IB 

Union Calendar No. 575 

116TH CONGRESS 

2D SESSION H. R. 7539 

[Report No. 116–692, Part I] 

To strengthen parity in mental health and substance use disorder benefits. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 9, 2020 

Mr. KENNEDY (for himself, Ms. PORTER, Mr. BILIRAKIS, and Mr. UPTON) 

introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and 

Means, and Education and Labor, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions 

as fall within the jurisdiction of the committee concerned 

DECEMBER 24, 2020 

Additional sponsors: Mr. LUJA ́N, Mr. SOTO, and Mr. FITZPATRICK

DECEMBER 24, 2020 

Reported from the Committee on Energy and Commerce with an amendment 

[Strike out all after the enacting clause and insert the part printed in italic] 

DECEMBER 24, 2020 

Committees on Ways and Means and Education and Labor discharged; committed to the Committee of the Whole House on the State of the Union 

and ordered to be printed 

[For text of introduced bill, see copy of bill as introduced on July 9, 2020] 


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A BILL 

To strengthen parity in mental health and substance use 

disorder benefits. 


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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Strengthening Behav5 ioral Health Parity Act’’. 

6 SEC. 2. STRENGTHENING PARITY IN MENTAL HEALTH AND 

7 SUBSTANCE USE DISORDER BENEFITS. 

8 (a) PHSA.— 

9 (1) IN GENERAL.—Title XXVII of the Public 

10 Health Service Act (42 U.S.C. 300gg–11 et seq.) is 

11 amended by adding at the end the following new part: 

12 ‘‘PART D—ADDITIONAL COVERAGE PROVISIONS 

13 ‘‘SEC. 2799A–1. PARITY IN MENTAL HEALTH AND SUB14 STANCE USE DISORDER BENEFITS. 

15 ‘‘(a) IN GENERAL.— 

16 ‘‘(1) AGGREGATE LIFETIME LIMITS.—In the case 

17 of a group health plan or a health insurance issuer 

18 offering group or individual health insurance cov19 erage that provides both medical and surgical benefits 

20 and mental health or substance use disorder bene21 fits— 

22 ‘‘(A) NO LIFETIME LIMIT.—If the plan or 

23 coverage does not include an aggregate lifetime 

24 limit on substantially all medical and surgical 

25 benefits, the plan or coverage may not impose 


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1 any aggregate lifetime limit on mental health or 

2 substance use disorder benefits. 

3 ‘‘(B) LIFETIME LIMIT.—If the plan or cov4 erage includes an aggregate lifetime limit on 

5 substantially all medical and surgical benefits 

6 (in this paragraph referred to as the ‘applicable 

7 lifetime limit’), the plan or coverage shall ei8 ther— 

9 ‘‘(i) apply the applicable lifetime limit 

10 both to the medical and surgical benefits to 

11 which it otherwise would apply and to men12 tal health and substance use disorder bene13 fits and not distinguish in the application 

14 of such limit between such medical and sur15 gical benefits and mental health and sub16 stance use disorder benefits; or 

17 ‘‘(ii) not include any aggregate lifetime 

18 limit on mental health or substance use dis19 order benefits that is less than the applica20 ble lifetime limit. 

21 ‘‘(C) RULE IN CASE OF DIFFERENT LIM22 ITS.—In the case of a plan or coverage that is 

23 not described in subparagraph (A) or (B) and 

24 that includes no or different aggregate lifetime 

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1 gical benefits, the Secretary shall establish rules 

2 under which subparagraph (B) is applied to 

3 such plan or coverage with respect to mental 

4 health and substance use disorder benefits by 

5 substituting for the applicable lifetime limit an 

6 average aggregate lifetime limit that is computed 

7 taking into account the weighted average of the 

8 aggregate lifetime limits applicable to such cat9 egories. 

10 ‘‘(2) ANNUAL LIMITS.—In the case of a group 

11 health plan or a health insurance issuer offering 

12 group or individual health insurance coverage that 

13 provides both medical and surgical benefits and men14 tal health or substance use disorder benefits— 

15 ‘‘(A) NO ANNUAL LIMIT.—If the plan or 

16 coverage does not include an annual limit on 

17 substantially all medical and surgical benefits, 

18 the plan or coverage may not impose any annual 

19 limit on mental health or substance use disorder 

20 benefits. 

21 ‘‘(B) ANNUAL LIMIT.—If the plan or cov22 erage includes an annual limit on substantially 

23 all medical and surgical benefits (in this para24 graph referred to as the ‘applicable annual 

25 limit’), the plan or coverage shall either— 


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1 ‘‘(i) apply the applicable annual limit 

2 both to medical and surgical benefits to 

3 which it otherwise would apply and to men4 tal health and substance use disorder bene5 fits and not distinguish in the application 

6 of such limit between such medical and sur7 gical benefits and mental health and sub8 stance use disorder benefits; or 

9 ‘‘(ii) not include any annual limit on 

10 mental health or substance use disorder ben11 efits that is less than the applicable annual 

12 limit. 

13 ‘‘(C) RULE IN CASE OF DIFFERENT LIM14 ITS.—In the case of a plan or coverage that is 

15 not described in subparagraph (A) or (B) and 

16 that includes no or different annual limits on 

17 different categories of medical and surgical bene18 fits, the Secretary shall establish rules under 

19 which subparagraph (B) is applied to such plan 

20 or coverage with respect to mental health and 

21 substance use disorder benefits by substituting 

22 for the applicable annual limit an average an23 nual limit that is computed taking into account 

24 the weighted average of the annual limits appli25 cable to such categories. 


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1 ‘‘(3) FINANCIAL REQUIREMENTS AND TREATMENT

2 LIMITATIONS.— 

3 ‘‘(A) IN GENERAL.—In the case of a group 

4 health plan or a health insurance issuer offering 

5 group or individual health insurance coverage 

6 that provides both medical and surgical benefits 

7 and mental health or substance use disorder ben8 efits, such plan or coverage shall ensure that— 

9 ‘‘(i) the financial requirements appli10 cable to such mental health or substance use 

11 disorder benefits are no more restrictive 

12 than the predominant financial require13 ments applied to substantially all medical 

14 and surgical benefits covered by the plan (or 

15 coverage), and there are no separate cost 

16 sharing requirements that are applicable 

17 only with respect to mental health or sub18 stance use disorder benefits; and 

19 ‘‘(ii) the treatment limitations applica20 ble to such mental health or substance use 

21 disorder benefits are no more restrictive 

22 than the predominant treatment limitations 

23 applied to substantially all medical and 

24 surgical benefits covered by the plan (or 

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1 ment limitations that are applicable only 

2 with respect to mental health or substance 

3 use disorder benefits. 

4 ‘‘(B) DEFINITIONS.—In this paragraph: 

5 ‘‘(i) FINANCIAL REQUIREMENT.—The 

6 term ‘financial requirement’ includes 

7 deductibles, copayments, coinsurance, and 

8 out-of-pocket expenses, but excludes an ag9 gregate lifetime limit and an annual limit 

10 subject to paragraphs (1) and (2). 

11 ‘‘(ii) PREDOMINANT.—A financial re12 quirement or treatment limit is considered 

13 to be predominant if it is the most common 

14 or frequent of such type of limit or require15 ment. 

16 ‘‘(iii) TREATMENT LIMITATION.—The 

17 term ‘treatment limitation’ includes limits 

18 on the frequency of treatment, number of 

19 visits, days of coverage, or other similar 

20 limits on the scope or duration of treat21 ment. 

22 ‘‘(4) AVAILABILITY OF PLAN INFORMATION.—The 

23 criteria for medical necessity determinations made 

24 under the plan with respect to mental health or sub25 stance use disorder benefits (or the health insurance 


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1 coverage offered in connection with the plan with re2 spect to such benefits) shall be made available by the 

3 plan administrator (or the health insurance issuer of4 fering such coverage) in accordance with regulations 

5 to any current or potential participant, beneficiary, 

6 or contracting provider upon request. The reason for 

7 any denial under the plan (or coverage) of reimburse8 ment or payment for services with respect to mental 

9 health or substance use disorder benefits in the case 

10 of any participant or beneficiary shall, on request or 

11 as otherwise required, be made available by the plan 

12 administrator (or the health insurance issuer offering 

13 such coverage) to the participant or beneficiary in ac14 cordance with regulations. 

15 ‘‘(5) OUT-OF-NETWORK PROVIDERS.—In the case 

16 of a plan or coverage that provides both medical and 

17 surgical benefits and mental health or substance use 

18 disorder benefits, if the plan or coverage provides cov19 erage for medical or surgical benefits provided by out20 of-network providers, the plan or coverage shall pro21 vide coverage for mental health or substance use dis22 order benefits provided by out-of-network providers in 

23 a manner that is consistent with the requirements of 

24 this section. 


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1 ‘‘(6) COMPLIANCE PROGRAM GUIDANCE DOCU2 MENT.— 

3 ‘‘(A) IN GENERAL.—Not later than 12 

4 months after the date of enactment of the Help5 ing Families in Mental Health Crisis Reform 

6 Act of 2016, the Secretary, the Secretary of 

7 Labor, and the Secretary of the Treasury, in 

8 consultation with the Inspector General of the 

9 Department of Health and Human Services, the 

10 Inspector General of the Department of Labor, 

11 and the Inspector General of the Department of 

12 the Treasury, shall issue a compliance program 

13 guidance document to help improve compliance 

14 with this section, section 712 of the Employee 

15 Retirement Income Security Act of 1974, and 

16 section 9812 of the Internal Revenue Code of 

17 1986, as applicable. In carrying out this para18 graph, the Secretaries may take into consider19 ation the 2016 publication of the Department of 

20 Health and Human Services and the Depart21 ment of Labor, entitled ‘Warning Signs - Plan 

22 or Policy Non-Quantitative Treatment Limita23 tions (NQTLs) that Require Additional Analysis 

24 to Determine Mental Health Parity Compliance’. 


