Senate version of full parity legislation, the Paul Wellstone Mental Health and
Addiction Equity Act requires plans to cover all mental illnesses, similar to the
Federal Employee Health Benefit Plan.

CRS-12
S. 1337 (Children’s Mental Health Parity Act). Introduced by Senator Kerry on
May 8, 2007. The bill was referred to the Committee on Finance. It would amend
Title XXI of the Social Security Act to provide for equal coverage of mental health
services under the State Children’s Health Insurance Program.
Congressional Hearings
House Ways and Means Health Subcommittee, March 27, 2007, Mental Health
and Substance Abuse Parity. Witnesses included Representative Kennedy, Mental
Health America, Anna Westin Foundation, Group Health Cooperative, George
Washington University, and Constella Group LLC.
Roll Call Votes
No roll call votes conducted as yet.

CRS-13
Appendix A. Medicare Mental Health Legislation
This section lists bills that focus solely on Medicare mental health. None of
these bills became law.
95th Congress
H.R. 13460 (Mental Health Amendments of 1978). Introduced by
Representative Claude Pepper on July 13, 1978. Provided coverage for mental
illness on the same basis as coverage for physical illness under Medicare and
provided coverage for certain psychologic services under the supplementary medical
insurance benefits program.
96th Congress
H.R. 640 (Mental Health Amendments of 1979). Introduced by Representative
Claude Pepper on January 15, 1979. Provided coverage for mental illness on the
same basis as coverage for physical illness under Medicare and provided coverage
for certain psychologic services under the supplementary medical insurance benefits
program.
104th Congress
H.R. 1456 (Medicare Mental Health Improvement Act). Introduced by
Representative Pete Stark on April 6, 1995. Provided expanded coverage of mental
health and substance abuse services under Medicare.
106th Congress
S. 3233 (Medicare Mental Health Modernization Act of 2000). Introduced by
Senator Wellstone on October 25, 2000. Replaced the 50% coinsurance for
outpatient psychiatric services with the 20% coinsurance required for all other
Medicare part B services. Added community-based and residential services to the
Medicare mental health benefit package and expanded the number of mental health
professionals eligible to provide services through Medicare to include clinical social
workers and licensed professional mental health counselors.
107th Congress
H.R. 1522/S. 690 (Medicare Mental Health Modernization Act of 2001).
Introduced by Representative Pete Stark and Senator Wellstone on April 4, 2001.
Replaced the 50% coinsurance for outpatient psychiatric services with the 20%
coinsurance required for all other Medicare part B services. Added community-based
and residential services to the Medicare mental health benefit package and expanded
the number of mental health professionals eligible to provide services through
Medicare to include clinical social workers and licensed professional mental health
counselors.

