69–008 

110TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 2d Session 110–538 

PROVIDING FOR CONSIDERATION OF THE BILL (H.R. 1424) TO AMEND SECTION 712 OF THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 

1974, SECTION 2705 OF THE PUBLIC HEALTH SERVICE ACT, AND SECTION 9812 OF THE INTERNAL REVENUE CODE OF 1986 TO REQUIRE EQUITY IN THE PROVISION OF MENTAL HEALTH AND SUBSTANCE-RELATED DISORDER BENEFITS UNDER GROUP HEALTH PLANS 

MARCH 4, 2008.—Referred to the House Calendar and ordered to be printed 

Ms. CASTOR, from the Committee on Rules, 

submitted the following 

R E P O R T 

[To accompany H. Res. 1014] 

The Committee on Rules, having had under consideration House 

Resolution 1014, by a nonrecord vote report the same to the House 

with the recommendation that the resolution be adopted. 

SUMMARY OF PROVISIONS OF THE RESOLUTION

The resolution provides for consideration of H.R. 1424, the Paul 

Wellstone Mental Health and Addiction Equity Act of 2007, under 

a closed rule providing two hours of general debate in the House 

with 40 minutes equally divided and controlled by the Chairman 

and Ranking Minority Member of the Committee on Energy and 

Commerce, 40 minutes equally divided and controlled by the Chairman and Ranking Minority Member of the Committee on Ways and 

Means, and 40 minutes equally divided and controlled by the 

Chairman and Ranking Minority Member of the Committee on 

Education and Labor. The rule waives all points of order against 

consideration of the bill except for clauses 9 and 10 of rule XXI. 

The rule provides that the bill shall be considered as read. The rule 

provides that in lieu of the amendments recommended by the Committees on Energy and Commerce, Ways and Means, and Education and Labor, the amendment in the nature of a substitute 

printed in this report shall be considered as adopted. The rule 

waives all points of order against the bill as amended. This waiver 

does not affect the point of order available under clause 9 of rule 

XXI (regarding earmark disclosure). The rule provides one motion 

to recommit with or without instructions. The rule provides that in 

the engrossment of H.R. 1424, the text of H.R. 493, as passed the 

House, shall be added at the end of H.R. 1424. Finally, the rule 


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provides that the Chair may postpone further consideration of the 

bill to a time designated by the Speaker. 

EXPLANATION OF WAIVERS

The waiver of all points of order against consideration of the bill 

(except for clauses 9 and 10 of rule XXI) includes a waiver of rule 

XIII, clause 4(a), requiring a three-day layover of the committee report and a waiver of rule XIII clause 3(c) regarding the statement 

of performance goals in committee reports. Although the rule 

waives all points of order against the provisions in the bill, as 

amended, the Committee is not aware of any points of order. The 

waiver of all points of order is prophylactic. 

COMMITTEE VOTES

The results of each record vote on an amendment or motion to 

report, together with the names of those voting for and against, are 

printed below: 

Rules Committee record vote No. 441 

Date: March 4, 2008. 

Measure: H.R. 1424. 

Motion by: Mr. Dreier. 

Summary of motion: To make in order and provide appropriate 

waivers for an amendment submitted by Reps. Wilson, Heather 

(NM)/Kline (MN)/Camp (MI), #11, which provides a substitute for 

the language of H.R. 1424 by incorporating the text of S. 558. The 

amendment also includes a provision that requires all states to implement an electronic asset-verification program for Medicaid eligibility verification. 

Results: Defeated 2–7. 

Vote by Members: McGovern—Nay; Hastings (FL)—Nay; Matsui—Nay; Welch—Nay; Castor—Nay; Arcuri—Nay; Sutton—Nay; 

Dreier—Yea; Hastings (WA)—Yea. 

Rules Committee record vote No. 442 

Date: March 4, 2008. 

Measure: H.R. 1424. 

Motion by: Mr. Dreier. 

Summary of motion: To make in order and provide appropriate 

waivers for an amendment by Rep. Barton (TX), #3, which provides 

that, to the extent the requirements of DSM apply, plans shall also 

maintain coverage for mental health disorders or conditions arising 

out of abortions, or loss of an unborn child. 

Results: Defeated 2–7. 

Vote by Members: McGovern—Nay; Hastings (FL)—Nay; Matsui—Nay; Welch—Nay; Castor—Nay; Arcuri—Nay; Sutton—Nay; 

Dreier—Yea; Hastings (WA)—Yea. 

Rules Committee record vote No. 443 

Date: March 4, 2008. 

Measure: H.R. 1424. 

Motion by: Mr. Dreier. 

Summary of motion: To make in order and provide appropriate 

waivers for an amendment by Rep. Barton (TX), #4, which provides 

that nothing about codification of the DSM creates a defense in 


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criminal cases including for child abusers. Nothing about the codification of the DSM overrides any requirements for reporting of 

criminal conduct, including for child abusers, or creates any new 

privilege against disclosure. 

Results: Defeated 2–7. 

Vote by Members: McGovern—Nay; Hastings (FL)—Nay; Matsui—Nay; Welch—Nay; Castor—Nay; Arcuri—Nay; Sutton—Nay; 

Dreier—Yea; Hastings (WA)—Yea. 

Rules Committee record vote No. 444 

Date: March 4, 2008. 

Measure: H.R. 1424. 

Motion by: Mr. Hastings (WA). 

Summary of motion: To make in order and provide appropriate 

waivers for an amendment by Rep. Hastings (WA) and Rep. 

McMorris (WA), #7, which removes the prohibition on physician referral to hospitals that are more than 40 percent doctor owned. The 

amendment also removes the limitation on hospital facility expansion. 

Results: Defeated 2–7. 

Vote by Members: McGovern—Nay; Hastings (FL)—Nay; Matsui—Nay; Welch—Nay; Castor—Nay; Arcuri—Nay; Sutton—Nay; 

Dreier—Yea; Hastings (WA)—Yea. 

Rules Committee record vote No. 445 

Date: March 4, 2008. 

Measure: H.R. 1424. 

Motion by: Mr. Hastings (WA). 

Summary of motion: To make in order and provide appropriate 

waivers for the amendments en bloc by Reps. Hastings (WA) and 

McMorris (WA), #8, which removes the prohibition on physician referral to hospitals that are more than 40 percent doctor owned and 

the limitation on hospital facility expansion for hospitals that meet 

the following requirements: (1) over half of their care is provided 

to Medicare and Medicaid patients and (2) have obtained a certificate of need from the state; and the amendment by Rep. Hastings 

(WA) and Rep. McMorris (WA), #9, which removes the prohibition 

on physician referral to hospitals that are more than 40 percent 

doctor owned and the limitation on hospital facility expansion in 

cases where the Governor submits written notice to the Secretary 

that the hospital is needed to maintain an adequate level of access 

to care in the state. 

Results: Defeated 2–7. 

Vote by Members: McGovern—Nay; Hastings (FL)—Nay; Matsui—Nay; Welch—Nay; Castor—Nay; Arcuri—Nay; Sutton—Nay; 

Dreier—Yea; Hastings (WA)—Yea. 

Rules Committee record vote No. 446 

Date: March 4, 2008. 

Measure: H.R. 1424. 

Motion by: Mr. Hastings (WA). 

Summary of motion: To make in order and provide appropriate 

waivers for an amendment by Rep. Hinojosa (TX), #5, which exempts large full service hospitals from the ownership requirements 

and would make it easier for large full service hospitals to qualify 


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for the expansion exception. The amendment would allow the Secretary to disallow the grandfather if there is overutilization. 

Results: Defeated 2–7. 

Vote by Members: McGovern—Nay; Hastings (FL)—Nay; Matsui—Nay; Welch—Nay; Castor—Nay; Arcuri—Nay; Sutton—Nay; 

Dreier—Yea; Hastings (WA)—Yea. 

Rules Committee record vote No. 447. 

Date: March 4, 2008. 

Measure: H.R. 1424. 

Motion by: Mr. Hastings (WA). 

Summary of motion: To make in order and provide appropriate 

waivers for an amendment by Rep. Broun (GA), #2, which strikes 

the increased cost exemption for plans in the bill, reverting to the 

existing law which exempts firms whose costs rise 1% as a result 

of the federal mandates. 

Results: Defeated 2–7. 

Vote by Members: McGovern—Nay, Hastings (FL)—Nay; Matsui—Nay; Welch—Nay; Castor—Nay; Arcuri—Nay; Sutton—Nay; 

Dreier—Yea; Hastings (WA)—Yea. 

SUMMARY OF THE AMENDMENT IN THE NATURE OF A SUBSTITUTE TO

BE CONSIDERED AS ADOPTED

The Amendment in the Nature of a Substitute expands the Mental Health Parity Act of 1996 to provide for equity in the terms of 

employer sponsored health benefits for mental health and substance-related disorders compared to medical and surgical disorders. It ensures that health plans do not charge higher copayments, coinsurance, deductibles, and impose maximum out-of-pocket limits and lower day and visit limits on mental health and addiction care than for medical and surgical benefits. The Department of Health and Human Services, the Department of Labor, and 

the Internal Revenue Service can penalize insurers for discriminatory practices in plan design under this bill and individuals may 

sue in court to obtain promised benefits. It includes an increase in 

the rebate, or discount, that pharmaceutical companies are required to provide to State Medicaid programs for drugs provided to 

Medicaid beneficiaries. It includes language to prohibit physicians 

from referring patients to hospitals in which they have an ownership interest, but also provides the ability to grandfather and grow 

existing physician-owned hospitals. 