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1 ‘‘(B) EXAMPLES ILLUSTRATING COMPLIANCE

2 AND NONCOMPLIANCE.— 

3 ‘‘(i) IN GENERAL.—The compliance 

4 program guidance document required under 

5 this paragraph shall provide illustrative, 

6 de-identified examples (that do not disclose 

7 any protected health information or indi8 vidually identifiable information) of pre9 vious findings of compliance and non10 compliance with this section, section 712 of 

11 the Employee Retirement Income Security 

12 Act of 1974, or section 9812 of the Internal 

13 Revenue Code of 1986, as applicable, based 

14 on investigations of violations of such sec15 tions, including— 

16 ‘‘(I) examples illustrating require17 ments for information disclosures and 

18 nonquantitative treatment limitations; 

19 and 

20 ‘‘(II) descriptions of the violations 

21 uncovered during the course of such in22 vestigations. 

23 ‘‘(ii) NONQUANTITATIVE TREATMENT

24 LIMITATIONS.—To the extent that any ex25 ample described in clause (i) involves a 


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1 finding of compliance or noncompliance 

2 with regard to any requirement for non3 quantitative treatment limitations, the ex4 ample shall provide sufficient detail to fully 

5 explain such finding, including a full de6 scription of the criteria involved for approv7 ing medical and surgical benefits and the 

8 criteria involved for approving mental 

9 health and substance use disorder benefits. 

10 ‘‘(iii) ACCESS TO ADDITIONAL INFOR11 MATION REGARDING COMPLIANCE.—In de12 veloping and issuing the compliance pro13 gram guidance document required under 

14 this paragraph, the Secretaries specified in 

15 subparagraph (A)— 

16 ‘‘(I) shall enter into interagency 

17 agreements with the Inspector General 

18 of the Department of Health and 

19 Human Services, the Inspector General 

20 of the Department of Labor, and the 

21 Inspector General of the Department of 

22 the Treasury to share findings of com23 pliance and noncompliance with this 

24 section, section 712 of the Employee 

25 Retirement Income Security Act of 


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1 1974, or section 9812 of the Internal 

2 Revenue Code of 1986, as applicable; 

3 and 

4 ‘‘(II) shall seek to enter into an 

5 agreement with a State to share infor6 mation on findings of compliance and 

7 noncompliance with this section, sec8 tion 712 of the Employee Retirement 

9 Income Security Act of 1974, or section 

10 9812 of the Internal Revenue Code of 

11 1986, as applicable. 

12 ‘‘(C) RECOMMENDATIONS.—The compliance 

13 program guidance document shall include rec14 ommendations to advance compliance with this 

15 section, section 712 of the Employee Retirement 

16 Income Security Act of 1974, or section 9812 of 

17 the Internal Revenue Code of 1986, as applica18 ble, and encourage the development and use of 

19 internal controls to monitor adherence to appli20 cable statutes, regulations, and program require21 ments. Such internal controls may include illus22 trative examples of nonquantitative treatment 

23 limitations on mental health and substance use 

24 disorder benefits, which may fail to comply with 

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1 ment Income Security Act of 1974, or section 

2 9812 of the Internal Revenue Code of 1986, as 

3 applicable, in relation to nonquantitative treat4 ment limitations on medical and surgical bene5 fits. 

6 ‘‘(D) UPDATING THE COMPLIANCE PROGRAM

7 GUIDANCE DOCUMENT.—The Secretary, the Sec8 retary of Labor, and the Secretary of the Treas9 ury, in consultation with the Inspector General 

10 of the Department of Health and Human Serv11 ices, the Inspector General of the Department of 

12 Labor, and the Inspector General of the Depart13 ment of the Treasury, shall update the compli14 ance program guidance document every 2 years 

15 to include illustrative, de-identified examples 

16 (that do not disclose any protected health infor17 mation or individually identifiable information) 

18 of previous findings of compliance and non19 compliance with this section, section 712 of the 

20 Employee Retirement Income Security Act of 

21 1974, or section 9812 of the Internal Revenue 

22 Code of 1986, as applicable. 

23 ‘‘(7) ADDITIONAL GUIDANCE.— 

24 ‘‘(A) IN GENERAL.—Not later than 12 

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1 ing Families in Mental Health Crisis Reform 

2 Act of 2016, the Secretary, the Secretary of 

3 Labor, and the Secretary of the Treasury shall 

4 issue guidance to group health plans and health 

5 insurance issuers offering group or individual 

6 health insurance coverage to assist such plans 

7 and issuers in satisfying the requirements of this 

8 section, section 712 of the Employee Retirement 

9 Income Security Act of 1974, or section 9812 of 

10 the Internal Revenue Code of 1986, as applica11 ble. 

12 ‘‘(B) DISCLOSURE.— 

13 ‘‘(i) GUIDANCE FOR PLANS AND

14 ISSUERS.—The guidance issued under this 

15 paragraph shall include clarifying informa16 tion and illustrative examples of methods 

17 that group health plans and health insur18 ance issuers offering group or individual 

19 health insurance coverage may use for dis20 closing information to ensure compliance 

21 with the requirements under this section, 

22 section 712 of the Employee Retirement In23 come Security Act of 1974, or section 9812 

24 of the Internal Revenue Code of 1986, as 

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1 gated pursuant to such sections, as applica2 ble). 

3 ‘‘(ii) DOCUMENTS FOR PARTICIPANTS, 

4 BENEFICIARIES, CONTRACTING PROVIDERS, 

5 OR AUTHORIZED REPRESENTATIVES.—The 

6 guidance issued under this paragraph shall 

7 include clarifying information and illus8 trative examples of methods that group 

9 health plans and health insurance issuers 

10 offering group or individual health insur11 ance coverage may use to provide any par12 ticipant, beneficiary, contracting provider, 

13 or authorized representative, as applicable, 

14 with documents containing information 

15 that the health plans or issuers are required 

16 to disclose to participants, beneficiaries, 

17 contracting providers, or authorized rep18 resentatives to ensure compliance with this 

19 section, section 712 of the Employee Retire20 ment Income Security Act of 1974, or sec21 tion 9812 of the Internal Revenue Code of 

22 1986, as applicable, compliance with any 

23 regulation issued pursuant to such respec24 tive section, or compliance with any other 

25 applicable law or regulation. Such guidance 


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1 shall include information that is compara2 tive in nature with respect to— 

3 ‘‘(I) nonquantitative treatment 

4 limitations for both medical and sur5 gical benefits and mental health and 

6 substance use disorder benefits; 

7 ‘‘(II) the processes, strategies, evi8 dentiary standards, and other factors 

9 used to apply the limitations described 

10 in subclause (I); and 

11 ‘‘(III) the application of the limi12 tations described in subclause (I) to en13 sure that such limitations are applied 

14 in parity with respect to both medical 

15 and surgical benefits and mental 

16 health and substance use disorder bene17 fits. 

18 ‘‘(C) NONQUANTITATIVE TREATMENT LIMI19 TATIONS.—The guidance issued under this para20 graph shall include clarifying information and 

21 illustrative examples of methods, processes, strat22 egies, evidentiary standards, and other factors 

23 that group health plans and health insurance 

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1 ment and application of nonquantitative treat2 ment limitations to ensure compliance with this 

3 section, section 712 of the Employee Retirement 

4 Income Security Act of 1974, or section 9812 of 

5 the Internal Revenue Code of 1986, as applica6 ble, (and any regulations promulgated pursuant 

7 to such respective section), including— 

8 ‘‘(i) examples of methods of deter9 mining appropriate types of nonquantita10 tive treatment limitations with respect to 

11 both medical and surgical benefits and men12 tal health and substance use disorder bene13 fits, including nonquantitative treatment 

14 limitations pertaining to— 

15 ‘‘(I) medical management stand16 ards based on medical necessity or ap17 propriateness, or whether a treatment 

18 is experimental or investigative; 

19 ‘‘(II) limitations with respect to 

20 prescription drug formulary design; 

21 and 

22 ‘‘(III) use of fail-first or step ther23 apy protocols; 

24 ‘‘(ii) examples of methods of deter25 mining— 


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1 ‘‘(I) network admission standards 

2 (such as credentialing); and 

3 ‘‘(II) factors used in provider re4 imbursement methodologies (such as 

5 service type, geographic market, de6 mand for services, and provider sup7 ply, practice size, training, experience, 

8 and licensure) as such factors apply to 

9 network adequacy; 

10 ‘‘(iii) examples of sources of informa11 tion that may serve as evidentiary stand12 ards for the purposes of making determina13 tions regarding the development and appli14 cation of nonquantitative treatment limita15 tions; 

16 ‘‘(iv) examples of specific factors, and 

17 the evidentiary standards used to evaluate 

18 such factors, used by such plans or issuers 

19 in performing a nonquantitative treatment 

20 limitation analysis; 

21 ‘‘(v) examples of how specific evi22 dentiary standards may be used to deter23 mine whether treatments are considered ex24 perimental or investigative; 


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1 ‘‘(vi) examples of how specific evi2 dentiary standards may be applied to each 

3 service category or classification of benefits; 

4 ‘‘(vii) examples of methods of reaching 

5 appropriate coverage determinations for 

6 new mental health or substance use disorder 

7 treatments, such as evidence-based early 

8 intervention programs for individuals with 

9 a serious mental illness and types of med10 ical management techniques; 

11 ‘‘(viii) examples of methods of reaching 

12 appropriate coverage determinations for 

13 which there is an indirect relationship be14 tween the covered mental health or sub15 stance use disorder benefit and a traditional 

16 covered medical and surgical benefit, such 

17 as residential treatment or hospitalizations 

18 involving voluntary or involuntary commit19 ment; and 

20 ‘‘(ix) additional illustrative examples 

21 of methods, processes, strategies, evidentiary 

22 standards, and other factors for which the 

23 Secretary determines that additional guid24 ance is necessary to improve compliance 

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1 ployee Retirement Income Security Act of 

2 1974, or section 9812 of the Internal Rev3 enue Code of 1986, as applicable. 

4 ‘‘(D) PUBLIC COMMENT.—Prior to issuing 

5 any final guidance under this paragraph, the 

6 Secretary shall provide a public comment period 

7 of not less than 60 days during which any mem8 ber of the public may provide comments on a 

9 draft of the guidance. 

