PRINTER'S NO. 1455
No. 1286 Session of 1997
INTRODUCED BY GANNON, MICHLOVIC, DeLUCA, STERN, TIGUE, GRUPPO,
OLASZ, COWELL, M. COHEN, LaGROTTA, PLATTS, E. Z. TAYLOR,
ROBERTS, BELARDI, PESCI, TRAVAGLIO, CAWLEY, VAN HORNE,
TRELLO, JAMES, SANTONI, MUNDY, ITKIN, COLAIZZO, SCRIMENTI,
STETLER, LEVDANSKY, MANDERINO, STEELMAN, BUNT, SURRA, RAMOS,
KENNEY, MILLER, HERMAN, STABACK, J. TAYLOR, SEMMEL,
YOUNGBLOOD, BOYES, HENNESSEY, BARD, JOSEPHS, REBER, CORRIGAN,
BROWNE, CLYMER, TANGRETTI, MELIO, SATHER, LYNCH, WOJNAROSKI,
McGILL, GIGLIOTTI, CAPPABIANCA, STEVENSON, SCHRODER, GEORGE,
BEBKO-JONES, VEON, KREBS, STRITTMATTER, McCALL, PETRONE,
BISHOP, C. WILLIAMS, HORSEY, L. I. COHEN, ROEBUCK, RIEGER,
LEDERER, MYERS, M. N. WRIGHT, O'BRIEN, CURRY, RUBLEY, OLIVER,
CIVERA, THOMAS, NAILOR, STURLA, RAYMOND, WASHINGTON, DeWEESE,
BARRAR, CARN, DALEY, MARKOSEK, MAYERNIK, PETTIT, ROSS, TRICH,
TRUE, TULLI, WALKO, A. H. WILLIAMS, WOGAN, EVANS, SEYFERT,
EACHUS, McGEEHAN, DiGIROLAMO, LAWLESS, KELLER, HERSHEY,
DONATUCCI, DERMODY, BUXTON, CALTAGIRONE, COLAFELLA, EGOLF,
MAITLAND AND SCHULER, APRIL 10, 1997
REFERRED TO COMMITTEE ON INSURANCE, APRIL 10, 1997
AN ACT
1 Prohibiting health insurance discrimination on the basis of
2 mental illness; and conferring powers upon the Department of
3 Health and the Insurance Department.
4 The General Assembly of the Commonwealth of Pennsylvania
5 hereby enacts as follows:
6 Section 1. Short title.
7 This act shall be known and may be cited as the Mental Health
8 Antidiscrimination Act.
9 Section 2. Legislative findings and intent.
10 The General Assembly finds and declares as follows:
1 (1) Approximately 455,000 adults in this Commonwealth
2 have a major mental illness in any one year, and
3 approximately 192,000 children in this Commonwealth suffer
4 from mental illness.
5 (2) The cost of not treating mental illness outweighs
6 the expense of mental health care. In 1990 the direct cost of
7 treating mental disorders was estimated at $67,000,000,000
8 nationwide, whereas the indirect costs of mental illnesses,
9 including lost productivity, lost earnings and premature
10 death, were estimated at an additional $81,000,000,000.
11 (3) We spend more to treat diseases of the
12 cardiovascular system than we spend on treating mental
13 illnesses, even though the treatment success rates for many
14 mental disorders exceed the success rates for such common
15 cardiovascular treatments as atheroctomy and angioplasty.
16 (4) The ability to diagnose and effectively treat mental
17 illness is equivalent to that for physical illnesses.
18 (5) The failure of private insurance to adequately cover
19 mental illnesses shifts the financial burden to the
20 Commonwealth.
21 (6) Scientific research has demonstrated that the
22 traditional dichotomy between mental and physical injuries
23 and illnesses is inaccurate and that both physical and mental
24 illnesses have biological, social and psychological
25 components.
26 (7) Treatment and insurance coverage for mental
27 illnesses shall be as available and at parity with that for
28 physical illnesses.
29 Section 3. Definitions.
30 The following words and phrases when used in this act shall
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1 have the meanings given to them in this section unless the
2 context clearly indicates otherwise:
3 "Health insurance policy." A group insurance policy,
4 contract or plan or an individual policy, contract or plan which
5 provides medical coverage on an expense incurred, service or
6 prepaid basis. The term includes a policy, contract or plan
7 issued by an entity subject to any of the following statutes:
8 (1) The act of June 2, 1915 (P.L.736, No.338), known as
9 the Workers' Compensation Act.
