That mandate equal coverage for physical and Mental Health care. Mental Health Care Providers testified about difficulties in implementing a federal health care parity law. This hearing of the house energy and subcommittee on health is an hour and 40 minutes. Ladies and gentlemen, if youll take your seats, well start. The subcommittee will come to order. Before we begin, i want to make a note that members may be filtering in and out throughout the hearing. Unfortunately, the condensed september session, there are a number of scheduling conflicts this morning. But we wanted to be sure to have this important hearing before congress recessed at the end of the month. With that being said, chair recognize himself for an Opening Statement. Todays Health Subcommittee hearing will examine the federal Mental Health parity laws and regulations. In 2008, Congress Passed a bill requiring most Group Health Plans to provide more generous coverage for treatment of Mental Illnesses comparable to what is provided for physical illnesses. This Mental Health parity and addiction equity act, mhpaea which followed the Mental Health parity act of 1996, the mhpa requires equivalence or parity in coverage of mental and physical ailments. Parity means that insurers need to treat copayments, treatment limits, prior authorization for Mental Health, Substance Use disorder the same way they treat for physical health care. The mhpaea originally applied to Group Health Plans and Group Health Insurance coverage, and then was amended by the Affordable Care act to also apply to individual Health Insurance coverage as well as medicaid benchmark, and benchmark equivalent plans. With more than 11 million americans who suffer with severe Mental Illness such as schizophrenia, bipolar disorder, major depression, this issue is vitally important for individual patients as well as families seeking appropriate care for their loved ones. Since there seems to be ongoing discussions or protections as envisioned in the Mental Health parity laws previously enacted, it is timely for this committee to consider ways to streamline the Mental Health parity system. Title 8 of the helping families in mental crisis act authored by Committee Member tim murphy of my home state pennsylvania and Bernice Johnson of texas offers eight provision concerning Mental Health parity such as improved compliance guidance and disclosure support. Of particular interest to our democratic Committee Members is a proposal by representative joe kennedy of massachusetts, hr 4276, the Behavioral Health coverage Transparency Act of 2015. And this bill offers one of the many approaches to modifying parity requirements. Today we have three expert panelists who will provide testimony and answer questions on the strengths and challenges of Mental Health parity standards. And i look forward to the testimony today. To ambulance my time. Thank you, mr. Chairman. And to our witnesses today, we thank you. I want to thank the chairman for calling the hearing. And i want to thank all of my colleagues for the great work that we all did together as a team to pass that Mental Health reform package and through the house, get it through the house in july. And i think it was significant that both sides came together on what i see as a very important issue today as we talk with you all, im going to want to highlight some items pertaining to the zika virus. I do have tremendous concern about what we see happening here. Wall street journal had an article, and id like to submit this for the record, mr. Chairman, researchers in the fda now are mentioning that with the zika virus, we could potentially probably will see an uptick in Mental Illness, parkinsons, diseases of that nature, dementia, et cetera. We know that the virus is fast spreading, fast growing. I think 16,000 cases now in the u. S. And our territories. And im quite concerned about the parallels between the virus and some of the Mental Health issues that we have. So i do want to highlight that. And mr. Chairman without objection, so ordered. I appreciate that and i yield back my time. Is anyone seeking time . Mr. Chairman, i go to a local Health Care Provider in the Mental Health space, john markley from centerstone, illinois. I asked him these very same questions. What can be done to be helpful. The federal government should use specific guidance to state regulators on plans on how to implement the federal parity law. Identify parity violations and enforce the law in public and private insurance. The federal government should issue Additional Guidance requiring the transparency requirements and molding issuers and appropriate coverage and plan design. And robustly enforce requirements of the federal Mental Health substance youth disorder parity law perspectively during plan approval and retrospectively through complete investigations. And well probably hear some of that from the testimony from our panelists. And i appreciate the time of the chairman. I yield back. The chair thanks. I also have a question. A consent to submit the following letters from americas Health Insurance plans to the president s task force. A letter from the eating disorders coalition. A letter to congress from 43 organizations representing providers, professionals, patients, family members and consumers. The chair now recognizes Ranking Member of the subcommittee, mr. Green. Five minutes for Opening Statement. Thank you, mr. Chairman, for having this important hearing. And our witnesses, i thank each of you for taking your time out and being here this morning. For too long Mental Health and Substance Abuse care has been siloed from the rest of the Health Care System and stigmatized. Perhaps the biggest barrier to accessing care has been higher cost, lack of coverage for Mental Health, and Substance Use care. To begin address, Congress Passed the Mental Health parity act in 1996. The law prohibited employers, sponsored Group Health Plans from setting higher annual or lifetime dollar limits on Mental Health benefits and many other benefits. The Paul Wellstone and Pete Domenici addiction equity act in 2008 built on this first step and provided protections regarding your quality of coverage for medical and surgical benefits and Mental Health and Substance Use benefits. This was further strengthened by the Affordable Care act in 2010. While the progress has been made, there is much room for improvement. Since mhpeaea was enacted in 2008, insufficient enforcement and compliance, spotty disclosure of medical manage information and other implementation barriers to accessing Mental Health and Substance Abuse services with the equivalency to physical Health Services has muted the promise of the law for many. Today well be at hearing with witnesses from the current state of parity laws and on