10 ‘‘(8) COMPLIANCE REQUIREMENTS.— 

11 ‘‘(A) NONQUANTITATIVE TREATMENT LIMI12 TATION (NQTL) REQUIREMENTS.—In the case of a 

13 group health plan or a health insurance issuer 

14 offering group or individual health insurance 

15 coverage that provides both medical and surgical 

16 benefits and mental health or substance use dis17 order benefits and that imposes nonquantitative 

18 treatment limitations (referred to in this section 

19 as ‘NQTL’) on mental health or substance use 

20 disorder benefits, the plan or issuer offering 

21 health insurance coverage shall perform com22 parative analyses of the design and application 

23 of NQTLs in accordance with subparagraph (B), 

24 and, beginning 45 days after the date of enact25 ment of this paragraph, make available to the 


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1 applicable State authority (or, as applicable, the 

2 Secretary), upon request, the comparative anal3 yses and the following information: 

4 ‘‘(i) The specific plan or coverage 

5 terms regarding the NQTL, that applies to 

6 such plan or coverage, and a description of 

7 all mental health or substance use disorder 

8 and medical or surgical benefits to which it 

9 applies in each respective benefits classifica10 tion. 

11 ‘‘(ii) The factors used to determine that 

12 the NQTL will apply to mental health or 

13 substance use disorder benefits and medical 

14 or surgical benefits. 

15 ‘‘(iii) The evidentiary standards used 

16 for the factors identified in clause (ii), when 

17 applicable, provided that every factor shall 

18 be defined and any other source or evidence 

19 relied upon to design and apply the NQTL 

20 to mental health or substance use disorder 

21 benefits and medical or surgical benefits. 

22 ‘‘(iv) The comparative analyses dem23 onstrating that the processes, strategies, evi24 dentiary standards, and other factors used 

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1 eration processes and strategies as written 

2 and in operation that are used to apply the 

3 NQTL for mental health or substance use 

4 disorder benefits are comparable to, and are 

5 applied no more stringently than, the proc6 esses, strategies, evidentiary standards, and 

7 other factors used to design the NQTL, as 

8 written, and the operation processes and 

9 strategies as written and in operation that 

10 are used to apply the NQTL to medical or 

11 surgical benefits. 

12 ‘‘(v) A disclosure of the specific find13 ings and conclusions reached by the plan or 

14 coverage that the results of the analyses de15 scribed in this subparagraph indicate that 

16 the plan or coverage is in compliance with 

17 this section. 

18 ‘‘(B) SECRETARY REQUEST PROCESS.— 

19 ‘‘(i) SUBMISSION UPON REQUEST.— 

20 The Secretary shall request that a group 

21 health plan or a health insurance issuer of22 fering group or individual health insurance 

23 coverage submit the comparative analyses 

24 described in subparagraph (A) for plans 

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1 tion or complaints regarding noncompli2 ance with this section that concern NQTLs 

3 and any other instances in which the Sec4 retary determines appropriate. The Sec5 retary shall request not fewer than 20 such 

6 analyses per year. 

7 ‘‘(ii) ADDITIONAL INFORMATION.—In 

8 instances in which the Secretary has con9 cluded that the plan or coverage has not 

10 submitted sufficient information for the Sec11 retary to review the comparative analyses 

12 described in subparagraph (A), as requested 

13 under clause (i), the Secretary shall specify 

14 to the plan or coverage the information the 

15 plan or coverage must submit to be respon16 sive to the request under clause (i) for the 

17 Secretary to review the comparative anal18 yses described in subparagraph(A) for com19 pliance with this section. Nothing in this 

20 paragraph shall require the Secretary to 

21 conclude that a plan is in compliance with 

22 this section solely based upon the inspection 

23 of the comparative analyses described in 

24 subparagraph (A), as requested under clause 

25 (i). 


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1 ‘‘(iii) REQUIRED ACTION.— 

2 ‘‘(I) IN GENERAL.—In instances 

3 in which the Secretary has reviewed 

4 the comparative analyses described in 

5 subparagraph (A), as requested under 

6 clause (i), and determined that the 

7 plan or coverage is not in compliance 

8 with this section, the plan or cov9 erage— 

10 ‘‘(aa) shall specify to the Sec11 retary the actions the plan or cov12 erage will take to be in compli13 ance with this section and provide 

14 to the Secretary comparative 

15 analyses described in subpara16 graph (A) that demonstrate com17 pliance with this section not later 

18 than 45 days after the initial de19 termination by the Secretary that 

20 the plan or coverage is not in 

21 compliance; and 

22 ‘‘(bb) following the 45-day 

23 corrective action period under 

24 item (aa), if the Secretary deter25 mines that the plan or coverage 


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1 still is not in compliance with 

2 this section, not later than 7 days 

3 after such determination, shall no4 tify all individuals enrolled in the 

5 plan or coverage that the plan or 

6 coverage has been determined to be 

7 not in compliance with this sec8 tion. 

9 ‘‘(II) EXEMPTION FROM DISCLO10 SURE.—Documents or communications 

11 produced in connection with the Sec12 retary’s recommendations to the plan 

13 or coverage shall not be subject to dis14 closure pursuant to section 552 of title 

15 5, United States Code. 

16 ‘‘(iv) REPORT.—Not later than 1 year 

17 after the date of enactment of this para18 graph, and not later than October 1 of each 

19 year thereafter, the Secretary shall submit 

20 to Congress, and make publicly available, a 

21 report that contains— 

22 ‘‘(I) a summary of the compara23 tive analyses requested under clause 

24 (i), including the identity of each plan 

25 or coverage that is determined to be 


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1 not in compliance after the final deter2 mination by the Secretary described in 

3 clause (iii)(I)(bb); 

4 ‘‘(II) the Secretary’s conclusions 

5 as to whether each plan or coverage 

6 submitted sufficient information for the 

7 Secretary to review the comparative 

8 analyses requested under clause (i) for 

9 compliance with this section; 

10 ‘‘(III) for each plan or coverage 

11 that did submit sufficient information 

12 for the Secretary to review the com13 parative analyses requested under 

14 clause (i), the Secretary’s conclusions 

15 as to whether and why the plan or cov16 erage is in compliance with the re17 quirements under this section; 

18 ‘‘(IV) the Secretary’s specifica19 tions described in clause (ii) for each 

20 plan or coverage that the Secretary de21 termined did not submit sufficient in22 formation for the Secretary to review 

23 the comparative analyses requested 

24 under clause (i) for compliance with 

25 this section; and 


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1 ‘‘(V) the Secretary’s specifications 

2 described in clause (iii) of the actions 

3 each plan or coverage that the Sec4 retary determined is not in compliance 

5 with this section must take to be in 

6 compliance with this section, including 

7 the reason why the Secretary deter8 mined the plan or coverage is not in 

9 compliance. 

10 ‘‘(C) COMPLIANCE PROGRAM GUIDANCE

11 DOCUMENT UPDATE PROCESS.— 

12 ‘‘(i) IN GENERAL.—The Secretary shall 

13 include instances of noncompliance that the 

14 Secretary discovers upon reviewing the com15 parative analyses requested under subpara16 graph (B)(i) in the compliance program 

17 guidance document described in paragraph 

18 (6), as it is updated every 2 years, except 

19 that such instances shall not disclose any 

20 protected health information or individually 

21 identifiable information. 

22 ‘‘(ii) GUIDANCE AND REGULATIONS.— 

23 Not later than 18 months after the date of 

24 enactment of this paragraph, the Secretary 

25 shall finalize any draft or interim guidance 


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1 and regulations relating to mental health 

2 parity under this section. Such draft guid3 ance shall include guidance to clarify the 

4 process and timeline for current and poten5 tial participants and beneficiaries (and au6 thorized representatives and health care 

7 providers of such participants and bene8 ficiaries) with respect to plans to file com9 plaints of such plans or issuers being in 

10 violation of this section, including guidance, 

11 by plan type, on the relevant State, re12 gional, or national office with which such 

13 complaints should be filed. 

14 ‘‘(iii) STATE.—The Secretary shall 

15 share information on findings of compliance 

16 and noncompliance discovered upon review17 ing the comparative analyses requested 

18 under subparagraph (B)(i) with the State 

19 where the group health plan is located or 

20 the State where the health insurance issuer 

21 is licensed to do business for coverage offered 

22 by a health insurance issuer in the group 

23 market, in accordance with paragraph 

24 (6)(B)(iii)(II). 


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1 ‘‘(b) CONSTRUCTION.—Nothing in this section shall be 

2 construed— 

3 ‘‘(1) as requiring a group health plan or a 

4 health insurance issuer offering group or individual 

5 health insurance coverage to provide any mental 

6 health or substance use disorder benefits; or 

7 ‘‘(2) in the case of a group health plan or a 

8 health insurance issuer offering group or individual 

9 health insurance coverage that provides mental health 

10 or substance use disorder benefits, as affecting the 

11 terms and conditions of the plan or coverage relating 

12 to such benefits under the plan or coverage, except as 

13 provided in subsection (a). 

14 ‘‘(c) EXEMPTIONS.— 

15 ‘‘(1) SMALL EMPLOYER EXEMPTION.—This sec16 tion shall not apply to any group health plan and a 

17 health insurance issuer offering group or individual 

18 health insurance coverage for any plan year of a 

19 small employer (as defined in section 2791(e)(4), ex20 cept that for purposes of this paragraph such term 

21 shall include employers with 1 employee in the case 

22 of an employer residing in a State that permits small 

23 groups to include a single individual). 

24 ‘‘(2) COST EXEMPTION.— 


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

2 health plan or a health insurance issuer offering 

3 group or individual health insurance coverage, if 

4 the application of this section to such plan (or 

5 coverage) results in an increase for the plan year 

6 involved of the actual total costs of coverage with 

7 respect to medical and surgical benefits and 

8 mental health and substance use disorder benefits 

9 under the plan (as determined and certified 

10 under subparagraph (C)) by an amount that ex11 ceeds the applicable percentage described in sub12 paragraph (B) of the actual total plan costs, the 

13 provisions of this section shall not apply to such 

14 plan (or coverage) during the following plan 

15 year, and such exemption shall apply to the plan 

16 (or coverage) for 1 plan year. An employer may 

17 elect to continue to apply mental health and sub18 stance use disorder parity pursuant to this sec19 tion with respect to the group health plan (or 

20 coverage) involved regardless of any increase in 

21 total costs. 

