II 

116TH CONGRESS 

1ST SESSION S. 1576 

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

IN THE SENATE OF THE UNITED STATES 

MAY 21, 2019 

Ms. WARREN (for herself, Mr. MARKEY, Mr. BROWN, Mr. BLUMENTHAL, Ms. 

BALDWIN, Ms. SMITH, Mr. BOOKER, Mr. SANDERS, Ms. STABENOW, Mr. 

KAINE, Ms. HARRIS, Ms. HASSAN, Mrs. SHAHEEN, Mr. VAN HOLLEN, 

Mrs. GILLIBRAND, Ms. KLOBUCHAR, and Mr. MURPHY) introduced the 

following bill; which was read twice and referred to the Committee on 

Health, Education, Labor, and Pensions 

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 ‘‘Behavioral Health Cov5 erage Transparency Act’’. 

6 SEC. 2. STRENGTHENING PARITY IN MENTAL HEALTH AND 

7 SUBSTANCE USE DISORDER BENEFITS. 

8 (a) PUBLIC HEALTH SERVICE ACT.—Section 

9 2726(a) of the Public Health Service Act (42 U.S.C. 


pamtmann on DSKBFK8HB2PROD with BILLS
2 

•S 1576 IS

1 300gg–26(a)) is amended by adding at the end the fol2 lowing new paragraph: 

3 ‘‘(8) DISCLOSURE AND ENFORCEMENT RE4 QUIREMENTS.— 

5 ‘‘(A) DISCLOSURE REQUIREMENTS.— 

6 ‘‘(i) REGULATIONS.—Not later than 6 

7 months after the date of enactment of this 

8 paragraph, the Secretary, in cooperation 

9 with the Secretaries of Labor and the 

10 Treasury, shall issue regulations for car11 rying out this section, including an expla12 nation of documents that group health 

13 plans and health insurance issuers offering 

14 group or individual health insurance cov15 erage shall disclose in accordance with 

16 clause (ii), the process governing the dis17 closure of such documents, and analyses 

18 that such plans and issuers shall conduct 

19 in order to demonstrate compliance with 

20 this section. 

21 ‘‘(ii) DISCLOSURE REQUIREMENTS.— 

22 The documents required to be disclosed by 

23 a group health plan or a health insurance 

24 issuer offering group or individual health 

25 insurance under clause (i) shall include an 


pamtmann on DSKBFK8HB2PROD with BILLS
3 

•S 1576 IS

1 annual report that details the specific anal2 yses performed to ensure compliance of 

3 such plan or issuer with this section, in4 cluding any regulation promulgated pursu5 ant to this section. At a minimum, with re6 spect to the application of nonquantitative 

7 treatment limitations (in this paragraph 

8 referred to as ‘NQTLs’) to benefits under 

9 the plan or coverage, such report shall— 

10 ‘‘(I) identify the specific factors 

11 the plan or issuer used in performing 

12 its NQTLs analysis; 

13 ‘‘(II) identify and define the spe14 cific evidentiary standards relied on to 

15 evaluate such factors; 

16 ‘‘(III) describe how the evi17 dentiary standards are applied to each 

18 service category for mental health 

19 benefits, substance use disorder bene20 fits, medical benefits, and surgical 

21 benefits; 

22 ‘‘(IV) disclose the results of the 

23 analyses of the specific evidentiary 

24 standards in each service category; 

25 and 


pamtmann on DSKBFK8HB2PROD with BILLS
4 

•S 1576 IS

1 ‘‘(V) disclose the specific findings 

2 of the plan or issuer in each service 

3 category and the conclusions reached 

4 with respect to whether the processes, 

5 strategies, evidentiary standards, or 

6 other factors used in applying the 

7 NQTLs to mental health or substance 

8 use disorder benefits are comparable 

9 to, and applied no more stringently 

10 than, the processes, strategies, evi11 dentiary standards, or other factors 

12 used in applying the NQTLs to med13 ical and surgical benefits in the same 

14 classification. 

15 ‘‘(iii) GUIDANCE.—Not later than 6 

16 months after the date of enactment of this 

17 paragraph, the Secretary, in cooperation 

18 with the Secretaries of Labor and the 

19 Treasury, shall issue guidance to group 

20 health plans and health insurance issuers 

21 offering group or individual health insur22 ance coverage on how to satisfy the re23 quirements of this section, with respect to 

24 making information available to current 


pamtmann on DSKBFK8HB2PROD with BILLS
5 

•S 1576 IS

1 and potential participants and bene2 ficiaries. Such information shall include— 

3 ‘‘(I) certificate of coverage docu4 ments and instruments under which 

5 the plan or coverage involved is ad6 ministered and operated that specify, 

7 include, or refer to procedures, for8 mulas, and methodologies applied to 

9 determine a participant’s or bene10 ficiary’s benefit under the plan or cov11 erage, regardless of whether such in12 formation is contained in a document 