TEXT OF THE AMENDMENT IN THE NATURE OF A SUBSTITUTE TO BE

CONSIDERED AS ADOPTED

Strike all after the enacting clause and insert the following: 

SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

(a) SHORT TITLE.—This Act may be cited as the ‘‘Paul Wellstone 

Mental Health and Addiction Equity Act of 2007’’. 

(b) TABLE OF CONTENTS.—The table of contents of this Act is as 

follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Amendments to the Employee Retirement Income Security Act of 1974. 

Sec. 3. Amendments to the Public Health Service Act relating to the group market. 

Sec. 4. Amendments to the Internal Revenue Code of 1986. 


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Sec. 5. Medicaid drug rebate. 

Sec. 6. Limitation on Medicare exception to the prohibition on certain physician referrals for hospitals. 

Sec. 7. Studies and reports. 

SEC. 2. AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974. 

(a) EXTENSION OF PARITY TO TREATMENT LIMITS AND BENE- FICIARY FINANCIAL REQUIREMENTS.—Section 712 of the Employee 

Retirement Income Security Act of 1974 (29 U.S.C. 1185a) is 

amended— (1) in subsection (a), by adding at the end the following new 

paragraphs: ‘‘(3) TREATMENT LIMITS.—In the case of a group health plan 

that provides both medical and surgical benefits and mental 

health or substance-related disorder benefits— ‘‘(A) NO TREATMENT LIMIT.—If the plan or coverage does 

not include a treatment limit (as defined in subparagraph 

(D)) on substantially all medical and surgical benefits in 

any category of items or services, the plan or coverage may 

not impose any treatment limit on mental health or substance-related disorder benefits that are classified in the 

same category of items or services. ‘‘(B) TREATMENT LIMIT.—If the plan or coverage includes 

a treatment limit on substantially all medical and surgical 

benefits in any category of items or services, the plan or 

coverage may not impose such a treatment limit on mental 

health or substance-related disorder benefits for items and 

services within such category that is more restrictive than 

the predominant treatment limit that is applicable to medical and surgical benefits for items and services within 

such category. ‘‘(C) CATEGORIES OF ITEMS AND SERVICES FOR APPLICA- TION OF TREATMENT LIMITS AND BENEFICIARY FINANCIAL

REQUIREMENTS.—For purposes of this paragraph and paragraph (4), there shall be the following five categories of 

items and services for benefits, whether medical and surgical benefits or mental health and substance-related disorder benefits, and all medical and surgical benefits and 

all mental health and substance related benefits shall be 

classified into one of the following categories: ‘‘(i) INPATIENT, IN-NETWORK.—Items and services not 

described in clause (v) furnished on an inpatient basis 

and within a network of providers established or recognized under such plan or coverage. 

‘‘(ii) INPATIENT, OUT-OF-NETWORK.—Items and services not described in clause (v) furnished on an inpatient basis and outside any network of providers established or recognized under such plan or coverage. 

‘‘(iii) OUTPATIENT, IN-NETWORK.—Items and services 

not described in clause (v) furnished on an outpatient 

basis and within a network of providers established or 

recognized under such plan or coverage. 

‘‘(iv) OUTPATIENT, OUT-OF-NETWORK.—Items and 

services not described in clause (v) furnished on an 

outpatient basis and outside any network of providers 

established or recognized under such plan or coverage. 


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‘‘(v) EMERGENCY CARE.—Items and services, whether 

furnished on an inpatient or outpatient basis or within 

or outside any network of providers, required for the 

treatment of an emergency medical condition (as defined in section 1867(e) of the Social Security Act, including an emergency condition relating to mental 

health or substance-related disorders). ‘‘(D) TREATMENT LIMIT DEFINED.—For purposes of this 

paragraph, the term ‘treatment limit’ means, with respect 

to a plan or coverage, limitation on the frequency of treatment, number of visits or days of coverage, or other similar 

limit on the duration or scope of treatment under the plan 

or coverage. ‘‘(E) PREDOMINANCE.—For purposes of this subsection, a 

treatment limit or financial requirement with respect to a 

category of items and services is considered to be predominant if it is the most common or frequent of such type of 

limit or requirement with respect to such category of items 

and services. 

‘‘(4) BENEFICIARY FINANCIAL REQUIREMENTS.—In the case of 

a group health plan that provides both medical and surgical 

benefits and mental health or substance-related disorder benefits—

‘‘(A) NO BENEFICIARY FINANCIAL REQUIREMENT.—If the 

plan or coverage does not include a beneficiary financial 

requirement (as defined in subparagraph (C)) on substantially all medical and surgical benefits within a category of 

items and services (specified under paragraph (3)(C)), the 

plan or coverage may not impose such a beneficiary financial requirement on mental health or substance-related 

disorder benefits for items and services within such category. ‘‘(B) BENEFICIARY FINANCIAL REQUIREMENT.— ‘‘(i) TREATMENT OF DEDUCTIBLES, OUT-OF-POCKET

LIMITS, AND SIMILAR FINANCIAL REQUIREMENTS.—If the 

plan or coverage includes a deductible, a limitation on 

out-of-pocket expenses, or similar beneficiary financial 

requirement that does not apply separately to individual items and services on substantially all medical 

and surgical benefits within a category of items and 

services (as specified in paragraph (3)(C)), the plan or 

coverage shall apply such requirement (or, if there is 

more than one such requirement for such category of 

items and services, the predominant requirement for 

such category) both to medical and surgical benefits 

within such category and to mental health and substance-related disorder benefits within such category 

and shall not distinguish in the application of such requirement between such medical and surgical benefits 

and such mental health and substance-related disorder benefits. 

‘‘(ii) OTHER FINANCIAL REQUIREMENTS.—If the plan 

or coverage includes a beneficiary financial requirement not described in clause (i) on substantially all 

medical and surgical benefits within a category of 


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items and services, the plan or coverage may not impose such financial requirement on mental health or 

substance-related disorder benefits for items and services within such category in a way that results in 

greater out-of-pocket expenses to the participant or 

beneficiary than the predominant beneficiary financial 

requirement applicable to medical and surgical benefits for items and services within such category. ‘‘(C) BENEFICIARY FINANCIAL REQUIREMENT DEFINED.— For purposes of this paragraph, the term ‘beneficiary financial requirement’ includes, with respect to a plan or 

coverage, any deductible, coinsurance, co-payment, other 

cost sharing, and limitation on the total amount that may 

be paid by a participant or beneficiary with respect to benefits under the plan or coverage, but does not include the 

application of any aggregate lifetime limit or annual 

limit.’’; and 

(2) in subsection (b)— (A) by striking ‘‘construed—’’ and all that follows 

through ‘‘(1) as requiring’’ and inserting ‘‘construed as requiring’’; 

(B) by striking ‘‘; or’’ and inserting a period; and 

(C) by striking paragraph (2). 

(b) EXPANSION TO SUBSTANCE-RELATED DISORDER BENEFITS AND

REVISION OF DEFINITION.—Such section is further amended— (1) by striking ‘‘mental health benefits’’ each place it appears 

(other than in any provision amended by paragraph (2)) and 

inserting ‘‘mental health or substance-related disorder benefits’’, 

(2) by striking ‘‘mental health benefits’’ each place it appears 

in subsections (a)(1)(B)(i), (a)(1)(C), (a)(2)(B)(i), and (a)(2)(C) 

and inserting ‘‘mental health and substance-related disorder 

benefits’’, and 

(3) in subsection (e), by striking paragraph (4) and inserting 

the following new paragraphs: 

‘‘(4) MENTAL HEALTH BENEFITS.—The term ‘mental health 

benefits’ means benefits with respect to services for mental 

health conditions, as defined under the terms of the plan and 

in accordance with applicable law, but does not include substance-related disorder benefits. ‘‘(5) SUBSTANCE-RELATED DISORDER BENEFITS.—The term 

‘substance-related disorder benefits’ means benefits with respect to services for substance-related disorders, as defined 

under the terms of the plan and in accordance with applicable 

law.’’. 

(c) AVAILABILITY OF PLAN INFORMATION ABOUT CRITERIA FOR

MEDICAL NECESSITY.—Subsection (a) of such section, as amended 

by subsection (a)(1), is further amended by adding at the end the 

following new paragraph: ‘‘(5) AVAILABILITY OF PLAN INFORMATION.—The criteria for 

medical necessity determinations made under the plan with respect to mental health and substance-related disorder benefits 

(or the health insurance coverage offered in connection with 

the plan with respect to such benefits) shall be made available 

by the plan administrator (or the health insurance issuer offerVerDate Aug 31 2005 04:43 Mar 05, 2008 Jkt 069008 PO 00000 Frm 00007 Fmt 6659 Sfmt 6602 E:\HR\OC\HR538.XXX HR538

smartinez on PRODPC61 with REPORTS
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ing such coverage) in accordance with regulations to any current or potential participant, beneficiary, or contracting provider upon request. The reason for any denial under the plan 

(or coverage) of reimbursement or payment for services with 

respect to mental health and substance-related disorder benefits in the case of any participant or beneficiary shall, on request or as otherwise required, be made available by the plan 

administrator (or the health insurance issuer offering such coverage) to the participant or beneficiary in accordance with regulations.’’. (d) MINIMUM BENEFIT REQUIREMENTS.—Subsection (a) of such 

section is further amended by adding at the end the following new 

paragraph: ‘‘(6) MINIMUM SCOPE OF COVERAGE AND EQUITY IN OUT-OFNETWORK BENEFITS.—

‘‘(A) MINIMUM SCOPE OF MENTAL HEALTH AND SUBSTANCE-RELATED DISORDER BENEFITS.—In the case of a 

group health plan (or health insurance coverage offered in 

connection with such a plan) that provides any mental 

health or substance-related disorder benefits, the plan or 

coverage shall include benefits for any mental health condition or substance-related disorder included in the most 

recent edition of the Diagnostic and Statistical Manual of 

Mental Disorders published by the American Psychiatric 

Association. 

