I 

116TH CONGRESS 

2D SESSION H. R. 7539 

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 

A BILL 

To strengthen parity in mental health and substance use 

disorder benefits. 

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.— 


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

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

3 amended by adding at the end the following new 

4 part: 

5 ‘‘PART D—ADDITIONAL COVERAGE PROVISIONS 

6 ‘‘SEC. 2799A–1. PARITY IN MENTAL HEALTH AND SUB7 STANCE USE DISORDER BENEFITS. 

8 ‘‘(a) IN GENERAL.— 

9 ‘‘(1) AGGREGATE LIFETIME LIMITS.—In the 

10 case of a group health plan or a health insurance 

11 issuer offering group or individual health insurance 

12 coverage that provides both medical and surgical 

13 benefits and mental health or substance use disorder 

14 benefits— 

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

16 coverage does not include an aggregate lifetime 

17 limit on substantially all medical and surgical 

18 benefits, the plan or coverage may not impose 

19 any aggregate lifetime limit on mental health or 

20 substance use disorder benefits. 

21 ‘‘(B) LIFETIME LIMIT.—If the plan or cov22 erage includes an aggregate lifetime limit on 

23 substantially all medical and surgical benefits 

24 (in this paragraph referred to as the ‘applicable 


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1 lifetime limit’), the plan or coverage shall ei2 ther— 

3 ‘‘(i) apply the applicable lifetime limit 

4 both to the medical and surgical benefits to 

5 which it otherwise would apply and to 

6 mental health and substance use disorder 

7 benefits and not distinguish in the applica8 tion of such limit between such medical 

9 and surgical benefits and mental health 

10 and substance use disorder benefits; or 

11 ‘‘(ii) not include any aggregate life12 time limit on mental health or substance 

13 use disorder benefits that is less than the 

14 applicable lifetime limit. 

15 ‘‘(C) RULE IN CASE OF DIFFERENT LIM16 ITS.—In the case of a plan or coverage that is 

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

18 that includes no or different aggregate lifetime 

19 limits on different categories of medical and 

20 surgical benefits, the Secretary shall establish 

21 rules under which subparagraph (B) is applied 

22 to such plan or coverage with respect to mental 

23 health and substance use disorder benefits by 

24 substituting for the applicable lifetime limit an 

25 average aggregate lifetime limit that is comVerDate Sep 11 2014 18:49 Jul 29, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H7539.IH H7539

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1 puted taking into account the weighted average 

2 of the aggregate lifetime limits applicable to 

3 such categories. 

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

5 health plan or a health insurance issuer offering 

6 group or individual health insurance coverage that 

7 provides both medical and surgical benefits and 

8 mental health or substance use disorder benefits— 

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

10 coverage does not include an annual limit on 

11 substantially all medical and surgical benefits, 

12 the plan or coverage may not impose any an13 nual limit on mental health or substance use 

14 disorder benefits. 

15 ‘‘(B) ANNUAL LIMIT.—If the plan or cov16 erage includes an annual limit on substantially 

17 all medical and surgical benefits (in this para18 graph referred to as the ‘applicable annual 

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

20 ‘‘(i) apply the applicable annual limit 

21 both to medical and surgical benefits to 

22 which it otherwise would apply and to 

23 mental health and substance use disorder 

24 benefits and not distinguish in the applica25 tion of such limit between such medical 


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1 and surgical benefits and mental health 

2 and substance use disorder benefits; or 

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

4 mental health or substance use disorder 

5 benefits that is less than the applicable an6 nual limit. 

7 ‘‘(C) RULE IN CASE OF DIFFERENT LIM8 ITS.—In the case of a plan or coverage that is 

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

10 that includes no or different annual limits on 

11 different categories of medical and surgical ben12 efits, the Secretary shall establish rules under 

13 which subparagraph (B) is applied to such plan 

14 or coverage with respect to mental health and 

15 substance use disorder benefits by substituting 

16 for the applicable annual limit an average an17 nual limit that is computed taking into account 

18 the weighted average of the annual limits appli19 cable to such categories. 

20 ‘‘(3) FINANCIAL REQUIREMENTS AND TREAT21 MENT LIMITATIONS.— 

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

23 health plan or a health insurance issuer offering 

24 group or individual health insurance coverage 

25 that provides both medical and surgical benefits 


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1 and mental health or substance use disorder 

2 benefits, such plan or coverage shall ensure 

3 that— 

4 ‘‘(i) the financial requirements appli5 cable to such mental health or substance 

6 use disorder benefits are no more restric7 tive than the predominant financial re8 quirements applied to substantially all 

9 medical and surgical benefits covered by 

10 the plan (or coverage), and there are no 

11 separate cost sharing requirements that 

12 are applicable only with respect to mental 

13 health or substance use disorder benefits; 

14 and 

15 ‘‘(ii) the treatment limitations applica16 ble to such mental health or substance use 

17 disorder benefits are no more restrictive 

18 than the predominant treatment limita19 tions applied to substantially all medical 

20 and surgical benefits covered by the plan 

21 (or coverage) and there are no separate 

22 treatment limitations that are applicable 

23 only with respect to mental health or sub24 stance use disorder benefits. 

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


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1 ‘‘(i) FINANCIAL REQUIREMENT.—The 

2 term ‘financial requirement’ includes 

3 deductibles, copayments, coinsurance, and 

4 out-of-pocket expenses, but excludes an ag5 gregate lifetime limit and an annual limit 

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

7 ‘‘(ii) PREDOMINANT.—A financial re8 quirement or treatment limit is considered 

9 to be predominant if it is the most com10 mon or frequent of such type of limit or 

11 requirement. 

12 ‘‘(iii) TREATMENT LIMITATION.—The 

13 term ‘treatment limitation’ includes limits 

14 on the frequency of treatment, number of 

15 visits, days of coverage, or other similar 

16 limits on the scope or duration of treat17 ment. 

18 ‘‘(4) AVAILABILITY OF PLAN INFORMATION.— 

19 The criteria for medical necessity determinations 

20 made under the plan with respect to mental health 

21 or substance use disorder benefits (or the health in22 surance coverage offered in connection with the plan 

23 with respect to such benefits) shall be made avail24 able by the plan administrator (or the health insur25 ance issuer offering such coverage) in accordance 


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1 with regulations to any current or potential partici2 pant, beneficiary, or contracting provider upon re3 quest. The reason for any denial under the plan (or 

4 coverage) of reimbursement or payment for services 

5 with respect to mental health or substance use dis6 order benefits in the case of any participant or bene7 ficiary shall, on request or as otherwise required, be 

8 made available by the plan administrator (or the 

9 health insurance issuer offering such coverage) to 

10 the participant or beneficiary in accordance with 

11 regulations. 

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

13 case of a plan or coverage that provides both med14 ical and surgical benefits and mental health or sub15 stance use disorder benefits, if the plan or coverage 

16 provides coverage for medical or surgical benefits 

17 provided by out-of-network providers, the plan or 

18 coverage shall provide coverage for mental health or 

19 substance use disorder benefits provided by out-of20 network providers in a manner that is consistent 

21 with the requirements of this section. 

22 ‘‘(6) COMPLIANCE PROGRAM GUIDANCE DOCU23 MENT.— 

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

25 months after the date of enactment of the 


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1 Helping Families in Mental Health Crisis Re2 form Act of 2016, the Secretary, the Secretary 

3 of Labor, and the Secretary of the Treasury, in 

4 consultation with the Inspector General of the 

5 Department of Health and Human Services, the 

6 Inspector General of the Department of Labor, 

7 and the Inspector General of the Department of 

8 the Treasury, shall issue a compliance program 

9 guidance document to help improve compliance 

10 with this section, section 712 of the Employee 

11 Retirement Income Security Act of 1974, and 

12 section 9812 of the Internal Revenue Code of 

13 1986, as applicable. In carrying out this para14 graph, the Secretaries may take into consider15 ation the 2016 publication of the Department 

16 of Health and Human Services and the Depart17 ment of Labor, entitled ‘Warning Signs - Plan 

18 or Policy Non-Quantitative Treatment Limita19 tions (NQTLs) that Require Additional Anal20 ysis to Determine Mental Health Parity Com21 pliance’. 

22 ‘‘(B) EXAMPLES ILLUSTRATING COMPLI23 ANCE AND NONCOMPLIANCE.— 

24 ‘‘(i) IN GENERAL.—The compliance 

25 program guidance document required 


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1 under this paragraph shall provide illus2 trative, de-identified examples (that do not 

3 disclose any protected health information 

4 or individually identifiable information) of 

5 previous findings of compliance and non6 compliance with this section, section 712 of 

7 the Employee Retirement Income Security 

8 Act of 1974, or section 9812 of the Inter9 nal Revenue Code of 1986, as applicable, 

10 based on investigations of violations of 

11 such sections, including— 

12 ‘‘(I) examples illustrating re13 quirements for information disclosures 

14 and nonquantitative treatment limita15 tions; and 

16 ‘‘(II) descriptions of the viola17 tions uncovered during the course of 

18 such investigations. 

