II 

118TH CONGRESS 

2D SESSION S. 4331 

To amend the Public Health Service Act, the Employee Retirement Income 

Security Act of 1974, and the Internal Revenue Code of 1986 to require 

that group health plans and health insurance issuers offering group 

or individual health insurance that provide coverage for mental health 

services and substance use disorder services provide such services without 

the imposition of cost-sharing from the diagnosis of pregnancy through 

the 1-year period following such pregnancy, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MAY 14, 2024 

Mrs. SHAHEEN (for herself and Ms. BALDWIN) 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, the Employee Retirement Income Security Act of 1974, and the Internal 

Revenue Code of 1986 to require that group health plans 

and health insurance issuers offering group or individual 

health insurance that provide coverage for mental health 

services and substance use disorder services provide such 

services without the imposition of cost-sharing from the 

diagnosis of pregnancy through the 1-year period following such pregnancy, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Mental Health and 

3 Making Access More Affordable Act of 2024’’ or the 

4 ‘‘Mental Health and MAMA Act of 2024’’. 

5 SEC. 2. COST-SHARING WITH RESPECT TO MENTAL HEALTH 

6 SERVICES AND SUBSTANCE USE DISORDER 

7 SERVICES FOR PREGNANT AND POSTPARTUM 

8 INDIVIDUALS. 

9 (a) PHSA.— 

10 (1) IN GENERAL.—Part D of title XXVII of the 

11 Public Health Service Act (42 U.S.C. 300gg–111 et 

12 seq.) is amended by adding at the end the following 

13 new section: 

14 ‘‘SEC. 2799A–11. COST-SHARING REQUIREMENTS WITH RE15 SPECT TO MENTAL HEALTH SERVICES AND 

16 SUBSTANCE USE DISORDER SERVICES FOR 

17 PREGNANT AND POSTPARTUM INDIVIDUALS. 

18 ‘‘(a) IN GENERAL.—In the case of a group health 

19 plan or a health insurance issuer offering group or indi20 vidual health insurance coverage that provides a benefit 

21 for mental health services or substance use disorder serv22 ices (including such services which are telehealth services 

23 and are provided under such plan or coverage) with re24 spect to plan years beginning on or after the date that 

25 is 2 years after the date of enactment of this section, the 

26 plan or coverage shall not impose any cost-sharing requireVerDate Sep 11 2014 02:14 Jun 15, 2024 Jkt 049200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S4331.IS S4331

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1 ment for such services that are furnished by an in-network 

2 provider to a participant, beneficiary, or enrollee under the 

3 plan or coverage from the diagnosis of pregnancy (as de4 fined by the Secretary) through the 1-year period begin5 ning on the day after the last day of such pregnancy of 

6 such participant, beneficiary, or enrollee (or, in the case 

7 of an individual enrolled in such plan or coverage for a 

8 portion of such period, during such portion). 

9 ‘‘(b) DEFINITIONS.—In this section: 

10 ‘‘(1) The terms ‘mental health services’ and 

11 ‘substance use disorder services’ have the meaning 

12 given such terms for purposes of section 2726. 

13 ‘‘(2) The term ‘telehealth service’ means a serv14 ice that is furnished through telehealth technologies 

15 (as defined in section 330I(a)).’’. 

16 (2) CONTINUITY OF CARE.—Section 2799A–3 

17 of the Public Health Service Act (42 U.S.C. 300gg– 

18 113) is amended— 

19 (A) in subsection (a)(2)(C), by inserting ‘‘, 

20 in the case of a continuing care patient de21 scribed in subsection (b)(1)(D)(ii), the date on 

22 which such individual is no longer such a con23 tinuing care patient with respect to such pro24 vider or facility, or in the case of a continuing 

25 care patient described in subsection (b)(1) other 


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1 than in subparagraph (D)(ii) of such sub2 section,’’ after ‘‘is provided and ending on’’; 

3 and 

4 (B) by amending subsection (b)(1)(D) to 

5 read as follows: 

6 ‘‘(D)(i) is pregnant and undergoing a 

7 course of treatment for the pregnancy from the 

8 provider or facility; or 

9 ‘‘(ii)(I) requires mental health services or 

10 substance use disorder services from a provider 

11 or facility following a pregnancy; 

12 ‘‘(II) received a course of mental health or 

13 substance use disorder treatment from such 

14 provider or facility while pregnant; and 

15 ‘‘(III) the last day of such pregnancy oc16 curred during the previous 1-year period; or’’. 