‘‘(B) EQUITY IN COVERAGE OF OUT-OF-NETWORK BENE- FITS.—

‘‘(i) IN GENERAL.—In the case of a plan or coverage 

that provides both medical and surgical benefits and 

mental health or substance-related disorder benefits, if 

medical and surgical benefits are provided for substantially all items and services in a category specified in 

clause (ii) furnished outside any network of providers 

established or recognized under such plan or coverage, 

the mental health and substance-related disorder benefits shall also be provided for items and services in 

such category furnished outside any network of providers established or recognized under such plan or 

coverage in accordance with the requirements of this 

section. 

‘‘(ii) CATEGORIES OF ITEMS AND SERVICES.—For purposes of clause (i), there shall be the following three 

categories of items and services for benefits, whether 

medical and surgical benefits or mental health and 

substance-related disorder benefits, and all medical 

and surgical benefits and all mental health and substance-related disorder benefits shall be classified into 

one of the following categories: 

‘‘(I) EMERGENCY.—Items and services, whether 

furnished on an inpatient or outpatient basis, required for the treatment of an emergency medical 

condition (as defined in section 1867(e) of the Social Security Act, including an emergency condition relating to mental health or substance-related 

disorders). 


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‘‘(II) INPATIENT.—Items and services not described in subclause (I) furnished on an inpatient 

basis. ‘‘(III) OUTPATIENT.—Items and services not described in subclause (I) furnished on an outpatient 

basis.’’. (e) REVISION OF INCREASED COST EXEMPTION.—Paragraph (2) of 

subsection (c) of such section is amended to read as follows: ‘‘(2) INCREASED COST EXEMPTION.— ‘‘(A) IN GENERAL.—With respect to a group health plan 

(or health insurance coverage offered in connection with 

such a plan), if the application of this section to such plan 

(or coverage) results in an increase for the plan year involved of the actual total costs of coverage with respect to 

medical and surgical benefits and mental health and substance-related disorder benefits under the plan (as determined and certified under subparagraph (C)) by an 

amount that exceeds the applicable percentage described 

in subparagraph (B) of the actual total plan costs, the provisions of this section shall not apply to such plan (or coverage) during the following plan year, and such exemption 

shall apply to the plan (or coverage) for 1 plan year. ‘‘(B) APPLICABLE PERCENTAGE.—With respect to a plan 

(or coverage), the applicable percentage described in this 

paragraph shall be— ‘‘(i) 2 percent in the case of the first plan year to 

which this paragraph applies; and ‘‘(ii) 1 percent in the case of each subsequent plan 

year. ‘‘(C) DETERMINATIONS BY ACTUARIES.—Determinations as 

to increases in actual costs under a plan (or coverage) for 

purposes of this subsection shall be made in writing and 

prepared and certified by a qualified and licensed actuary 

who is a member in good standing of the American Academy of Actuaries. Such determinations shall be made 

available by the plan administrator (or health insurance 

issuer, as the case may be) to the general public. ‘‘(D) 6-MONTH DETERMINATIONS.—If a group health plan 

(or a health insurance issuer offering coverage in connection with such a plan) seeks an exemption under this paragraph, determinations under subparagraph (A) shall be 

made after such plan (or coverage) has complied with this 

section for the first 6 months of the plan year involved. ‘‘(E) NOTIFICATION.—An election to modify coverage of 

mental health and substance-related disorder benefits as 

permitted under this paragraph shall be treated as a material modification in the terms of the plan as described in 

section 102(a) and notice of which shall be provided a reasonable period in advance of the change. ‘‘(F) NOTIFICATION OF APPROPRIATE AGENCY.— ‘‘(i) IN GENERAL.—A group health plan that, based 

on a certification described under subparagraph (C), 

qualifies for an exemption under this paragraph, and 

elects to implement the exemption, shall notify the Department of Labor of such election. 


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‘‘(ii) REQUIREMENT.—A notification under clause (i) 

shall include— ‘‘(I) a description of the number of covered lives 

under the plan (or coverage) involved at the time 

of the notification, and as applicable, at the time 

of any prior election of the cost-exemption under 

this paragraph by such plan (or coverage); ‘‘(II) for both the plan year upon which a cost 

exemption is sought and the year prior, a description of the actual total costs of coverage with respect to medical and surgical benefits and mental 

health and substance-related disorder benefits 

under the plan; and ‘‘(III) for both the plan year upon which a cost 

exemption is sought and the year prior, the actual 

total costs of coverage with respect to mental 

health and substance-related disorder benefits 

under the plan. ‘‘(iii) CONFIDENTIALITY.—A notification under clause 

(i) shall be confidential. The Department of Labor 

shall make available, upon request to the appropriate 

committees of Congress and on not more than an annual basis, an anonymous itemization of such notifications, that includes—

‘‘(I) a breakdown of States by the size and any 

type of employers submitting such notification; 

and 

‘‘(II) a summary of the data received under 

clause (ii). 

‘‘(G) NO IMPACT ON APPLICATION OF STATE LAW.—The 

fact that a plan or coverage is exempt from the provisions 

of this section under subparagraph (A) shall not affect the 

application of State law to such plan or coverage. ‘‘(H) CONSTRUCTION.—Nothing in this paragraph shall be 

construed as preventing a group health plan (or health insurance coverage offered in connection with such a plan) 

from complying with the provisions of this section notwithstanding that the plan or coverage is not required to comply with such provisions due to the application of subparagraph (A).’’. 

(f) CHANGE IN EXCLUSION FOR SMALLEST EMPLOYERS.—Subsection (c)(1)(B) of such section is amended—

(1) by inserting ‘‘(or 1 in the case of an employer residing in 

a State that permits small groups to include a single individual)’’ after ‘‘at least 2’’ the first place it appears; and 

(2) by striking ‘‘and who employs at least 2 employees on the 

first day of the plan year’’. 

(g) ELIMINATION OF SUNSET PROVISION.—Such section is amended by striking subsection (f). 

(h) CLARIFICATION REGARDING PREEMPTION.—Such section is further amended by inserting after subsection (e) the following new 

subsection: ‘‘(f) PREEMPTION, RELATION TO STATE LAWS.—

‘‘(1) IN GENERAL.—This part shall not be construed to supersede any provision of State law which establishes, implements, 


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or continues in effect any consumer protections, benefits, methods of access to benefits, rights, external review programs, or 

remedies solely relating to health insurance issuers in connection with group health insurance coverage (including benefit 

mandates or regulation of group health plans of 50 or fewer 

employees) except to the extent that such provision prevents 

the application of a requirement of this part. 

‘‘(2) CONTINUED PREEMPTION WITH RESPECT TO GROUP

HEALTH PLANS.—Nothing in this section shall be construed to 

affect or modify the provisions of section 514 with respect to 

group health plans. 

‘‘(3) OTHER STATE LAWS.—Nothing in this section shall be 

construed to exempt or relieve any person from any laws of 

any State not solely related to health insurance issuers in connection with group health coverage insofar as they may now or 

hereafter relate to insurance, health plans, or health coverage.’ ’’. 

(i) CONFORMING AMENDMENTS TO HEADING.—

(1) IN GENERAL.—The heading of such section is amended to 

read as follows: 

‘‘SEC. 712. EQUITY IN MENTAL HEALTH AND SUBSTANCE-RELATED 

DISORDER BENEFITS.’’. 

(2) CLERICAL AMENDMENT.—The table of contents in section 

1 of such Act is amended by striking the item relating to section 712 and inserting the following new item: 

‘‘Sec. 712. Equity in mental health and substance-related disorder benefits.’’. 

(j) EFFECTIVE DATE.—

(1) IN GENERAL.—The amendments made by this section 

shall apply with respect to plan years beginning on or after 

January 1, 2009. 

(2) SPECIAL RULE FOR COLLECTIVE BARGAINING AGREEMENTS.—In the case of a group health plan maintained pursuant to one or more collective bargaining agreements between 

employee representatives and one or more employers ratified 

before the date of the enactment of this Act, the amendments 

made by this section shall not apply to plan years beginning 

before the later of—

(A) the date on which the last of the collective bargaining agreements relating to the plan terminates (determined without regard to any extension thereof agreed to 

after the date of the enactment of this Act), or 

(B) January 1, 2009. 

For purposes of subparagraph (A), any plan amendment made 

pursuant to a collective bargaining agreement relating to the 

plan which amends the plan solely to conform to any requirement added by this section shall not be treated as a termination of such collective bargaining agreement. 

(k) DOL ANNUAL SAMPLE COMPLIANCE.—The Secretary of Labor 

shall annually sample and conduct random audits of group health 

plans (and health insurance coverage offered in connection with 

such plans) in order to determine their compliance with the amendments made by this Act and shall submit to the appropriate committees of Congress an annual report on such compliance with such 

amendments. The Secretary shall share the results of such audits 


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with the Secretaries of Health and Human Services and of the 

Treasury. 

