II 

116TH CONGRESS 

1ST SESSION S. 1737 

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

IN THE SENATE OF THE UNITED STATES 

JUNE 5, 2019 

Mr. MURPHY (for himself and Mr. CASSIDY) 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 ‘‘Mental Health Parity 

5 Compliance Act’’. 

6 SEC. 2. STRENGTHENING PARITY IN MENTAL HEALTH AND 

7 SUBSTANCE USE DISORDER BENEFITS. 

8 (a) EMPLOYEE RETIREMENT INCOME SECURITY ACT

9 OF 1974.—Section 712(a) of the Employee Retirement InVerDate Sep 11 2014 22:54 Jun 10, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1737.IS S1737

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1 come Security Act of 1974 (29 U.S.C. 1185a(a)) is 

2 amended by adding at the end the following: 

3 ‘‘(6) COMPLIANCE REQUIREMENTS.— 

4 ‘‘(A) NONQUANTITATIVE TREATMENT LIM5 ITATION (NQTL) REQUIREMENTS.—In the case 

6 of a group health plan (or health insurance cov7 erage offered in connection with such a plan) 

8 that provides both medical and surgical benefits 

9 and mental health or substance use disorder 

10 benefits, the plan or coverage shall perform 

11 comparative analyses about the design and ap12 plication of nonquantitative treatment limita13 tions (referred to in this paragraph as the 

14 ‘NQTL’) in accordance with the following proc15 ess, and make available to the Secretary upon 

16 request within 60 days beginning January 1, 

17 2020, and immediately upon request beginning 

18 January 1, 2021 the following information: 

19 ‘‘(i) The specific plan or coverage lan20 guage regarding the NQTL and a descrip21 tion of all mental health or substance use 

22 disorder and medical/surgical services to 

23 which it applies in each respective benefits 

24 classification. 


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1 ‘‘(ii) The factors used to determine 

2 that an NQTL will apply to mental health 

3 or substance use disorder benefits and 

4 medical/surgical benefits, including factors 

5 that were considered but rejected. 

6 ‘‘(iii) The evidentiary standard (both 

7 identified and deidentified) for each of the 

8 factors identified in clause (ii) and any 

9 other evidence relied upon to design and 

10 apply the NQTL to mental health or sub11 stance use disorder benefits and medical/ 

12 surgical benefits. 

13 ‘‘(iv) The comparative analyses dem14 onstrating that the processes and strate15 gies used to design the NQTL, as written, 

16 and the as written processes and strategies 

17 used to apply the NQTL for mental health 

18 or substance use disorder benefits are com19 parable to, and are applied no more strin20 gently than, the processes and strategies 

21 used to design the NQTL, as written, and 

22 the as written processes and strategies 

23 used to apply the NQTL to medical/sur24 gical benefits. 


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1 ‘‘(v) The comparative analyses dem2 onstrating that the processes and strate3 gies used to apply the NQTL, in operation, 

4 for mental health and substance use dis5 order benefits are comparable to, and are 

6 applied no more stringently than, the proc7 esses and strategies used to apply each 

8 NQTL, in operation, for medical and sur9 gical benefits. 

10 ‘‘(vi) A disclosure of the specific find11 ings and conclusions reached by the plan 

12 or coverage that the results of the analyses 

13 described in this subparagraph indicate 

14 that the plan or coverage is in compliance 

15 with this section. 

16 ‘‘(B) SECRETARY REQUEST PROCESS.— 

17 ‘‘(i) SUBMISSION UPON COMPLAINT.— 

18 The Secretary shall request that a group 

19 health plan (or health insurance coverage 

20 offered in connection with such a plan) 

21 submit the comparative analyses described 

22 in subparagraph (A) if the Secretary has 

23 received any complaints about such a plan 

24 or coverage that involve mental health or 

25 substance use disorder benefits. 


