Time for Recovery and Equal Access to Treatment in America (TREAT America) Act of 2005 - Amends the Public Health Service Act, the Employee Retirement Income Security Act of 1974 (ERISA), and the Internal Revenue Code to prohibit a group health plan or group health coverage that provides both medical and surgical benefits and substance abuse benefits from imposing treatment limitations or financial requirements on the substance abuse treatment benefits unless similar limitations or requirements are imposed for medical and surgical benefits. Excludes such requirements for plans and coverage for small employers and for cases in which the application of such requirements results in an increase in the cost under the plan of at least one percent.
Applies such requirements to health insurance coverage offered in the individual market.
[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1258 Introduced in House (IH)]
109th CONGRESS
1st Session
H. R. 1258
To amend the Employee Retirement Income Security Act of 1974, Public
Health Service Act, and the Internal Revenue Code of 1986 to provide
parity with respect to substance abuse treatment benefits under group
health plans and health insurance coverage.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 10, 2005
Mr. Ramstad introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committees on
Education and the Workforce and Ways and Means, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To amend the Employee Retirement Income Security Act of 1974, Public
Health Service Act, and the Internal Revenue Code of 1986 to provide
parity with respect to substance abuse treatment benefits under group
health plans and health insurance coverage.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Time for Recovery and Equal Access
to Treatment in America (TREAT America) Act of 2005''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) Substance abuse, if left untreated, is a medical
emergency and a private and public health crisis.
(2) Nothing in this Act should be construed as prohibiting
application of the concept of parity to substance abuse
treatment provided by faith-based treatment providers.
SEC. 3. PARITY IN SUBSTANCE ABUSE TREATMENT BENEFITS.
(a) Group Health Plans.--
(1) Public health service act amendments.--
(A) In general.--Subpart 2 of part A of title XXVII
of the Public Health Service Act is amended by adding
at the end the following new section:
``SEC. 2707. PARITY IN THE APPLICATION OF TREATMENT LIMITATIONS AND
FINANCIAL REQUIREMENTS TO SUBSTANCE ABUSE TREATMENT
BENEFITS.
``(a) In General.--In the case of a group health plan (or health
insurance coverage offered in connection with such a plan) that
provides both medical and surgical benefits and substance abuse
treatment benefits, the plan or coverage shall not impose treatment
limitations or financial requirements on the substance abuse treatment
benefits unless similar limitations or requirements are imposed for
medical and surgical benefits.
``(b) Construction.--Nothing in this section shall be construed--
``(1) as requiring a group health plan (or health insurance
coverage offered in connection with such a plan) to provide any
substance abuse treatment benefits; or
``(2) to prevent a group health plan or a health insurance
issuer offering group health insurance coverage from
negotiating the level and type of reimbursement with a provider
for care provided in accordance with this section.
``(c) Exemptions.--
``(1) Small employer exemption.--
``(A) In general.--This section shall not apply to
any group health plan (and group health insurance
coverage offered in connection with a group health
plan) for any plan year of a small employer.
``(B) Small employer.--For purposes of subparagraph
(A), the term `small employer' means, in connection
with a group health plan with respect to a calendar
year and a plan year, an employer who employed an
average of at least 2 but not more than 50 employees on
business days during the preceding calendar year and
who employs at least 2 employees on the first day of
the plan year.
``(C) Application of certain rules in determination
of employer size.--For purposes of this paragraph--
``(i) Application of aggregation rule for
employers.--Rules similar to the rules under
subsections (b), (c), (m), and (o) of section
414 of the Internal Revenue Code of 1986 shall
apply for purposes of treating persons as a
single 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 employer 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 include a
reference to any predecessor of such employer.
``(2) Increased cost exemption.--This section shall not
apply with respect to a group health plan (or health insurance
coverage offered in connection with a group health plan) if the
application of this section to such plan (or to such coverage)
results in an increase in the cost under the plan (or for such
coverage) of at least 1 percent.
``(d) Separate Application to Each Option Offered.--In the case of
a group health plan that offers a participant or beneficiary two or
more benefit package options under the plan, the requirements of this
section shall be applied separately with respect to each such option.
``(e) Definitions.--For purposes of this section--
``(1) Treatment limitation.--The term `treatment
limitation' means, with respect to benefits under a group
health plan or health insurance coverage, any day or visit
limits imposed on coverage of benefits under the plan or
coverage during a period of time.