(l) ASSISTANCE TO PARTICIPANTS AND BENEFICIARIES.—The Secretary of Labor shall provide assistance to participants and beneficiaries of group health plans with any questions or problems with 

compliance with the requirements of this Act. The Secretary shall 

notify participants and beneficiaries how they can obtain assistance 

from State consumer and insurance agencies and the Secretary 

shall coordinate with State agencies to ensure that participants 

and beneficiaries are protected and afforded the rights provided 

under this Act. 

SEC. 3. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT RELATING TO THE GROUP MARKET. 

(a) EXTENSION OF PARITY TO TREATMENT LIMITS AND BENE- FICIARY FINANCIAL REQUIREMENTS.—Section 2705 of the Public 

Health Service Act (42 U.S.C. 300gg–5) is amended— (1) in subsection (a), by adding at the end the following new 

paragraphs: ‘‘(3) TREATMENT LIMITS.—In the case of a group health plan 

that provides both medical and surgical benefits and mental 

health or substance-related disorder benefits— ‘‘(A) NO TREATMENT LIMIT.—If the plan or coverage does 

not include a treatment limit (as defined in subparagraph 

(D)) on substantially all medical and surgical benefits in 

any category of items or services (specified in subparagraph (C)), the plan or coverage may not impose any treatment limit on mental health or substance-related disorder 

benefits that are classified in the same category of items 

or services. ‘‘(B) TREATMENT LIMIT.—If the plan or coverage includes 

a treatment limit on substantially all medical and surgical 

benefits in any category of items or services, the plan or 

coverage may not impose such a treatment limit on mental 

health or substance-related disorder benefits for items and 

services within such category that is more restrictive than 

the predominant treatment limit that is applicable to medical and surgical benefits for items and services within 

such category. 

‘‘(C) CATEGORIES OF ITEMS AND SERVICES FOR APPLICATION OF TREATMENT LIMITS AND BENEFICIARY FINANCIAL

REQUIREMENTS.—For purposes of this paragraph and paragraph (4), there shall be the following five categories of 

items and services for benefits, whether medical and surgical benefits or mental health and substance-related disorder benefits, and all medical and surgical benefits and 

all mental health and substance related benefits shall be 

classified into one of the following categories: 

‘‘(i) INPATIENT, IN-NETWORK.—Items and services not 

described in clause (v) furnished on an inpatient basis 

and within a network of providers established or recognized under such plan or coverage. 

‘‘(ii) INPATIENT, OUT-OF-NETWORK.—Items and services not described in clause (v) furnished on an inpatient basis and outside any network of providers established or recognized under such plan or coverage. 


smartinez on PRODPC61 with REPORTS
13 

‘‘(iii) OUTPATIENT, IN-NETWORK.—Items and services 

not described in clause (v) furnished on an outpatient 

basis and within a network of providers established or 

recognized under such plan or coverage. ‘‘(iv) OUTPATIENT, OUT-OF-NETWORK.—Items and 

services not described in clause (v) furnished on an 

outpatient basis and outside any network of providers 

established or recognized under such plan or coverage. ‘‘(v) EMERGENCY CARE.—Items and services, whether 

furnished on an inpatient or outpatient basis or within 

or outside any network of providers, required for the 

treatment of an emergency medical condition (as defined in section 1867(e) of the Social Security Act, including an emergency condition relating to mental 

health or substance-related disorders). ‘‘(D) TREATMENT LIMIT DEFINED.—For purposes of this 

paragraph, the term ‘treatment limit’ means, with respect 

to a plan or coverage, limitation on the frequency of treatment, number of visits or days of coverage, or other similar 

limit on the duration or scope of treatment under the plan 

or coverage. 

‘‘(E) PREDOMINANCE.—For purposes of this subsection, a 

treatment limit or financial requirement with respect to a 

category of items and services is considered to be predominant if it is the most common or frequent of such type of 

limit or requirement with respect to such category of items 

and services. ‘‘(4) BENEFICIARY FINANCIAL REQUIREMENTS.—In the case of 

a group health plan that provides both medical and surgical 

benefits and mental health or substance-related disorder benefits— ‘‘(A) NO BENEFICIARY FINANCIAL REQUIREMENT.—If the 

plan or coverage does not include a beneficiary financial 

requirement (as defined in subparagraph (C)) on substantially all medical and surgical benefits within a category of 

items and services (specified in paragraph (3)(C)), the plan 

or coverage may not impose such a beneficiary financial requirement on mental health or substance-related disorder 

benefits for items and services within such category. ‘‘(B) BENEFICIARY FINANCIAL REQUIREMENT.—

‘‘(i) TREATMENT OF DEDUCTIBLES, OUT-OF-POCKET

LIMITS, AND SIMILAR FINANCIAL REQUIREMENTS.—If the 

plan or coverage includes a deductible, a limitation on 

out-of-pocket expenses, or similar beneficiary financial 

requirement that does not apply separately to individual items and services on substantially all medical 

and surgical benefits within a category of items and 

services, the plan or coverage shall apply such requirement (or, if there is more than one such requirement 

for such category of items and services, the predominant requirement for such category) both to medical 

and surgical benefits within such category and to mental health and substance-related disorder benefits 

within such category and shall not distinguish in the 

application of such requirement between such medical 


smartinez on PRODPC61 with REPORTS
14 

and surgical benefits and such mental health and substance-related disorder benefits. ‘‘(ii) OTHER FINANCIAL REQUIREMENTS.—If the plan 

or coverage includes a beneficiary financial requirement not described in clause (i) on substantially all 

medical and surgical benefits within a category of 

items and services, the plan or coverage may not impose such financial requirement on mental health or 

substance-related disorder benefits for items and services within such category in a way that results in 

greater out-of-pocket expenses to the participant or 

beneficiary than the predominant beneficiary financial 

requirement applicable to medical and surgical benefits for items and services within such category. ‘‘(C) BENEFICIARY FINANCIAL REQUIREMENT DEFINED.—

For purposes of this paragraph, the term ‘beneficiary financial requirement’ includes, with respect to a plan or 

coverage, any deductible, coinsurance, co-payment, other 

cost sharing, and limitation on the total amount that may 

be paid by a participant or beneficiary with respect to benefits under the plan or coverage, but does not include the 

application of any aggregate lifetime limit or annual 

limit.’’; and 

(2) in subsection (b)—

(A) by striking ‘‘construed—’’ and all that follows 

through ‘‘(1) as requiring’’ and inserting ‘‘construed as requiring’’; 

(B) by striking ‘‘; or’’ and inserting a period; and 

(C) by striking paragraph (2). 

(b) EXPANSION TO SUBSTANCE-RELATED DISORDER BENEFITS AND

REVISION OF DEFINITION.—Such section is further amended— (1) by striking ‘‘mental health benefits’’ each place it appears 

(other than in any provision amended by paragraph (2)) and 

inserting ‘‘mental health or substance-related disorder benefits’’, 

(2) by striking ‘‘mental health benefits’’ each place it appears 

in subsections (a)(1)(B)(i), (a)(1)(C), (a)(2)(B)(i), and (a)(2)(C) 

and inserting ‘‘mental health and substance-related disorder 

benefits’’, and 

(3) in subsection (e), by striking paragraph (4) and inserting 

the following new paragraphs: 

‘‘(4) MENTAL HEALTH BENEFITS.—The term ‘mental health 

benefits’ means benefits with respect to services for mental 

health conditions, as defined under the terms of the plan and 

in accordance with applicable law, but does not include substance-related disorder benefits. 

‘‘(5) SUBSTANCE-RELATED DISORDER BENEFITS.—The term 

‘substance-related disorder benefits’ means benefits with respect to services for substance-related disorders, as defined 

under the terms of the plan and in accordance with applicable 

law.’’. (c) AVAILABILITY OF PLAN INFORMATION ABOUT CRITERIA FOR

MEDICAL NECESSITY.—Subsection (a) of such section, as amended 

by subsection (a)(1), is further amended by adding at the end the 

following new paragraph: 


smartinez on PRODPC61 with REPORTS
15 

‘‘(5) AVAILABILITY OF PLAN INFORMATION.—The criteria for 

medical necessity determinations made under the plan with respect to mental health and substance-related disorder benefits 

(or the health insurance coverage offered in connection with 

the plan with respect to such benefits) shall be made available 

by the plan administrator (or the health insurance issuer offering such coverage) in accordance with regulations to any current or potential participant, beneficiary, or contracting provider upon request. The reason for any denial under the plan 

(or coverage) of reimbursement or payment for services with 

respect to mental health and substance-related disorder benefits in the case of any participant or beneficiary shall, on request or as otherwise required, be made available by the plan 

administrator (or the health insurance issuer offering such coverage) to the participant or beneficiary in accordance with regulations.’’. (d) MINIMUM BENEFIT REQUIREMENTS.—Subsection (a) of such 

section is further amended by adding at the end the following new 

paragraph: 

‘‘(6) MINIMUM SCOPE OF COVERAGE AND EQUITY IN OUT-OF- NETWORK BENEFITS.— ‘‘(A) MINIMUM SCOPE OF MENTAL HEALTH AND SUB- STANCE-RELATED DISORDER BENEFITS.—In the case of a 

group health plan (or health insurance coverage offered in 

connection with such a plan) that provides any mental 

health or substance-related disorder benefits, the plan or 

coverage shall include benefits for any mental health condition or substance-related disorder included in the most 

recent edition of the Diagnostic and Statistical Manual of 

Mental Disorders published by the American Psychiatric 

Association. ‘‘(B) EQUITY IN COVERAGE OF OUT-OF-NETWORK BENEFITS.—

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

(or health insurance coverage offered in connection 

with such a plan) that provides both medical and surgical benefits and mental health or substance-related 

disorder benefits, if medical and surgical benefits are 

provided for substantially all items and services in a 

category specified in clause (ii) furnished outside any 

network of providers established or recognized under 

such plan or coverage, the mental health and substance-related disorder benefits shall also be provided 

for items and services in such category furnished outside any network of providers established or recognized under such plan or coverage in accordance with 

the requirements of this section. 