CRS-14
108th Congress
H.R. 1340/S. 646 (Medicare Mental Health Modernization Act of 2003).
Introduced by Representative Pete Stark and Senator Corzine on March 18, 2003.
Replaced the 50% coinsurance for outpatient psychiatric services with the 20%
coinsurance required for all other Medicare part B services. Added community-based
and residential services to the Medicare mental health benefit package and expanded
the number of mental health professionals eligible to provide services through
Medicare to include clinical social workers and licensed professional mental health
counselors.
H.R. 2787/S. 853 (Medicare Mental Health Copayment Equity Act of 2003).
Introduced by Representative Ted Strickland on July 17, 2003, and by Senator Snowe
on April 10, 2003. Replaced the 50% coinsurance for outpatient psychiatric services
with the 20% coinsurance required for all other Medicare part B services.
109th Congress
H.R. 1946/S. 927 (Medicare Mental Health Modernization Act of 2005).
Introduced by Representative Pete Stark and Senator Corzine on April 27, 2005.
Eliminates lifetime limit on inpatient mental health services, provides for parity in
treatment for outpatient mental health services, coverage of intensive residential
services under Medicare part A (Hospital Insurance) and of intensive outpatient
services under Medicare part B (Supplementary Medical Insurance); excludes clinical
social worker services from coverage under the Medicare skilled nursing facility
prospective payment system. Added coverage of marriage and family therapist
services and mental health counselor services under Medicare.
H.R. 1125/S. 1152 (Medicare Mental Health Copayment Equity Act of 2005).
Introduced by Representative Ted Strickland on March 3, 2005, and by Senator
Snowe May 26, 2005. Provides for a gradual reduction (from 50% to the standard
20%) by 2009 of copayment rates for outpatient psychiatric services under the
Medicare program.
110th Congress
H.R. 1571 (Seniors Access to Mental Health Act of 2007). Introduced by
Representatives Murphy and Napolitano on March 19, 2007. Phases out the
difference in copayment rates for outpatient psychiatric services, over five years.
Referred to the Committee on Energy and Commerc, and to the Committee on Ways
and Means for consideration.
H.R. 1663 (Medicare Health Modernization Act of 2007). Introduced by
Representatives Stark and Kennedy on March 23, 2007. Reduces the discriminatory
co-payment for outpatient mental health services (from 50% to the standard 20%).
Eliminates the 190-day lifetime cap on inpatient services in psychiatric hospitals.
No bill addressing mental health parity in Medicare has been introduced in the
Senate in the 110th Congress.


CRS-15
Appendix B. State Laws Mandating Parity
for Mental Health Coverage
Forty-nine states and the District of Columbia (DC) have enacted legislation
addressing mental health coverage in some manner. Of those, 26 states have enacted
full mental health parity laws. State parity laws do not apply to federally funded
public programs such as Medicaid, Medicare, and the Veterans Administration, nor
do they apply to self-insured health plans which are exempt from state regulations
under ERISA.
The following map summarizes the parity laws in each of the 50 states and DC.
The 26 states shaded in dark grey have laws requiring “full parity” for mental health.
The eight states shaded in light grey have “minimum mandated” laws, which require
coverage for mental illness but do not require coverage that is equal to that provided
for other physical illnesses. The 15 states shaded in black have “mandated offering”
laws, which either require the insurer to offer the option of a policy with coverage for
mental illness, or require that if the insurer chooses to offer mental health benefits,
then they must be provided at the level specified in the law. The state that is not
shaded, Wyoming, has not enacted any parity legislation.
Figure 1. Map of State Mental Health Parity Laws
Source: National Conference on State Legislatures, Health Policy Tracking Service.

CRS-16
Table 1 compares the state parity laws with FEHBP, and includes the following
information. First, it summarizes the type of parity law (full parity, minimum
mandated, or mandated offering). States that have full parity require annual and
lifetime limits, treatment limitations, and coinsurance and copayments for mental
health coverage to be on par with that for other physical illnesses. Second, the table
compares the kinds of health insurance plans that are covered by the different states’
parity laws. They could include health maintenance organizations (HMO), groups
plans, individual plans, and state employee plans.7 In four states, mental health parity
laws apply only to plans that cover state employees. Third, the table compares the
types of mental illness covered by the states’ parity laws. Some states require
coverage for all illness listed in the DSM-IV. Others require coverage for biologically
based mental illness, severe mental illness, or serious mental illness.8 Fourth, the
table summarizes whether the financial and treatment limitations on mental health
coverage are required to be equal to that for other physical illnesses. Finally, the table
lists criteria under which certain employers and insurers may be exempt from the
requirements of the state parity laws. Fifth, the table lists whether each state
explicitly or implicitly allows medical management of the mental health benefits.
Not all state statutes specify all the requirements compared in the table. In instances
where the criteria are unspecified, this information is noted in the table.
7 HMOs are managed care organizations that provide health insurance coverage through
hospitals, doctors, and other providers with which the HMO has a contract.
Group Insurance: A group is the master insured and the insurance company contracts with
the group. Insurance certificates, issued to participating members, act as their policy.
Individual Insurance: Individual plans are those purchased by an individual directly with
the insurance company.
State Employee Plan: Plan that covers state employees.
8 Biological: There are 13 DSM-IV diagnoses commonly referred to as biologically-based
mental illnesses by mental health providers and consumer organizations. However, DSM-IV
itself does not distinguish between biologically-based and other types of mental illness.
Severe Mental Illness: Different states define this term slightly differently. Most include,
under this category, schizophrenia, schizoaffective disorder, bipolar mood disorder, major
depression, obsessive compulsive disorder, and delusional disorder.
Serious Mental Illness: Mental illnesses which are of sufficient severity to result in
substantial interference with the activities of daily living. This includes schizophrenia,
schizoaffective disorder, and bipolar mood disorder.