``(2) Financial requirement.--The term `financial
requirement' means, with respect to benefits under a group
health plan or health insurance coverage, any deductible,
coinsurance, or cost-sharing or an annual or lifetime dollar
limit imposed with respect to the benefits under the plan or
coverage.
``(3) Medical or surgical benefits.--The term `medical or
surgical benefits' means benefits with respect to medical or
surgical services, as defined under the terms of the plan or
coverage (as the case may be), but does not include substance
abuse treatment benefits.
``(4) Substance abuse treatment benefits.--The term
`substance abuse treatment benefits' means benefits with
respect to substance abuse treatment services.
``(5) Substance abuse treatment services.--The term
`substance abuse services' means any of the following items and
services provided for the treatment of substance abuse:
``(A) Inpatient treatment, including
detoxification.
``(B) Non-hospital residential treatment.
``(C) Outpatient treatment, including screening and
assessment, medication management, individual, group,
and family counseling, and relapse prevention.
``(D) Prevention services, including health
education and individual and group counseling to
encourage the reduction of risk factors for substance
abuse.
``(6) Substance abuse.--The term `substance abuse' includes
chemical dependency.
``(f) Notice.--A group health plan under this part shall comply
with the notice requirement under section 714(f) of the Employee
Retirement Income Security Act of 1974 with respect to the requirements
of this section as if such section applied to such plan.''.
(B) Conforming amendment.--Section 2723(c) of such
Act (42 U.S.C. 300gg-23(c)) is amended by striking
``section 2704'' and inserting ``sections 2704 and
2707''.
(2) ERISA amendments.--
(A) In general.--Subpart B of part 7 of subtitle B
of title I of the Employee Retirement Income Security
Act of 1974 is amended by adding at the end the
following new section:
``SEC. 714. PARITY IN THE APPLICATION OF TREATMENT LIMITATIONS AND
FINANCIAL REQUIREMENTS TO SUBSTANCE ABUSE TREATMENT
BENEFITS.
``(a) In General.--In the case of a group health plan (or health
insurance coverage offered in connection with such a plan) that
provides both medical and surgical benefits and substance abuse
treatment benefits, the plan or coverage shall not impose treatment
limitations or financial requirements on the substance abuse treatment
benefits unless similar limitations or requirements are imposed for
medical and surgical benefits.
``(b) Construction.--Nothing in this section shall be construed--
``(1) as requiring a group health plan (or health insurance
coverage offered in connection with such a plan) to provide any
substance abuse treatment benefits; or
``(2) to prevent a group health plan or a health insurance
issuer offering group health insurance coverage from
negotiating the level and type of reimbursement with a provider
for care provided in accordance with this section.
``(c) Exemptions.--
``(1) Small employer exemption.--
``(A) In general.--This section shall not apply to
any group health plan (and group health insurance
coverage offered in connection with a group health
plan) for any plan year of a small employer.
``(B) Small employer.--For purposes of subparagraph
(A), the term `small employer' means, in connection
with a group health plan with respect to a calendar
year and a plan year, an employer who employed an
average of at least 2 but not more than 50 employees on
business days during the preceding calendar year and
who employs at least 2 employees on the first day of
the plan year.
``(C) Application of certain rules in determination
of employer size.--For purposes of this paragraph--
``(i) Application of aggregation rule for
employers.--Rules similar to the rules under
subsections (b), (c), (m), and (o) of section
414 of the Internal Revenue Code of 1986 shall
apply for purposes of treating persons as a
single 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 employer 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 include a
reference to any predecessor of such employer.
``(2) Increased cost exemption.--This section shall not
apply with respect to a group health plan (or health insurance
coverage offered in connection with a group health plan) if the
application of this section to such plan (or to such coverage)
results in an increase in the cost under the plan (or for such
coverage) of at least 1 percent.
``(d) Separate Application to Each Option Offered.--In the case of
a group health plan that offers a participant or beneficiary two or
more benefit package options under the plan, the requirements of this
section shall be applied separately with respect to each such option.
``(e) Definitions.--For purposes of this section--
``(1) Treatment limitation.--The term `treatment
limitation' means, with respect to benefits under a group
health plan or health insurance coverage, any day or visit
limits imposed on coverage of benefits under the plan or
coverage during a period of time.