‘‘(ii) CATEGORIES OF ITEMS AND SERVICES.—For purposes of clause (i), there shall be the following three 

categories of items and services for benefits, whether 

medical and surgical benefits or mental health and 

substance-related disorder benefits, and all medical 

and surgical benefits and all mental health and substance-related disorder benefits shall be classified into 

one of the following categories: 


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16 

‘‘(I) EMERGENCY.—Items and services, whether 

furnished on an inpatient or outpatient basis, required for the treatment of an emergency medical 

condition (as defined in section 1867(e) of the Social Security Act, including an emergency condition relating to mental health or substance-related 

disorders). 

‘‘(II) INPATIENT.—Items and services not described in subclause (I) furnished on an inpatient 

basis. 

‘‘(III) OUTPATIENT.—Items and services not described in subclause (I) furnished on an outpatient 

basis.’’. 

(e) REVISION OF INCREASED COST EXEMPTION.—Paragraph (2) of 

subsection (c) of such section is amended to read as follows: 

‘‘(2) INCREASED COST EXEMPTION.—

‘‘(A) IN GENERAL.—With respect to a group health plan 

(or health insurance coverage offered in connection with 

such a plan), if the application of this section to such plan 

(or coverage) results in an increase for the plan year involved of the actual total costs of coverage with respect to 

medical and surgical benefits and mental health and substance-related disorder benefits under the plan (as determined and certified under subparagraph (C)) by an 

amount that exceeds the applicable percentage described 

in subparagraph (B) of the actual total plan costs, the provisions of this section shall not apply to such plan (or coverage) during the following plan year, and such exemption 

shall apply to the plan (or coverage) for 1 plan year. 

‘‘(B) APPLICABLE PERCENTAGE.—With respect to a plan 

(or coverage), the applicable percentage described in this 

paragraph shall be—

‘‘(i) 2 percent in the case of the first plan year to 

which this paragraph applies; and 

‘‘(ii) 1 percent in the case of each subsequent plan 

year. 

‘‘(C) DETERMINATIONS BY ACTUARIES.—Determinations as 

to increases in actual costs under a plan (or coverage) for 

purposes of this subsection shall be made in writing and 

prepared and certified by a qualified and licensed actuary 

who is a member in good standing of the American Academy of Actuaries. Such determinations shall be made 

available by the plan administrator (or health insurance 

issuer, as the case may be) to the general public. 

‘‘(D) 6-MONTH DETERMINATIONS.—If a group health plan 

(or a health insurance issuer offering coverage in connection with such a plan) seeks an exemption under this paragraph, determinations under subparagraph (A) shall be 

made after such plan (or coverage) has complied with this 

section for the first 6 months of the plan year involved. 

‘‘(E) NOTIFICATION.—A group health plan under this part 

shall comply with the notice requirement under section 

712(c)(2)(E) of the Employee Retirement Income Security 

Act of 1974 with respect to a modification of mental health 


smartinez on PRODPC61 with REPORTS
17 

and substance-related disorder benefits as permitted under 

this paragraph as if such section applied to such plan. 

‘‘(F) NOTIFICATION OF APPROPRIATE AGENCY.—

‘‘(i) IN GENERAL.—A group health plan that, based 

on a certification described under subparagraph (C), 

qualifies for an exemption under this paragraph, and 

elects to implement the exemption, shall notify the 

Secretary of Health and Human Services of such election. 

‘‘(ii) REQUIREMENT.—A notification under clause (i) 

shall include—

‘‘(I) a description of the number of covered lives 

under the plan (or coverage) involved at the time 

of the notification, and as applicable, at the time 

of any prior election of the cost-exemption under 

this paragraph by such plan (or coverage); 

‘‘(II) for both the plan year upon which a cost 

exemption is sought and the year prior, a description of the actual total costs of coverage with respect to medical and surgical benefits and mental 

health and substance-related disorder benefits 

under the plan; and 

‘‘(III) for both the plan year upon which a cost 

exemption is sought and the year prior, the actual 

total costs of coverage with respect to mental 

health and substance-related disorder benefits 

under the plan. 

‘‘(iii) CONFIDENTIALITY.—A notification under clause 

(i) shall be confidential. The Secretary of Health and 

Human Services shall make available, upon request to 

the appropriate committees of Congress and on not 

more than an annual basis, an anonymous itemization 

of such notifications, that includes—

‘‘(I) a breakdown of States by the size and any 

type of employers submitting such notification; 

and 

‘‘(II) a summary of the data received under 

clause (ii). 

‘‘(G) CONSTRUCTION.—Nothing in this paragraph shall be 

construed as preventing a group health plan (or health insurance coverage offered in connection with such a plan) 

from complying with the provisions of this section notwithstanding that the plan or coverage is not required to comply with such provisions due to the application of subparagraph (A).’’. 

(f) CHANGE IN EXCLUSION FOR SMALLEST EMPLOYERS.—Subsection (c)(1)(B) of such section is amended—

(1) by inserting ‘‘(or 1 in the case of an employer residing in 

a State that permits small groups to include a single individual)’’ after ‘‘at least 2’’ the first place it appears; and 

(2) by striking ‘‘and who employs at least 2 employees on the 

first day of the plan year’’. 

(g) ELIMINATION OF SUNSET PROVISION.—Such section is amended by striking out subsection (f). 


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18 

(h) CLARIFICATION REGARDING PREEMPTION.—Such section is further amended by inserting after subsection (e) the following new 

subsection: 

‘‘(f) PREEMPTION, RELATION TO STATE LAWS.—

‘‘(1) IN GENERAL.—Nothing in this section shall be construed 

to preempt any State law that provides greater consumer protections, benefits, methods of access to benefits, rights or remedies that are greater than the protections, benefits, methods 

of access to benefits, rights or remedies provided under this 

section. 

‘‘(2) CONSTRUCTION.—Nothing in this section shall be construed to affect or modify the provisions of section 2723 with 

respect to group health plans.’’. 

(i) CONFORMING AMENDMENT TO HEADING.—The heading of such 

section is amended to read as follows: 

‘‘SEC. 2705. EQUITY IN MENTAL HEALTH AND SUBSTANCE-RELATED 

DISORDER BENEFITS.’’. 

(j) EFFECTIVE DATE.—

(1) IN GENERAL.—Except as otherwise provided in this subsection, the amendments made by this section shall apply with 

respect to plan years beginning on or after January 1, 2009. 

(2) ELIMINATION OF SUNSET.—The amendment made by subsection (g) shall apply to benefits for services furnished after 

December 31, 2007. 

(3) SPECIAL RULE FOR COLLECTIVE BARGAINING AGREEMENTS.—In the case of a group health plan maintained pursuant to one or more collective bargaining agreements between 

employee representatives and one or more employers ratified 

before the date of the enactment of this Act, the amendments 

made by this section shall not apply to plan years beginning 

before the later of—

(A) the date on which the last of the collective bargaining agreements relating to the plan terminates (determined without regard to any extension thereof agreed to 

after the date of the enactment of this Act), or 

(B) January 1, 2009. 

For purposes of subparagraph (A), any plan amendment made 

pursuant to a collective bargaining agreement relating to the 

plan which amends the plan solely to conform to any requirement added by this section shall not be treated as a termination of such collective bargaining agreement. 

SEC. 4. AMENDMENTS TO THE INTERNAL REVENUE CODE OF 1986. 

(a) EXTENSION OF PARITY TO TREATMENT LIMITS AND BENE- FICIARY FINANCIAL REQUIREMENTS.—Section 9812 of the Internal 

Revenue Code of 1986 is amended—

(1) in subsection (a), by adding at the end the following new 

paragraphs: 

‘‘(3) TREATMENT LIMITS.—In the case of a group health plan 

that provides both medical and surgical benefits and mental 

health or substance-related disorder benefits— ‘‘(A) NO TREATMENT LIMIT.—If the plan does not include 

a treatment limit (as defined in subparagraph (D)) on substantially all medical and surgical benefits in any category 

of items or services (specified in subparagraph (C)), the 


smartinez on PRODPC61 with REPORTS
19 

plan may not impose any treatment limit on mental health 

or substance-related disorder benefits that are classified in 

the same category of items or services. 

‘‘(B) TREATMENT LIMIT.—If the plan includes a treatment 

limit on substantially all medical and surgical benefits in 

any category of items or services, the plan may not impose 

such a treatment limit on mental health or substance-related disorder benefits for items and services within such 

category that is more restrictive than the predominant 

treatment limit that is applicable to medical and surgical 

benefits for items and services within such category. 

‘‘(C) CATEGORIES OF ITEMS AND SERVICES FOR APPLICATION OF TREATMENT LIMITS AND BENEFICIARY FINANCIAL

REQUIREMENTS.—For purposes of this paragraph and paragraph (4), there shall be the following five categories of 

items and services for benefits, whether medical and surgical benefits or mental health and substance-related disorder benefits, and all medical and surgical benefits and 

all mental health and substance related benefits shall be 

classified into one of the following categories: 

‘‘(i) INPATIENT, IN-NETWORK.—Items and services not 

described in clause (v) furnished on an inpatient basis 

and within a network of providers established or recognized under such plan. 