13 designated as the ‘plan document’; 

14 and 

15 ‘‘(II) a disclosure of how the plan 

16 or issuer involved has provided that 

17 processes, strategies, evidentiary stan18 dards, and other factors used in ap19 plying the NQTLs to mental health or 

20 substance use disorder benefits are 

21 comparable to, and applied no more 

22 stringently than, the processes, strate23 gies, evidentiary standards, or other 

24 factors used in applying the NQTLs 


pamtmann on DSKBFK8HB2PROD with BILLS
6 

•S 1576 IS

1 to medical and surgical benefits in the 

2 same classification. 

3 ‘‘(iv) DEFINITIONS.—In this para4 graph and paragraph (7), the terms ‘non5 quantitative treatment limitations’, ‘com6 parable to’, and ‘applied no more strin7 gently than’ have the meanings given such 

8 terms in sections 146.136 and 147.160 of 

9 title 45, Code of Federal Regulations (or 

10 any successor regulation). 

11 ‘‘(B) ENFORCEMENT.— 

12 ‘‘(i) PROCESS FOR COMPLAINTS.—Not 

13 later than 6 months after the date of en14 actment of this paragraph, the Secretary, 

15 in cooperation with the Secretaries of 

16 Labor and the Treasury, shall, with re17 spect to group health plans and health in18 surance issuers offering group or indi19 vidual health insurance coverage, issue 

20 guidance to clarify the process and 

21 timeline for current and potential partici22 pants and beneficiaries (and authorized 

23 representatives and health care providers 

24 of such participants and beneficiaries) with 

25 respect to such plans and coverage to file 


pamtmann on DSKBFK8HB2PROD with BILLS
7 

•S 1576 IS

1 formal complaints of such plans or issuers 

2 being in violation of this section, including 

3 guidance, by plan type, on the relevant 

4 State, regional, and national offices with 

5 which such complaints should be filed. 

6 ‘‘(ii) AUDITS.— 

7 ‘‘(I) RANDOMIZED AUDITS.—Be8 ginning 1 year after the date of enact9 ment of this paragraph, the Secretary, 

10 in cooperation with the Secretaries of 

11 Labor and the Treasury, as applica12 ble, shall conduct randomized audits 

13 of group health plans and health in14 surance issuers offering group or indi15 vidual health insurance coverage to 

16 determine compliance with this sec17 tion. Such audits shall be conducted 

18 on no fewer than 12 plans or cov19 erages per plan year. 

20 ‘‘(II) ADDITIONAL AUDITS.—Be21 ginning 1 year after the date of enact22 ment of this paragraph, in the case of 

23 a group health plan or health insur24 ance issuer offering group or indi25 vidual health insurance coverage with 


pamtmann on DSKBFK8HB2PROD with BILLS
8 

•S 1576 IS

1 respect to which any claim has been 

2 filed during a plan year, the Sec3 retary, in cooperation with the Secre4 taries of Labor and the Treasury, as 

5 applicable, may audit the books and 

6 records of such plan or issuer to de7 termine compliance with this section. 

8 ‘‘(iii) DENIAL RATES.—The Secretary, 

9 in cooperation with the Secretaries of 

10 Labor and the Treasury, shall collect infor11 mation on the rates of and reasons for de12 nial by group health plans and health in13 surance issuers offering group or indi14 vidual health insurance coverage of claims 

15 for outpatient and inpatient mental health 

16 and substance use disorder benefits com17 pared to the rates of and reasons for de18 nial of claims for medical and surgical ben19 efits. For the first plan year that begins on 

20 or after the date that is 2 years after the 

21 date of enactment of this paragraph, and 

22 each subsequent plan year, the Secretary, 

23 in such cooperation, shall submit to the 

24 Committee on Energy and Commerce of 

25 the House of Representatives and the 


pamtmann on DSKBFK8HB2PROD with BILLS
9 

•S 1576 IS

1 Committee on Health, Education, Labor, 

2 and Pensions of the Senate the informa3 tion collected under the previous sentence 

4 with respect to the previous plan year. 

5 ‘‘(C) EFFECTIVE DATE.—Any require6 ments of group health plans and health insur7 ance issuers offering group or individual health 

8 insurance coverage that are included in the reg9 ulations issued under subparagraph (A)(i), in10 cluding the requirement described in subpara11 graph (A)(ii) to disclose documents, shall have 

12 an effective date of 1 year after the date of en13 actment of this paragraph.’’. 