22 ‘‘(B) APPLICABLE PERCENTAGE.—With re23 spect to a plan (or coverage), the applicable per24 centage described in this subparagraph shall 

25 be— 


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1 ‘‘(i) 2 percent in the case of the first 

2 plan year in which this section is applied; 

3 and 

4 ‘‘(ii) 1 percent in the case of each sub5 sequent plan year. 

6 ‘‘(C) DETERMINATIONS BY ACTUARIES.— 

7 Determinations as to increases in actual costs 

8 under a plan (or coverage) for purposes of this 

9 section shall be made and certified by a qualified 

10 and licensed actuary who is a member in good 

11 standing of the American Academy of Actuaries. 

12 All such determinations shall be in a written re13 port prepared by the actuary. The report, and 

14 all underlying documentation relied upon by the 

15 actuary, shall be maintained by the group health 

16 plan or health insurance issuer for a period of 

17 6 years following the notification made under 

18 subparagraph (E). 

19 ‘‘(D) 6-MONTH DETERMINATIONS.—If a 

20 group health plan (or a health insurance issuer 

21 offering coverage in connection with a group 

22 health plan) seeks an exemption under this para23 graph, determinations under subparagraph (A) 

24 shall be made after such plan (or coverage) has 


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1 complied with this section for the first 6 months 

2 of the plan year involved. 

3 ‘‘(E) NOTIFICATION.— 

4 ‘‘(i) IN GENERAL.—A group health 

5 plan (or a health insurance issuer offering 

6 coverage in connection with a group health 

7 plan) that, based upon a certification de8 scribed under subparagraph (C), qualifies 

9 for an exemption under this paragraph, 

10 and elects to implement the exemption, shall 

11 promptly notify the Secretary, the appro12 priate State agencies, and participants and 

13 beneficiaries in the plan of such election. 

14 ‘‘(ii) REQUIREMENT.—A notification 

15 to the Secretary under clause (i) shall in16 clude— 

17 ‘‘(I) a description of the number 

18 of covered lives under the plan (or cov19 erage) involved at the time of the noti20 fication, and as applicable, at the time 

21 of any prior election of the cost-exemp22 tion under this paragraph by such 

23 plan (or coverage); 

24 ‘‘(II) for both the plan year upon 

25 which a cost exemption is sought and 


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1 the year prior, a description of the ac2 tual total costs of coverage with respect 

3 to medical and surgical benefits and 

4 mental health and substance use dis5 order benefits under the plan; and 

6 ‘‘(III) for both the plan year upon 

7 which a cost exemption is sought and 

8 the year prior, the actual total costs of 

9 coverage with respect to mental health 

10 and substance use disorder benefits 

11 under the plan. 

12 ‘‘(iii) CONFIDENTIALITY.—A notifica13 tion to the Secretary under clause (i) shall 

14 be confidential. The Secretary shall make 

15 available, upon request and on not more 

16 than an annual basis, an anonymous 

17 itemization of such notifications, that in18 cludes— 

19 ‘‘(I) a breakdown of States by the 

20 size and type of employers submitting 

21 such notification; and 

22 ‘‘(II) a summary of the data re23 ceived under clause (ii). 

24 ‘‘(F) AUDITS BY APPROPRIATE AGENCIES.— 

25 To determine compliance with this paragraph, 


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1 the Secretary may audit the books and records of 

2 a group health plan or health insurance issuer 

3 relating to an exemption, including any actu4 arial reports prepared pursuant to subparagraph 

5 (C), during the 6 year period following the noti6 fication of such exemption under subparagraph 

7 (E). A State agency receiving a notification 

8 under subparagraph (E) may also conduct such 

9 an audit with respect to an exemption covered 

10 by such notification. 

11 ‘‘(d) SEPARATE APPLICATION TO EACH OPTION OF12 FERED.—In the case of a group health plan that offers a 

13 participant or beneficiary two or more benefit package op14 tions under the plan, the requirements of this section shall 

15 be applied separately with respect to each such option. 

16 ‘‘(e) DEFINITIONS.—For purposes of this section— 

17 ‘‘(1) AGGREGATE LIFETIME LIMIT.—The term 

18 ‘aggregate lifetime limit’ means, with respect to bene19 fits under a group health plan or health insurance 

20 coverage, a dollar limitation on the total amount that 

21 may be paid with respect to such benefits under the 

22 plan or health insurance coverage with respect to an 

23 individual or other coverage unit. 

24 ‘‘(2) ANNUAL LIMIT.—The term ‘annual limit’ 

25 means, with respect to benefits under a group health 


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1 plan or health insurance coverage, a dollar limitation 

2 on the total amount of benefits that may be paid with 

3 respect to such benefits in a 12-month period under 

4 the plan or health insurance coverage with respect to 

5 an individual or other coverage unit. 

6 ‘‘(3) MEDICAL OR SURGICAL BENEFITS.—The 

7 term ‘medical or surgical benefits’ means benefits 

8 with respect to medical or surgical services, as defined 

9 under the terms of the plan or coverage (as the case 

10 may be), but does not include mental health or sub11 stance use disorder benefits. 

12 ‘‘(4) MENTAL HEALTH BENEFITS.—The term 

13 ‘mental health benefits’ means benefits with respect to 

14 services for mental health conditions, as defined under 

15 the terms of the plan and in accordance with applica16 ble Federal and State law. 

17 ‘‘(5) SUBSTANCE USE DISORDER BENEFITS.— 

18 The term ‘substance use disorder benefits’ means bene19 fits with respect to services for substance use dis20 orders, as defined under the terms of the plan and in 

21 accordance with applicable Federal and State law.’’. 

22 (2) SUNSET.—Section 2726 of the Public Health 

23 Service Act (42 U.S.C. 300gg–26) is amended by add24 ing at the end the following new subsection 


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1 ‘‘(f) SUNSET.—The provisions of this section shall have 

2 no force or effect after the date of the enactment of the 

3 Strengthening Behavioral Health Parity Act.’’. 

4 (3) ADMINISTRATION; CONFORMING AMEND5 MENTS.— 

6 (A) APPLICATION OF IMPLEMENTATION

7 REGULATIONS.—The provisions of sections 

8 146.136 and 147.160 of title 45, Code of Federal 

9 Regulations shall apply to section 2799A–1 of 

10 the Public Health Service Act, as added by para11 graph (1), in the same manner as such provi12 sions applied to section 2726 of the Public 

13 Health Service Act (42 U.S.C. 300gg–26) before 

14 the date of the enactment of this Act. 

15 (B) CONFORMING AMENDMENTS.— 

16 (i) Section 2722 of the Public Health 

17 Service Act (42 U.S.C. 300gg–21) is amend18 ed— 

19 (I) in subsection (a)(1), by insert20 ing ‘‘and part D’’ after ‘‘subparts 1 

21 and 2’’; 

22 (II) in subsection (b), by inserting 

23 ‘‘and part D’’ after ‘‘subparts 1 and 

24 2’’; 


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1 (III) in subsection (c)(1), by in2 serting ‘‘and part D’’ after ‘‘subparts 1 

3 and 2’’; 

4 (IV) in subsection (c)(2), by in5 serting ‘‘and part D’’ after ‘‘subparts 1 

6 and 2’’; 

7 (V) in subsection (c)(3), by insert8 ing ‘‘and part D’’ after ‘‘this part’’; 

9 and 

10 (VI) in subsection (d), in the mat11 ter preceding paragraph (1), by insert12 ing ‘‘and part D’’ after ‘‘this part’’. 

13 (ii) Section 2723 of the Public Health 

14 Service Act (42 U.S.C. 300gg–22) is amend15 ed— 

16 (I) in subsection (a)(1), by insert17 ing ‘‘and part D’’ after ‘‘this part’’; 

18 (II) in subsection (a)(2), by in19 serting ‘‘or part D’’ after ‘‘this part’’; 

20 (III) in subsection (b)(1), by in21 serting ‘‘or part D’’ after ‘‘this part’’; 

22 (IV) in subsection (b)(2)(A), by 

23 inserting ‘‘or part D’’ after ‘‘this 

24 part’’; and 


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1 (V) in subsection (b)(2)(C)(ii), by 

2 inserting ‘‘and part D’’ after ‘‘this 

3 part’’. 

4 (iii) Section 2724 of the Public Health 

5 Service Act (42 U.S.C. 300gg–23) is amend6 ed— 

7 (I) in subsection (a)(1)— 

8 (aa) by striking ‘‘this part 

9 and part C insofar as it relates to 

10 this part’’ and inserting ‘‘this 

11 part, part D, and part C insofar 

12 as it relates to this part or part 

13 D’’; and 

14 (bb) by inserting ‘‘or part D’’ 

15 after ‘‘requirement of this part’’; 

16 (II) in subsection (a)(2), by in17 serting ‘‘or part D’’ after ‘‘this part’’; 

18 and 

19 (III) in subsection (c), by insert20 ing ‘‘or part D’’ after ‘‘this part (other 

21 than section 2704)’’. 

22 (b) ERISA.—Section 712(a) of the Employee Retire23 ment Income Security Act of 1974 (1185a(a)) is amended 

24 by adding at the end the following new paragraphs: 


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1 ‘‘(6) COMPLIANCE PROGRAM GUIDANCE DOCU2 MENT.— 

3 ‘‘(A) IN GENERAL.—Not later than 12 

4 months after the date of enactment of the Help5 ing Families in Mental Health Crisis Reform 

6 Act of 2016, the Secretary, the Secretary of 

7 Health and Human Services, and the Secretary 

8 of the Treasury, in consultation with the Inspec9 tor General of the Department of Health and 

10 Human Services, the Inspector General of the 

11 Department of Labor, and the Inspector General 

12 of the Department of the Treasury, shall issue a 

13 compliance program guidance document to help 

14 improve compliance with this section, section 

15 2799A–1 of the Public Health Service Act, and 

16 section 9812 of the Internal Revenue Code of 

17 1986, as applicable. In carrying out this para18 graph, the Secretaries may take into consider19 ation the 2016 publication of the Department of 

20 Health and Human Services and the Depart21 ment of Labor, entitled ‘Warning Signs - Plan 

22 or Policy Non-Quantitative Treatment Limita23 tions (NQTLs) that Require Additional Analysis 

24 to Determine Mental Health Parity Compliance’. 