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1 ‘‘(ii) RANDOM SUBMISSIONS.—The 

2 Secretary shall request the comparative 

3 analyses described in subparagraph (A) 

4 from no fewer than 50 plans or coverages 

5 selected at random, annually, and such 

6 plans or coverages shall not be the same 

7 plans or coverages for which the compara8 tive analyses are requested under clause 

9 (i). 

10 ‘‘(iii) ADDITIONAL INFORMATION.—In 

11 instances in which the Secretary has con12 cluded that the plan or coverage has not 

13 submitted sufficient information for the 

14 Secretary to review the comparative anal15 yses described in subparagraph (A), as re16 quested under clauses (i) and (ii), the Sec17 retary shall specify to the plan or coverage 

18 the additional information the plan or cov19 erage must submit for the Secretary to re20 view the comparative analyses described in 

21 subparagraph (A) for compliance with this 

22 section. 

23 ‘‘(iv) REQUIRED ACTION.—In in24 stances in which the Secretary has re25 viewed the comparative analyses described 


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1 in subparagraph (A), as requested under 

2 clauses (i) and (ii), and determined that 

3 the plan or coverage is not in compliance 

4 with this section, the Secretary shall speci5 fy to the plan or coverage the actions the 

6 plan or coverage must take to be in compli7 ance with this section. 

8 ‘‘(v) REPORT.—Not later than 1 year 

9 after the date of enactment of this para10 graph, and annually thereafter, the Sec11 retary shall submit to the Committee on 

12 Education and Labor of the House of Rep13 resentatives and the Committee on Health, 

14 Education, Labor, and Pensions of the 

15 Senate a report that contains— 

16 ‘‘(I) each of the comparative 

17 analyses requested under clauses (i) 

18 and (ii), except that the identity of 

19 each plan or coverage and any con20 tracted entity of a plan or coverage 

21 shall be redacted; 

22 ‘‘(II) the Secretary’s conclusions 

23 as to whether each plan or coverage 

24 submitted sufficient information for 

25 the Secretary to review the comparaVerDate Sep 11 2014 22:54 Jun 10, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1737.IS S1737

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1 tive analyses requested under clauses 

2 (i) and (ii) for compliance with this 

3 section; 

4 ‘‘(III) for each plan or coverage 

5 that did submit sufficient information 

6 for the Secretary to review the com7 parative analyses requested under 

8 clause (i), the Secretary’s conclusions 

9 as to whether the plan or coverage is 

10 in compliance with this section; 

11 ‘‘(IV) the Secretary’s specifica12 tions described in clause (iii) for each 

13 plan or coverage that the Secretary 

14 determined did not submit sufficient 

15 information for the Secretary to re16 view the comparative analyses re17 quested under clauses (i) and (ii) for 

18 compliance with this section; and 

19 ‘‘(V) the Secretary’s specifica20 tions described in clause (iv) of the 

21 actions each plan or coverage that the 

22 Secretary determined is not in compli23 ance with this section must take to be 

24 in compliance with this section. 


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1 ‘‘(C) COMPLIANCE PROGRAM GUIDANCE

2 DOCUMENT UPDATE PROCESS.— 

3 ‘‘(i) IN GENERAL.—The Secretary 

4 shall include select instances of noncompli5 ance that the Secretary discovers upon re6 viewing the comparative analyses requested 

7 under clauses (i) and (ii) of subparagraph 

8 (B) in the compliance program guidance 

9 document described in section 2726(a)(6) 

10 of the Public Health Service Act, as it is 

11 updated every 2 years, except that all in12 stances shall be deidentified and such in13 stances shall not disclose any protected 

14 health information or individually identifi15 able information. 