CRS-17
Table 1. Comparison of FEHB and State Parity Laws
Plans
Illnesses
Lifetime/
Copayments &
Treatment Limits
Medical
State
Type of Benefit
Exemptions
Covereda
Covered
Annual Limits
Coinsurance
Inpatient Outpatient
b
Managementc
FEHB
Full Parity
1,2
DSM-IV
Equal
Equal
Equal
Equal
2
Not Applicable
AR
Full Parity
1,2
DSM-IV
Equal
Equal
Equal
Equal
1,2
Allowed
AL
Mandated Offering
1
DSM-IV
Equal
Equal
Equal
Equal
1
Allowed
AK
Minimum Mandated
2
DSM-IV
Equal
Equal
Equal
Equal
1,2
Implied
AZ
Mandated Offering
1,2,3,4
DSM-IV
Equal
Unequal
Unspecified
Unspecified
Implied
Severe Mental
CA
Full Parity
1,2,3
Equal
Equal
Equal
Equal
Allowed
Illness
CO
Full Parity
2
Biological
Equal
Equal
Equal
Equal
Not Specified
CT
Full Parity
2,3
DSM-IV
Equal
Equal
Equal
Equal
Allowed
Serious Mental
DE
Full Parity
1,2,3,4
Equal
Equal
Equal
Equal
Allowed
Illness
DC
Mandated Offering
2,3
DSM-IV
Equal
Equal
Equal
Equal
2
Allowed
FL
Mandated Offering
1,2
DSM-IV
Unspecified
Unspecified
Unequal
Unequal
Not Specified
GA
Mandated Offering
2,3
DSM-IV
Equal
Equal
Unequal
Unspecified
Not Specified
HI
Full Parity
2,3
DSM-IV
Equal
Equal
Equal
Equal
Allowed
Serious Mental
ID
Full Parity
4
Equal
Equal
Equal
Equal
Not Specified
Illness
Serious Mental
IL
Full Parity
2
Equal
Equal
Equal
Equal
1
Allowed
Illness
IN
Mandated Offering
1,2,3,4
DSM-IV
Equal
Equal
Equal
Equal
2
Implied
IA
Full Parity
2
Biological
Equal
Equal
Equal
Equal
1
Allowed
KS
Mandated Offering
1,2,4
DSM-IV
Unspecified
Equal
Unequal
Unspecified
Implied
KY
Mandated Offering
2
DSM-IV
Equal
Equal
Equal
Equal
1
Allowed
LA
Mandated Offering
1,2,4
DSM-IV
Equal
Equal
Unequal
Unequal
1,2
Implied
ME
Full Parity
1,2
DSM-IV
Equal
Equal
Equal
Equal
1
Allowed
MD
Minimum Mandated
1,2,3
DSM-IV
Equal
Equal
Equal
Unequal
Implied
MA
Full Parity
1,2,3,4
Biological
Equal
Equal
Equal
Equal
1
Implied
MI
Minimum Mandated
1,2,3
DSM-IV
Unspecified
Equal
Unequal
Unequal
2
Not Specified
MN
Full Parity
1
DSM-IV
Equal
Equal
Equal
Equal
Implied
MS
Mandated Offering
2,3
DSM-IV
Equal
Equal
Unequal
Unequal
2
Allowed
MO
Mandated Offering
1,2,3
DSM-IV
Unequal
Unequal
Unequal
Unequal
Implied
Severe Mental
MT
Full Parity
2,3
Equal
Equal
Equal
Equal
Implied
Illness
Serious Mental
NE
Mandated Offering
1,2
Equal
Equal
Unequal Unequal
1,2
Allowed
Illness
Severe Mental
NV
Minimum Mandated
1,2,3
Equal
Unequal
Equal Unspecified
1,2
Not
specified
Illness
NH
Full Parity
1,2,3,4
Biological
Equal
Equal
Equal
Equal
Implied