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1 ‘‘(B) EXAMPLES ILLUSTRATING COMPLIANCE

2 AND NONCOMPLIANCE.— 

3 ‘‘(i) IN GENERAL.—The compliance 

4 program guidance document required under 

5 this paragraph shall provide illustrative, 

6 de-identified examples (that do not disclose 

7 any protected health information or indi8 vidually identifiable information) of pre9 vious findings of compliance and non10 compliance with this section, section 

11 2799A–1 of the Public Health Service Act, 

12 or section 9812 of the Internal Revenue 

13 Code of 1986, as applicable, based on inves14 tigations of violations of such sections, in15 cluding— 

16 ‘‘(I) examples illustrating require17 ments for information disclosures and 

18 nonquantitative treatment limitations; 

19 and 

20 ‘‘(II) descriptions of the violations 

21 uncovered during the course of such in22 vestigations. 

23 ‘‘(ii) NONQUANTITATIVE TREATMENT

24 LIMITATIONS.—To the extent that any ex25 ample described in clause (i) involves a 


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1 finding of compliance or noncompliance 

2 with regard to any requirement for non3 quantitative treatment limitations, the ex4 ample shall provide sufficient detail to fully 

5 explain such finding, including a full de6 scription of the criteria involved for approv7 ing medical and surgical benefits and the 

8 criteria involved for approving mental 

9 health and substance use disorder benefits. 

10 ‘‘(iii) ACCESS TO ADDITIONAL INFOR11 MATION REGARDING COMPLIANCE.—In de12 veloping and issuing the compliance pro13 gram guidance document required under 

14 this paragraph, the Secretaries specified in 

15 subparagraph (A)— 

16 ‘‘(I) shall enter into interagency 

17 agreements with the Inspector General 

18 of the Department of Health and 

19 Human Services, the Inspector General 

20 of the Department of Labor, and the 

21 Inspector General of the Department of 

22 the Treasury to share findings of com23 pliance and noncompliance with this 

24 section, section 2799A–1 of the Public 

25 Health Service Act, or section 9812 of 


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1 the Internal Revenue Code of 1986, as 

2 applicable; and 

3 ‘‘(II) shall seek to enter into an 

4 agreement with a State to share infor5 mation on findings of compliance and 

6 noncompliance with this section, sec7 tion 2799A–1 of the Public Health 

8 Service Act, or section 9812 of the In9 ternal Revenue Code of 1986, as appli10 cable. 

11 ‘‘(C) RECOMMENDATIONS.—The compliance 

12 program guidance document shall include rec13 ommendations to advance compliance with this 

14 section, section 2799A–1 of the Public Health 

15 Service Act, or section 9812 of the Internal Rev16 enue Code of 1986, as applicable, and encourage 

17 the development and use of internal controls to 

18 monitor adherence to applicable statutes, regula19 tions, and program requirements. Such internal 

20 controls may include illustrative examples of 

21 nonquantitative treatment limitations on mental 

22 health and substance use disorder benefits, which 

23 may fail to comply with this section, section 

24 2799A–1 of the Public Health Service Act, or 

25 section 9812 of the Internal Revenue Code of 


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1 1986, as applicable, in relation to nonquantita2 tive treatment limitations on medical and sur3 gical benefits. 

4 ‘‘(D) UPDATING THE COMPLIANCE PROGRAM

5 GUIDANCE DOCUMENT.—The Secretary, the Sec6 retary of Health and Human Services, and the 

7 Secretary of the Treasury, in consultation with 

8 the Inspector General of the Department of 

9 Health and Human Services, the Inspector Gen10 eral of the Department of Labor, and the Inspec11 tor General of the Department of the Treasury, 

12 shall update the compliance program guidance 

13 document every 2 years to include illustrative, 

14 de-identified examples (that do not disclose any 

15 protected health information or individually 

16 identifiable information) of previous findings of 

17 compliance and noncompliance with this section, 

18 section 2799A–1 of the Public Health Service 

19 Act, or section 9812 of the Internal Revenue 

20 Code of 1986, as applicable. 

21 ‘‘(7) ADDITIONAL GUIDANCE.— 

22 ‘‘(A) IN GENERAL.—Not later than 12 

23 months after the date of enactment of the Help24 ing Families in Mental Health Crisis Reform 

25 Act of 2016, the Secretary, the Secretary of 


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1 Health and Human Services, and the Secretary 

2 of the Treasury shall issue guidance to group 

3 health plans and health insurance issuers offer4 ing group or individual health insurance cov5 erage to assist such plans and issuers in satis6 fying the requirements of this section, section 

7 2799A–1 of the Public Health Service Act, or 

8 section 9812 of the Internal Revenue Code of 

9 1986, as applicable. 

10 ‘‘(B) DISCLOSURE.— 

11 ‘‘(i) GUIDANCE FOR PLANS AND

12 ISSUERS.—The guidance issued under this 

13 paragraph shall include clarifying informa14 tion and illustrative examples of methods 

15 that group health plans and health insur16 ance issuers offering group or individual 

17 health insurance coverage may use for dis18 closing information to ensure compliance 

19 with the requirements under this section, 

20 section 2799A–1 of the Public Health Serv21 ice Act, or section 9812 of the Internal Rev22 enue Code of 1986, as applicable, (and any 

23 regulations promulgated pursuant to such 

24 sections, as applicable). 


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1 ‘‘(ii) DOCUMENTS FOR PARTICIPANTS, 

2 BENEFICIARIES, CONTRACTING PROVIDERS, 

3 OR AUTHORIZED REPRESENTATIVES.—The 

4 guidance issued under this paragraph shall 

5 include clarifying information and illus6 trative examples of methods that group 

7 health plans and health insurance issuers 

8 offering group or individual health insur9 ance coverage may use to provide any par10 ticipant, beneficiary, contracting provider, 

11 or authorized representative, as applicable, 

12 with documents containing information 

13 that the health plans or issuers are required 

14 to disclose to participants, beneficiaries, 

15 contracting providers, or authorized rep16 resentatives to ensure compliance with this 

17 section, section 2799A–1 of the Public 

18 Health Service Act, or section 9812 of the 

19 Internal Revenue Code of 1986, as applica20 ble, compliance with any regulation issued 

21 pursuant to such respective section, or com22 pliance with any other applicable law or 

23 regulation. Such guidance shall include in24 formation that is comparative in nature 

25 with respect to— 


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1 ‘‘(I) nonquantitative treatment 

2 limitations for both medical and sur3 gical benefits and mental health and 

4 substance use disorder benefits; 

5 ‘‘(II) the processes, strategies, evi6 dentiary standards, and other factors 

7 used to apply the limitations described 

8 in subclause (I); and 

9 ‘‘(III) the application of the limi10 tations described in subclause (I) to en11 sure that such limitations are applied 

12 in parity with respect to both medical 

13 and surgical benefits and mental 

14 health and substance use disorder bene15 fits. 

16 ‘‘(C) NONQUANTITATIVE TREATMENT LIMI17 TATIONS.—The guidance issued under this para18 graph shall include clarifying information and 

19 illustrative examples of methods, processes, strat20 egies, evidentiary standards, and other factors 

21 that group health plans and health insurance 

22 issuers offering group or individual health insur23 ance coverage may use regarding the develop24 ment and application of nonquantitative treat25 ment limitations to ensure compliance with this 


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1 section, section 2799A–1 of the Public Health 

2 Service Act, or section 9812 of the Internal Rev3 enue Code of 1986, as applicable, (and any regu4 lations promulgated pursuant to such respective 

5 section), including— 

6 ‘‘(i) examples of methods of deter7 mining appropriate types of nonquantita8 tive treatment limitations with respect to 

9 both medical and surgical benefits and men10 tal health and substance use disorder bene11 fits, including nonquantitative treatment 

12 limitations pertaining to— 

13 ‘‘(I) medical management stand14 ards based on medical necessity or ap15 propriateness, or whether a treatment 

16 is experimental or investigative; 

17 ‘‘(II) limitations with respect to 

18 prescription drug formulary design; 

19 and 

20 ‘‘(III) use of fail-first or step ther21 apy protocols; 

22 ‘‘(ii) examples of methods of deter23 mining— 

24 ‘‘(I) network admission standards 

25 (such as credentialing); and 


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1 ‘‘(II) factors used in provider re2 imbursement methodologies (such as 

3 service type, geographic market, de4 mand for services, and provider sup5 ply, practice size, training, experience, 

6 and licensure) as such factors apply to 

7 network adequacy; 

8 ‘‘(iii) examples of sources of informa9 tion that may serve as evidentiary stand10 ards for the purposes of making determina11 tions regarding the development and appli12 cation of nonquantitative treatment limita13 tions; 

14 ‘‘(iv) examples of specific factors, and 

15 the evidentiary standards used to evaluate 

16 such factors, used by such plans or issuers 

17 in performing a nonquantitative treatment 

18 limitation analysis; 

19 ‘‘(v) examples of how specific evi20 dentiary standards may be used to deter21 mine whether treatments are considered ex22 perimental or investigative; 

23 ‘‘(vi) examples of how specific evi24 dentiary standards may be applied to each 

25 service category or classification of benefits; 


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1 ‘‘(vii) examples of methods of reaching 

2 appropriate coverage determinations for 

3 new mental health or substance use disorder 

4 treatments, such as evidence-based early 

5 intervention programs for individuals with 

6 a serious mental illness and types of med7 ical management techniques; 

8 ‘‘(viii) examples of methods of reaching 

9 appropriate coverage determinations for 

10 which there is an indirect relationship be11 tween the covered mental health or sub12 stance use disorder benefit and a traditional 

13 covered medical and surgical benefit, such 

14 as residential treatment or hospitalizations 

15 involving voluntary or involuntary commit16 ment; and 

17 ‘‘(ix) additional illustrative examples 

18 of methods, processes, strategies, evidentiary 

19 standards, and other factors for which the 

20 Secretary determines that additional guid21 ance is necessary to improve compliance 

22 with this section, section 2799A–1 of the 

23 Public Health Service Act, or section 9812 

24 of the Internal Revenue Code of 1986, as 

25 applicable. 