16 ‘‘(ii) INSPECTOR GENERAL.—Any in17 stances of noncompliance the Secretary 

18 discovers upon reviewing the comparative 

19 analyses requested under clauses (i) and 

20 (ii) of subparagraph (B) shall be shared 

21 with Inspector General of the Department 

22 of Health and Human Services, the Inspec23 tor General of the Department of Labor, 

24 and the Inspector General of the Depart25 ment of the Treasury, in accordance with 


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1 section 2726(a)(6)(B)(iii)(I) of the Public 

2 Health Service Act. 

3 ‘‘(iii) STATE.—Any instances of non4 compliance the Secretary discovers upon 

5 reviewing the comparative analyses re6 quested under clauses (i) and (ii) of sub7 paragraph (B) shall be shared with a 

8 State, in accordance with section 

9 2726(a)(6)(B)(iii)(II) of the Public Health 

10 Service Act.’’. 

11 (b) INTERNAL REVENUE CODE OF 1986.—Section 

12 9812(a) of the Internal Revenue Code of 1986 is amended 

13 by adding at the end the following: 

14 ‘‘(6) COMPLIANCE REQUIREMENTS.— 

15 ‘‘(A) NONQUANTITATIVE TREATMENT LIM16 ITATION (NQTL) REQUIREMENTS.—In the case 

17 of a group health plan that provides both med18 ical and surgical benefits and mental health or 

19 substance use disorder benefits, the plan shall 

20 perform comparative analyses about the design 

21 and application of nonquantitative treatment 

22 limitations (referred to in this paragraph as the 

23 ‘NQTL’) in accordance with the following proc24 ess, and make available to the Secretary upon 

25 request within 60 days beginning January 1, 


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1 2020, and immediately upon request beginning 

2 January 1, 2021 the following information: 

3 ‘‘(i) The specific plan language re4 garding the NQTL and a description of all 

5 mental health or substance use disorder 

6 and medical/surgical services to which it 

7 applies in each respective benefits classi8 fication. 

9 ‘‘(ii) The factors used to determine 

10 that an NQTL will apply to mental health 

11 or substance use disorder benefits and 

12 medical/surgical benefits, including factors 

13 that were considered but rejected. 

14 ‘‘(iii) The evidentiary standard (both 

15 identified and deidentified) for each of the 

16 factors identified in clause (ii) and any 

17 other evidence relied upon to design and 

18 apply the NQTL to mental health or sub19 stance use disorder benefits and medical/ 

20 surgical benefits. 

21 ‘‘(iv) The comparative analyses dem22 onstrating that the processes and strate23 gies used to design the NQTL, as written, 

24 and the as written processes and strategies 

25 used to apply the NQTL for mental health 


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1 or substance use disorder benefits are com2 parable to, and are applied no more strin3 gently than, the processes and strategies 

4 used to design the NQTL, as written, and 

5 the as written processes and strategies 

6 used to apply the NQTL to medical/sur7 gical benefits. 

8 ‘‘(v) The comparative analyses dem9 onstrating that the processes and strate10 gies used to apply the NQTL, in operation, 

11 for mental health and substance use dis12 order benefits are comparable to, and are 

13 applied no more stringently than, the proc14 esses and strategies used to apply each 

15 NQTL, in operation, for medical and sur16 gical benefits. 

17 ‘‘(vi) A disclosure of the specific find18 ings and conclusions reached by the plan 

19 that the results of the analyses described 

20 in this subparagraph indicate that the plan 

21 or coverage is in compliance with this sec22 tion. 

23 ‘‘(B) SECRETARY REQUEST PROCESS.— 

24 ‘‘(i) SUBMISSION UPON COMPLAINT.— 

25 The Secretary shall request that a group 


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1 health plan submit the comparative anal2 yses described in subparagraph (A) if the 

3 Secretary has received any complaints 

4 about such a plan that involve mental 

5 health or substance use disorder benefits. 

6 ‘‘(ii) RANDOM SUBMISSIONS.—The 

7 Secretary shall request the comparative 

8 analyses described in subparagraph (A) 

9 from no fewer than 50 plans selected at 

10 random, annually, and such plans shall not 

11 be the same plans for which the compara12 tive analyses are requested under clause 

13 (i). 