‘‘(ii) INPATIENT, OUT-OF-NETWORK.—Items and services not described in clause (v) furnished on an inpatient basis and outside any network of providers established or recognized under such plan. 

‘‘(iii) OUTPATIENT, IN-NETWORK.—Items and services 

not described in clause (v) furnished on an outpatient 

basis and within a network of providers established or 

recognized under such plan. 

‘‘(iv) OUTPATIENT, OUT-OF-NETWORK.—Items and 

services not described in clause (v) furnished on an 

outpatient basis and outside any network of providers 

established or recognized under such plan. 

‘‘(v) EMERGENCY CARE.—Items and services, whether 

furnished on an inpatient or outpatient basis or within 

or outside any network of providers, required for the 

treatment of an emergency medical condition (as defined in section 1867(e) of the Social Security Act, including an emergency condition relating to mental 

health or substance-related disorders). 

‘‘(D) TREATMENT LIMIT DEFINED.—For purposes of this 

paragraph, the term ‘treatment limit’ means, with respect 

to a plan, limitation on the frequency of treatment, number of visits or days of coverage, or other similar limit on 

the duration or scope of treatment under the plan. 

‘‘(E) PREDOMINANCE.—For purposes of this subsection, a 

treatment limit or financial requirement with respect to a 

category of items and services is considered to be predominant if it is the most common or frequent of such type of 

limit or requirement with respect to such category of items 

and services. 


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20 

‘‘(4) BENEFICIARY FINANCIAL REQUIREMENTS.—In the case of 

a group health plan that provides both medical and surgical 

benefits and mental health or substance-related disorder benefits— ‘‘(A) NO BENEFICIARY FINANCIAL REQUIREMENT.—If the 

plan does not include a beneficiary financial requirement 

(as defined in subparagraph (C)) on substantially all medical and surgical benefits within a category of items and 

services (specified in paragraph (3)(C)), the plan may not 

impose such a beneficiary financial requirement on mental 

health or substance-related disorder benefits for items and 

services within such category. ‘‘(B) BENEFICIARY FINANCIAL REQUIREMENT.—

‘‘(i) TREATMENT OF DEDUCTIBLES, OUT-OF-POCKET

LIMITS, AND SIMILAR FINANCIAL REQUIREMENTS.—If the 

plan includes a deductible, a limitation on out-of-pocket expenses, or similar beneficiary financial requirement that does not apply separately to individual 

items and services on substantially all medical and 

surgical benefits within a category of items and services, the plan shall apply such requirement (or, if 

there is more than one such requirement for such category of items and services, the predominant requirement for such category) both to medical and surgical 

benefits within such category and to mental health 

and substance-related disorder benefits within such 

category and shall not distinguish in the application of 

such requirement between such medical and surgical 

benefits and such mental health and substance-related 

disorder benefits. 

‘‘(ii) OTHER FINANCIAL REQUIREMENTS.—If the plan 

includes a beneficiary financial requirement not described in clause (i) on substantially all medical and 

surgical benefits within a category of items and services, the plan may not impose such financial requirement on mental health or substance-related disorder 

benefits for items and services within such category in 

a way that results in greater out-of-pocket expenses to 

the participant or beneficiary than the predominant 

beneficiary financial requirement applicable to medical 

and surgical benefits for items and services within 

such category. 

‘‘(C) BENEFICIARY FINANCIAL REQUIREMENT DEFINED.—

For purposes of this paragraph, the term ‘beneficiary financial requirement’ includes, with respect to a plan, any 

deductible, coinsurance, co-payment, other cost sharing, 

and limitation on the total amount that may be paid by a 

participant or beneficiary with respect to benefits under 

the plan, but does not include the application of any aggregate lifetime limit or annual limit.’’, and 

(2) in subsection (b)— (A) by striking ‘‘construed—’’ and all that follows 

through ‘‘(1) as requiring’’ and inserting ‘‘construed as requiring’’, (B) by striking ‘‘; or’’ and inserting a period, and 


smartinez on PRODPC61 with REPORTS
21 

(C) by striking paragraph (2). 

(b) EXPANSION TO SUBSTANCE-RELATED DISORDER BENEFITS AND

REVISION OF DEFINITION.—Section 9812 of such Code is further 

amended— (1) by striking ‘‘mental health benefits’’ each place it appears 

(other than in any provision amended by paragraph (2)) and 

inserting ‘‘mental health or substance-related disorder benefits’’, 

(2) by striking ‘‘mental health benefits’’ each place it appears 

in subsections (a)(1)(B)(i), (a)(1)(C), (a)(2)(B)(i), and (a)(2)(C) 

and inserting ‘‘mental health and substance-related disorder 

benefits’’, and 

(3) in subsection (e), by striking paragraph (4) and inserting 

the following new paragraphs: ‘‘(4) MENTAL HEALTH BENEFITS.—The term ‘mental health 

benefits’ means benefits with respect to services for mental 

health conditions, as defined under the terms of the plan and 

in accordance with applicable law, but does not include substance-related disorder benefits. 

‘‘(5) SUBSTANCE-RELATED DISORDER BENEFITS.—The term 

‘substance-related disorder benefits’ means benefits with respect to services for substance-related disorders, as defined 

under the terms of the plan and in accordance with applicable 

law.’’. 

(c) AVAILABILITY OF PLAN INFORMATION ABOUT CRITERIA FOR

MEDICAL NECESSITY.—Subsection (a) of section 9812 of such Code, 

as amended by subsection (a)(1), is further amended by adding at 

the end the following new paragraph: ‘‘(5) AVAILABILITY OF PLAN INFORMATION.—The criteria for 

medical necessity determinations made under the plan with respect to mental health and substance-related disorder benefits 

shall be made available by the plan administrator in accordance with regulations to any current or potential participant, 

beneficiary, or contracting provider upon request. The reason 

for any denial under the plan of reimbursement or payment for 

services with respect to mental health and substance-related 

disorder benefits in the case of any participant or beneficiary 

shall, on request or as otherwise required, be made available 

by the plan administrator to the participant or beneficiary in 

accordance with regulations.’’. (d) MINIMUM BENEFIT REQUIREMENTS.—Subsection (a) of section 

9812 of such Code is further amended by adding at the end the following new paragraph: 

‘‘(6) MINIMUM SCOPE OF COVERAGE AND EQUITY IN OUT-OFNETWORK BENEFITS.—

‘‘(A) MINIMUM SCOPE OF MENTAL HEALTH AND SUBSTANCE-RELATED DISORDER BENEFITS.—In the case of a 

group health plan that provides any mental health or substance-related disorder benefits, the plan shall include 

benefits for any mental health condition or substance-related disorder included in the most recent edition of the 

Diagnostic and Statistical Manual of Mental Disorders 

published by the American Psychiatric Association. ‘‘(B) EQUITY IN COVERAGE OF OUT-OF-NETWORK BENEFITS.—


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22 

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

that provides both medical and surgical benefits and 

mental health or substance-related disorder benefits, if 

medical and surgical benefits are provided for substantially all items and services in a category specified in 

clause (ii) furnished outside any network of providers 

established or recognized under such plan, the mental 

health and substance-related disorder benefits shall 

also be provided for items and services in such category furnished outside any network of providers established or recognized under such plan in accordance 

with the requirements of this section. 

‘‘(ii) CATEGORIES OF ITEMS AND SERVICES.—For purposes of clause (i), there shall be the following three 

categories of items and services for benefits, whether 

medical and surgical benefits or mental health and 

substance-related disorder benefits, and all medical 

and surgical benefits and all mental health and substance-related disorder benefits shall be classified into 

one of the following categories: 

‘‘(I) EMERGENCY.—Items and services, whether 

furnished on an inpatient or outpatient basis, required for the treatment of an emergency medical 

condition (as defined in section 1867(e) of the Social Security Act, including an emergency condition relating to mental health or substance-related 

disorders). 

‘‘(II) INPATIENT.—Items and services not described in subclause (I) furnished on an inpatient 

basis. 

‘‘(III) OUTPATIENT.—Items and services not described in subclause (I) furnished on an outpatient 

basis.’’. 

(e) REVISION OF INCREASED COST EXEMPTION.—Paragraph (2) of 

section 9812(c) of such Code is amended to read as follows: 

‘‘(2) INCREASED COST EXEMPTION.—

‘‘(A) IN GENERAL.—With respect to a group health plan, 

if the application of this section to such plan results in an 

increase for the plan year involved of the actual total costs 

of coverage with respect to medical and surgical benefits 

and mental health and substance-related disorder benefits 

under the plan (as determined and certified under subparagraph (C)) by an amount that exceeds the applicable 

percentage described in subparagraph (B) of the actual 

total plan costs, the provisions of this section shall not 

apply to such plan during the following plan year, and 

such exemption shall apply to the plan for 1 plan year. 

‘‘(B) APPLICABLE PERCENTAGE.—With respect to a plan, 

the applicable percentage described in this paragraph shall 

be—

‘‘(i) 2 percent in the case of the first plan year to 

which this paragraph applies, and 

‘‘(ii) 1 percent in the case of each subsequent plan 

year. 