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1 ‘‘(D) PUBLIC COMMENT.—Prior to issuing 

2 any final guidance under this paragraph, the 

3 Secretary shall provide a public comment period 

4 of not less than 60 days during which any mem5 ber of the public may provide comments on a 

6 draft of the guidance. 

7 ‘‘(8) COMPLIANCE REQUIREMENTS.— 

8 ‘‘(A) NONQUANTITATIVE TREATMENT LIMI9 TATION (NQTL) REQUIREMENTS.—Beginning 45 

10 days after the date of enactment of this para11 graph, in the case of a group health plan or a 

12 health insurance issuer offering group health in13 surance coverage that provides both medical and 

14 surgical benefits and mental health or substance 

15 use disorder benefits and that imposes non16 quantitative treatment limitations (referred to in 

17 this section as ‘NQTL’) on mental health or sub18 stance use disorder benefits, the plan or issuer of19 fering health insurance coverage shall perform 

20 comparative analyses of the design and applica21 tion of NQTLs in accordance with subparagraph 

22 (B), and make available to the applicable State 

23 authority (or, as applicable, the Secretary), upon 

24 request, the following information: 


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1 ‘‘(i) The specific plan or coverage 

2 terms regarding the NQTL, that applies to 

3 such plan or coverage, and a description of 

4 all mental health or substance use disorder 

5 and medical or surgical benefits to which it 

6 applies in each respective benefits classifica7 tion. 

8 ‘‘(ii) The factors used to determine that 

9 the NQTL will apply to mental health or 

10 substance use disorder benefits and medical 

11 or surgical benefits. 

12 ‘‘(iii) The evidentiary standards used 

13 for the factors identified in clause (ii), when 

14 applicable, provided that every factor shall 

15 be defined and any other source or evidence 

16 relied upon to design and apply the NQTL 

17 to mental health or substance use disorder 

18 benefits and medical or surgical benefits. 

19 ‘‘(iv) The comparative analyses dem20 onstrating that the processes, strategies, evi21 dentiary standards, and other factors used 

22 to design the NQTL, as written, and the op23 eration processes and strategies as written 

24 and in operation that are used to apply the 

25 NQTL for mental health or substance use 


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1 disorder benefits are comparable to, and are 

2 applied no more stringently than, the proc3 esses, strategies, evidentiary standards, and 

4 other factors used to design the NQTL, as 

5 written, and the operation processes and 

6 strategies as written and in operation that 

7 are used to apply the NQTL to medical or 

8 surgical benefits. 

9 ‘‘(v) A disclosure of the specific find10 ings and conclusions reached by the plan or 

11 coverage that the results of the analyses de12 scribed in this subparagraph indicate that 

13 the plan or coverage is in compliance with 

14 this section. 

15 ‘‘(B) SECRETARY REQUEST PROCESS.— 

16 ‘‘(i) SUBMISSION UPON REQUEST.— 

17 The Secretary shall request that a group 

18 health plan or a health insurance issuer of19 fering group health insurance coverage sub20 mit the comparative analyses described in 

21 subparagraph (A) for plans that involve po22 tential violations of this section or com23 plaints regarding noncompliance with this 

24 section that concern NQTLs and any other 

25 instances in which the Secretary determines 


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1 appropriate. The Secretary shall request not 

2 fewer than 20 such analyses per year. 

3 ‘‘(ii) ADDITIONAL INFORMATION.—In 

4 instances in which the Secretary has con5 cluded that the plan or coverage has not 

6 submitted sufficient information for the Sec7 retary to review the comparative analyses 

8 described in subparagraph (A), as requested 

9 under clause (i), the Secretary shall specify 

10 to the plan or coverage the information the 

11 plan or coverage must submit to be respon12 sive to the request under clause (i) for the 

13 Secretary to review the comparative anal14 yses described in subparagraph(A) for com15 pliance with this section. Nothing in this 

16 paragraph shall require the Secretary to 

17 conclude that a plan is in compliance with 

18 this section solely based upon the inspection 

19 of the comparative analyses described in 

20 subparagraph (A), as requested under clause 

21 (i). 

22 ‘‘(iii) REQUIRED ACTION.— 

23 ‘‘(I) IN GENERAL.—In instances 

24 in which the Secretary has reviewed 

25 the comparative analyses described in 


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1 subparagraph (A), as requested under 

2 clause (i), and determined that the 

3 plan or coverage is not in compliance 

4 with this section, the plan or cov5 erage— 

6 ‘‘(aa) shall specify to the Sec7 retary the actions the plan or cov8 erage will take to be in compli9 ance with this section and provide 

10 to the Secretary comparative 

11 analyses described in subpara12 graph (A) that demonstrate com13 pliance with this section not later 

14 than 45 days after the initial de15 termination by the Secretary that 

16 the plan or coverage is not in 

17 compliance; and 

18 ‘‘(bb) following the 45-day 

19 corrective action period under 

20 item (aa), if the Secretary deter21 mines that the plan or coverage 

22 still is not in compliance with 

23 this section, not later than 7 days 

24 after such determination, shall no25 tify all individuals enrolled in the 


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1 plan or coverage that the plan or 

2 coverage has been determined to be 

3 not in compliance with this sec4 tion. 

5 ‘‘(II) EXEMPTION FROM DISCLO6 SURE.—Documents or communications 

7 produced in connection with the Sec8 retary’s recommendations to the plan 

9 or coverage shall not be subject to dis10 closure pursuant to section 552 of title 

11 5, United States Code. 

12 ‘‘(iv) REPORT.—Not later than 1 year 

13 after the date of enactment of this para14 graph, and not later than October 1 of each 

15 year thereafter, the Secretary shall submit 

16 to Congress, and make publicly available, a 

17 report that contains— 

18 ‘‘(I) a summary of the compara19 tive analyses requested under clause 

20 (i), including the identity of each plan 

21 or coverage that is determined to be 

22 not in compliance after the final deter23 mination by the Secretary described in 

24 clause (iii)(I)(bb); 


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1 ‘‘(II) the Secretary’s conclusions 

2 as to whether each plan or coverage 

3 submitted sufficient information for the 

4 Secretary to review the comparative 

5 analyses requested under clause (i) for 

6 compliance with this section; 

7 ‘‘(III) for each plan or coverage 

8 that did submit sufficient information 

9 for the Secretary to review the com10 parative analyses requested under 

11 clause (i), the Secretary’s conclusions 

12 as to whether and why the plan or cov13 erage is in compliance with the re14 quirements under this section; 

15 ‘‘(IV) the Secretary’s specifica16 tions described in clause (ii) for each 

17 plan or coverage that the Secretary de18 termined did not submit sufficient in19 formation for the Secretary to review 

20 the comparative analyses requested 

21 under clause (i) for compliance with 

22 this section; and 

23 ‘‘(V) the Secretary’s specifications 

24 described in clause (iii) of the actions 

25 each plan or coverage that the SecVerDate Sep 11 2014 18:13 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00057 Fmt 6652 Sfmt 6203 E:\BILLS\H7539.RH H7539

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1 retary determined is not in compliance 

2 with this section must take to be in 

3 compliance with this section, including 

4 the reason why the Secretary deter5 mined the plan or coverage is not in 

6 compliance. 

7 ‘‘(C) COMPLIANCE PROGRAM GUIDANCE

8 DOCUMENT UPDATE PROCESS.— 

9 ‘‘(i) IN GENERAL.—The Secretary shall 

10 include instances of noncompliance that the 

11 Secretary discovers upon reviewing the com12 parative analyses requested under subpara13 graph (B)(i) in the compliance program 

14 guidance document described in paragraph 

15 (6), as it is updated every 2 years, except 

16 that such instances shall not disclose any 

17 protected health information or individually 

18 identifiable information. 

19 ‘‘(ii) GUIDANCE AND REGULATIONS.— 

20 Not later than 18 months after the date of 

21 enactment of this paragraph, the Secretary 

22 shall finalize any draft or interim guidance 

23 and regulations relating to mental health 

24 parity under this section. Such draft guid25 ance shall include guidance to clarify the 


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1 process and timeline for current and poten2 tial participants and beneficiaries (and au3 thorized representatives and health care 

4 providers of such participants and bene5 ficiaries) with respect to plans to file com6 plaints of such plans or issuers being in 

7 violation of this section, including guidance, 

8 by plan type, on the relevant State, re9 gional, or national office with which such 

10 complaints should be filed. 

11 ‘‘(iii) STATE.—The Secretary shall 

12 share information on findings of compliance 

13 and noncompliance discovered upon review14 ing the comparative analyses requested 

15 under subparagraph (B)(i) with the State 

16 where the group health plan is located or 

17 the State where the health insurance issuer 

18 is licensed to do business for coverage offered 

19 by a health insurance issuer in the group 

20 market, in accordance with paragraph 

21 (6)(B)(iii)(II).’’. 

22 (c) IRC.—Section 9812 of the Internal Revenue Code 

23 of 1986 is amended by adding at the end the following new 

24 paragraphs: 


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1 ‘‘(6) COMPLIANCE PROGRAM GUIDANCE DOCU2 MENT.— 

3 ‘‘(A) IN GENERAL.—Not later than 12 

4 months after the date of enactment of the Help5 ing Families in Mental Health Crisis Reform 

6 Act of 2016, the Secretary, the Secretary of 

7 Labor, and the Secretary of Health and Human 

8 Services, in consultation with the Inspector Gen9 eral of the Department of Health and Human 

10 Services, the Inspector General of the Depart11 ment of Labor, and the Inspector General of the 

12 Department of the Treasury, shall issue a com13 pliance program guidance document to help im14 prove compliance with this section, section 712 of 

15 the Employee Retirement Income Security Act of 

16 1974, and section 2799A–1 of the Public Health 

17 Service Act, as applicable. In carrying out this 

18 paragraph, the Secretaries may take into consid19 eration the 2016 publication of the Department 

20 of Health and Human Services and the Depart21 ment of Labor, entitled ‘Warning Signs - Plan 

22 or Policy Non-Quantitative Treatment Limita23 tions (NQTLs) that Require Additional Analysis 

24 to Determine Mental Health Parity Compliance’. 


