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For every $1 states spenddollar sign on substance misuse and addiction, 94 cents go to 'shovel up' the consequences instead of for treatment and prevention. TELL YOUR LEGISLATORS

Legislation to Provide Parity for Prevention and Treatment Introduced in Senate 

Senators Coleman (R-MN) and Clinton (D-NY) this week introduced S. 803, the Help Expand Access to Recovery and Treatment (HEART) Act of 2005, legislation that would amend the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code of 1986 to provide parity with respect to substance abuse prevention and addiction treatment benefits under group health plans and health insurance coverage.

The Help Expand Access to Recovery and Treatment (HEART) Act of 2005 would not mandate insurance companies to offer substance abuse prevention and alcohol and drug treatment coverage, but would require that if an insurer does provide such coverage that it be on par with other medical and surgical benefits. The HEART Act is the companion bill to the Time for Recovery and Equal Access to Treatment in America (TREAT America) Act of 2005 that was introduced by Congressman Ramstad (R-MN) in the House several weeks ago.

S. 803 would:

  • Require that group health plans (or health insurance offered in connection with such a plan) that provide both medical and surgical benefits and substance abuse treatment benefits not impose treatment limitations, such as any day or visit limits, on the treatment benefits unless similar limitations are imposed for medical and surgical benefits.
  • Prohibit group health plans (or health insurance offered in connection with such a plan) that offer coverage for substance abuse treatment benefits from imposing financial requirements such as any deductible, coinsurance, or costsharing, or an annual or lifetime dollar limit imposed with respect to the benefits under the plan or coverage, on substance abuse treatment benefits unless similar requirements are imposed for medical and surgical benefits.
  • Define substance abuse treatment services as including: inpatient treatment, including detoxification; non-hospital residential treatment; outpatient treatment, including screening and assessment, medication management, individual, group and family counseling, and relapse prevention;
  • Prevention services, including health education and individual and group counseling to encourage the reduction of risk factors for substance abuse.
  • Provide an exemption from complying for small employers (those with fewer than 50 employees).

Following introduction, the HEART Act was referred to the Senate Committee on Health, Education, Labor and Pensions (HELP) where the legislation awaits review.

(4/29/2005)