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23 

‘‘(C) DETERMINATIONS BY ACTUARIES.—Determinations as 

to increases in actual costs under a plan for purposes of 

this subsection shall be made in writing and prepared and 

certified by a qualified and licensed actuary who is a member in good standing of the American Academy of Actuaries. Such determinations shall be made available by the 

plan administrator to the general public. ‘‘(D) 6-MONTH DETERMINATIONS.—If a group health plan 

seeks an exemption under this paragraph, determinations 

under subparagraph (A) shall be made after such plan has 

complied with this section for the first 6 months of the 

plan year involved. ‘‘(E) NOTIFICATION OF APPROPRIATE AGENCY.—

‘‘(i) IN GENERAL.—A group health plan that, based 

on a certification described under subparagraph (C), 

qualifies for an exemption under this paragraph, and 

elects to implement the exemption, shall notify the 

Secretary of the Treasury of such election. 

‘‘(ii) REQUIREMENT.—A notification under clause (i) 

shall include—

‘‘(I) a description of the number of covered lives 

under the plan (or coverage) involved at the time 

of the notification, and as applicable, at the time 

of any prior election of the cost-exemption under 

this paragraph by such plan (or coverage); 

‘‘(II) for both the plan year upon which a cost 

exemption is sought and the year prior, a description of the actual total costs of coverage with respect to medical and surgical benefits and mental 

health and substance-related disorder benefits 

under the plan; and 

‘‘(III) for both the plan year upon which a cost 

exemption is sought and the year prior, the actual 

total costs of coverage with respect to mental 

health and substance-related disorder benefits 

under the plan. ‘‘(iii) CONFIDENTIALITY.—A notification under clause 

(i) shall be confidential. The Secretary of the Treasury 

shall make available, upon request to the appropriate 

committees of Congress and on not more than an annual basis, an anonymous itemization of such notifications, that includes— ‘‘(I) a breakdown of States by the size and any 

type of employers submitting such notification; 

and ‘‘(II) a summary of the data received under 

clause (ii). ‘‘(F) CONSTRUCTION.—Nothing in this paragraph shall be 

construed as preventing a group health plan from complying with the provisions of this section notwithstanding 

that the plan is not required to comply with such provisions due to the application of subparagraph (A).’’. 

(f) CHANGE IN EXCLUSION FOR SMALLEST EMPLOYERS.—Paragraph (1) of section 9812(c) of such Code is amended to read as follows: 


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24 

‘‘(1) SMALL EMPLOYER EXEMPTION.— ‘‘(A) IN GENERAL.—This section shall not apply to any 

group health plan for any plan year of a small employer. ‘‘(B) SMALL EMPLOYER.—For purposes of subparagraph 

(A), the term ‘small employer’ means, with respect to a calendar year and a plan year, an employer who employed an 

average of at least 2 (or 1 in the case of an employer residing in a State that permits small groups to include a single 

individual) but not more than 50 employees on business 

days during the preceding calendar year. For purposes of 

the preceding sentence, all persons treated as a single employer under subsection (b), (c), (m), or (o) of section 414 

shall be treated as 1 employer and rules similar to rules 

of subparagraphs (B) and (C) of section 4980D(d)(2) shall 

apply.’’. (g) ELIMINATION OF SUNSET PROVISION.—Section 9812 of such 

Code is amended by striking subsection (f). 

(h) CONFORMING AMENDMENTS TO HEADING.— (1) IN GENERAL.—The heading of section 9812 of such Code 

is amended to read as follows: 

‘‘SEC. 9812. EQUITY IN MENTAL HEALTH AND SUBSTANCE-RELATED 

DISORDER BENEFITS.’’. 

(2) CLERICAL AMENDMENT.—The table of sections for subchapter B of chapter 100 of such Code is amended by striking 

the item relating to section 9812 and inserting the following 

new item: 

‘‘Sec. 9812. Equity in mental health and substance-related disorder benefits.’’. 

(i) EFFECTIVE DATE.—

(1) IN GENERAL.—Except as otherwise provided in this subsection, the amendments made by this section shall apply with 

respect to plan years beginning on or after January 1, 2009. 

(2) ELIMINATION OF SUNSET.—The amendment made by subsection (g) shall apply to benefits for services furnished after 

December 31, 2007. 

(3) SPECIAL RULE FOR COLLECTIVE BARGAINING AGREEMENTS.—In the case of a group health plan maintained pursuant to one or more collective bargaining agreements between 

employee representatives and one or more employers ratified 

before the date of the enactment of this Act, the amendments 

made by this section (other than subsection (g)) shall not apply 

to plan years beginning before the later of—

(A) the date on which the last of the collective bargaining agreements relating to the plan terminates (determined without regard to any extension thereof agreed to 

after the date of the enactment of this Act), or 

(B) January 1, 2009. 

For purposes of subparagraph (A), any plan amendment made 

pursuant to a collective bargaining agreement relating to the 

plan which amends the plan solely to conform to any requirement added by this section shall not be treated as a termination of such collective bargaining agreement. 

SEC. 5. MEDICAID DRUG REBATE. 

Paragraph (1)(B)(i) of section 1927(c) of the Social Security Act 

(42 U.S.C. 1396r–8(c)) is amended—


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25 

(1) by striking ‘‘and’’ at the end of subclause (IV); 

(2) in subclause (V)—

(A) by inserting ‘‘and before January 1, 2009, and after 

December 31, 2014,’’ after ‘‘December 31, 1995,’’; and 

(B) by striking the period at the end and inserting ‘‘; 

and’’; and 

(3) by adding at the end the following new subclause: 

‘‘(VI) after December 31, 2008, and before January 1, 2015, is 20.1 percent.’’. 

SEC. 6. LIMITATION ON MEDICARE EXCEPTION TO THE PROHIBITION 

ON CERTAIN PHYSICIAN REFERRALS FOR HOSPITALS. 

(a) IN GENERAL.—Section 1877 of the Social Security Act (42 

U.S.C. 1395nn) is amended—

(1) in subsection (d)(2)—

(A) in subparagraph (A), by striking ‘‘and’’ at the end; 

(B) in subparagraph (B), by striking the period at the 

end and inserting ‘‘; and’’; and 

(C) by adding at the end the following new subparagraph: 

‘‘(C) in the case where the entity is a hospital, the hospital meets the requirements of paragraph (3)(D).’’; 

(2) in subsection (d)(3)—

(A) in subparagraph (B), by striking ‘‘and’’ at the end; 

(B) in subparagraph (C), by striking the period at the 

end and inserting ‘‘; and’’; and 

(C) by adding at the end the following new subparagraph: 

‘‘(D) the hospital meets the requirements described in 

subsection (i)(1) not later than 18 months after the date of 

the enactment of this subparagraph.’’; and 

(3) by adding at the end the following new subsection: 

‘‘(i) REQUIREMENTS FOR HOSPITALS TO QUALIFY FOR HOSPITAL

EXCEPTION TO OWNERSHIP OR INVESTMENT PROHIBITION.—

‘‘(1) REQUIREMENTS DESCRIBED.—For purposes of subsection 

(d)(3)(D), the requirements described in this paragraph for a 

hospital are as follows: 

‘‘(A) PROVIDER AGREEMENT.—The hospital had—

‘‘(i) physician ownership on the date of enactment of 

this subsection; and 

‘‘(ii) a provider agreement under section 1866 in effect on such date of enactment. 

‘‘(B) LIMITATION ON EXPANSION OF FACILITY CAPACITY.—

Except as provided in paragraph (3), the number of operating rooms and beds of the hospital at any time on or 

after the date of the enactment of this subsection are no 

greater than the number of operating rooms and beds as 

of such date. 

‘‘(C) PREVENTING CONFLICTS OF INTEREST.—

‘‘(i) The hospital submits to the Secretary an annual 

report containing a detailed description of—

‘‘(I) the identity of each physician owner and 

any other owners of the hospital; and 

‘‘(II) the nature and extent of all ownership interests in the hospital. 


smartinez on PRODPC61 with REPORTS
26 

‘‘(ii) The hospital has procedures in place to require 

that any referring physician owner discloses to the patient being referred, by a time that permits the patient 

to make a meaningful decision regarding the receipt of 

care, as determined by the Secretary— ‘‘(I) the ownership interest of such referring 

physician in the hospital; and ‘‘(II) if applicable, any such ownership interest 

of the treating physician. ‘‘(iii) The hospital does not condition any physician 

ownership interests either directly or indirectly on the 

physician owner making or influencing referrals to the 

hospital or otherwise generating business for the hospital. ‘‘(iv) The hospital discloses the fact that the hospital 

is partially owned by physicians— ‘‘(I) on any public website for the hospital; and 

‘‘(II) in any public advertising for the hospital. ‘‘(D) ENSURING BONA FIDE INVESTMENT.—

‘‘(i) Physician owners in the aggregate do not own 

more than 40 percent of the total value of the investment interests held in the hospital or in an entity 

whose assets include the hospital. 

‘‘(ii) The investment interest of any individual physician owner does not exceed 2 percent of the total value 

of the investment interests held in the hospital or in 

an entity whose assets include the hospital. 

‘‘(iii) Any ownership or investment interests that the 

hospital offers to a physician owner are not offered on 

more favorable terms than the terms offered to a person who is not a physician owner. 