14 ‘‘(iii) ADDITIONAL INFORMATION.—In 

15 instances in which the Secretary has con16 cluded that the plan has not submitted suf17 ficient information for the Secretary to re18 view the comparative analyses described in 

19 subparagraph (A), as requested under 

20 clauses (i) and (ii), the Secretary shall 

21 specify to the plan the additional informa22 tion the plan must submit for the Sec23 retary to review the comparative analyses 

24 described in subparagraph (A) for compli25 ance with this section. 


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1 ‘‘(iv) REQUIRED ACTION.—In in2 stances in which the Secretary has re3 viewed the comparative analyses described 

4 in subparagraph (A), as requested under 

5 clauses (i) and (ii), and determined that 

6 the plan is not in compliance with this sec7 tion, the Secretary shall specify to the plan 

8 the actions the plan must take to be in 

9 compliance with this section. 

10 ‘‘(v) REPORT.—Not later than 1 year 

11 after the date of enactment of this para12 graph, and annually thereafter, the Sec13 retary shall submit to the Committee on 

14 Ways and Means of the House of Rep15 resentatives and the Committee on Finance 

16 of the Senate a report that contains— 

17 ‘‘(I) each of the comparative 

18 analyses requested under clauses (i) 

19 and (ii), except that the identity of 

20 each plan and any contracted entity of 

21 a plan shall be redacted; 

22 ‘‘(II) the Secretary’s conclusions 

23 as to whether each plan submitted 

24 sufficient information for the Sec25 retary to review the comparative analVerDate Sep 11 2014 22:54 Jun 10, 2019 Jkt 089200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\S1737.IS S1737

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1 yses requested under clauses (i) and 

2 (ii) for compliance with this section; 

3 ‘‘(III) for each plan that did sub4 mit sufficient information for the Sec5 retary to review the comparative anal6 yses requested under clause (i), the 

7 Secretary’s conclusions as to whether 

8 the plan is in compliance with this 

9 section; 

10 ‘‘(IV) the Secretary’s specifica11 tions described in clause (iii) for each 

12 plan that the Secretary determined 

13 did not submit sufficient information 

14 for the Secretary to review the com15 parative analyses requested under 

16 clauses (i) and (ii) for compliance 

17 with this section; and 

18 ‘‘(V) the Secretary’s specifica19 tions described in clause (iv) of the 

20 actions each plan that the Secretary 

21 determined is not in compliance with 

22 this section must take to be in compli23 ance with this section. 

24 ‘‘(C) COMPLIANCE PROGRAM GUIDANCE

25 DOCUMENT UPDATE PROCESS.— 


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1 ‘‘(i) IN GENERAL.—The Secretary 

2 shall include select instances of noncompli3 ance that the Secretary discovers upon re4 viewing the comparative analyses requested 

5 under clauses (i) and (ii) of subparagraph 

6 (B) in the compliance program guidance 

7 document described in section 2726(a)(6) 

8 of the Public Health Service Act, as it is 

9 updated every 2 years, except that all in10 stances shall be deidentified and such in11 stances shall not disclose any protected 

12 health information or individually identifi13 able information. 

14 ‘‘(ii) INSPECTOR GENERAL.—Any in15 stances of noncompliance the Secretary 

16 discovers upon reviewing the comparative 

17 analyses requested under clauses (i) and 

18 (ii) of subparagraph (B) shall be shared 

19 with Inspector General of the Department 

20 of Health and Human Services, the Inspec21 tor General of the Department of Labor, 

22 and the Inspector General of the Depart23 ment of the Treasury, in accordance with 

24 section 2726(a)(6)(B)(iii)(I) of the Public 

25 Health Service Act. 


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1 ‘‘(iii) STATE.—Any instances of non2 compliance the Secretary discovers upon 

3 reviewing the comparative analyses re4 quested under clauses (i) and (ii) of sub5 paragraph (B) shall be shared with a 