19 ‘‘(ii) NONQUANTITATIVE TREATMENT

20 LIMITATIONS.—To the extent that any ex21 ample described in clause (i) involves a 

22 finding of compliance or noncompliance 

23 with regard to any requirement for non24 quantitative treatment limitations, the ex25 ample shall provide sufficient detail to fully 


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1 explain such finding, including a full de2 scription of the criteria involved for ap3 proving medical and surgical benefits and 

4 the criteria involved for approving mental 

5 health and substance use disorder benefits. 

6 ‘‘(iii) ACCESS TO ADDITIONAL INFOR7 MATION REGARDING COMPLIANCE.—In de8 veloping and issuing the compliance pro9 gram guidance document required under 

10 this paragraph, the Secretaries specified in 

11 subparagraph (A)— 

12 ‘‘(I) shall enter into interagency 

13 agreements with the Inspector Gen14 eral of the Department of Health and 

15 Human Services, the Inspector Gen16 eral of the Department of Labor, and 

17 the Inspector General of the Depart18 ment of the Treasury to share find19 ings of compliance and noncompliance 

20 with this section, section 712 of the 

21 Employee Retirement Income Security 

22 Act of 1974, or section 9812 of the 

23 Internal Revenue Code of 1986, as 

24 applicable; and 


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1 ‘‘(II) shall seek to enter into an 

2 agreement with a State to share infor3 mation on findings of compliance and 

4 noncompliance with this section, sec5 tion 712 of the Employee Retirement 

6 Income Security Act of 1974, or sec7 tion 9812 of the Internal Revenue 

8 Code of 1986, as applicable. 

9 ‘‘(C) RECOMMENDATIONS.—The compli10 ance program guidance document shall include 

11 recommendations to advance compliance with 

12 this section, section 712 of the Employee Re13 tirement Income Security Act of 1974, or sec14 tion 9812 of the Internal Revenue Code of 

15 1986, as applicable, and encourage the develop16 ment and use of internal controls to monitor 

17 adherence to applicable statutes, regulations, 

18 and program requirements. Such internal con19 trols may include illustrative examples of non20 quantitative treatment limitations on mental 

21 health and substance use disorder benefits, 

22 which may fail to comply with this section, sec23 tion 712 of the Employee Retirement Income 

24 Security Act of 1974, or section 9812 of the In25 ternal Revenue Code of 1986, as applicable, in 


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1 relation to nonquantitative treatment limita2 tions on medical and surgical benefits. 

3 ‘‘(D) UPDATING THE COMPLIANCE PRO4 GRAM GUIDANCE DOCUMENT.—The Secretary, 

5 the Secretary of Labor, and the Secretary of 

6 the Treasury, in consultation with the Inspector 

7 General of the Department of Health and 

8 Human Services, the Inspector General of the 

9 Department of Labor, and the Inspector Gen10 eral of the Department of the Treasury, shall 

11 update the compliance program guidance docu12 ment every 2 years to include illustrative, de13 identified examples (that do not disclose any 

14 protected health information or individually 

15 identifiable information) of previous findings of 

16 compliance and noncompliance with this sec17 tion, section 712 of the Employee Retirement 

18 Income Security Act of 1974, or section 9812 

19 of the Internal Revenue Code of 1986, as appli20 cable. 

21 ‘‘(7) ADDITIONAL GUIDANCE.— 

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

23 months after the date of enactment of the 

24 Helping Families in Mental Health Crisis Re25 form Act of 2016, the Secretary, the Secretary 


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1 of Labor, and the Secretary of the Treasury 

2 shall issue guidance to group health plans and 

3 health insurance issuers offering group or indi4 vidual health insurance coverage to assist such 

5 plans and issuers in satisfying the requirements 

6 of this section, section 712 of the Employee Re7 tirement Income Security Act of 1974, or sec8 tion 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 712 of the Employee Retirement 

21 Income Security Act of 1974, or section 

22 9812 of the Internal Revenue Code of 

23 1986, as applicable (and any regulations 

24 promulgated pursuant to such sections, as 

25 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 re14 quired to disclose to participants, bene15 ficiaries, contracting providers, or author16 ized representatives to ensure compliance 

17 with this section, section 712 of the Em18 ployee Retirement Income Security Act of 

19 1974, or section 9812 of the Internal Rev20 enue Code of 1986, as applicable, compli21 ance with any regulation issued pursuant 

22 to such respective section, or compliance 

23 with any other applicable law or regula24 tion. Such guidance shall include informaVerDate Sep 11 2014 18:49 Jul 29, 2020 Jkt 099200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\H7539.IH H7539

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1 tion that is comparative in nature with re2 spect 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, 

8 evidentiary standards, and other fac9 tors used to apply the limitations de10 scribed in subclause (I); and 

11 ‘‘(III) the application of the limi12 tations described in subclause (I) to 

13 ensure that such limitations are ap14 plied in parity with respect to both 

15 medical and surgical benefits and 

16 mental health and substance use dis17 order benefits. 

18 ‘‘(C) NONQUANTITATIVE TREATMENT LIM19 ITATIONS.—The guidance issued under this 

20 paragraph shall include clarifying information 

21 and illustrative examples of methods, processes, 

22 strategies, evidentiary standards, and other fac23 tors that group health plans and health insur24 ance issuers offering group or individual health 

25 insurance coverage may use regarding the deVerDate Sep 11 2014 18:49 Jul 29, 2020 Jkt 099200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\H7539.IH H7539

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1 velopment and application of nonquantitative 

2 treatment limitations to ensure compliance with 

3 this section, section 712 of the Employee Re4 tirement Income Security Act of 1974, or sec5 tion 9812 of the Internal Revenue Code of 

6 1986, as applicable (and any regulations pro7 mulgated pursuant to such respective section), 

8 including— 

9 ‘‘(i) examples of methods of deter10 mining appropriate types of nonquantita11 tive treatment limitations with respect to 

12 both medical and surgical benefits and 

13 mental health and substance use disorder 

14 benefits, including nonquantitative treat15 ment limitations pertaining to— 

16 ‘‘(I) medical management stand17 ards based on medical necessity or ap18 propriateness, or whether a treatment 

19 is experimental or investigative; 

20 ‘‘(II) limitations with respect to 

21 prescription drug formulary design; 

22 and 

23 ‘‘(III) use of fail-first or step 

24 therapy protocols; 


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1 ‘‘(ii) examples of methods of deter2 mining— 

3 ‘‘(I) network admission standards 

4 (such as credentialing); and 

5 ‘‘(II) factors used in provider re6 imbursement methodologies (such as 

7 service type, geographic market, de8 mand for services, and provider sup9 ply, practice size, training, experience, 

10 and licensure) as such factors apply to 

11 network adequacy; 

12 ‘‘(iii) examples of sources of informa13 tion that may serve as evidentiary stand14 ards for the purposes of making deter15 minations regarding the development and 

16 application of nonquantitative treatment 

17 limitations; 

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

19 the evidentiary standards used to evaluate 

20 such factors, used by such plans or issuers 

21 in performing a nonquantitative treatment 

22 limitation analysis; 

23 ‘‘(v) examples of how specific evi24 dentiary standards may be used to deterVerDate Sep 11 2014 18:49 Jul 29, 2020 Jkt 099200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 E:\BILLS\H7539.IH H7539

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1 mine whether treatments are considered 

2 experimental or investigative; 

3 ‘‘(vi) examples of how specific evi4 dentiary standards may be applied to each 

5 service category or classification of bene6 fits; 

7 ‘‘(vii) examples of methods of reach8 ing appropriate coverage determinations 

9 for new mental health or substance use 

10 disorder treatments, such as evidence11 based early intervention programs for indi12 viduals with a serious mental illness and 

13 types of medical management techniques; 

14 ‘‘(viii) examples of methods of reach15 ing appropriate coverage determinations 

16 for which there is an indirect relationship 

17 between the covered mental health or sub18 stance use disorder benefit and a tradi19 tional covered medical and surgical benefit, 

20 such as residential treatment or hos21 pitalizations involving voluntary or involun22 tary commitment; and 

23 ‘‘(ix) additional illustrative examples 

24 of methods, processes, strategies, evi25 dentiary standards, and other factors for 


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1 which the Secretary determines that addi2 tional guidance is necessary to improve 

3 compliance with this section, section 712 of 

4 the Employee Retirement Income Security 

5 Act of 1974, or section 9812 of the Inter6 nal Revenue Code of 1986, as applicable. 

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

8 any final guidance under this paragraph, the 

9 Secretary shall provide a public comment period 

10 of not less than 60 days during which any 

11 member of the public may provide comments on 

12 a draft of the guidance. 

