The drive to require insurers to treat mental health in parity with physical conditions is boiling down to negotiations between Sen. Edward Kennedy (D-Mass.) and his son, Rep. Patrick Kennedy (D-R.I.).

While both bills have the same general goal, the House legislation (H.R. 1367) also mandates that plans provide the same coverage as that given to federal workers under the Federal Employees Health Benefit Program. That bill was introduced March 7 and has 235 co-sponsors.

In addition, the House legislation takes a different approach on whether the federal government can preempt state laws on the matter. The Senate bill (S. 558) would specifically allow the federal government to pre-empt certain state rules on mental health coverage, with the new federal standard serving as a floor for insurance coverage. By contrast, the House bill contains no such pre-emption provision.

The House bill is an effort to “draw a line in the sand” over the role of insurance companies in setting the scope of mental health coverage, and aims to ensure that states can continue to mandate benefits in excess of any new federal standard, Rep. Kennedy said in an interview. The Senate bill, he said, “lets the insurers define” coverage, he added.

Rep. Kennedy said that House lawmakers have been working longer on the issue and really know what the states need from the federal government. “We are going to pass a stronger version than the Senate,” he said.

Meanwhile, Sen. Kennedy is trying to hold together a fragile coalition of interest groups including the insurance industry, patient groups and businesses by putting forth a more limited approach that can win the broadest possible consensus.

The decision about whether to mandate the scope of coverage is “the biggest divide” between the House and Senate, a senior aide to Sen. Kennedy said. “It’s hard” to find middle ground between these positions,” the aide said., and Rep. Kennedy needs to consider what kind of bill could realistically become law.

“There is a difference between a compromise bill and a bad bill,” the Senate aide said.

The answer is for both sides to negotiate these issues informally prior to the calling of a conference committee, the aide said. All of the committees of jurisdiction plan to get together in a “pre-conference” to find common ground.

“There aren’t many differences, but the differences are big,” the Senate aide said.

Rep. Kennedy agreed that conference negotiations will be necessary to hammer out a compromise.

The Congressman also plans to introduce legislation to establish a broader “patient’s bill of rights” that goes beyond mental health coverage. That legislation would define what medical benefits patients are entitled to, he said. But first, Rep. Kennedy wants to resolve the mental health parity issue.