6 State, in accordance with section 

7 2726(a)(6)(B)(iii)(II) of the Public Health 

8 Service Act.’’. 

9 (c) PUBLIC HEALTH SERVICE ACT.—Section 2726 of 

10 the Public Health Service Act (42 U.S.C. 300gg–26) is 

11 amended— 

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

13 following: 

14 ‘‘(8) COMPLIANCE REQUIREMENTS.— 

15 ‘‘(A) NONQUANTITATIVE TREATMENT LIM16 ITATION (NQTL) REQUIREMENTS.—In the case 

17 of a group health plan or a health insurance 

18 issuer offering group or individual health insur19 ance coverage that provides both medical and 

20 surgical benefits and mental health or sub21 stance use disorder benefits, the plan or issuer 

22 offering group or individual health insurance 

23 coverage shall perform comparative analyses 

24 about the design and application of non25 quantitative treatment limitations (referred to 


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1 in this paragraph as the ‘NQTL’) in accordance 

2 with the following process, and make available 

3 to State, or to the Secretary as permitted under 

4 subsections (a)(2) and (b)(1) of section 2723, 

5 upon request within 60 days beginning January 

6 1, 2020, and immediately upon request begin7 ning January 1, 2021, the following informa8 tion: 

9 ‘‘(i) The specific plan or coverage lan10 guage regarding the NQTL and a descrip11 tion of all mental health or substance use 

12 disorder and medical/surgical services to 

13 which it applies in each respective benefits 

14 classification. 

15 ‘‘(ii) The factors used to determine 

16 that an NQTL will apply to mental health 

17 or substance use disorder benefits and 

18 medical/surgical benefits, including factors 

19 that were considered but rejected. 

20 ‘‘(iii) The evidentiary standard (both 

21 identified and deidentified) for each of the 

22 factors identified in clause (ii) and any 

23 other evidence relied upon to design and 

24 apply the NQTL to mental health or subVerDate Sep 11 2014 22:54 Jun 10, 2019 Jkt 089200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\S1737.IS S1737

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1 stance use disorder benefits and medical/ 

2 surgical benefits. 

3 ‘‘(iv) The comparative analyses dem4 onstrating that the processes and strate5 gies used to design the NQTL, as written, 

6 and the as written processes and strategies 

7 used to apply the NQTL for mental health 

8 or substance use disorder benefits are com9 parable to, and are applied no more strin10 gently than, the processes and strategies 

11 used to design the NQTL, as written, and 

12 the as written processes and strategies 

13 used to apply the NQTL to medical/sur14 gical benefits. 

15 ‘‘(v) The comparative analyses dem16 onstrating that the processes and strate17 gies used to apply the NQTL, in operation, 

18 for mental health and substance use dis19 order benefits are comparable to, and are 

20 applied no more stringently than, the proc21 esses and strategies used to apply each 

22 NQTL, in operation, for medical and sur23 gical benefits. 

24 ‘‘(vi) A disclosure of the specific find25 ings and conclusions reached by the plan 


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1 or health insurance issuer offering group 

2 or individual health insurance coverage 

3 that the results of the analyses described 

4 in this subparagraph indicate that the plan 

5 or coverage is in compliance with this sec6 tion. 

7 ‘‘(B) SECRETARY REQUEST PROCESS.— 

8 ‘‘(i) SUBMISSION UPON COMPLAINT.— 

9 As permitted under subsections (a)(2) and 

10 (b)(1) of section 2723, the Secretary shall 

11 request that a group health plan or a 

12 health insurance issuer offering group or 

13 individual health insurance coverage sub14 mit the comparative analyses described in 

15 subparagraph (A) if the Secretary has re16 ceived any complaints about such a plan or 

17 issuer that involve mental health or sub18 stance use disorder benefits. 

19 ‘‘(ii) RANDOM SUBMISSIONS.—As per20 mitted under subsections (a)(2) and (b)(1) 

21 of section 2723, the Secretary shall request 

22 the comparative analyses described in sub23 paragraph (A) from no fewer than 50 

24 plans or issuers selected at random, annu25 ally, and such plans or issuers shall not be 


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1 the same plans or issuers for which the 

2 comparative analyses are requested under 

3 clause (i). 