``(2) Financial requirement.--The term `financial
requirement' means, with respect to benefits under a group
health plan or health insurance coverage, any deductible,
coinsurance, or cost-sharing or an annual or lifetime dollar
limit imposed with respect to the benefits under the plan or
coverage.
``(3) Medical or surgical benefits.--The term `medical or
surgical benefits' means benefits with respect to medical or
surgical services, as defined under the terms of the plan or
coverage (as the case may be), but does not include substance
abuse treatment benefits.
``(4) Substance abuse treatment benefits.--The term
`substance abuse treatment benefits' means benefits with
respect to substance abuse treatment services.
``(5) Substance abuse treatment services.--The term
`substance abuse services' means any of the following items and
services provided for the treatment of substance abuse:
``(A) Inpatient treatment, including
detoxification.
``(B) Non-hospital residential treatment.
``(C) Outpatient treatment, including screening and
assessment, medication management, individual, group,
and family counseling, and relapse prevention.
``(D) Prevention services, including health
education and individual and group counseling to
encourage the reduction of risk factors for substance
abuse.
``(6) Substance abuse.--The term `substance abuse' includes
chemical dependency.
``(f) Notice Under Group Health Plan.--The imposition of the
requirements of this section shall be treated as a material
modification in the terms of the plan described in section 102(a)(1),
for purposes of assuring notice of such requirements under the plan;
except that the summary description required to be provided under the
last sentence of section 104(b)(1) with respect to such modification
shall be provided by not later than 60 days after the first day of the
first plan year in which such requirements apply.''.
(B) Section 731(c) of such Act (29 U.S.C. 1191(c))
is amended by striking ``section 711'' and inserting
``sections 711 and 714''.
(C) Section 732(a) of such Act (29 U.S.C. 1191a(a))
is amended by striking ``section 711'' and inserting
``sections 711 and 714''.
(D) The table of contents in section 1 of such Act
is amended by inserting after the item relating to
section 713 the following new item:
``714. Parity in the application of treatment limitations and financial
requirements to substance abuse treatment
benefits.''.
(3) Internal revenue code amendments.--(A) Subchapter B of
chapter 100 of the Internal Revenue Code of 1986 (relating to
other requirements) is amended by adding at the end the
following new section:
``SEC. 9813. PARITY IN THE APPLICATION OF TREATMENT LIMITATIONS AND
FINANCIAL REQUIREMENTS TO SUBSTANCE ABUSE TREATMENT
BENEFITS.
``(a) In General.--In the case of a group health plan that provides
both medical and surgical benefits and substance abuse treatment
benefits, the plan shall not impose treatment limitations or financial
requirements on the substance abuse treatment benefits unless similar
limitations or requirements are imposed for medical and surgical
benefits.
``(b) Construction.--Nothing in this section shall be construed--
``(1) as requiring a group health plan to provide any
substance abuse treatment benefits; or
``(2) to prevent a group health plan from negotiating the
level and type of reimbursement with a provider for care
provided in accordance with this section.
``(c) Exemptions.--
``(1) Small employer exemption.--
``(A) In general.--This section shall not apply to
any group health plan for any plan year of a small
employer.
``(B) Small employer.--For purposes of subparagraph
(A), the term `small employer' means, in connection
with a group health plan with respect to a calendar
year and a plan year, an employer who employed an
average of at least 2 but not more than 50 employees on
business days during the preceding calendar year and
who employs at least 2 employees on the first day of
the plan year.
``(C) Application of certain rules in determination
of employer size.--For purposes of this paragraph--
``(i) Application of aggregation rule for
employers.--Rules similar to the rules under
subsections (b), (c), (m), and (o) of section
414 shall apply for purposes of treating
persons as a single 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 employer 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 include a
reference to any predecessor of such employer.
``(2) Increased cost exemption.--This section shall not
apply with respect to a group health plan if the application of
this section to such plan results in an increase in the cost
under the plan of at least 1 percent.
``(d) Separate Application to Each Option Offered.--In the case of
a group health plan that offers a participant or beneficiary two or
more benefit package options under the plan, the requirements of this
section shall be applied separately with respect to each such option.
``(e) Definitions.--For purposes of this section--
``(1) Treatment limitation.--The term `treatment
limitation' means, with respect to benefits under a group
health plan, any day or visit limits imposed on coverage of
benefits under the plan during a period of time.