13 ‘‘(8) COMPLIANCE REQUIREMENTS.— 

14 ‘‘(A) NONQUANTITATIVE TREATMENT LIM15 ITATION (NQTL) REQUIREMENTS.—Beginning 

16 45 days after the date of enactment of this 

17 paragraph, in the case of a group health plan 

18 or a health insurance issuer offering group or 

19 individual health insurance coverage that pro20 vides both medical and surgical benefits and 

21 mental health or substance use disorder benefits 

22 and that imposes nonquantitative treatment 

23 limitations (referred to in this section as 

24 ‘NQTL’) on mental health or substance use dis25 order benefits, the plan or issuer offering health 


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1 insurance coverage shall perform comparative 

2 analyses of the design and application of 

3 NQTLs in accordance with subparagraph (B), 

4 and make available to the applicable State au5 thority (or, as applicable, the Secretary), upon 

6 request, the following information: 

7 ‘‘(i) The specific plan or coverage 

8 terms regarding the NQTL, that applies to 

9 such plan or coverage, and a description of 

10 all mental health or substance use disorder 

11 and medical or surgical benefits to which it 

12 applies in each respective benefits classi13 fication. 

14 ‘‘(ii) The factors used to determine 

15 that the NQTL will apply to mental health 

16 or substance use disorder benefits and 

17 medical or surgical benefits. 

18 ‘‘(iii) The evidentiary standards used 

19 for the factors identified in clause (ii), 

20 when applicable, provided that every factor 

21 shall be defined and any other source or 

22 evidence relied upon to design and apply 

23 the NQTL to mental health or substance 

24 use disorder benefits and medical or sur25 gical benefits. 


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1 ‘‘(iv) The comparative analyses dem2 onstrating that the processes, strategies, 

3 evidentiary standards, and other factors 

4 used to design the NQTL, as written, and 

5 the operation processes and strategies as 

6 written and in operation that are used to 

7 apply the NQTL for mental health or sub8 stance use disorder benefits are com9 parable to, and are applied no more strin10 gently than, the processes, strategies, evi11 dentiary standards, and other factors used 

12 to design the NQTL, as written, and the 

13 operation processes and strategies as writ14 ten and in operation that are used to apply 

15 the NQTL to medical or surgical benefits. 

16 ‘‘(v) A disclosure of the specific find17 ings and conclusions reached by the plan 

18 or coverage that the results of the analyses 

19 described in this subparagraph indicate 

20 that the plan or coverage is in compliance 

21 with this section. 

22 ‘‘(B) SECRETARY REQUEST PROCESS.— 

23 ‘‘(i) SUBMISSION UPON REQUEST.— 

24 The Secretary shall request that a group 

25 health plan or a health insurance issuer ofVerDate Sep 11 2014 18:49 Jul 29, 2020 Jkt 099200 PO 00000 Frm 00022 Fmt 6652 Sfmt 6201 E:\BILLS\H7539.IH H7539

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1 fering group or individual health insurance 

2 coverage submit the comparative analyses 

3 described in subparagraph (A) for plans 

4 that involve potential violations of this sec5 tion or complaints regarding noncompli6 ance with this section that concern NQTLs 

7 and any other instances in which the Sec8 retary determines appropriate. The Sec9 retary shall request not fewer than 20 such 

10 analyses per year. 

11 ‘‘(ii) ADDITIONAL INFORMATION.—In 

12 instances in which the Secretary has con13 cluded that the plan or coverage has not 

14 submitted sufficient information for the 

15 Secretary to review the comparative anal16 yses described in subparagraph (A), as re17 quested under clause (i), the Secretary 

18 shall specify to the plan or coverage the in19 formation the plan or coverage must sub20 mit to be responsive to the request under 

21 clause (i) for the Secretary to review the 

22 comparative analyses described in subpara23 graph (A) for compliance with this section. 

24 Nothing in this paragraph shall require the 

25 Secretary to conclude that a plan is in 


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1 compliance with this section solely based 

2 upon the inspection of the comparative 

3 analyses described in subparagraph (A), as 

4 requested under clause (i). 

5 ‘‘(iii) REQUIRED ACTION.— 

6 ‘‘(I) IN GENERAL.—In instances 

7 in which the Secretary has reviewed 

8 the comparative analyses described in 

9 subparagraph (A), as requested under 

10 clause (i), and determined that the 

11 plan or coverage is not in compliance 

12 with this section, the plan or cov13 erage— 

14 ‘‘(aa) shall specify to the 

15 Secretary the actions the plan or 

16 coverage will take to be in com17 pliance with this section and pro18 vide to the Secretary comparative 

19 analyses described in subpara20 graph (A) that demonstrate com21 pliance with this section not later 

22 than 45 days after the initial de23 termination by the Secretary that 

24 the plan or coverage is not in 

25 compliance; and 


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1 ‘‘(bb) following the 45-day 

2 corrective action period under 

3 item (aa), if the Secretary deter4 mines that the plan or coverage 

5 still is not in compliance with 

6 this section, not later than 7 

7 days after such determination, 

8 shall notify all individuals en9 rolled in the plan or coverage 

10 that the plan or coverage has 

11 been determined to be not in 

12 compliance with this section. 

13 ‘‘(II) EXEMPTION FROM DISCLO14 SURE.—Documents or communica15 tions produced in connection with the 

16 Secretary’s recommendations to the 

17 plan or coverage shall not be subject 

18 to disclosure pursuant to section 552 

19 of title 5, United States Code. 

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

21 after the date of enactment of this para22 graph, and not later than October 1 of 

23 each year thereafter, the Secretary shall 

24 submit to Congress, and make publicly 

25 available, a report that contains— 


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1 ‘‘(I) a summary of the compara2 tive analyses requested under clause 

3 (i), including the identity of each plan 

4 or coverage that is determined to be 

5 not in compliance after the final de6 termination by the Secretary de7 scribed in clause (iii)(I)(bb); 

8 ‘‘(II) the Secretary’s conclusions 

9 as to whether each plan or coverage 

10 submitted sufficient information for 

11 the Secretary to review the compara12 tive analyses requested under clause 

13 (i) for compliance with this section; 

14 ‘‘(III) for each plan or coverage 

15 that did submit sufficient information 

16 for the Secretary to review the com17 parative analyses requested under 

18 clause (i), the Secretary’s conclusions 

19 as to whether and why the plan or 

20 coverage is in compliance with the re21 quirements under this section; 

22 ‘‘(IV) the Secretary’s specifica23 tions described in clause (ii) for each 

24 plan or coverage that the Secretary 

25 determined did not submit sufficient 


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1 information for the Secretary to re2 view the comparative analyses re3 quested under clause (i) for compli4 ance with this section; and 

5 ‘‘(V) the Secretary’s specifica6 tions described in clause (iii) of the 

7 actions each plan or coverage that the 

8 Secretary determined is not in compli9 ance with this section must take to be 

10 in compliance with this section, in11 cluding the reason why the Secretary 

12 determined the plan or coverage is not 

13 in compliance. 

14 ‘‘(C) COMPLIANCE PROGRAM GUIDANCE

15 DOCUMENT UPDATE PROCESS.— 

16 ‘‘(i) IN GENERAL.—The Secretary 

17 shall include instances of noncompliance 

18 that the Secretary discovers upon review19 ing the comparative analyses requested 

20 under subparagraph (B)(i) in the compli21 ance program guidance document de22 scribed in paragraph (6), as it is updated 

23 every 2 years, except that such instances 

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1 formation or individually identifiable infor2 mation. 

3 ‘‘(ii) GUIDANCE AND REGULATIONS.— 

4 Not later than 18 months after the date of 

5 enactment of this paragraph, the Secretary 

6 shall finalize any draft or interim guidance 

7 and regulations relating to mental health 

8 parity under this section. Such draft guid9 ance shall include guidance to clarify the 

10 process and timeline for current and poten11 tial participants and beneficiaries (and au12 thorized representatives and health care 

13 providers of such participants and bene14 ficiaries) with respect to plans to file com15 plaints of such plans or issuers being in 

16 violation of this section, including guid17 ance, by plan type, on the relevant State, 

18 regional, or national office with which such 

19 complaints should be filed. 

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

21 share information on findings of compli22 ance and noncompliance discovered upon 

23 reviewing the comparative analyses re24 quested under subparagraph (B)(i) with 

25 the State where the group health plan is 


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1 located or the State where the health in2 surance issuer is licensed to do business 

3 for coverage offered by a health insurance 

4 issuer in the group market, in accordance 

5 with paragraph (6)(B)(iii)(II). 

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

7 be construed— 

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

9 health insurance issuer offering group or individual 

10 health insurance coverage to provide any mental 

11 health or substance use disorder benefits; or 

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

13 health insurance issuer offering group or individual 

14 health insurance coverage that provides mental 

15 health or substance use disorder benefits, as affect16 ing the terms and conditions of the plan or coverage 

17 relating to such benefits under the plan or coverage, 

18 except as provided in subsection (a). 