‘‘(iv) The hospital (or any investors in the hospital) 

does not directly or indirectly provide loans or financing for any physician owner investments in the hospital. ‘‘(v) The hospital (or any investors in the hospital) 

does not directly or indirectly guarantee a loan, make 

a payment toward a loan, or otherwise subsidize a 

loan, for any individual physician owner or group of 

physician owners that is related to acquiring any ownership interest in the hospital. ‘‘(vi) Investment returns are distributed to each investor in the hospital in an amount that is directly 

proportional to the investment of capital by such investor in the hospital. ‘‘(vii) Physician owners do not receive, directly or indirectly, any guaranteed receipt of or right to purchase 

other business interests related to the hospital, including the purchase or lease of any property under the 

control of other investors in the hospital or located 

near the premises of the hospital. 

‘‘(viii) The hospital does not offer a physician owner 

the opportunity to purchase or lease any property 

under the control of the hospital or any other investor 

in the hospital on more favorable terms than the 


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27 

terms offered to an individual who is not a physician 

owner. ‘‘(E) PATIENT SAFETY.— ‘‘(i) Insofar as the hospital admits a patient and does 

not have any physician available on the premises to 

provide services during all hours in which the hospital 

is providing services to such patient, before admitting 

the patient— ‘‘(I) the hospital discloses such fact to a patient; 

and ‘‘(II) following such disclosure, the hospital receives from the patient a signed acknowledgment 

that the patient understands such fact. ‘‘(ii) The hospital has the capacity to— ‘‘(I) provide assessment and initial treatment for 

patients; and ‘‘(II) refer and transfer patients to hospitals 

with the capability to treat the needs of the patient involved. ‘‘(2) PUBLICATION OF INFORMATION REPORTED.—The Secretary 

shall publish, and update on an annual basis, the information 

submitted by hospitals under paragraph (1)(C)(i) on the public 

Internet website of the Centers for Medicare & Medicaid Services. 

‘‘(3) EXCEPTION TO PROHIBITION ON EXPANSION OF FACILITY

CAPACITY.— ‘‘(A) PROCESS.— ‘‘(i) ESTABLISHMENT.—The Secretary shall establish 

and implement a process under which an applicable 

hospital (as defined in subparagraph (E)) may apply 

for an exception from the requirement under paragraph (1)(B). ‘‘(ii) OPPORTUNITY FOR COMMUNITY INPUT.—The 

process under clause (i) shall provide individuals and 

entities in the community that the applicable hospital 

applying for an exception is located with the opportunity to provide input with respect to the application. ‘‘(iii) TIMING FOR IMPLEMENTATION.—The Secretary 

shall implement the process under clause (i) on the 

date that is 18 months after the date of enactment of 

this subsection. ‘‘(iv) REGULATIONS.—Not later than the date that is 

18 months after the date of enactment of this subsection, the Secretary shall promulgate regulations to 

carry out the process under clause (i). 

‘‘(B) FREQUENCY.—The process described in subparagraph (A) shall permit an applicable hospital to apply for 

an exception up to once every 2 years. 

‘‘(C) PERMITTED INCREASE.— ‘‘(i) IN GENERAL.—Subject to clause (ii) and subparagraph (D), an applicable hospital granted an exception 

under the process described in subparagraph (A) may 

increase the number of operating rooms and beds of 

the applicable hospital above the baseline number of 

operating rooms and beds of the applicable hospital 


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(or, if the applicable hospital has been granted a previous exception under this paragraph, above the number of operating rooms and beds of the hospital after 

the application of the most recent increase under such 

an exception) by an amount determined appropriate 

by the Secretary. 

‘‘(ii) LIFETIME 50 PERCENT INCREASE LIMITATION.—

The Secretary shall not permit an increase in the 

number of operating rooms and beds of an applicable 

hospital under clause (i) to the extent such increase 

would result in the number of operating rooms and 

beds of the applicable hospital exceeding 150 percent 

of the baseline number of operating rooms and beds of 

the applicable hospital. 

‘‘(iii) BASELINE NUMBER OF OPERATING ROOMS AND

BEDS.—In this paragraph, the term ‘baseline number 

of operating rooms and beds’ means the number of operating rooms and beds of the applicable hospital as of 

the date of enactment of this subsection. 

‘‘(D) INCREASE LIMITED TO FACILITIES ON THE MAIN CAMPUS OF THE HOSPITAL.—Any increase in the number of operating rooms and beds of an applicable hospital pursuant 

to this paragraph may only occur in facilities on the main 

campus of the applicable hospital. 

‘‘(E) APPLICABLE HOSPITAL.—In this paragraph, the term 

‘applicable hospital’ means a hospital—

‘‘(i) that is located in a county in which the percentage increase in the population during the most recent 

5-year period (as of the date of the application under 

subparagraph (A)) is at least 200 percent of the percentage increase in the population growth of the 

United States during that period, as estimated by Bureau of the Census; 

‘‘(ii) whose annual percent of total inpatient admissions and outpatient visits that represent inpatient 

admissions and outpatient visits under the program 

under title XIX is equal to or greater than the average 

percent with respect to such admissions and visits for 

all hospitals located in the State; 

‘‘(iii) that does not discriminate against beneficiaries 

of Federal health care programs and does not permit 

physicians practicing at the hospital to discriminate 

against such beneficiaries; 

‘‘(iv) that is located in a State in which the average 

bed capacity in the State is less than the national average bed capacity; and 

‘‘(v) in the case of a hospital located—

‘‘(I) in a core-based statistical area, that is located in such an area in which the average bed occupancy rate in such area is greater than 80 percent; or 

‘‘(II) outside of a core-based statistical area, that 

is located in a State in which the average bed occupancy rate is greater than 80 percent. 


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‘‘(F) PUBLICATION OF FINAL DECISIONS.—The Secretary 

shall publish final decisions with respect to applications 

under this paragraph in the Federal Register. ‘‘(G) LIMITATION ON REVIEW.—There shall be no administrative or judicial review under section 1869, section 1878, 

or otherwise of the process under this paragraph (including the establishment of such process). ‘‘(4) COLLECTION OF OWNERSHIP AND INVESTMENT INFORMA- TION.—For purposes of clauses (i) and (ii) of paragraph (1)(D), 

the Secretary shall collect physician ownership and investment 

information for each hospital as it existed on the date of the 

enactment of this subsection. ‘‘(5) PHYSICIAN OWNER DEFINED.—For purposes of this subsection, the term ‘physician owner’ means a physician (or an 

immediate family member of such physician) with a direct or 

an indirect ownership interest in the hospital.’’. (b) ENFORCEMENT.— (1) ENSURING COMPLIANCE.—The Secretary of Health and 

Human Services shall establish policies and procedures to ensure compliance with the requirements described in subsection 

(i)(1) of section 1877 of the Social Security Act, as added by 

subsection (a)(3), beginning on the date such requirements first 

apply. Such policies and procedures may include unannounced 

site reviews of hospitals. 

(2) AUDITS.—Beginning not later than 18 months after the 

date of the enactment of this Act, the Secretary of Health and 

Human Services shall conduct audits to determine if hospitals 

violate the requirements referred to in paragraph (1). 

(c) ADJUSTMENT TO PAQI FUND.—Section 1848(l)(2)(A)(i)(III) of 

the Social Security Act (42 U.S.C. 1395w-4(l)(2)(A)(i)(III)), as 

amended by section 101(a)(2) of the Medicare, Medicaid, and 

SCHIP Extension Act of 2007 (Public Law 110-173), is amended by 

striking ‘‘$4,960,000,000’’ and inserting ‘‘$5,120,000,000’’. 

SEC. 7. STUDIES AND REPORTS. 

(a) IMPLEMENTATION OF ACT.— (1) GAO STUDY.—The Comptroller General of the United 

States shall conduct a study that evaluates the effect of the implementation of the amendments made by this Act on— (A) the cost of health insurance coverage; 

(B) access to health insurance coverage (including the 

availability of in-network providers); 

(C) the quality of health care; 

(D) Medicare, Medicaid, and State and local mental 

health and substance abuse treatment spending; 

(E) the number of individuals with private insurance 

who received publicly funded health care for mental health 

and substance-related disorders; 

(F) spending on public services, such as the criminal justice system, special education, and income assistance programs; 

(G) the use of medical management of mental health and 

substance-related disorder benefits and medical necessity 

determinations by group health plans (and health insurance issuers offering health insurance coverage in connection with such plans) and timely access by participants 


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and beneficiaries to clinically-indicated care for mental 

health and substance-use disorders; and 

(H) other matters as determined appropriate by the 

Comptroller General. 

(2) REPORT.—Not later than 2 years after the date of enactment of this Act, the Comptroller General shall prepare and 

submit to the appropriate committees of the Congress a report 

containing the results of the study conducted under paragraph 

(1). 

(b) GAO REPORT ON UNIFORM PATIENT PLACEMENT CRITERIA.— Not later than 18 months after the date of the enactment of this 

Act, the Comptroller General shall submit to each House of the 

Congress a report on availability of uniform patient placement criteria for mental health and substance-related disorders that could 

be used by group health plans and health insurance issuers to 

guide determinations of medical necessity and the extent to which 

health plans utilize such criteria. If such criteria do not exist, the 

report shall include recommendations on a process for developing 

such criteria. 

(c) DOL BIANNUAL REPORT ON ANY OBSTACLES IN OBTAINING

COVERAGE.—Every two years, the Secretary of Labor, in consultation with the Secretaries of Health and Human Services and the 

Treasury, shall submit to the appropriate committees of each 

House of the Congress a report on obstacles, if any, that individuals face in obtaining mental health and substance-related disorder 

care under their health plans. 

Æ 


smartinez on PRODPC61 with REPORTS