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1 ‘‘(B) EXAMPLES ILLUSTRATING COMPLIANCE

2 AND NONCOMPLIANCE.— 

3 ‘‘(i) IN GENERAL.—The compliance 

4 program guidance document required under 

5 this paragraph shall provide illustrative, 

6 de-identified examples (that do not disclose 

7 any protected health information or indi8 vidually identifiable information) of pre9 vious findings of compliance and non10 compliance with this section, section 712 of 

11 the Employee Retirement Income Security 

12 Act of 1974, or section 2799A–1 of the Pub13 lic Health Service Act, as applicable, based 

14 on investigations of violations of such sec15 tions, including— 

16 ‘‘(I) examples illustrating require17 ments for information disclosures and 

18 nonquantitative treatment limitations; 

19 and 

20 ‘‘(II) descriptions of the violations 

21 uncovered during the course of such in22 vestigations. 

23 ‘‘(ii) NONQUANTITATIVE TREATMENT

24 LIMITATIONS.—To the extent that any ex25 ample described in clause (i) involves a 


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1 finding of compliance or noncompliance 

2 with regard to any requirement for non3 quantitative treatment limitations, the ex4 ample shall provide sufficient detail to fully 

5 explain such finding, including a full de6 scription of the criteria involved for approv7 ing medical and surgical benefits and the 

8 criteria involved for approving mental 

9 health and substance use disorder benefits. 

10 ‘‘(iii) ACCESS TO ADDITIONAL INFOR11 MATION REGARDING COMPLIANCE.—In de12 veloping and issuing the compliance pro13 gram guidance document required under 

14 this paragraph, the Secretaries specified in 

15 subparagraph (A)— 

16 ‘‘(I) shall enter into interagency 

17 agreements with the Inspector General 

18 of the Department of Health and 

19 Human Services, the Inspector General 

20 of the Department of Labor, and the 

21 Inspector General of the Department of 

22 the Treasury to share findings of com23 pliance and noncompliance with this 

24 section, section 712 of the Employee 

25 Retirement Income Security Act of 


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1 1974, or section 2799A–1 of the Public 

2 Health Service Act, as applicable; and 

3 ‘‘(II) shall seek to enter into an 

4 agreement with a State to share infor5 mation on findings of compliance and 

6 noncompliance with this section, sec7 tion 712 of the Employee Retirement 

8 Income Security Act of 1974, or section 

9 2799A–1 of the Public Health Service 

10 Act, as applicable. 

11 ‘‘(C) RECOMMENDATIONS.—The compliance 

12 program guidance document shall include rec13 ommendations to advance compliance with this 

14 section, section 712 of the Employee Retirement 

15 Income Security Act of 1974, or section 2799A– 

16 1 of the Public Health Service Act, as applicable, 

17 and encourage the development and use of inter18 nal controls to monitor adherence to applicable 

19 statutes, regulations, and program requirements. 

20 Such internal controls may include illustrative 

21 examples of nonquantitative treatment limita22 tions on mental health and substance use dis23 order benefits, which may fail to comply with 

24 this section, section 712 of the Employee Retire25 ment Income Security Act of 1974, or section 


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1 2799A–1 of the Public Health Service Act, as ap2 plicable, in relation to nonquantitative treat3 ment limitations on medical and surgical bene4 fits. 

5 ‘‘(D) UPDATING THE COMPLIANCE PROGRAM

6 GUIDANCE DOCUMENT.—The Secretary, the Sec7 retary of Labor, and the Secretary of Health and 

8 Human Services, in consultation with the In9 spector General of the Department of Health and 

10 Human Services, the Inspector General of the 

11 Department of Labor, and the Inspector General 

12 of the Department of the Treasury, shall update 

13 the compliance program guidance document 

14 every 2 years to include illustrative, de-identified 

15 examples (that do not disclose any protected 

16 health information or individually identifiable 

17 information) of previous findings of compliance 

18 and noncompliance with this section, section 712 

19 of the Employee Retirement Income Security Act 

20 of 1974, or section 2799A–1 of the Public Health 

21 Service Act, as applicable. 

22 ‘‘(7) ADDITIONAL GUIDANCE.— 

23 ‘‘(A) IN GENERAL.—Not later than 12 

24 months after the date of enactment of the Help25 ing Families in Mental Health Crisis Reform 


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1 Act of 2016, the Secretary, the Secretary of 

2 Labor, and the Secretary of Health and Human 

3 Services shall issue guidance to group health 

4 plans and health insurance issuers offering 

5 group or individual health insurance coverage to 

6 assist such plans and issuers in satisfying the re7 quirements of this section, section 712 of the Em8 ployee Retirement Income Security Act of 1974, 

9 or section 2799A–1 of the Public Health Service 

10 Act, as applicable. 

11 ‘‘(B) DISCLOSURE.— 

12 ‘‘(i) GUIDANCE FOR PLANS AND

13 ISSUERS.—The guidance issued under this 

14 paragraph shall include clarifying informa15 tion and illustrative examples of methods 

16 that group health plans and health insur17 ance issuers offering group or individual 

18 health insurance coverage may use for dis19 closing information to ensure compliance 

20 with the requirements under this section, 

21 section 712 of the Employee Retirement In22 come Security Act of 1974, or section 

23 2799A–1 of the Public Health Service Act, 

24 (and any regulations promulgated pursuant 

25 to such sections, as applicable). 


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1 ‘‘(ii) DOCUMENTS FOR PARTICIPANTS, 

2 BENEFICIARIES, CONTRACTING PROVIDERS, 

3 OR AUTHORIZED REPRESENTATIVES.—The 

4 guidance issued under this paragraph shall 

5 include clarifying information and illus6 trative examples of methods that group 

7 health plans and health insurance issuers 

8 offering group or individual health insur9 ance coverage may use to provide any par10 ticipant, beneficiary, contracting provider, 

11 or authorized representative, as applicable, 

12 with documents containing information 

13 that the health plans or issuers are required 

14 to disclose to participants, beneficiaries, 

15 contracting providers, or authorized rep16 resentatives to ensure compliance with this 

17 section, section 712 of the Employee Retire18 ment Income Security Act of 1974, or sec19 tion 2799A–1 of the Public Health Service 

20 Act, as applicable, compliance with any 

21 regulation issued pursuant to such respec22 tive section, or compliance with any other 

23 applicable law or regulation. Such guidance 

24 shall include information that is compara25 tive in nature with respect to— 


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1 ‘‘(I) nonquantitative treatment 

2 limitations for both medical and sur3 gical benefits and mental health and 

4 substance use disorder benefits; 

5 ‘‘(II) the processes, strategies, evi6 dentiary standards, and other factors 

7 used to apply the limitations described 

8 in subclause (I); and 

9 ‘‘(III) the application of the limi10 tations described in subclause (I) to en11 sure that such limitations are applied 

12 in parity with respect to both medical 

13 and surgical benefits and mental 

14 health and substance use disorder bene15 fits. 

16 ‘‘(C) NONQUANTITATIVE TREATMENT LIMI17 TATIONS.—The guidance issued under this para18 graph shall include clarifying information and 

19 illustrative examples of methods, processes, strat20 egies, evidentiary standards, and other factors 

21 that group health plans and health insurance 

22 issuers offering group or individual health insur23 ance coverage may use regarding the develop24 ment and application of nonquantitative treat25 ment limitations to ensure compliance with this 


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1 section, section 712 of the Employee Retirement 

2 Income Security Act of 1974, or section 2799A– 

3 1 of the Public Health Service Act, as applicable, 

4 (and any regulations promulgated pursuant to 

5 such respective section), including— 

6 ‘‘(i) examples of methods of deter7 mining appropriate types of nonquantita8 tive treatment limitations with respect to 

9 both medical and surgical benefits and men10 tal health and substance use disorder bene11 fits, including nonquantitative treatment 

12 limitations pertaining to— 

13 ‘‘(I) medical management stand14 ards based on medical necessity or ap15 propriateness, or whether a treatment 

16 is experimental or investigative; 

17 ‘‘(II) limitations with respect to 

18 prescription drug formulary design; 

19 and 

20 ‘‘(III) use of fail-first or step ther21 apy protocols; 

22 ‘‘(ii) examples of methods of deter23 mining— 

24 ‘‘(I) network admission standards 

25 (such as credentialing); and 


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1 ‘‘(II) factors used in provider re2 imbursement methodologies (such as 

3 service type, geographic market, de4 mand for services, and provider sup5 ply, practice size, training, experience, 

6 and licensure) as such factors apply to 

7 network adequacy; 

8 ‘‘(iii) examples of sources of informa9 tion that may serve as evidentiary stand10 ards for the purposes of making determina11 tions regarding the development and appli12 cation of nonquantitative treatment limita13 tions; 

14 ‘‘(iv) examples of specific factors, and 

15 the evidentiary standards used to evaluate 

16 such factors, used by such plans or issuers 

17 in performing a nonquantitative treatment 

18 limitation analysis; 

19 ‘‘(v) examples of how specific evi20 dentiary standards may be used to deter21 mine whether treatments are considered ex22 perimental or investigative; 

23 ‘‘(vi) examples of how specific evi24 dentiary standards may be applied to each 

25 service category or classification of benefits; 


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1 ‘‘(vii) examples of methods of reaching 

2 appropriate coverage determinations for 

3 new mental health or substance use disorder 

4 treatments, such as evidence-based early 

5 intervention programs for individuals with 

6 a serious mental illness and types of med7 ical management techniques; 

8 ‘‘(viii) examples of methods of reaching 

9 appropriate coverage determinations for 

10 which there is an indirect relationship be11 tween the covered mental health or sub12 stance use disorder benefit and a traditional 

13 covered medical and surgical benefit, such 

14 as residential treatment or hospitalizations 

15 involving voluntary or involuntary commit16 ment; and 

17 ‘‘(ix) additional illustrative examples 

18 of methods, processes, strategies, evidentiary 

19 standards, and other factors for which the 

20 Secretary determines that additional guid21 ance is necessary to improve compliance 

22 with this section, section 712 of the Em23 ployee Retirement Income Security Act of 

24 1974, or section 2799A–1 of the Public 

25 Health Service Act, as applicable. 


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1 ‘‘(D) PUBLIC COMMENT.—Prior to issuing 

2 any final guidance under this paragraph, the 

3 Secretary shall provide a public comment period 

4 of not less than 60 days during which any mem5 ber of the public may provide comments on a 

6 draft of the guidance. 