19 ‘‘(c) EXEMPTIONS.— 

20 ‘‘(1) SMALL EMPLOYER EXEMPTION.—This sec21 tion shall not apply to any group health plan and a 

22 health insurance issuer offering group or individual 

23 health insurance coverage for any plan year of a 

24 small employer (as defined in section 2791(e)(4), ex25 cept that for purposes of this paragraph such term 


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1 shall include employers with 1 employee in the case 

2 of an employer residing in a State that permits 

3 small groups to include a single individual). 

4 ‘‘(2) COST EXEMPTION.— 

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

6 group health plan or a health insurance issuer 

7 offering group or individual health insurance 

8 coverage, if the application of this section to 

9 such plan (or coverage) results in an increase 

10 for the plan year involved of the actual total 

11 costs of coverage with respect to medical and 

12 surgical benefits and mental health and sub13 stance use disorder benefits under the plan (as 

14 determined and certified under subparagraph 

15 (C)) by an amount that exceeds the applicable 

16 percentage described in subparagraph (B) of 

17 the actual total plan costs, the provisions of this 

18 section shall not apply to such plan (or cov19 erage) during the following plan year, and such 

20 exemption shall apply to the plan (or coverage) 

21 for 1 plan year. An employer may elect to con22 tinue to apply mental health and substance use 

23 disorder parity pursuant to this section with re24 spect to the group health plan (or coverage) in25 volved regardless of any increase in total costs. 


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1 ‘‘(B) APPLICABLE PERCENTAGE.—With re2 spect to a plan (or coverage), the applicable 

3 percentage described in this subparagraph shall 

4 be— 

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

6 plan year in which this section is applied; 

7 and 

8 ‘‘(ii) 1 percent in the case of each 

9 subsequent plan year. 

10 ‘‘(C) DETERMINATIONS BY ACTUARIES.— 

11 Determinations as to increases in actual costs 

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

13 section shall be made and certified by a quali14 fied and licensed actuary who is a member in 

15 good standing of the American Academy of Ac16 tuaries. All such determinations shall be in a 

17 written report prepared by the actuary. The re18 port, and all underlying documentation relied 

19 upon by the actuary, shall be maintained by the 

20 group health plan or health insurance issuer for 

21 a period of 6 years following the notification 

22 made under subparagraph (E). 

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

24 group health plan (or a health insurance issuer 

25 offering coverage in connection with a group 


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1 health plan) seeks an exemption under this 

2 paragraph, determinations under subparagraph 

3 (A) shall be made after such plan (or coverage) 

4 has complied with this section for the first 6 

5 months of the plan year involved. 

6 ‘‘(E) NOTIFICATION.— 

7 ‘‘(i) IN GENERAL.—A group health 

8 plan (or a health insurance issuer offering 

9 coverage in connection with a group health 

10 plan) that, based upon a certification de11 scribed under subparagraph (C), qualifies 

12 for an exemption under this paragraph, 

13 and elects to implement the exemption, 

14 shall promptly notify the Secretary, the ap15 propriate State agencies, and participants 

16 and beneficiaries in the plan of such elec17 tion. 

18 ‘‘(ii) REQUIREMENT.—A notification 

19 to the Secretary under clause (i) shall in20 clude— 

21 ‘‘(I) a description of the number 

22 of covered lives under the plan (or 

23 coverage) involved at the time of the 

24 notification, and as applicable, at the 

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1 exemption under this paragraph by 

2 such plan (or coverage); 

3 ‘‘(II) for both the plan year upon 

4 which a cost exemption is sought and 

5 the year prior, a description of the ac6 tual total costs of coverage with re7 spect to medical and surgical benefits 

8 and mental health and substance use 

9 disorder benefits under the plan; and 

10 ‘‘(III) for both the plan year 

11 upon which a cost exemption is sought 

12 and the year prior, the actual total 

13 costs of coverage with respect to men14 tal health and substance use disorder 

15 benefits under the plan. 

16 ‘‘(iii) CONFIDENTIALITY.—A notifica17 tion to the Secretary under clause (i) shall 

18 be confidential. The Secretary shall make 

19 available, upon request and on not more 

20 than an annual basis, an anonymous 

21 itemization of such notifications, that in22 cludes— 

23 ‘‘(I) a breakdown of States by 

24 the size and type of employers submit25 ting such notification; and 


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1 ‘‘(II) a summary of the data re2 ceived under clause (ii). 

3 ‘‘(F) AUDITS BY APPROPRIATE AGEN4 CIES.—To determine compliance with this para5 graph, the Secretary may audit the books and 

6 records of a group health plan or health insur7 ance issuer relating to an exemption, including 

8 any actuarial reports prepared pursuant to sub9 paragraph (C), during the 6 year period fol10 lowing the notification of such exemption under 

11 subparagraph (E). A State agency receiving a 

12 notification under subparagraph (E) may also 

13 conduct such an audit with respect to an ex14 emption covered by such notification. 

15 ‘‘(d) SEPARATE APPLICATION TO EACH OPTION OF16 FERED.—In the case of a group health plan that offers 

17 a participant or beneficiary two or more benefit package 

18 options under the plan, the requirements of this section 

19 shall be applied separately with respect to each such op20 tion. 

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

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

23 ‘aggregate lifetime limit’ means, with respect to ben24 efits under a group health plan or health insurance 

25 coverage, a dollar limitation on the total amount 


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1 that may be paid with respect to such benefits under 

2 the plan or health insurance coverage with respect to 

3 an individual or other coverage unit. 

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

5 means, with respect to benefits under a group health 

6 plan or health insurance coverage, a dollar limitation 

7 on the total amount of benefits that may be paid 

8 with respect to such benefits in a 12-month period 

9 under the plan or health insurance coverage with re10 spect to an individual or other coverage unit. 

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

12 term ‘medical or surgical benefits’ means benefits 

13 with respect to medical or surgical services, as de14 fined under the terms of the plan or coverage (as the 

15 case may be), but does not include mental health or 

16 substance use disorder benefits. 

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

18 ‘mental health benefits’ means benefits with respect 

19 to services for mental health conditions, as defined 

20 under the terms of the plan and in accordance with 

21 applicable Federal and State law. 

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

23 The term ‘substance use disorder benefits’ means 

24 benefits with respect to services for substance use 

25 disorders, as defined under the terms of the plan 


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1 and in accordance with applicable Federal and State 

2 law.’’. 

3 (2) SUNSET.—Section 2726 of the Public 

4 Health Service Act (42 U.S.C. 300gg–26) is amend5 ed by adding at the end the following new sub6 section: 

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

8 have no force or effect after the date of the enactment 

9 of the Strengthening Behavioral Health Parity Act.’’. 

10 (b) ERISA.—Section 712(a) of the Employee Retire11 ment Income Security Act of 1974 (1185a(a)) is amended 

12 by adding at the end the following new paragraphs: 

13 ‘‘(6) COMPLIANCE PROGRAM GUIDANCE DOCU14 MENT.— 

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

16 months after the date of enactment of the 

17 Helping Families in Mental Health Crisis Re18 form Act of 2016, the Secretary, the Secretary 

19 of Health and Human Services, and the Sec20 retary of the Treasury, in consultation with the 

21 Inspector General of the Department of Health 

22 and Human Services, the Inspector General of 

23 the Department of Labor, and the Inspector 

24 General of the Department of the Treasury, 

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1 ument to help improve compliance with this sec2 tion, section 2799A–1 of the Public Health 

3 Service Act, and section 9812 of the Internal 

4 Revenue Code of 1986, as applicable. In car5 rying out this paragraph, the Secretaries may 

6 take into consideration the 2016 publication of 

7 the Department of Health and Human Services 

8 and the Department of Labor, entitled ‘Warn9 ing Signs - Plan or Policy Non-Quantitative 

10 Treatment Limitations (NQTLs) that Require 

11 Additional Analysis to Determine Mental 

12 Health Parity Compliance’. 

13 ‘‘(B) EXAMPLES ILLUSTRATING COMPLI14 ANCE AND NONCOMPLIANCE.— 

15 ‘‘(i) IN GENERAL.—The compliance 

16 program guidance document required 

17 under this paragraph shall provide illus18 trative, de-identified examples (that do not 

19 disclose any protected health information 

20 or individually identifiable information) of 

21 previous findings of compliance and non22 compliance with this section, section 

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

24 or section 9812 of the Internal Revenue 

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1 vestigations of violations of such sections, 

2 including— 

3 ‘‘(I) examples illustrating re4 quirements for information disclosures 

5 and nonquantitative treatment limita6 tions; and 

7 ‘‘(II) descriptions of the viola8 tions uncovered during the course of 

9 such investigations. 