14 (b) EMPLOYEE RETIREMENT INCOME SECURITY ACT

15 OF 1974.—Section 712(a) of the Employee Retirement In16 come Security Act of 1974 (29 U.S.C. 1185a(a)) is 

17 amended by adding at the end the following new para18 graph: 

19 ‘‘(6) DISCLOSURE AND ENFORCEMENT RE20 QUIREMENTS.— 

21 ‘‘(A) DISCLOSURE REQUIREMENTS.— 

22 ‘‘(i) REGULATIONS.—Not later than 6 

23 months after the date of enactment of this 

24 paragraph, the Secretary, in cooperation 

25 with the Secretaries of Health and Human 


pamtmann on DSKBFK8HB2PROD with BILLS
10 

•S 1576 IS

1 Services and the Treasury, shall issue reg2 ulations for carrying out this section, in3 cluding an explanation of documents that a 

4 group health plan (or health insurance 

5 issuer offering health insurance coverage in 

6 connection with such a plan) shall disclose 

7 in accordance with clause (ii), the process 

8 governing the disclosure of such docu9 ments, and analyses that such plans and 

10 issuers shall conduct in order to dem11 onstrate compliance with this section. 

12 ‘‘(ii) DISCLOSURE REQUIREMENTS.— 

13 The documents required to be disclosed by 

14 a group health plan (or a health insurance 

15 issuer offering health insurance coverage in 

16 connection with such a plan) under clause 

17 (i) shall include an annual report that de18 tails the specific analyses performed to en19 sure compliance of such plan or issuer with 

20 this section, including any regulation pro21 mulgated pursuant to this section. At a 

22 minimum, with respect to the application 

23 of nonquantitative treatment limitations 

24 (in this paragraph referred to as ‘NQTLs’) 


pamtmann on DSKBFK8HB2PROD with BILLS
11 

•S 1576 IS

1 to benefits under the plan or coverage, 

2 such report shall— 

3 ‘‘(I) identify the specific factors 

4 the plan or issuer used in performing 

5 its NQTLs analysis; 

6 ‘‘(II) identify and define the spe7 cific evidentiary standards relied on to 

8 evaluate such factors; 

9 ‘‘(III) describe how the evi10 dentiary standards are applied to each 

11 service category for mental health 

12 benefits, substance use disorder bene13 fits, medical benefits, and surgical 

14 benefits; 

15 ‘‘(IV) disclose the results of the 

16 analyses of the specific evidentiary 

17 standards in each service category; 

18 and 

19 ‘‘(V) disclose the specific findings 

20 of the plan or issuer in each service 

21 category and the conclusions reached 

22 with respect to whether the processes, 

23 strategies, evidentiary standards, or 

24 other factors used in applying the 

25 NQTLs to mental health or substance 


pamtmann on DSKBFK8HB2PROD with BILLS
12 

•S 1576 IS

1 use disorder benefits are comparable 

2 to, and applied no more stringently 

3 than, the processes, strategies, evi4 dentiary standards, or other factors 

5 used in applying the NQTLs to med6 ical and surgical benefits in the same 

7 classification. 

8 ‘‘(iii) GUIDANCE.—Not later than 6 

9 months after the date of enactment of this 

10 paragraph, the Secretary, in cooperation 

11 with the Secretaries of Health and Human 

12 Services and the Treasury, shall issue 

13 guidance to group health plans (and health 

14 insurance issuers offering health insurance 

15 coverage in connection with such plans) on 

16 how to satisfy the requirements of this sec17 tion, with respect to making information 

18 available to current and potential partici19 pants and beneficiaries. Such information 

20 shall include— 

21 ‘‘(I) certificate of coverage docu22 ments and instruments under which 

23 the plan or coverage involved is ad24 ministered and operated that specify, 

25 include, or refer to procedures, forVerDate Sep 11 2014 01:38 Jun 01, 2019 Jkt 089200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S1576.IS S1576

pamtmann on DSKBFK8HB2PROD with BILLS
13 

•S 1576 IS

1 mulas, and methodologies applied to 

2 determine a participant’s or bene3 ficiary’s benefit under the plan or cov4 erage, regardless of whether such in5 formation is contained in a document 

6 designated as the ‘plan document’; 

7 and 

8 ‘‘(II) a disclosure of how the plan 

9 or issuer involved has provided that 

10 processes, strategies, evidentiary stan11 dards, and other factors used in ap12 plying the NQTLs to mental health or 

13 substance use disorder benefits are 

14 comparable to, and applied no more 

15 stringently than, the processes, strate16 gies, evidentiary standards, or other 

17 factors used in applying the NQTLs 

18 to medical and surgical benefits in the 

19 same classification. 