10 (2) The act of May 17, 1921 (P.L.682, No.284), known as
11 The Insurance Company Law of 1921.
12 (3) The act of December 29, 1972 (P.L.1701, No.364),
13 known as the Health Maintenance Organization Act.
14 (4) The act of May 18, 1976 (P.L.123, No.54), known as
15 the Individual Accident and Sickness Insurance Minimum
16 Standards Act.
17 (5) 40 Pa.C.S. Ch. 61 (relating to hospital plan
18 corporations), 63 (relating to professional health services
19 plan corporations) or 67 (relating to beneficial societies).
20 (6) 75 Pa.C.S. Ch. 17 (relating to financial
21 responsibility).
22 (7) Any successor law of the statutory provisions
23 referred to in paragraphs (1) through (6).
24 The term includes a multiple employer welfare arrangement, as
25 defined in section 3(40)(A) of the Employee Retirement Income
26 Security Act of 1974 (Public Law 93-406, 29 U.S.C. §
27 1002(40)(A)), and any other employee welfare benefit plan as
28 defined in section 3 of the Employee Retirement Income Security
29 Act of 1974, except to the extent that the plan is exempt from
30 State law under the preemption clause in section 514 of the
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1 Employee Retirement Income Security Act of 1974.
2 Section 4. Discrimination prohibited.
3 (a) Coverage.--Except as provided in section 8, every health
4 insurance policy shall provide medical coverage for the
5 diagnosis and treatment of mental illnesses.
6 (b) Prohibited discrimination.--Health insurance policies
7 under this act may not discriminate against mental illness and
8 other injuries, illnesses or conditions in regard to durational,
9 frequency or dollar limits; deductibles, coinsurance or other
10 patient cost-sharing amounts or out-of-pocket limits; or
11 preauthorization or other utilization review requirements or
12 processes.
13 Section 5. Medical necessity.
14 This act shall not be construed as prohibiting a health
15 insurance policy from excluding from coverage mental health
16 services that are medically unnecessary, if the medical
17 necessity determination is made in accordance with generally
18 accepted standards of the medical profession and other
19 applicable laws and regulations.
20 Section 6. Permitted provisions.
21 (a) Mental health coverage.--A health insurance policy may
22 provide coverage for a health service, such as intensive case
23 management, community residential treatment programs or social
24 rehabilitation programs, which is used in the diagnosis or
25 treatment of mental illness, but which is generally not used for
26 other injuries, illnesses and conditions, as long as the other
27 requirements of this act are met.
28 (b) Other coverage.--A health insurance policy may provide
29 coverage for a health service, such as physical rehabilitation
30 or durable medical equipment, which is generally not used in the
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1 diagnosis or treatment of mental illness, but which is used for
2 other injuries, illnesses and conditions, as long as the other
3 requirements of this act are met.
4 Section 7. Applicability.
5 (a) General.--This act shall apply to a health insurance
6 policy that is delivered, issued for delivery, renewed, extended
7 or modified in this Commonwealth on or after the effective date
8 of this act.
9 (b) Delivery.--If a health insurance policy provides
10 coverage or benefits to a resident of this Commonwealth, the
11 policy shall be deemed to be delivered in this Commonwealth
12 within the meaning of subsection (a), regardless of whether the
13 health care insurer or other entity which provides the coverage
14 is located within or outside this Commonwealth.
15 Section 8. Exclusions.
16 This act shall not apply to any of the following:
17 (1) Dental policies.
18 (2) Vision policies.
19 (3) Specified-disease policies.
20 (4) Accidental injury policies.
21 (5) Medicare Supplement policies as subject to section
22 1882 of the Social Security Act (49 Stat. 620, 42 U.S.C. §
23 1395ss).
24 (6) Policies which pay on a fixed-indemnity basis.
25 Section 9. Regulations.
26 The Department of Health and the Insurance Department may
27 promulgate joint regulations to implement this act.
28 Section 10. Effective date.
29 This act shall take effect in 180 days.
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