10 ‘‘(ii) NONQUANTITATIVE TREATMENT

11 LIMITATIONS.—To the extent that any ex12 ample described in clause (i) involves a 

13 finding of compliance or noncompliance 

14 with regard to any requirement for non15 quantitative treatment limitations, the ex16 ample shall provide sufficient detail to fully 

17 explain such finding, including a full de18 scription of the criteria involved for ap19 proving medical and surgical benefits and 

20 the criteria involved for approving mental 

21 health and substance use disorder benefits. 

22 ‘‘(iii) ACCESS TO ADDITIONAL INFOR23 MATION REGARDING COMPLIANCE.—In de24 veloping and issuing the compliance pro25 gram guidance document required under 


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1 this paragraph, the Secretaries specified in 

2 subparagraph (A)— 

3 ‘‘(I) shall enter into interagency 

4 agreements with the Inspector Gen5 eral of the Department of Health and 

6 Human Services, the Inspector Gen7 eral of the Department of Labor, and 

8 the Inspector General of the Depart9 ment of the Treasury to share find10 ings of compliance and noncompliance 

11 with this section, section 2799A–1 of 

12 the Public Health Service Act, or sec13 tion 9812 of the Internal Revenue 

14 Code of 1986, as applicable; and 

15 ‘‘(II) shall seek to enter into an 

16 agreement with a State to share infor17 mation on findings of compliance and 

18 noncompliance with this section, sec19 tion 2799A–1 of the Public Health 

20 Service Act, or section 9812 of the In21 ternal Revenue Code of 1986, as ap22 plicable. 

23 ‘‘(C) RECOMMENDATIONS.—The compli24 ance program guidance document shall include 

25 recommendations to advance compliance with 


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

2 Health Service Act, or section 9812 of the In3 ternal Revenue Code of 1986, as applicable, and 

4 encourage the development and use of internal 

5 controls to monitor adherence to applicable 

6 statutes, regulations, and program require7 ments. Such internal controls may include illus8 trative examples of nonquantitative treatment 

9 limitations on mental health and substance use 

10 disorder benefits, which may fail to comply with 

11 this section, section 2799A–1 of the Public 

12 Health Service Act, or section 9812 of the In13 ternal Revenue Code of 1986, as applicable, in 

14 relation to nonquantitative treatment limita15 tions on medical and surgical benefits. 

16 ‘‘(D) UPDATING THE COMPLIANCE PRO17 GRAM GUIDANCE DOCUMENT.—The Secretary, 

18 the Secretary of Health and Human Services, 

19 and the Secretary of the Treasury, in consulta20 tion with the Inspector General of the Depart21 ment of Health and Human Services, the In22 spector General of the Department of Labor, 

23 and the Inspector General of the Department of 

24 the Treasury, shall update the compliance pro25 gram guidance document every 2 years to inVerDate Sep 11 2014 18:49 Jul 29, 2020 Jkt 099200 PO 00000 Frm 00040 Fmt 6652 Sfmt 6201 E:\BILLS\H7539.IH H7539

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1 clude illustrative, de-identified examples (that 

2 do not disclose any protected health information 

3 or individually identifiable information) of pre4 vious findings of compliance and noncompliance 

5 with this section, section 2799A–1 of the Public 

6 Health Service Act, or section 9812 of the In7 ternal Revenue Code of 1986, as applicable. 

8 ‘‘(7) ADDITIONAL GUIDANCE.— 

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

10 months after the date of enactment of the 

11 Helping Families in Mental Health Crisis Re12 form Act of 2016, the Secretary, the Secretary 

13 of Health and Human Services, and the Sec14 retary of the Treasury shall issue guidance to 

15 group health plans and health insurance issuers 

16 offering group or individual health insurance 

17 coverage to assist such plans and issuers in sat18 isfying the requirements of this section, section 

19 2799A–1 of the Public Health Service Act, or 

20 section 9812 of the Internal Revenue Code of 

21 1986, as applicable. 

22 ‘‘(B) DISCLOSURE.— 

23 ‘‘(i) GUIDANCE FOR PLANS AND

24 ISSUERS.—The guidance issued under this 

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1 tion and illustrative examples of methods 

2 that group health plans and health insur3 ance issuers offering group or individual 

4 health insurance coverage may use for dis5 closing information to ensure compliance 

6 with the requirements under this section, 

7 section 2799A–1 of the Public Health 

8 Service Act, or section 9812 of the Inter9 nal Revenue Code of 1986, as applicable, 

10 (and any regulations promulgated pursu11 ant to such sections, as applicable). 

12 ‘‘(ii) DOCUMENTS FOR PARTICIPANTS, 

13 BENEFICIARIES, CONTRACTING PROVIDERS, 

14 OR AUTHORIZED REPRESENTATIVES.—The 

15 guidance issued under this paragraph shall 

16 include clarifying information and illus17 trative examples of methods that group 

18 health plans and health insurance issuers 

19 offering group or individual health insur20 ance coverage may use to provide any par21 ticipant, beneficiary, contracting provider, 

22 or authorized representative, as applicable, 

23 with documents containing information 

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1 ficiaries, contracting providers, or author2 ized representatives to ensure compliance 

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

4 Public Health Service Act, or section 9812 

5 of the Internal Revenue Code of 1986, as 

6 applicable, compliance with any regulation 

7 issued pursuant to such respective section, 

8 or compliance with any other applicable 

9 law or regulation. Such guidance shall in10 clude information that is comparative in 

11 nature with respect to— 

12 ‘‘(I) nonquantitative treatment 

13 limitations for both medical and sur14 gical benefits and mental health and 

15 substance use disorder benefits; 

16 ‘‘(II) the processes, strategies, 

17 evidentiary standards, and other fac18 tors used to apply the limitations de19 scribed in subclause (I); and 

20 ‘‘(III) the application of the limi21 tations described in subclause (I) to 

22 ensure that such limitations are ap23 plied in parity with respect to both 

24 medical and surgical benefits and 


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1 mental health and substance use dis2 order benefits. 

3 ‘‘(C) NONQUANTITATIVE TREATMENT LIM4 ITATIONS.—The guidance issued under this 

5 paragraph shall include clarifying information 

6 and illustrative examples of methods, processes, 

7 strategies, evidentiary standards, and other fac8 tors that group health plans and health insur9 ance issuers offering group or individual health 

10 insurance coverage may use regarding the de11 velopment and application of nonquantitative 

12 treatment limitations to ensure compliance with 

13 this section, section 2799A–1 of the Public 

14 Health Service Act, or section 9812 of the In15 ternal Revenue Code of 1986, as applicable 

16 (and any regulations promulgated pursuant to 

17 such respective section), including— 

18 ‘‘(i) examples of methods of deter19 mining appropriate types of nonquantita20 tive treatment limitations with respect to 

21 both medical and surgical benefits and 

22 mental health and substance use disorder 

23 benefits, including nonquantitative treat24 ment limitations pertaining to— 


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1 ‘‘(I) medical management stand2 ards based on medical necessity or ap3 propriateness, or whether a treatment 

4 is experimental or investigative; 

5 ‘‘(II) limitations with respect to 

6 prescription drug formulary design; 

7 and 

8 ‘‘(III) use of fail-first or step 

9 therapy protocols; 

10 ‘‘(ii) examples of methods of deter11 mining— 

12 ‘‘(I) network admission standards 

13 (such as credentialing); and 

14 ‘‘(II) factors used in provider re15 imbursement methodologies (such as 

16 service type, geographic market, de17 mand for services, and provider sup18 ply, practice size, training, experience, 

19 and licensure) as such factors apply to 

20 network adequacy; 

21 ‘‘(iii) examples of sources of informa22 tion that may serve as evidentiary stand23 ards for the purposes of making deter24 minations regarding the development and 


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1 application of nonquantitative treatment 

2 limitations; 

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

4 the evidentiary standards used to evaluate 

5 such factors, used by such plans or issuers 

6 in performing a nonquantitative treatment 

7 limitation analysis; 

8 ‘‘(v) examples of how specific evi9 dentiary standards may be used to deter10 mine whether treatments are considered 

11 experimental or investigative; 

12 ‘‘(vi) examples of how specific evi13 dentiary standards may be applied to each 

14 service category or classification of bene15 fits; 

16 ‘‘(vii) examples of methods of reach17 ing appropriate coverage determinations 

18 for new mental health or substance use 

19 disorder treatments, such as evidence20 based early intervention programs for indi21 viduals with a serious mental illness and 

22 types of medical management techniques; 

23 ‘‘(viii) examples of methods of reach24 ing appropriate coverage determinations 

25 for which there is an indirect relationship 


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1 between the covered mental health or sub2 stance use disorder benefit and a tradi3 tional covered medical and surgical benefit, 

4 such as residential treatment or hos5 pitalizations involving voluntary or involun6 tary commitment; and 

7 ‘‘(ix) additional illustrative examples 

8 of methods, processes, strategies, evi9 dentiary standards, and other factors for 

10 which the Secretary determines that addi11 tional guidance is necessary to improve 

12 compliance with this section, section 

13 2799A–1 of the Public Health Service Act, 

14 or section 9812 of the Internal Revenue 

15 Code of 1986, as applicable. 

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

17 any final guidance under this paragraph, the 

18 Secretary shall provide a public comment period 

19 of not less than 60 days during which any 

20 member of the public may provide comments on 

21 a draft of the guidance. 