20 ‘‘(iv) DEFINITIONS.—In this para21 graph, the terms ‘nonquantitative treat22 ment limitations’, ‘comparable to’, and ‘ap23 plied no more stringently than’ have the 

24 meanings given such terms in sections 

25 146.136 and 147.160 of title 45, Code of 


pamtmann on DSKBFK8HB2PROD with BILLS
14 

•S 1576 IS

1 Federal Regulations (or any successor reg2 ulation). 

3 ‘‘(B) ENFORCEMENT.— 

4 ‘‘(i) PROCESS FOR COMPLAINTS.—Not 

5 later than 6 months after the date of en6 actment of this paragraph, the Secretary, 

7 in cooperation with the Secretaries of 

8 Health and Human Services and the 

9 Treasury, shall, with respect to group 

10 health plans (and health insurance issuers 

11 offering health insurance coverage in con12 nection with such plans), issue guidance to 

13 clarify the process and timeline for current 

14 and potential participants and beneficiaries 

15 (and authorized representatives and health 

16 care providers of such participants and 

17 beneficiaries) with respect to such plans 

18 and coverage to file formal complaints of 

19 such plans or issuers being in violation of 

20 this section, including guidance, by plan 

21 type, on the relevant State, regional, and 

22 national offices with which such complaints 

23 should be filed. 

24 ‘‘(ii) AUDITS.— 


pamtmann on DSKBFK8HB2PROD with BILLS
15 

•S 1576 IS

1 ‘‘(I) RANDOMIZED AUDITS.—Be2 ginning 1 year after the date of enact3 ment of this paragraph, the Secretary, 

4 in cooperation with the Secretaries of 

5 Health and Human Services and the 

6 Treasury, as applicable, shall conduct 

7 randomized audits of group health 

8 plans (and health insurance issuers 

9 offering health insurance coverage in 

10 connection with such plans) to deter11 mine compliance with this section. 

12 Such audits shall be conducted on no 

13 fewer than 12 plans or coverages per 

14 plan year. 

15 ‘‘(II) ADDITIONAL AUDITS.—Be16 ginning 1 year after the date of enact17 ment of this paragraph, in the case of 

18 a group health plan (or health insur19 ance issuer offering health insurance 

20 coverage in connection with such a 

21 plan) with respect to which any claim 

22 has been filed during a plan year, the 

23 Secretary, in cooperation with the 

24 Secretaries of Health and Human 

25 Services and the Treasury, as applicaVerDate Sep 11 2014 01:38 Jun 01, 2019 Jkt 089200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\S1576.IS S1576

pamtmann on DSKBFK8HB2PROD with BILLS
16 

•S 1576 IS

1 ble, may audit the books and records 

2 of such plan or issuer to determine 

3 compliance with this section. 

4 ‘‘(iii) DENIAL RATES.—The Secretary, 

5 in cooperation with the Secretaries of 

6 Health and Human Services and the 

7 Treasury, shall collect information on the 

8 rates of and reasons for denial by group 

9 health plans (and health insurance issuers 

10 offering health insurance coverage in con11 nection with such plans) of claims for out12 patient and inpatient mental health and 

13 substance use disorder benefits compared 

14 to the rates of and reasons for denial of 

15 claims for medical and surgical benefits. 

16 For the first plan year that begins on or 

17 after the date that is 2 years after the date 

18 of enactment of this paragraph, and each 

19 subsequent plan year, the Secretary, in 

20 such cooperation, shall submit to the Com21 mittee on Energy and Commerce of the 

22 House of Representatives and the Com23 mittee on Health, Education, Labor, and 

24 Pensions of the Senate the information colVerDate Sep 11 2014 01:38 Jun 01, 2019 Jkt 089200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\S1576.IS S1576

pamtmann on DSKBFK8HB2PROD with BILLS
17 

•S 1576 IS

1 lected under the previous sentence with re2 spect to the previous plan year. 

3 ‘‘(C) EFFECTIVE DATE.—Any require4 ments of group health plans (or health insur5 ance issuers offering health insurance coverage 

6 in connection with such plans) that are included 

7 in the regulations issued under subparagraph 

8 (A)(i), including the requirement described in 

9 subparagraph (A)(ii) to disclose documents, 

10 shall have an effective date of 1 year after the 

11 date of enactment of this paragraph.’’. 

12 (c) INTERNAL REVENUE CODE OF 1986.—Section 

13 9812(a) of the Internal Revenue Code of 1986 is amended 

14 by adding at the end the following new paragraph: 

15 ‘‘(6) DISCLOSURE AND ENFORCEMENT RE16 QUIREMENTS.— 

17 ‘‘(A) DISCLOSURE REQUIREMENTS.— 

18 ‘‘(i) REGULATIONS.—Not later than 6 

19 months after the date of enactment of this 

20 paragraph, the Secretary, in cooperation 

21 with the Secretaries of Health and Human 

22 Services and Labor, shall issue regulations 

23 for carrying out this section, including an 

24 explanation of documents that group 

25 health plans shall disclose in accordance 


pamtmann on DSKBFK8HB2PROD with BILLS
18 

•S 1576 IS

1 with clause (ii), the process governing the 

2 disclosure of such documents, and analyses 

3 that such plans shall conduct in order to 

4 demonstrate compliance with this section. 

