Mental Health Rules Put in Bailout

http://www.house.gov/apps/list/press/financialsvcs_dem/essabill.pdf

The above link is to the full text of the bailout bill, and I suggest that everybody read this bill. It was pushed through with only a couple of days debate by lawyers who have little understanding of the workings of Wall Street or The Fed. And they tacked a lot of pork barrel spending onto it to BRIBE Congress to agree to it. Unfortunately, mental health parity verbiage was tacked onto the bill with the pork. NAMI, of course, is celebrating the bill for its own sake without regard to what effect it will have, or when. Having appeased the mental health lobby, congress is off the hook as far as enacting any further legislation. Way to go!
http://www.house.gov/apps/list/press/financialsvcs_dem/essabill.pdf

“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.”

This means that you only get parity if your employer provides your insurance AND that insurance already has mental health coverage. It doesn’t seem to require them to cover it in the first place. It also doesn’t appear to apply to private health insurance.

There is a cost exemption so to limit mental health coverage if it increases costs by some undetermined amount. The insurance companies can still deny claims bases on their definition of “medical necessity” or by their definition of “reasonable and customary” services.

??(2) COST EXEMPTION.?
6 ??(A) IN GENERAL.?With respect to a
7 group health plan (or health insurance coverage
8 offered in connection with such a plan), if the
9 application of this section to such plan (or cov
10 erage) results in an increase for the plan year
11 involved of the actual total costs of coverage
12 with respect to medical and surgical benefits
13 and mental health and substance use disorder
14 benefits under the plan (as determined and cer
15 tified under subparagraph (C)) by an amount
16 that exceeds the applicable percentage described
17 in subparagraph (B) of the actual total plan
18 costs, the provisions of this section shall not
19 apply to such plan (or coverage) during the fol
20 lowing plan year, and such exemption shall
21 apply to the plan (or coverage) for 1 plan year.”

Discrimination on the basis of genetic information only affects illnesses for which genetic tests have been developed. This bill ignores a lot of of the provisions of the ADA, while modifying ERISA quite a bit. I am concerned that this will weaken the ADA by tightening the definitions to exclude non-genetic diseases.

Specific diagnoses this bill applies to will be determined by the GAO, which has 3 years to study it and present a report. Once the beancounters are through will this bill, we’ll have no more than we had the day before the bill passed.

(h) GAO STUDY ON COVERAGE AND EXCLUSION OF
4 MENTAL HEALTH AND SUBSTANCE USE DISORDER DIAG5
NOSES.?
6 (1) IN GENERAL.?The Comptroller General of
7 the United States shall conduct a study that ana8
lyzes the specific rates, patterns, and trends in cov9
erage and exclusion of specific mental health and
10 substance use disorder diagnoses by health plans
11 and health insurance.”

I doubt this will change anything in the near future.

A few years from now you’re going to hear Congressdroids bitching because they didn’t have enough time to collect the facts before enacting this bill.

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