22 ‘‘(8) COMPLIANCE REQUIREMENTS.— 

23 ‘‘(A) NONQUANTITATIVE TREATMENT LIM24 ITATION (NQTL) REQUIREMENTS.—Beginning 

25 45 days after the date of enactment of this 


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1 paragraph, in the case of a group health plan 

2 or a health insurance issuer offering group 

3 health insurance coverage that provides both 

4 medical and surgical benefits and mental health 

5 or substance use disorder benefits and that im6 poses nonquantitative treatment limitations (re7 ferred to in this section as ‘NQTL’) on mental 

8 health or substance use disorder benefits, the 

9 plan or issuer offering health insurance cov10 erage shall perform comparative analyses of the 

11 design and application of NQTLs in accordance 

12 with subparagraph (B), and make available to 

13 the applicable State authority (or, as applicable, 

14 the Secretary), upon request, the following in15 formation: 

16 ‘‘(i) The specific plan or coverage 

17 terms regarding the NQTL, that applies to 

18 such plan or coverage, and a description of 

19 all mental health or substance use disorder 

20 and medical or surgical benefits to which it 

21 applies in each respective benefits classi22 fication. 

23 ‘‘(ii) The factors used to determine 

24 that the NQTL will apply to mental health 


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•HR 7539 IH

1 or substance use disorder benefits and 

2 medical or surgical benefits. 

3 ‘‘(iii) The evidentiary standards used 

4 for the factors identified in clause (ii), 

5 when applicable, provided that every factor 

6 shall be defined and any other source or 

7 evidence relied upon to design and apply 

8 the NQTL to mental health or substance 

9 use disorder benefits and medical or sur10 gical benefits. 

11 ‘‘(iv) The comparative analyses dem12 onstrating that the processes, strategies, 

13 evidentiary standards, and other factors 

14 used to design the NQTL, as written, and 

15 the operation processes and strategies as 

16 written and in operation that are used to 

17 apply the NQTL for mental health or sub18 stance use disorder benefits are com19 parable to, and are applied no more strin20 gently than, the processes, strategies, evi21 dentiary standards, and other factors used 

22 to design the NQTL, as written, and the 

23 operation processes and strategies as writ24 ten and in operation that are used to apply 

25 the NQTL to medical or surgical benefits. 


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1 ‘‘(v) A disclosure of the specific find2 ings and conclusions reached by the plan 

3 or coverage that the results of the analyses 

4 described in this subparagraph indicate 

5 that the plan or coverage is in compliance 

6 with this section. 

7 ‘‘(B) SECRETARY REQUEST PROCESS.— 

8 ‘‘(i) SUBMISSION UPON REQUEST.— 

9 The Secretary shall request that a group 

10 health plan or a health insurance issuer of11 fering group health insurance coverage 

12 submit the comparative analyses described 

13 in subparagraph (A) for plans that involve 

14 potential violations of this section or com15 plaints regarding noncompliance with this 

16 section that concern NQTLs and any other 

17 instances in which the Secretary deter18 mines appropriate. The Secretary shall re19 quest not fewer than 20 such analyses per 

20 year. 

21 ‘‘(ii) ADDITIONAL INFORMATION.—In 

22 instances in which the Secretary has con23 cluded that the plan or coverage has not 

24 submitted sufficient information for the 

25 Secretary to review the comparative analVerDate Sep 11 2014 18:49 Jul 29, 2020 Jkt 099200 PO 00000 Frm 00050 Fmt 6652 Sfmt 6201 E:\BILLS\H7539.IH H7539

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1 yses described in subparagraph (A), as re2 quested under clause (i), the Secretary 

3 shall specify to the plan or coverage the in4 formation the plan or coverage must sub5 mit 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 

11 compliance with this section solely based 

12 upon the inspection of the comparative 

13 analyses described in subparagraph (A), as 

14 requested 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 or coverage is not in compliance 

22 with this section, the plan or cov23 erage— 

24 ‘‘(aa) shall specify to the 

25 Secretary the actions the plan or 


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1 coverage will take to be in com2 pliance with this section and pro3 vide to the Secretary comparative 

4 analyses described in subpara5 graph (A) that demonstrate com6 pliance with this section not later 

7 than 45 days after the initial de8 termination by the Secretary that 

9 the plan or coverage is not in 

10 compliance; and 

11 ‘‘(bb) following the 45-day 

12 corrective action period under 

13 item (aa), if the Secretary deter14 mines that the plan or coverage 

15 still is not in compliance with 

16 this section, not later than 7 

17 days after such determination, 

18 shall notify all individuals en19 rolled in the plan or coverage 

20 that the plan or coverage has 

21 been determined to be not in 

22 compliance with this section. 

23 ‘‘(II) EXEMPTION FROM DISCLO24 SURE.—Documents or communica25 tions produced in connection with the 


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1 Secretary’s recommendations to the 

2 plan or coverage shall not be subject 

3 to disclosure pursuant to section 552 

4 of title 5, United States Code. 

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

6 after the date of enactment of this para7 graph, and not later than October 1 of 

8 each year thereafter, the Secretary shall 

9 submit to Congress, and make publicly 

10 available, a report that contains— 

11 ‘‘(I) a summary of the compara12 tive analyses requested under clause 

13 (i), including the identity of each plan 

14 or coverage that is determined to be 

15 not in compliance after the final de16 termination by the Secretary de17 scribed in clause (iii)(I)(bb); 

18 ‘‘(II) the Secretary’s conclusions 

19 as to whether each plan or coverage 

20 submitted sufficient information for 

21 the Secretary to review the compara22 tive analyses requested under clause 

23 (i) for compliance with this section; 

24 ‘‘(III) for each plan or coverage 

25 that did submit sufficient information 


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1 for the Secretary to review the com2 parative analyses requested under 

3 clause (i), the Secretary’s conclusions 

4 as to whether and why the plan or 

5 coverage is in compliance with the re6 quirements under this section; 

7 ‘‘(IV) the Secretary’s specifica8 tions described in clause (ii) for each 

9 plan or coverage that the Secretary 

10 determined did not submit sufficient 

11 information for the Secretary to re12 view the comparative analyses re13 quested under clause (i) for compli14 ance with this section; and 

15 ‘‘(V) the Secretary’s specifica16 tions described in clause (iii) of the 

17 actions each plan or coverage that the 

18 Secretary determined is not in compli19 ance with this section must take to be 

20 in compliance with this section, in21 cluding the reason why the Secretary 

22 determined the plan or coverage is not 

23 in compliance. 

24 ‘‘(C) COMPLIANCE PROGRAM GUIDANCE

25 DOCUMENT UPDATE PROCESS.— 


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1 ‘‘(i) IN GENERAL.—The Secretary 

2 shall include instances of noncompliance 

3 that the Secretary discovers upon review4 ing the comparative analyses requested 

5 under subparagraph (B)(i) in the compli6 ance program guidance document de7 scribed in paragraph (6), as it is updated 

8 every 2 years, except that such instances 

9 shall not disclose any protected health in10 formation or individually identifiable infor11 mation. 

12 ‘‘(ii) GUIDANCE AND REGULATIONS.— 

13 Not later than 18 months after the date of 

14 enactment of this paragraph, the Secretary 

15 shall finalize any draft or interim guidance 

16 and regulations relating to mental health 

17 parity under this section. Such draft guid18 ance shall include guidance to clarify the 

19 process and timeline for current and poten20 tial participants and beneficiaries (and au21 thorized representatives and health care 

22 providers of such participants and bene23 ficiaries) with respect to plans to file com24 plaints of such plans or issuers being in 

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1 ance, by plan type, on the relevant State, 

2 regional, or national office with which such 

3 complaints should be filed. 

4 ‘‘(iii) STATE.—The Secretary shall 

5 share information on findings of compli6 ance and noncompliance discovered upon 

7 reviewing the comparative analyses re8 quested under subparagraph (B)(i) with 

9 the State where the group health plan is 

10 located or the State where the health in11 surance issuer is licensed to do business 

12 for coverage offered by a health insurance 

13 issuer in the group market, in accordance 

14 with paragraph (6)(B)(iii)(II).’’. 