5 ‘‘(ii) DISCLOSURE REQUIREMENTS.— 

6 The documents required to be disclosed by 

7 a group health plan under clause (i) shall 

8 include an annual report that details the 

9 specific analyses performed to ensure com10 pliance of such plan with this section, in11 cluding any regulation promulgated pursu12 ant to such section. At a minimum, with 

13 respect to the application of nonquantita14 tive treatment limitations (in this para15 graph referred to as ‘NQTLs’) to benefits 

16 under the plan, such report shall— 

17 ‘‘(I) identify the specific factors 

18 the plan used in performing its 

19 NQTLs analysis; 

20 ‘‘(II) identify and define the spe21 cific evidentiary standards relied on to 

22 evaluate such factors; 

23 ‘‘(III) describe how the evi24 dentiary standards are applied to each 

25 service category for mental health 


pamtmann on DSKBFK8HB2PROD with BILLS
19 

•S 1576 IS

1 benefits, substance use disorder bene2 fits, medical benefits, and surgical 

3 benefits; 

4 ‘‘(IV) disclose the results of the 

5 analyses of the specific evidentiary 

6 standards in each service category; 

7 and 

8 ‘‘(V) disclose the specific findings 

9 of the plan in each service category 

10 and the conclusions reached with re11 spect to whether the processes, strate12 gies, evidentiary standards, or other 

13 factors used in applying the NQTLs 

14 to mental health or substance use dis15 order benefits are comparable to, and 

16 applied no more stringently than, the 

17 processes, strategies, evidentiary stan18 dards, or other factors used in apply19 ing the NQTLs to medical and sur20 gical benefits in the same classifica21 tion. 

22 ‘‘(iii) GUIDANCE.—Not later than 6 

23 months after the date of enactment of this 

24 paragraph, the Secretary, in cooperation 

25 with the Secretaries of Health and Human 


pamtmann on DSKBFK8HB2PROD with BILLS
20 

•S 1576 IS

1 Services and Labor, shall issue guidance to 

2 group health plans on how to satisfy the 

3 requirements of this section, with respect 

4 to making information available to current 

5 and potential participants and bene6 ficiaries. Such information shall include— 

7 ‘‘(I) certificate of coverage docu8 ments and instruments under which 

9 the plan involved is administered and 

10 operated that specify, include, or refer 

11 to procedures, formulas, and meth12 odologies applied to determine a par13 ticipant’s or beneficiary’s benefit 

14 under the plan, regardless of whether 

15 such information is contained in a 

16 document designated as the ‘plan doc17 ument’; and 

18 ‘‘(II) a disclosure of how the plan 

19 involved has provided that processes, 

20 strategies, evidentiary standards, and 

21 other factors used in applying the 

22 NQTLs to mental health or substance 

23 use disorder benefits are comparable 

24 to, and applied no more stringently 

25 than, the processes, strategies, eviVerDate Sep 11 2014 01:38 Jun 01, 2019 Jkt 089200 PO 00000 Frm 00020 Fmt 6652 Sfmt 6201 E:\BILLS\S1576.IS S1576

pamtmann on DSKBFK8HB2PROD with BILLS
21 

•S 1576 IS

1 dentiary standards, or other factors 

2 used in applying the NQTLs to med3 ical and surgical benefits in the same 

4 classification. 

5 ‘‘(iv) DEFINITIONS.—In this para6 graph, the terms ‘nonquantitative treat7 ment limitations’, ‘comparable to’, and ‘ap8 plied no more stringently than’ have the 

9 meanings given such terms in sections 

10 146.136 and 147.160 of title 45, Code of 

11 Federal Regulations (or any successor reg12 ulation). 

13 ‘‘(B) ENFORCEMENT.— 

14 ‘‘(i) PROCESS FOR COMPLAINTS.—Not 

15 later than 6 months after the date of en16 actment of this paragraph, the Secretary, 

17 in cooperation with the Secretaries of 

18 Health and Human Services and Labor, 

19 shall, with respect to group health plans, 

20 issue guidance to clarify the process and 

21 timeline for current and potential partici22 pants and beneficiaries (and authorized 

23 representatives and health care providers 

24 of such participants and beneficiaries) with 

25 respect to such plans to file formal comVerDate Sep 11 2014 01:38 Jun 01, 2019 Jkt 089200 PO 00000 Frm 00021 Fmt 6652 Sfmt 6201 E:\BILLS\S1576.IS S1576

pamtmann on DSKBFK8HB2PROD with BILLS
22 

•S 1576 IS

1 plaints of such plans being in violation of 

2 this section, including guidance, by plan 

3 type, on the relevant State, regional, and 

4 national offices with which such complaints 

5 should be filed. 