``(2) Financial requirement.--The term `financial
requirement' means, with respect to benefits under a group
health plan, any deductible, coinsurance, or cost-sharing or an
annual or lifetime dollar limit imposed with respect to the
benefits under the plan.
``(3) Medical or surgical benefits.--The term `medical or
surgical benefits' means benefits with respect to medical or
surgical services, as defined under the terms of the plan, but
does not include substance abuse treatment benefits.
``(4) Substance abuse treatment benefits.--The term
`substance abuse treatment benefits' means benefits with
respect to substance abuse treatment services.
``(5) Substance abuse treatment services.--The term
`substance abuse services' means any of the following items and
services provided for the treatment of substance abuse:
``(A) Inpatient treatment, including
detoxification.
``(B) Non-hospital residential treatment.
``(C) Outpatient treatment, including screening and
assessment, medication management, individual, group,
and family counseling, and relapse prevention.
``(D) Prevention services, including health
education and individual and group counseling to
encourage the reduction of risk factors for substance
abuse.
``(6) Substance abuse.--The term `substance abuse' includes
chemical dependency.''.
(B) Section 4980D(d)(1) of such Code is amended by
inserting ``(other than a failure attributable to section
9813)'' after ``on any failure''.
(C) The table of sections of subchapter B of chapter 100 of
such Code is amended by adding at the end the following new
item:
``9813. Parity in the application of treatment limitations and
financial requirements to substance abuse
treatment benefits.''
(b) Individual Health Insurance.--(1) Part B of title XXVII of the
Public Health Service Act is amended by inserting after section 2752
the following new section:
``SEC. 2753. PARITY IN THE APPLICATION OF TREATMENT LIMITATIONS AND
FINANCIAL REQUIREMENTS TO SUBSTANCE ABUSE BENEFITS.
``(a) In General.--The provisions of section 2707 (other than
subsections (e)) shall apply to health insurance coverage offered by a
health insurance issuer in the individual market in the same manner as
it applies to health insurance coverage offered by a health insurance
issuer in connection with a group health plan in the small or large
group market.
``(b) Notice.--A health insurance issuer under this part shall
comply with the notice requirement under section 714(f) of the Employee
Retirement Income Security Act of 1974 with respect to the requirements
referred to in subsection (a) as if such section applied to such issuer
and such issuer were a group health plan.''.
(2) Section 2762(b)(2) of such Act (42 U.S.C. 300gg-62(b)(2)) is
amended by striking ``section 2751'' and inserting ``sections 2751 and
2753''.
(c) Effective Dates.--(1) Subject to paragraph (3), the amendments
made by subsection (a) apply with respect to group health plans for
plan years beginning on or after January 1, 2006.
(2) The amendments made by subsection (b) apply with respect to
health insurance coverage offered, sold, issued, renewed, in effect, or
operated in the individual market on or after January 1, 2006.
(3) In the case of a group health plan maintained pursuant to 1 or
more collective bargaining agreements between employee representatives
and 1 or more employers ratified before the date of enactment of this
Act, the amendments made in subsection (a) shall not apply to plan
years beginning before the later of--
(A) the date on which the last collective bargaining
agreements relating to the plan terminates (determined without
regard to any extension thereof agreed to after the date of
enactment of this Act), or
(B) January 1, 2006.
For purposes of subparagraph (A), any plan amendment made pursuant to a
collective bargaining agreement relating to the plan which amends the
plan solely to conform to any requirement added by subsection (a) shall
not be treated as a termination of such collective bargaining
agreement.
(d) Coordinated Regulations.--Section 104(1) of Health Insurance
Portability and Accountability Act of 1996 is amended by striking
``this subtitle (and the amendments made by this subtitle and section
401)'' and inserting ``the provisions of part 7 of subtitle B of title
I of the Employee Retirement Income Security Act of 1974, and the
provisions of parts A and C of title XXVII of the Public Health Service
Act, and chapter 1000 of the Internal Revenue Code of 1986''.
(e) Preemption.--Nothing in the amendments made by this section
shall be construed to preempt any provision of State law that provides
protections to individuals that are greater than the protections
provided under such amendments.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and the Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and the Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and the Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and the Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Employer-Employee Relations.
Sponsor introductory remarks on measure. (CR H8218)
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