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

16 of 1986 is amended by adding at the end the following 

17 new paragraphs: 

18 ‘‘(6) COMPLIANCE PROGRAM GUIDANCE DOCU19 MENT.— 

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

21 months after the date of enactment of the 

22 Helping Families in Mental Health Crisis Re23 form Act of 2016, the Secretary, the Secretary 

24 of Labor, and the Secretary of Health and 

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1 spector General of the Department of Health 

2 and Human Services, the Inspector General of 

3 the Department of Labor, and the Inspector 

4 General of the Department of the Treasury, 

5 shall issue a compliance program guidance doc6 ument to help improve compliance with this sec7 tion, section 712 of the Employee Retirement 

8 Income Security Act of 1974, and section 

9 2799A–1 of the Public Health Service Act, as 

10 applicable. In carrying out this paragraph, the 

11 Secretaries may take into consideration the 

12 2016 publication of the Department of Health 

13 and Human Services and the Department of 

14 Labor, entitled ‘Warning Signs - Plan or Policy 

15 Non-Quantitative Treatment Limitations 

16 (NQTLs) that Require Additional Analysis to 

17 Determine Mental Health Parity Compliance’. 

18 ‘‘(B) EXAMPLES ILLUSTRATING COMPLI19 ANCE AND NONCOMPLIANCE.— 

20 ‘‘(i) IN GENERAL.—The compliance 

21 program guidance document required 

22 under this paragraph shall provide illus23 trative, de-identified examples (that do not 

24 disclose any protected health information 

25 or individually identifiable information) of 


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1 previous findings of compliance and non2 compliance with this section, section 712 of 

3 the Employee Retirement Income Security 

4 Act of 1974, or section 2799A–1 of the 

5 Public Health Service Act, as applicable, 

6 based on investigations of violations of 

7 such sections, including— 

8 ‘‘(I) examples illustrating re9 quirements for information disclosures 

10 and nonquantitative treatment limita11 tions; and 

12 ‘‘(II) descriptions of the viola13 tions uncovered during the course of 

14 such investigations. 

15 ‘‘(ii) NONQUANTITATIVE TREATMENT

16 LIMITATIONS.—To the extent that any ex17 ample described in clause (i) involves a 

18 finding of compliance or noncompliance 

19 with regard to any requirement for non20 quantitative treatment limitations, the ex21 ample shall provide sufficient detail to fully 

22 explain such finding, including a full de23 scription of the criteria involved for ap24 proving medical and surgical benefits and 


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1 the criteria involved for approving mental 

2 health and substance use disorder benefits. 

3 ‘‘(iii) ACCESS TO ADDITIONAL INFOR4 MATION REGARDING COMPLIANCE.—In de5 veloping and issuing the compliance pro6 gram guidance document required under 

7 this paragraph, the Secretaries specified in 

8 subparagraph (A)— 

9 ‘‘(I) shall enter into interagency 

10 agreements with the Inspector Gen11 eral of the Department of Health and 

12 Human Services, the Inspector Gen13 eral of the Department of Labor, and 

14 the Inspector General of the Depart15 ment of the Treasury to share find16 ings of compliance and noncompliance 

17 with this section, section 712 of the 

18 Employee Retirement Income Security 

19 Act of 1974, or section 2799A–1 of 

20 the Public Health Service Act, as ap21 plicable; and 

22 ‘‘(II) shall seek to enter into an 

23 agreement with a State to share infor24 mation on findings of compliance and 

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1 tion 712 of the Employee Retirement 

2 Income Security Act of 1974, or sec3 tion 2799A–1 of the Public Health 

4 Service Act, as applicable. 

5 ‘‘(C) RECOMMENDATIONS.—The compli6 ance program guidance document shall include 

7 recommendations to advance compliance with 

8 this section, section 712 of the Employee Re9 tirement Income Security Act of 1974, or sec10 tion 2799A–1 of the Public Health Service Act, 

11 as applicable, and encourage the development 

12 and use of internal controls to monitor adher13 ence to applicable statutes, regulations, and 

14 program requirements. Such internal controls 

15 may include illustrative examples of non16 quantitative treatment limitations on mental 

17 health and substance use disorder benefits, 

18 which may fail to comply with this section, sec19 tion 712 of the Employee Retirement Income 

20 Security Act of 1974, or section 2799A–1 of 

21 the Public Health Service Act, as applicable, in 

22 relation to nonquantitative treatment limita23 tions on medical and surgical benefits. 

24 ‘‘(D) UPDATING THE COMPLIANCE PRO25 GRAM GUIDANCE DOCUMENT.—The Secretary, 


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1 the Secretary of Labor, and the Secretary of 

2 Health and Human Services, in consultation 

3 with the Inspector General of the Department 

4 of Health and Human Services, the Inspector 

5 General of the Department of Labor, and the 

6 Inspector General of the Department of the 

7 Treasury, shall update the compliance program 

8 guidance document every 2 years to include il9 lustrative, de-identified examples (that do not 

10 disclose any protected health information or in11 dividually identifiable information) of previous 

12 findings of compliance and noncompliance with 

13 this section, section 712 of the Employee Re14 tirement Income Security Act of 1974, or sec15 tion 2799A–1 of the Public Health Service Act, 

16 as applicable. 

17 ‘‘(7) ADDITIONAL GUIDANCE.— 

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

19 months after the date of enactment of the 

20 Helping Families in Mental Health Crisis Re21 form Act of 2016, the Secretary, the Secretary 

22 of Labor, and the Secretary of Health and 

23 Human Services shall issue guidance to group 

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1 erage to assist such plans and issuers in satis2 fying the requirements of this section, section 

3 712 of the Employee Retirement Income Secu4 rity Act of 1974, or section 2799A–1 of the 

5 Public Health Service Act, as applicable. 

6 ‘‘(B) DISCLOSURE.— 

7 ‘‘(i) GUIDANCE FOR PLANS AND

8 ISSUERS.—The guidance issued under this 

9 paragraph shall include clarifying informa10 tion and illustrative examples of methods 

11 that group health plans and health insur12 ance issuers offering group or individual 

13 health insurance coverage may use for dis14 closing information to ensure compliance 

15 with the requirements under this section, 

16 section 712 of the Employee Retirement 

17 Income Security Act of 1974, or section 

18 2799A–1 of the Public Health Service Act 

19 (and any regulations promulgated pursu20 ant to such sections, as applicable). 

21 ‘‘(ii) DOCUMENTS FOR PARTICIPANTS, 

22 BENEFICIARIES, CONTRACTING PROVIDERS, 

23 OR AUTHORIZED REPRESENTATIVES.—The 

24 guidance issued under this paragraph shall 

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1 trative examples of methods that group 

2 health plans and health insurance issuers 

3 offering group or individual health insur4 ance coverage may use to provide any par5 ticipant, beneficiary, contracting provider, 

6 or authorized representative, as applicable, 

7 with documents containing information 

8 that the health plans or issuers are re9 quired to disclose to participants, bene10 ficiaries, contracting providers, or author11 ized representatives to ensure compliance 

12 with this section, section 712 of the Em13 ployee Retirement Income Security Act of 

14 1974, or section 2799A–1 of the Public 

15 Health Service Act, as applicable, compli16 ance with any regulation issued pursuant 

17 to such respective section, or compliance 

18 with any other applicable law or regula19 tion. Such guidance shall include informa20 tion that is comparative in nature with re21 spect to— 

22 ‘‘(I) nonquantitative treatment 

23 limitations for both medical and sur24 gical benefits and mental health and 

25 substance use disorder benefits; 


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1 ‘‘(II) the processes, strategies, 

2 evidentiary standards, and other fac3 tors used to apply the limitations de4 scribed in subclause (I); and 

5 ‘‘(III) the application of the limi6 tations described in subclause (I) to 

7 ensure that such limitations are ap8 plied in parity with respect to both 

9 medical and surgical benefits and 

10 mental health and substance use dis11 order benefits. 