6 ‘‘(ii) AUDITS.— 

7 ‘‘(I) RANDOMIZED AUDITS.—Be8 ginning 1 year after the date of enact9 ment of this paragraph, the Secretary, 

10 in cooperation with the Secretaries of 

11 Health and Human Services and 

12 Labor, as applicable, shall conduct 

13 randomized audits of group health 

14 plans to determine compliance with 

15 this section. Such audits shall be con16 ducted on no fewer than 12 plans per 

17 plan year. 

18 ‘‘(II) ADDITIONAL AUDITS.—Be19 ginning 1 year after the date of enact20 ment of this paragraph, in the case of 

21 a group health plan with respect to 

22 which any claim has been filed during 

23 a plan year, the Secretary, in coopera24 tion with the Secretaries of Health 

25 and Human Services and Labor, as 


pamtmann on DSKBFK8HB2PROD with BILLS
23 

•S 1576 IS

1 applicable, may audit the books and 

2 records of such plan to determine 

3 compliance with this section. 

4 ‘‘(iii) DENIAL RATES.—The Secretary, 

5 in cooperation with the Secretaries of 

6 Health and Human Services and Labor, 

7 shall collect information on the rates of 

8 and reasons for denial by group health 

9 plans of claims for outpatient and inpa10 tient mental health and substance use dis11 order benefits compared to the rates of 

12 and reasons for denial of claims for med13 ical and surgical benefits. For the first 

14 plan year that begins on or after the date 

15 that is 2 years after the date of enactment 

16 of this paragraph, and each subsequent 

17 plan year, the Secretary, in such coopera18 tion, shall submit to the Committee on En19 ergy and Commerce of the House of Rep20 resentatives and the Committee on Health, 

21 Education, Labor, and Pensions of the 

22 Senate the information collected under the 

23 previous sentence with respect to the pre24 vious plan year. 


pamtmann on DSKBFK8HB2PROD with BILLS
24 

•S 1576 IS

1 ‘‘(C) EFFECTIVE DATE.—Any require2 ments of group health plans that are included 

3 in the regulations issued under subparagraph 

4 (A)(i), including the requirement described in 

5 subparagraph (A)(ii) to disclose documents, 

6 shall have an effective date of 1 year after the 

7 date of enactment of this paragraph.’’. 

8 SEC. 3. CONSUMER PARITY UNIT FOR MENTAL HEALTH 

9 AND SUBSTANCE USE DISORDER PARITY VIO10 LATIONS. 

11 (a) DEFINITIONS.—In this section: 

12 (1) APPLICABLE STATE AUTHORITY.—The term 

13 ‘‘applicable State authority’’ has the meaning given 

14 the term in section 2791 of the Public Health Serv15 ice Act (42 U.S.C. 300gg–91). 

16 (2) COVERED PLAN.—The term ‘‘covered plan’’ 

17 means any creditable coverage that is subject to any 

18 of the mental health parity laws. 

19 (3) CREDITABLE COVERAGE.—The term ‘‘cred20 itable coverage’’ has the meaning given the term in 

21 section 2704(c) of the Public Health Service Act (42 

22 U.S.C. 300gg–3(c)). 

23 (4) MENTAL HEALTH PARITY LAWS.—The term 

24 ‘‘mental health parity laws’’ means— 


pamtmann on DSKBFK8HB2PROD with BILLS
25 

•S 1576 IS

1 (A) section 2726 of the Public Health 

2 Service Act (42 U.S.C. 300gg–26); 

3 (B) section 712 of the Employee Retire4 ment Income Security Act of 1974 (29 U.S.C. 

5 1185a); 

6 (C) section 9812 of the Internal Revenue 

7 Code of 1986; or 

8 (D) any other law that applies the require9 ments under any of the sections described in 

10 subparagraph (A), (B), or (C), or requirements 

11 that are substantially similar to those provided 

12 under any such section, as determined by the 

13 Secretary, to creditable coverage. 

14 (5) SECRETARY.—The term ‘‘Secretary’’ means 

15 the Secretary of Health and Human Services. 