4 ‘‘(iii) ADDITIONAL INFORMATION.—In 

5 instances in which the Secretary has con6 cluded that the plan or issuer has not sub7 mitted sufficient information for the Sec8 retary to review the comparative analyses 

9 described in subparagraph (A), as re10 quested under clauses (i) and (ii), the Sec11 retary shall specify to the plan or issuer 

12 the additional information the plan or 

13 issuer must submit for the Secretary to re14 view the comparative analyses described in 

15 subparagraph (A) for compliance with this 

16 section. 

17 ‘‘(iv) REQUIRED ACTION.—In in18 stances in which the Secretary has re19 viewed the comparative analyses described 

20 in subparagraph (A), as requested under 

21 clauses (i) and (ii), and determined that 

22 the plan or issuer is not in compliance with 

23 this section, the Secretary shall specify to 

24 the plan or issuer the actions the plan or 


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1 issuer must take to be in compliance with 

2 this section. 

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

4 after the date of enactment of this para5 graph, and annually thereafter, the Sec6 retary shall submit to the Committee on 

7 Education and Labor of the House of Rep8 resentatives and the Committee on Health, 

9 Education, Labor, and Pensions of the 

10 Senate a report that contains— 

11 ‘‘(I) each of the comparative 

12 analyses requested under clauses (i) 

13 and (ii), except that the identity of 

14 each plan or issuer and any con15 tracted entity of a plan or issuer shall 

16 be redacted; 

17 ‘‘(II) the Secretary’s conclusions 

18 as to whether each plan or issuer sub19 mitted sufficient information for the 

20 Secretary to review the comparative 

21 analyses requested under clauses (i) 

22 and (ii) for compliance with this sec23 tion; 

24 ‘‘(III) for each plan or issuer 

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 the plan or issuer is in 

5 compliance with this section; 

6 ‘‘(IV) the Secretary’s specifica7 tions described in clause (iii) for each 

8 plan or issuer that the Secretary de9 termined did not submit sufficient in10 formation for the Secretary to review 

11 the comparative analyses requested 

12 under clauses (i) and (ii) for compli13 ance with this section; and 

14 ‘‘(V) the Secretary’s specifica15 tions described in clause (iv) of the 

16 actions each plan or issuer that the 

17 Secretary determined is not in compli18 ance with this section must take to be 

19 in compliance with this section. 

20 ‘‘(C) COMPLIANCE PROGRAM GUIDANCE

21 DOCUMENT UPDATE PROCESS.— 

22 ‘‘(i) IN GENERAL.—The Secretary 

23 shall include select instances of noncompli24 ance that the Secretary discovers upon re25 viewing the comparative analyses requested 


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1 under clauses (i) and (ii) of subparagraph 

2 (B) in the compliance program guidance 

3 document described in subsection (a)(6), as 

4 it is updated every 2 years, except that all 

5 instances shall be deidentified and such in6 stances shall not disclose any protected 

7 health information or individually identifi8 able information. 

9 ‘‘(ii) INSPECTOR GENERAL.—Any in10 stances of noncompliance the Secretary 

11 discovers upon reviewing the comparative 

12 analyses requested under clauses (i) and 

13 (ii) of subparagraph (B) shall be shared 

14 with Inspector General of the Department 

15 of Health and Human Services, the Inspec16 tor General of the Department of Labor, 

17 and the Inspector General of the Depart18 ment of the Treasury, in accordance with 

19 subsection (a)(6)(B)(iii)(I). 

20 ‘‘(iii) STATE.—Any instances of non21 compliance the Secretary discovers upon 

22 reviewing the comparative analyses re23 quested under clauses (i) and (ii) of sub24 paragraph (B) shall be shared with a 


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1 State, in accordance with subsection 

2 (a)(6)(B)(iii)(II).’’. 

Æ 


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