12 ‘‘(C) NONQUANTITATIVE TREATMENT LIM13 ITATIONS.—The guidance issued under this 

14 paragraph shall include clarifying information 

15 and illustrative examples of methods, processes, 

16 strategies, evidentiary standards, and other fac17 tors that group health plans and health insur18 ance issuers offering group or individual health 

19 insurance coverage may use regarding the de20 velopment and application of nonquantitative 

21 treatment limitations to ensure compliance with 

22 this section, section 712 of the Employee Re23 tirement Income Security Act of 1974, or sec24 tion 2799A–1 of the Public Health Service Act, 

25 as applicable (and any regulations promulgated 


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•HR 7539 IH

1 pursuant to such respective section), includ2 ing— 

3 ‘‘(i) examples of methods of deter4 mining appropriate types of nonquantita5 tive treatment limitations with respect to 

6 both medical and surgical benefits and 

7 mental health and substance use disorder 

8 benefits, including nonquantitative treat9 ment limitations pertaining to— 

10 ‘‘(I) medical management stand11 ards based on medical necessity or ap12 propriateness, or whether a treatment 

13 is experimental or investigative; 

14 ‘‘(II) limitations with respect to 

15 prescription drug formulary design; 

16 and 

17 ‘‘(III) use of fail-first or step 

18 therapy protocols; 

19 ‘‘(ii) examples of methods of deter20 mining— 

21 ‘‘(I) network admission standards 

22 (such as credentialing); and 

23 ‘‘(II) factors used in provider re24 imbursement methodologies (such as 

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1 mand for services, and provider sup2 ply, practice size, training, experience, 

3 and licensure) as such factors apply to 

4 network adequacy; 

5 ‘‘(iii) examples of sources of informa6 tion that may serve as evidentiary stand7 ards for the purposes of making deter8 minations regarding the development and 

9 application of nonquantitative treatment 

10 limitations; 

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

12 the evidentiary standards used to evaluate 

13 such factors, used by such plans or issuers 

14 in performing a nonquantitative treatment 

15 limitation analysis; 

16 ‘‘(v) examples of how specific evi17 dentiary standards may be used to deter18 mine whether treatments are considered 

19 experimental or investigative; 

20 ‘‘(vi) examples of how specific evi21 dentiary standards may be applied to each 

22 service category or classification of bene23 fits; 

24 ‘‘(vii) examples of methods of reach25 ing appropriate coverage determinations 


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•HR 7539 IH

1 for new mental health or substance use 

2 disorder treatments, such as evidence3 based early intervention programs for indi4 viduals with a serious mental illness and 

5 types of medical management techniques; 

6 ‘‘(viii) examples of methods of reach7 ing appropriate coverage determinations 

8 for which there is an indirect relationship 

9 between the covered mental health or sub10 stance use disorder benefit and a tradi11 tional covered medical and surgical benefit, 

12 such as residential treatment or hos13 pitalizations involving voluntary or involun14 tary commitment; and 

15 ‘‘(ix) additional illustrative examples 

16 of methods, processes, strategies, evi17 dentiary standards, and other factors for 

18 which the Secretary determines that addi19 tional guidance is necessary to improve 

20 compliance with this section, section 712 of 

21 the Employee Retirement Income Security 

22 Act of 1974, or section 2799A–1 of the 

23 Public Health Service Act, as applicable. 

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

25 any final guidance under this paragraph, the 


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1 Secretary shall provide a public comment period 

2 of not less than 60 days during which any 

3 member of the public may provide comments on 

4 a draft of the guidance. 

5 ‘‘(8) COMPLIANCE REQUIREMENTS.— 

6 ‘‘(A) NONQUANTITATIVE TREATMENT LIM7 ITATION (NQTL) REQUIREMENTS.—Beginning 

8 45 days after the date of enactment of this 

9 paragraph, in the case of a group health plan 

10 that provides both medical and surgical benefits 

11 and mental health or substance use disorder 

12 benefits and that imposes nonquantitative treat13 ment limitations (referred to in this section as 

14 ‘NQTL’) on mental health or substance use dis15 order benefits, the plan shall perform compara16 tive analyses of the design and application of 

17 NQTLs in accordance with subparagraph (B), 

18 and make available to the applicable State au19 thority (or, as applicable, the Secretary), upon 

20 request, the following information: 

21 ‘‘(i) The specific plan terms regarding 

22 the NQTL, that applies to such plan or 

23 coverage, and a description of all mental 

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1 ical or surgical benefits to which it applies 

2 in each respective benefits classification. 

3 ‘‘(ii) The factors used to determine 

4 that the NQTL will apply to mental health 

5 or substance use disorder benefits and 

6 medical or surgical benefits. 

7 ‘‘(iii) The evidentiary standards used 

8 for the factors identified in clause (ii), 

9 when applicable, provided that every factor 

10 shall be defined and any other source or 

11 evidence relied upon to design and apply 

12 the NQTL to mental health or substance 

13 use disorder benefits and medical or sur14 gical benefits. 

15 ‘‘(iv) The comparative analyses dem16 onstrating that the processes, strategies, 

17 evidentiary standards, and other factors 

18 used to design the NQTL, as written, and 

19 the operation processes and strategies as 

20 written and in operation that are used to 

21 apply the NQTL for mental health or sub22 stance use disorder benefits are com23 parable to, and are applied no more strin24 gently than, the processes, strategies, evi25 dentiary standards, and other factors used 


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1 to design the NQTL, as written, and the 

2 operation processes and strategies as writ3 ten and in operation that are used to apply 

4 the NQTL to medical or 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 

8 in this subparagraph indicate that the plan 

9 is 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 

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1 view the comparative analyses described in 

2 subparagraph (A), as requested under 

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

4 plan the information the plan or coverage 

5 must submit to be responsive to the re6 quest under clause (i) for the Secretary to 

7 review the comparative analyses described 

8 in subparagraph (A) for compliance with 

9 this section. Nothing in this paragraph 

10 shall require the Secretary to conclude that 

11 a plan is in compliance with this section 

12 solely based upon the inspection of the 

13 comparative analyses described in subpara14 graph (A), as requested 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 

24 Secretary the actions the plan 

25 will take to be in compliance with 


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1 this section and provide to the 

2 Secretary comparative analyses 

3 described in subparagraph (A) 

4 that demonstrate compliance with 

5 this section not later than 45 

6 days after the initial determina7 tion by the Secretary that the 

8 plan is not 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 de15 termination, shall notify all indi16 viduals enrolled in the plan or 

17 coverage that the plan has been 

18 determined to be not in compli19 ance with this section. 

20 ‘‘(II) EXEMPTION FROM DISCLO21 SURE.—Documents or communica22 tions produced in connection with the 

23 Secretary’s recommendations to the 

24 plan or coverage shall not be subject 


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1 to disclosure pursuant to section 552 

2 of title 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 

6 each year thereafter, the Secretary shall 

7 submit to Congress, and make publicly 

8 available, a 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 com13 pliance after the final determination 

14 by the Secretary described in clause 

15 (iii)(I)(bb); 

16 ‘‘(II) the Secretary’s conclusions 

17 as to whether each plan submitted 

18 sufficient information for the Sec19 retary to review the comparative anal20 yses requested under clause (i) for 

21 compliance 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 


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1 Secretary’s conclusions as to whether 

2 and why the plan or coverage is in 

3 compliance with the requirements 

4 under this section; 

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

7 plan that the Secretary determined 

8 did not submit sufficient information 

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

11 clause (i) for compliance with this sec12 tion; and 

13 ‘‘(V) the Secretary’s specifica14 tions described in clause (iii) of the 

15 actions each plan that the Secretary 

16 determined is not in compliance with 

17 this section must take to be in compli18 ance with this section, including the 

19 reason why the Secretary determined 

20 the plan or coverage is not in compli21 ance. 

22 ‘‘(C) COMPLIANCE PROGRAM GUIDANCE

23 DOCUMENT UPDATE PROCESS.— 

24 ‘‘(i) IN GENERAL.—The Secretary 

25 shall include instances of noncompliance 


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1 that the Secretary discovers upon review2 ing the comparative analyses requested 

3 under subparagraph (B)(i) in the compli4 ance program guidance document de5 scribed in paragraph (6), as it is updated 

6 every 2 years, except that such instances 

7 shall not disclose any protected health in8 formation or individually identifiable infor9 mation. 

10 ‘‘(ii) GUIDANCE AND REGULATIONS.— 

11 Not later than 18 months after the date of 

12 enactment of this paragraph, the Secretary 

13 shall finalize any draft or interim guidance 

14 and regulations relating to mental health 

15 parity under this section. Such draft guid16 ance shall include guidance to clarify the 

17 process and timeline for current and poten18 tial participants and beneficiaries (and au19 thorized representatives and health care 

20 providers of such participants and bene21 ficiaries) with respect to plans to file com22 plaints of such plans or issuers being in 

23 violation of this section, including guid24 ance, by plan type, on the relevant State, 


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1 regional, or national office with which such 

2 complaints should be filed. 

3 ‘‘(iii) STATE.—The Secretary shall 

4 share information on findings of compli5 ance and noncompliance discovered upon 

6 reviewing the comparative analyses re7 quested under subparagraph (B)(i) with 

8 the State where the group health plan is 

9 located or the State where the health in10 surance issuer is licensed to do business 

11 for coverage offered by a health insurance 

12 issuer in the group market, in accordance 

13 with paragraph (6)(B)(iii)(II).’’. 

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

15 Human Services, the Secretary of Labor, and the Sec16 retary of the Treasury may implement the paragraph (8) 

17 of section 2799A–1(a) of the Public Health Service Act, 

18 added by subsection (a), the paragraph (8) of section 

19 712(a) of the Employee Retirement Income Security Act 

20 of 1974, as added by subsection (b), and the paragraph 

21 (8) of section 9812(a) of the Internal Revenue Code of 

22 1986, as added by subsection (c), by program instruction, 

23 guidance, or otherwise. 

Æ 


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