16 (b) ESTABLISHMENT.—Not later than 6 months after 

17 the date of enactment of this Act, the Secretary, in con18 sultation with the Secretary of Labor, the Secretary of the 

19 Treasury, and the head of any other applicable agency, 

20 shall establish a consumer parity unit with functions that 

21 include— 

22 (1) facilitating the centralized collection of, 

23 monitoring of, and response to consumer complaints 

24 regarding violations of mental health parity laws 


pamtmann on DSKBFK8HB2PROD with BILLS
26 

•S 1576 IS

1 through developing and administering, in accordance 

2 with subsection (d)— 

3 (A) a single, toll-free telephone number; 

4 and 

5 (B) a public website portal, which may in6 clude enhancing a website portal in existence on 

7 the date of enactment of this Act; and 

8 (2) providing information to health care con9 sumers regarding the disclosure requirements and 

10 enforcement under section 2726(a)(8) of the Public 

11 Health Service Act, section 712(a)(6) of the Em12 ployee Retirement Income Security Act of 1974, and 

13 section 9812(a)(6) of the Internal Revenue Code of 

14 1986, as added by section 2. 

15 (c) WEBSITE PORTAL.—The Secretary, in consulta16 tion with the Secretary of Labor, the Secretary of the 

17 Treasury, and the head of any other applicable agency, 

18 shall make available on the website portal established 

19 under subsection (b)(1)(B)— 

20 (1) any guidance and any reports issued by the 

21 Secretary, the Secretary of Labor, or the Secretary 

22 of the Treasury, under section 2726 of the Public 

23 Health Service Act, section 712 of the Employee Re24 tirement Income Security Act of 1974, or section 

25 9812 of the Internal Revenue Code of 1986, respecVerDate Sep 11 2014 01:38 Jun 01, 2019 Jkt 089200 PO 00000 Frm 00026 Fmt 6652 Sfmt 6201 E:\BILLS\S1576.IS S1576

pamtmann on DSKBFK8HB2PROD with BILLS
27 

•S 1576 IS

1 tively, including the amendments to such sections 

2 made by section 2; 

3 (2) de-identified information on the results of, 

4 or progress on, any concluded or ongoing audits or 

5 investigations of the Secretary, the Secretary of 

6 Labor, or the Secretary of the Treasury, as applica7 ble, under such section 2726, 712, or 9812, respec8 tively; and 

9 (3) any information on rates of or reasons for 

10 denial collected by the Secretary, the Secretary of 

11 Labor, or the Secretary of the Treasury, pursuant to 

12 subsection (a)(8)(B)(iii) of such section 2726, sub13 section (a)(6)(B)(iii) of such section 712, or sub14 section (a)(6)(B)(iii) of such section 9812, respec15 tively. 

16 (d) RESPONSE TO CONSUMER COMPLAINTS AND IN17 QUIRIES.— 

18 (1) TIMELY RESPONSE TO CONSUMERS.—The 

19 Secretary, in consultation with the Secretary of 

20 Labor, the Secretary of the Treasury, and the head 

21 of any other applicable agency, shall establish rea22 sonable procedures for the consumer parity unit es23 tablished under this section to provide a timely re24 sponse (in writing if appropriate) to consumers reVerDate Sep 11 2014 01:38 Jun 01, 2019 Jkt 089200 PO 00000 Frm 00027 Fmt 6652 Sfmt 6201 E:\BILLS\S1576.IS S1576

pamtmann on DSKBFK8HB2PROD with BILLS
28 

•S 1576 IS

1 garding complaints received by the unit against, or 

2 inquiries concerning, a covered plan, including— 

3 (A) steps that have been taken by the ap4 propriate State or Federal enforcement agency 

5 in response to the complaint or inquiry of the 

6 consumer; 

7 (B) any responses received by the appro8 priate State or Federal enforcement agency 

9 from the covered plan; 

10 (C) any follow-up actions or planned fol11 low-up actions by the appropriate State or Fed12 eral enforcement agency in response to the com13 plaint or inquiry of the consumer; and 

14 (D) contact information of the appropriate 

15 enforcement agency for the consumer to follow 

16 up on the complaint or inquiry. 

17 (2) TIMELY RESPONSE TO REGULATORS.—A 

18 covered plan shall provide a timely response (in writ19 ing if appropriate) to the appropriate State or Fed20 eral enforcement agency having jurisdiction over 

21 such plan concerning a consumer complaint or in22 quiry submitted to the consumer parity unit estab23 lished under this section including— 


pamtmann on DSKBFK8HB2PROD with BILLS
29 

•S 1576 IS

1 (A) steps that have been taken by the plan 

2 to respond to the complaint or inquiry of the 

3 consumer; 

4 (B) any responses received by the plan 

5 from the consumer; and 

6 (C) follow-up actions or planned follow-up 

7 actions by the plan in response to the complaint 

8 or inquiry of the consumer. 