17 (b) ERISA.— 

18 (1) IN GENERAL.—Subpart B of part 7 of sub19 title B of title I of the Employee Retirement Income 

20 Security Act of 1974 is amended by adding at the 

21 end the following new section: 


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1 ‘‘SEC. 726. COST-SHARING REQUIREMENTS WITH RESPECT 

2 TO MENTAL HEALTH SERVICES AND SUB3 STANCE USE DISORDER SERVICES FOR PREG4 NANT AND POSTPARTUM INDIVIDUALS. 

5 ‘‘(a) IN GENERAL.—In the case of a group health 

6 plan or a health insurance issuer offering group health in7 surance coverage that provides a benefit for mental health 

8 services or substance use disorder services (including such 

9 services which are telehealth services and are provided 

10 under such plan or coverage) with respect to plan years 

11 beginning on or after the date that is 2 years after the 

12 date of enactment of this section, the plan or coverage 

13 shall not impose any cost-sharing requirement for such 

14 services that are furnished by an in-network provider to 

15 a participant or beneficiary under the plan or coverage 

16 from the diagnosis of pregnancy (as defined by the Sec17 retary) through the 1-year period beginning on the day 

18 after the last day of such pregnancy of such participant 

19 or beneficiary (or, in the case of an individual enrolled in 

20 such plan or coverage for a portion of such period, during 

21 such portion). 

22 ‘‘(b) DEFINITIONS.—In this section: 

23 ‘‘(1) The terms ‘mental health services’ and 

24 ‘substance use disorder services’ have the meaning 

25 given such terms for purposes of section 712. 


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1 ‘‘(2) The term ‘telehealth service’ means a serv2 ice that is furnished through telehealth technologies 

3 (as defined in section 330I(a) of the Public Health 

4 Service Act).’’. 

5 (2) CONTINUITY OF CARE.—Section 718 of the 

6 Employee Retirement Income Security Act of 1974 

7 (29 U.S.C. 1185g) is amended— 

8 (A) in subsection (a)(2)(C), by inserting ‘‘, 

9 in the case of a continuing care patient de10 scribed in subsection (b)(1)(D)(ii), the date on 

11 which such individual is no longer such a con12 tinuing care patient with respect to such pro13 vider or facility, or in the case of a continuing 

14 care patient described in subsection (b)(1) other 

15 than in subparagraph (D)(ii) of such sub16 section,’’ after ‘‘is provided and ending on’’; 

17 and 

18 (B) by amending subsection (b)(1)(D) to 

19 read as follows: 

20 ‘‘(D)(i) is pregnant and undergoing a 

21 course of treatment for the pregnancy from the 

22 provider or facility; or 

23 ‘‘(ii)(I) requires mental health services or 

24 substance use disorder services from a provider 

25 or facility following a pregnancy; 


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1 ‘‘(II) received a course of mental health or 

2 substance use disorder treatment from such 

3 provider or facility while pregnant; and 

4 ‘‘(III) the last day of such pregnancy oc5 curred during the previous 1-year period; or’’. 

6 (3) CLERICAL AMENDMENT.—The table of con7 tents in section 1 of the Employee Retirement In8 come Security Act of 1974 (29 U.S.C. 1001 et seq.) 

9 is amended by inserting after the item relating to 

10 section 725 the following new item: 

‘‘Sec. 726. Cost-sharing requirements with respect to mental health services 

and substance use disorder services for pregnant and 

postpartum individuals.’’. 