CRS-18
Plans
Illnesses
Lifetime/
Copayments &
Treatment Limits
Medical
State
Type of Benefit
Exemptions
Covereda
Covered
Annual Limits
Coinsurance
Inpatient Outpatient
b
Managementc
NJ
Full Parity
2,3,4
Biological
Equal
Equal
Equal
Equal
Implied
NM
Full Parity
2
Biological
Equal
Equal
Equal
Equal
Allowed
NY
Full Parity
1,2,3
Biological
Equal
Equal
Equal
Equal
1,2
Allowed
NC
Full Parity
2
DSM-IV
Equal
Equal
Equal
Equal
Allowed
ND
Minimum Mandated
4
DSM-IV
Unequal
Unspecified
Unequal
Unequal
Allowed
OH
Full Parity
2,3
Biological
Unspecified
Unequal
Equal
Equal
2
Allowed
Severe Mental
OK
Full Parity
2
Equal
Equal
Equal
Equal
1,2
Allowed
Illness
OR
Full Parity
1,2,3
DSM-IV
Unequal
Unequal
Unequal
Unequal
Allowed
Serious Mental
PA
Minimum Mandated
1,2
Equal
Unequal
Unequal Unspecified
1
Not
Specified
Illness
Serious Mental
RI
Full Parity
1,2,3
Equal
Equal
Equal
Equal
Allowed
Illness
SC
Full Parity
4
DSM-IV
Equal
Equal
Equal
Equal
Allowed
SD
Full Parity
1,2,3
Biological
Equal
Equal
Equal
Equal
Implied
TN
Minimum Mandated
2
DSM-IV
Equal
Equal
Unequal
Unequal
1,2
Allowed
Serious Mental
TX
Minimum Mandated
1,2,4
Equal
Equal
Unequal Unspecified
1
Allowed
Illness
UT
Mandated Offering
1,2
DSM-IV
Unequal
Unequal
Unspecified
Unspecified
Allowed
VT
Full Parity
2,3,4
DSM-IV
Equal
Equal
Equal
Equal
Allowed
VA
Full Parity
2,3
Biological
Equal
Equal
Equal
Equal
Allowed
WA
Full Parity
1,2
DSM-IV
Equal
Equal
Equal
Equal
Allowed
WV
Full Parity
4
DSM-IV
Equal
Unspecified
Equal
Equal
1,2
Allowed
WI
Mandated Offering
2
DSM-IV
Unequal
Unequal
Unequal
Unequal
Implied
WY
No parity law
Source: CRS.
Notes:
a. Plans covered by state law:
1 = Health Maintenance Organizations (HMOs)
2 = Group Insurance
3 = Individual Insurance
4 = State Employee Plans
b. Exemptions:
1 = Small employer: Employers with fewer than a given number of employees, which ranges from 10 to 51, may be exempt from the mental health parity
requirements.
2 = Increases cost by a given %: If a health plan demonstrates that providing parity mental health coverage raises the premium cost by more than a given %, they
may be exempt from the mental health parity requirements.
c. Medical Management:
Allowed: State law explicitly permits medical management or utilization review.
Implied: State law refers to allowing health plans to “manage care” for mental health.
Not specified: No language in state parity law with regards to utilization review or medical management.