9 (3) PROVISION OF INFORMATION TO CON10 SUMERS.— 

11 (A) IN GENERAL.—A covered plan shall, in 

12 a timely manner, comply with a consumer re13 quest for information in the control or posses14 sion of such covered plan concerning the cov15 erage the consumer obtained from such covered 

16 plan. 

17 (B) EXCEPTIONS.—Notwithstanding sub18 paragraph (A), a covered plan, and any agency 

19 or entity having jurisdiction over a covered 

20 plan, may not be required by this paragraph to 

21 make available to the consumer any information 

22 required to be kept confidential by any other 

23 provision of law. 

24 (e) REPORTS.— 


pamtmann on DSKBFK8HB2PROD with BILLS
30 

•S 1576 IS

1 (1) IN GENERAL.—Not later than March 31 of 

2 each year, the Secretary, in consultation with the 

3 Secretary of Labor, the Secretary of the Treasury, 

4 and the head of any other applicable agency, shall 

5 submit a report to Congress on the complaints re6 ceived by the consumer parity unit established under 

7 this section in the prior year regarding covered 

8 plans. 

9 (2) CONTENTS.—Each such report shall include 

10 information and analysis about complaint numbers, 

11 complaint types, and, where applicable, information 

12 about the resolution of complaints. 

13 (3) CONSUMER PARITY UNIT POSTING.—The 

14 Secretary shall submit such reports to the consumer 

15 parity unit established under this section, and such 

16 unit shall post the reports on the website portal es17 tablished under subsection (b)(1)(B). 

18 (f) DATA SHARING.—Subject to any applicable stand19 ards for Federal or State agencies with respect to pro20 tecting personally identifiable information and data secu21 rity and integrity— 

22 (1) the consumer parity unit established under 

23 this section shall share consumer complaint informa24 tion with the Secretary, and the head of any other 

25 applicable Federal or State agency; and 


pamtmann on DSKBFK8HB2PROD with BILLS
31 

•S 1576 IS

1 (2) the Secretary, and the head of any other 

2 applicable Federal or State agency, shall share data 

3 relating to consumer complaints regarding covered 

4 plans with such unit. 

5 (g) PRIVACY CONSIDERATIONS.— 

6 (1) IN GENERAL.—In carrying out this section, 

7 the consumer parity unit established under this sec8 tion and the Secretary, in consultation with the Sec9 retary of Labor, the Secretary of the Treasury, and 

10 the head of any other applicable agency, shall take 

11 measures to ensure that proprietary, personal, or 

12 confidential consumer information that is protected 

13 from public disclosure under section 552(b) or 552a 

14 of title 5, United States Code, or any other provision 

15 of law, is not made public under this section. 

16 (2) EXCEPTIONS.—The consumer parity unit 

17 established under this section may not obtain from 

18 a covered plan any personally identifiable informa19 tion about a consumer from the records of the cov20 ered plan, except— 

21 (A) if the records are reasonably described 

22 in a request by the consumer parity unit estab23 lished under this section, and the consumer pro24 vides appropriate permission for the disclosure 


pamtmann on DSKBFK8HB2PROD with BILLS
32 

•S 1576 IS

1 of such information by the covered plan to such 

2 unit; or 

3 (B) as may be specifically permitted or re4 quired under other applicable provisions of law, 

5 including HIPAA privacy and security law as 

6 defined in section 3009(a) of the Public Health 

7 Service Act (42 U.S.C. 300jj–19(a)). 

8 (h) COLLABORATION.— 

9 (1) AGREEMENTS WITH OTHER AGENCIES.— 

10 The Secretary, the Secretary of Labor, the Secretary 

11 of the Treasury, and the head of any other applica12 ble agency, shall enter into a memorandum of under13 standing with any affected Federal regulatory agen14 cy regarding procedures by which any covered plan, 

15 and any other agency having jurisdiction over a cov16 ered plan, shall comply with this section. 

17 (2) AGREEMENTS WITH STATES.—To the ex18 tent practicable, an applicable State authority may 

19 receive appropriate complaints from the consumer 

20 parity unit established under this section, if— 

21 (A) the applicable State authority has the 

22 functional capacity to receive calls or electronic 

23 reports routed by the unit; 

24 (B) the applicable State authority has sat25 isfied any conditions of participation that the 


pamtmann on DSKBFK8HB2PROD with BILLS
33 

•S 1576 IS

1 unit may establish, including treatment of per2 sonally identifiable information and sharing of 

3 information on complaint resolution or related 

4 compliance procedures and resources; and 

5 (C) participation by the applicable State 

6 authority includes measures necessary to pro7 tect personally identifiable information in ac8 cordance with standards that apply to Federal 

9 agencies with respect to protecting personally 

10 identifiable information and data security and 

11 integrity. 

Æ 


pamtmann on DSKBFK8HB2PROD with BILLS