Mental Health Patients' Rights Act

Mental Health Patients' Rights Act - Amends the Public Health Service Act to allow a health insurance issuer to impose a preexisting condition exclusion relating to a preexisting mental condition only if: (1) such exclusion relates to a condition for which medical advice, diagnosis, care, or treatment was recommended or received within the six-month period ending on the enrollment date; (2) such exclusion extends for no more than 12 months after the enrollment date; and (3) the exclusion period is reduced by the aggregate periods of creditable coverage applicable to the individual or dependent as of the enrollment date.

Prohibits any such issuer from requiring an individual or dependent with a preexisting mental health condition to pay a premium or contribution which is greater than that charged to an individual without such condition when the additional charge is based solely on such preexisting condition.

Defines `preexisting mental health condition' to mean a mental health condition, including all categories of mental health conditions listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM IV-TR), or the most recent edition if different than the Fourth Edition, that was present before the date of enrollment of such coverage, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before such date.

[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[S. 2393 Introduced in Senate (IS)]







107th CONGRESS
  2d Session
                                S. 2393

   To amend the Public Health Service Act to provide protections for 
  individuals who need mental health services, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             April 29, 2002

 Mr. Durbin (for himself, Mr. Kennedy, Mr. Wellstone, and Mr. Corzine) 
introduced the following bill; which was read twice and referred to the 
          Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
   To amend the Public Health Service Act to provide protections for 
  individuals who need mental health services, and for other purposes.

    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 ``Mental Health Patients' Rights 
Act''.

SEC. 2. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT.

    Subpart 1 of part B of the Public Health Service Act (42 U.S.C. 
300gg-41 et seq.) is amended by adding at the end the following:

``SEC. 2745. LIMITATION ON PREEXISTING CONDITION EXCLUSION PERIOD AND 
              PREMIUMS WITH RESPECT TO MENTAL HEALTH.

    ``(a) Limitation on Preexisting Condition Exclusion Period.--
            ``(1) In general.--Notwithstanding any other provision of 
        law, a health insurance issuer that offers health insurance 
        coverage in the individual market in a State may, with respect 
        to an individual or dependent of such individual, impose a 
        preexisting condition exclusion relating to a preexisting 
        mental health condition only if--
                    ``(A) such exclusion relates to a mental health 
                condition, regardless of the cause of the condition, 
                for which medical advice, diagnosis, care, or treatment 
                was recommended or received within the 6-month period 
                ending on the enrollment date;
                    ``(B) such exclusion extends for a period of not 
                more than 12 months after the enrollment date; and
                    ``(C) the period of any such preexisting condition 
                exclusion is reduced by the aggregate of the periods of 
                creditable coverage (if any, as defined in paragraph 
                (3)(A)) applicable to the individual or dependent of 
                such individual as of the enrollment date.
            ``(2) Definitions.--In this section:
                    ``(A) Preexisting mental health condition.--The 
                term `preexisting mental health condition' means, with 
                respect to coverage, a mental health condition, 
                including all categories of mental health conditions 
                listed in the Diagnostic and Statistical Manual of 
                Mental Disorders, Fourth Edition (DSM IV-TR), or the 
                most recent edition if different than the Fourth 
                Edition, that was present before the date of enrollment 
                of such coverage, whether or not any medical advice, 
                diagnosis, care, or treatment was recommended or 
                received before such date.
                    ``(B) Other terms.--The terms `preexisting 
                condition exclusion', `enrollment date', and `late 
                enrollee' shall have the meanings given such terms in 
                section 2701 as relating to individual health insurance 
                coverage.
            ``(3) Crediting previous coverage.--For purposes of 
        subsection (a), the term `creditable coverage' has the meaning 
        given such term in section 2701(c) and includes coverage of the 
        individual under any of the following:
                    ``(A) A college-sponsored health plan, or a plan 
                under which health benefits are offered by or through 
                an institution of higher education (as defined in 
                section 481(a) of the Higher Education Act of 1965 (20 
                U.S.C. 1088(a)) in relation to students at the 
                institution (not including benefits offered to such a 
                student as a participant or beneficiary in a group 
                health plan).
                    ``(B) Title XXI of the Social Security Act.
                    ``(C) A State or local employee health plan.
    ``(b) Prohibition on Increased Premiums Based on Preexisting Mental 
Health Condition.--A health insurance issuer that offers health 
insurance coverage in the individual market in a State may not, with 
respect to an individual or dependent of such individual, require any 
individual (as a condition of enrollment or continued enrollment) with 
a preexisting mental health condition to pay a premium or contribution 
which is greater than a premium or contribution for an individual 
without a preexisting mental health condition based solely on the 
determination that such individual has a preexisting mental health 
condition, as such term is defined in subsection (a)(2)(A).
    ``(c) Nonapplicability of Acceptable Alternative Mechanisms.--The 
provisions of section 2741(a)(2) shall not apply to a health insurance 
issuer that offers health insurance coverage in the individual market 
in a State, but only with respect to an individual, or dependent of 
such individual, with a preexisting mental health condition desiring to 
enroll in such individual health insurance coverage.''.
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