the ground enforcement. Without strong enforcement of the parity law, millions of people continue to struggle to get health care they need. I look forward to learning more about this critical from california, doris matsui. Thank you, mr. Green. What we really want to do today is treat Mental Illness as a disease. And if afford it the same enterally intervention that we have. Parity is designed to ensure that Insurance Companies cover Mental Health benefits the same way they cover physical health benefits. Congress started this effort with the Mental Health parity act in 1996, and we have continued to build on it since then. We have made Great Strides with the Affordable Care act by allaying the concept that parity to more types of plans and more types of benefits and adding Mental Health and Substance Use disorder to the list of essential health benefits. Yet we need to make sure that these laws are being applied and enforced consistently. We included provisions to include to strengthen the parity law and the Mental Health reform bill. This committee worked hard to pass before the august recess. I also support the ideas my League Representative kennedy has put forth to take these provisions a step further. I look forward to hearing from the witnesses today. And what we can do moving forward to ensure that everyone has access to the treatments and service they need. I yield back to the Ranking Member. Thank you. Thank my colleague for her work. And again, the time has come now to actually enforce the Mental Health parity laws over the last 20 years as both the state legislator and a member of congress. Ive watched how weve tried to improve it, but it has not been successful. So mr. Chairman, i thank you for calling this hearing today. And again, hopefully if not this session in early next session, we can continue to work on making sure we provide the parity of Mental Health has with our physical illnesses and our insurance policies. And does anyone else want time from my side . Chair . I yield back my time. Chair, thanks. Gentlemen now recognize the Ranking Member of the full committee. Five minutes for your Opening Statement. Im sorry. I just want to thank you, mr. Chairman, and mr. Green for this hearing on the state of Mental Health parity in america. Because current Mental Health parity law requires that insurers treat Mental Health and Substance Use disorder care the same way they treat physical care and that includes copayments and prior authorizations. Today more than 41 million adults have some form of Mental Illness. But in 2014, less than half of them received Mental Health care. And more than 20 Million People over the age of 12 have a Substance Use disorder, but only 2. 6 million received treatment at a specialty facility in 2014. Perhaps this can be explained in part because the majority of americans do not know that there are Mental Health parity protections in current law. This congress weve had several important conversations on the challenges facing our Mental Health system, and we recently passed a bipartisan Mental Health bill in the house. And im pleased that were here today to continue that work by having a more indepth discussion on Mental Health parity. The last time we made major improvements to Mental Health parity laws was in 2010 when we passed the Affordable Care act. The aca expanded both parity protections and Health Insurance coverage making early treatment and Treatment Prevention Services accessible to millions of americans. Under the new aca all individual and Small Group Insurance plans are mandated to cover Mental Health and Substance Abuse disorders as one of Ten Essential Health benefits. In addition, the aca expanded parity protections for Substance UseDisorder Services to individual health plans and certain medicaid plans. So this essentially means that these plans must provide coverage for Mental Health and Substance UseDisorder Services at the same level as coverage for other medical service. So today im interested in hearing from our witnesses about how our current parity laws are being implemented and enforced. Because without proper enforcement, those laws will not have the impact we hope for them to have. And finally, id like to thank congressman kennedy for his strong leadership on this topic and for requesting this hearing. He sponsored legislation this congress that contains important parity provisions that were not included in our housepassed Mental Health bill. Its clear that we can and should be doing more to ensure that americans are able to access necessary Mental Health and Substance UseDisorder Services. And i hope this hearing will shed some light on what steps we can take going forward. So i would like to yield the remainder of my time to congressman kennedy. I want to thank my excuse me thank the Ranking Member and the Ranking Member of the subcommittee, mr. Green. I also want to thank chairman upton and chairman pitts for allowing us to have this hearing today. And for their leadership on Mental Health and continuing to make Mental Health parity a priority for this committee. I also want to thank mr. Selig for his work and the work of Health Law Advocates. It touches thousands of families and patients across massachusetts. Its a privilege having you representing our commonwealth today, sir. And for all the advocates throughout that have helped inform our efforts in this committee. Without your support we wouldnt be where we are today. I thank you. When the house passed the bill in july, it was a need step forward in efforts to fix a deeply flawed system. But our work is far from over. Because no matter how many providers we train, Grant Programs we fund, failure to insurance basic Insurance Coverage for those service means the vast majority of working and middle class families cant afford them. Thats why im grateful for todays hearing. Parity. The simple idea that Substance Use disorder and Heart Disease should be treated the same is the law. Thats not what this debate is in fact about. But without proper enforcement and transparency, the law is little more than empty words. It is meaningless to the patients and families who need and deserve the access, the Mental Health parity act, the addiction equity act and the Affordable Care act were intended to guarantee. And that lack of enforcement and transparency has devastating consequences. I recently read a story of a mother whose son matt lost his life after an Insurance Company continually refused to cover longterm treatment for his Substance Use disorder. She wrote that she, quote, used to wish that matt had cancer. At least he would have received timely nonbiased treatment. Beneath the heartbreaking stories and anecdotes are statistics to back them up. Claims from Mental Health care are denied at nearly tw