11 (c) IRC.— 

12 (1) IN GENERAL.—Subchapter B of chapter 

13 100 of the Internal Revenue Code of 1986 is amend14 ed by adding at the end the following new section: 

15 ‘‘SEC. 9826. COST-SHARING REQUIREMENTS WITH RESPECT 

16 TO MENTAL HEALTH SERVICES AND SUB17 STANCE USE DISORDER SERVICES FOR PREG18 NANT AND POSTPARTUM INDIVIDUALS. 

19 ‘‘(a) IN GENERAL.—In the case of a group health 

20 plan that provides a benefit for mental health services or 

21 substance use disorder services (including such services 

22 which are telehealth services and are provided under such 

23 plan) with respect to plan years beginning on or after the 

24 date that is 2 years after the date of enactment of this 


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1 section, the plan shall not impose any cost-sharing require2 ment for such services that are furnished by an in-network 

3 provider to a participant or beneficiary under the plan 

4 from the diagnosis of pregnancy (as defined by the Sec5 retary) through the 1-year period beginning on the day 

6 after the last day of such pregnancy of such participant 

7 or beneficiary (or, in the case of an individual enrolled in 

8 such plan for a portion of such period, during such por9 tion). 

10 ‘‘(b) DEFINITIONS.—In this section: 

11 ‘‘(1) The terms ‘mental health services’ and 

12 ‘substance use disorder services’ have the meaning 

13 given such terms for purposes of section 9812. 

14 ‘‘(2) The term ‘telehealth service’ means a serv15 ice that is furnished through telehealth technologies 

16 (as defined in section 330I(a) of the Public Health 

17 Service Act).’’. 

18 (2) CONTINUITY OF CARE.—Section 9818 of 

19 the Internal Revenue Code of 1986 is amended— 

20 (A) in subsection (a)(2)(C), by inserting ‘‘, 

21 in the case of a continuing care patient de22 scribed in subsection (b)(1)(D)(ii), the date on 

23 which such individual is no longer such a con24 tinuing care patient with respect to such pro25 vider or facility, or in the case of a continuing 


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1 care patient described in subsection (b)(1) other 

2 than in subparagraph (D)(ii) of such sub3 section,’’ after ‘‘is provided and ending on’’; 

4 and 

5 (B) by amending subsection (b)(1)(D) to 

6 read as follows: 

7 ‘‘(D)(i) is pregnant and undergoing a 

8 course of treatment for the pregnancy from the 

9 provider or facility; or 

10 ‘‘(ii)(I) requires mental health services or 

11 substance use disorder services from a provider 

12 or facility following a pregnancy; 

13 ‘‘(II) received a course of mental health or 

14 substance use disorder treatment from such 

15 provider or facility while pregnant; and 

16 ‘‘(III) the last day of such pregnancy oc17 curred during the previous 1-year period; or’’. 

18 (3) CLERICAL AMENDMENT.—The table of sec19 tions for subchapter B of chapter 100 of the Inter20 nal Revenue Code of 1986 is amended by adding at 

21 the end the following new item: 

‘‘Sec. 9826. Cost-sharing requirements with respect to mental health services 

and substance use disorder services for pregnant and 

postpartum individuals.’’. 

22 (d) EFFECTIVE DATE.—The amendments made by 

23 subsections (a), (b), and (c) shall apply with respect to 


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1 plan years beginning on or after the date that is 2 years 

2 after the date of enactment of this Act. 

3 (e) FEHBP.— 

4 (1) IN GENERAL.—Section 8902(p) of title 5, 

5 United States Code, is amended— 

6 (A) by striking ‘‘and 2799A–7’’ and insert7 ing ‘‘2799A–7, and 2799A–11’’; 

8 (B) by striking ‘‘and 722’’ and inserting 

9 ‘‘722, and 726’’; and 

10 (C) by striking ‘‘and 9822’’ and inserting 

11 ‘‘9822, and 9826’’. 

12 (2) EFFECTIVE DATE.—The amendments made 

13 by paragraph (1) shall apply with respect to con14 tracts entered into or renewed for contract years be15 ginning on or after the date that is 2 years after the 

16 date of enactment of this Act. 

Æ 


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