7 ‘‘(8) COMPLIANCE REQUIREMENTS.— 

8 ‘‘(A) NONQUANTITATIVE TREATMENT LIMI9 TATION (NQTL) REQUIREMENTS.—Beginning 45 

10 days after the date of enactment of this para11 graph, in the case of a group health plan that 

12 provides both medical and surgical benefits and 

13 mental health or substance use disorder benefits 

14 and that imposes nonquantitative treatment lim15 itations (referred to in this section as ‘NQTL’) 

16 on mental health or substance use disorder bene17 fits, the plan shall perform comparative analyses 

18 of the design and application of NQTLs in ac19 cordance with subparagraph (B), and make 

20 available to the applicable State authority (or, 

21 as applicable, the Secretary), upon request, the 

22 following information: 

23 ‘‘(i) The specific plan terms regarding 

24 the NQTL, that applies to such plan or cov25 erage, and a description of all mental health 


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1 or substance use disorder and medical or 

2 surgical benefits to which it applies in each 

3 respective benefits classification. 

4 ‘‘(ii) The factors used to determine that 

5 the NQTL will apply to mental health or 

6 substance use disorder benefits and medical 

7 or surgical benefits. 

8 ‘‘(iii) The evidentiary standards used 

9 for the factors identified in clause (ii), when 

10 applicable, provided that every factor shall 

11 be defined and any other source or evidence 

12 relied upon to design and apply the NQTL 

13 to mental health or substance use disorder 

14 benefits and medical or surgical benefits. 

15 ‘‘(iv) The comparative analyses dem16 onstrating that the processes, strategies, evi17 dentiary standards, and other factors used 

18 to design the NQTL, as written, and the op19 eration processes and strategies as written 

20 and in operation that are used to apply the 

21 NQTL for mental health or substance use 

22 disorder benefits are comparable to, and are 

23 applied no more stringently than, the proc24 esses, strategies, evidentiary standards, and 

25 other factors used to design the NQTL, as 


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1 written, and the operation processes and 

2 strategies as written and in operation that 

3 are used to apply the NQTL to medical or 

4 surgical benefits. 

5 ‘‘(v) A disclosure of the specific find6 ings and conclusions reached by the plan 

7 that the results of the analyses described in 

8 this subparagraph indicate that the plan is 

9 in compliance with this section. 

10 ‘‘(B) SECRETARY REQUEST PROCESS.— 

11 ‘‘(i) SUBMISSION UPON REQUEST.— 

12 The Secretary shall request that a group 

13 health plan submit the comparative anal14 yses described in subparagraph (A) for 

15 plans that involve potential violations of 

16 this section or complaints regarding non17 compliance with this section that concern 

18 NQTLs and any other instances in which 

19 the Secretary determines appropriate. The 

20 Secretary shall request not fewer than 20 

21 such analyses per year. 

22 ‘‘(ii) ADDITIONAL INFORMATION.—In 

23 instances in which the Secretary has con24 cluded that the plan has not submitted suf25 ficient information for the Secretary to reVerDate Sep 11 2014 18:13 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00073 Fmt 6652 Sfmt 6203 E:\BILLS\H7539.RH H7539

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1 view the comparative analyses described in 

2 subparagraph (A), as requested under clause 

3 (i), the Secretary shall specify to the plan 

4 the information the plan or coverage must 

5 submit to be responsive to the request under 

6 clause (i) for the Secretary to review the 

7 comparative analyses described in subpara8 graph(A) for compliance with this section. 

9 Nothing in this paragraph shall require the 

10 Secretary to conclude that a plan is in com11 pliance with this section solely based upon 

12 the inspection of the comparative analyses 

13 described in subparagraph (A), as requested 

14 under clause (i). 

15 ‘‘(iii) REQUIRED ACTION.— 

16 ‘‘(I) IN GENERAL.—In instances 

17 in which the Secretary has reviewed 

18 the comparative analyses described in 

19 subparagraph (A), as requested under 

20 clause (i), and determined that the 

21 plan is not in compliance with this 

22 section, the plan— 

23 ‘‘(aa) shall specify to the Sec24 retary the actions the plan will 

25 take to be in compliance with this 


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1 section and provide to the Sec2 retary comparative analyses de3 scribed in subparagraph (A) that 

4 demonstrate compliance with this 

5 section not later than 45 days 

6 after the initial determination by 

7 the Secretary that the plan is not 

8 in compliance; and 

9 ‘‘(bb) following the 45-day 

10 corrective action period under 

11 item (aa), if the Secretary deter12 mines that the plan still is not in 

13 compliance with this section, not 

14 later than 7 days after such deter15 mination, shall notify all individ16 uals enrolled in the plan or cov17 erage that the plan has been deter18 mined to be not in compliance 

19 with this section. 

20 ‘‘(II) EXEMPTION FROM DISCLO21 SURE.—Documents or communications 

22 produced in connection with the Sec23 retary’s recommendations to the plan 

24 or coverage shall not be subject to disVerDate Sep 11 2014 18:13 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00075 Fmt 6652 Sfmt 6203 E:\BILLS\H7539.RH H7539

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1 closure pursuant to section 552 of title 

2 5, United States Code. 

3 ‘‘(iv) REPORT.—Not later than 1 year 

4 after the date of enactment of this para5 graph, and not later than October 1 of each 

6 year thereafter, the Secretary shall submit 

7 to Congress, and make publicly available, a 

8 report that contains— 

9 ‘‘(I) a summary of the compara10 tive analyses requested under clause 

11 (i), including the identity of each plan 

12 that is determined to be not in compli13 ance after the final determination by 

14 the Secretary described in clause 

15 (iii)(I)(bb); 

16 ‘‘(II) the Secretary’s conclusions 

17 as to whether each plan submitted suf18 ficient information for the Secretary to 

19 review the comparative analyses re20 quested under clause (i) for compliance 

21 with this section; 

22 ‘‘(III) for each plan that did sub23 mit sufficient information for the Sec24 retary to review the comparative anal25 yses requested under clause (i), the SecVerDate Sep 11 2014 18:13 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00076 Fmt 6652 Sfmt 6203 E:\BILLS\H7539.RH H7539

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1 retary’s conclusions as to whether and 

2 why the plan or coverage is in compli3 ance with the requirements under this 

4 section; 

5 ‘‘(IV) the Secretary’s specifica6 tions described in clause (ii) for each 

7 plan that the Secretary determined did 

8 not submit sufficient information for 

9 the Secretary to review the compara10 tive analyses requested under clause (i) 

11 for compliance with this section; and 

12 ‘‘(V) the Secretary’s specifications 

13 described in clause (iii) of the actions 

14 each plan hat the Secretary determined 

15 is not in compliance with this section 

16 must take to be in compliance with 

17 this section, including the reason why 

18 the Secretary determined the plan or 

19 coverage is not in compliance. 

20 ‘‘(C) COMPLIANCE PROGRAM GUIDANCE

21 DOCUMENT UPDATE PROCESS.— 

22 ‘‘(i) IN GENERAL.—The Secretary shall 

23 include instances of noncompliance that the 

24 Secretary discovers upon reviewing the com25 parative analyses requested under subparaVerDate Sep 11 2014 18:13 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00077 Fmt 6652 Sfmt 6203 E:\BILLS\H7539.RH H7539

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1 graph (B)(i) in the compliance program 

2 guidance document described in paragraph 

3 (6), as it is updated every 2 years, except 

4 that such instances shall not disclose any 

5 protected health information or individually 

6 identifiable information. 

7 ‘‘(ii) GUIDANCE AND REGULATIONS.— 

8 Not later than 18 months after the date of 

9 enactment of this paragraph, the Secretary 

10 shall finalize any draft or interim guidance 

11 and regulations relating to mental health 

12 parity under this section. Such draft guid13 ance shall include guidance to clarify the 

14 process and timeline for current and poten15 tial participants and beneficiaries (and au16 thorized representatives and health care 

17 providers of such participants and bene18 ficiaries) with respect to plans to file com19 plaints of such plans or issuers being in 

20 violation of this section, including guidance, 

21 by plan type, on the relevant State, re22 gional, or national office with which such 

23 complaints should be filed. 

24 ‘‘(iii) STATE.—The Secretary shall 

25 share information on findings of compliance 


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1 and noncompliance discovered upon review2 ing the comparative analyses requested 

3 under subparagraph (B)(i) with the State 

4 where the group health plan is located or 

5 the State where the health insurance issuer 

6 is licensed to do business for coverage offered 

7 by a health insurance issuer in the group 

8 market, in accordance with paragraph 

9 (6)(B)(iii)(II).’’. 

10 (d) IMPLEMENTATION.—The Secretary of Health and 

11 Human Services, the Secretary of Labor, and the Secretary 

12 of the Treasury may implement the paragraph (8) of section 

13 2799A–1(a) of the Public Health Service Act, added by sub14 section (a), the paragraph (8) of section 712(a) of the Em15 ployee Retirement Income Security Act of 1974, as addedby 

16 subsection (b), and the paragraph (8) of section 9812(a) of 

17 the Internal Revenue Code of 1986, as added by subsection 

18 (c), by program instruction, guidance, or otherwise. 


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Union Calendar No. 575 

116TH CONGRESS 

2D SESSION H. R. 7539 

[Report No. 116–692, Part I] 

A BILL 

To strengthen parity in mental health and 

substance use disorder benefits. 

DECEMBER 24, 2020 

Reported from the Committee on Energy and Commerce 

D

with an amendment 

ECEMBER 24, 2020 

Committees on Ways and Means and Education and 

to be printed Whole House on the State of the Union and ordered Labor discharged; committed to the Committee of the 


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