I 
116TH CONGRESS 
1ST SESSION H. R. 2874 
To strengthen parity in mental health and substance use disorder benefits. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 21, 2019 
Mr. KENNEDY (for himself, Mr. TONKO, Mr. MICHAEL F. DOYLE of Pennsyl-
vania, Ms. CLARKE of New York, Mr. ENGEL, Mr. SOTO, Mr. CA´RDENAS, 
Mrs. DINGELL, Ms. CASTOR of Florida, Mr. DEUTCH, Mr. CROW, Ms. 
SCHAKOWSKY, and Mr. DESAULNIER) 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 com-
mittee concerned 
A BILL 
To strengthen parity in mental health and substance use 
disorder benefits. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Behavioral Health Cov-
erage Transparency Act’’. 
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SEC. 2. STRENGTHENING PARITY IN MENTAL HEALTH AND 
SUBSTANCE USE DISORDER BENEFITS. 
(a) 
PUBLIC
HEALTH
SERVICE
ACT.—Section 
2726(a) of the Public Health Service Act (42 U.S.C. 
300gg–26(a)) is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(8) DISCLOSURE
AND
ENFORCEMENT
RE-
QUIREMENTS.— 
‘‘(A) DISCLOSURE REQUIREMENTS.— 
‘‘(i) REGULATIONS.—Not later than 6 
months after the date of enactment of this 
paragraph, the Secretary, in cooperation 
with the Secretaries of Labor and the 
Treasury, shall issue regulations for car-
rying out this section, including an expla-
nation of documents that group health 
plans and health insurance issuers offering 
group or individual health insurance cov-
erage shall disclose in accordance with 
clause (ii), the process governing the dis-
closure of such documents, and analyses 
that such plans and issuers shall conduct 
in order to demonstrate compliance with 
this section. 
‘‘(ii) DISCLOSURE REQUIREMENTS.— 
The documents required to be disclosed by 
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a group health plan or a health insurance 
issuer offering group or individual health 
insurance coverage under clause (i) shall 
include an annual report that details the 
specific analyses performed to ensure com-
pliance of such plan or issuer with this sec-
tion, including any regulation promulgated 
pursuant to this section. At a minimum, 
with respect to the application of non-
quantitative treatment limitations (in this 
paragraph referred to as ‘NQTLs’) to ben-
efits under the plan or coverage, such re-
port shall— 
‘‘(I) identify the specific factors 
the plan or issuer used in performing 
its NQTLs analysis; 
‘‘(II) identify and define the spe-
cific evidentiary standards relied on to 
evaluate such factors; 
‘‘(III) describe how the evi-
dentiary standards are applied to each 
service category for mental health 
benefits, substance use disorder bene-
fits, medical benefits, and surgical 
benefits; 
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‘‘(IV) disclose the results of the 
analyses of the specific evidentiary 
standards in each service category; 
and 
‘‘(V) disclose the specific findings 
of the plan or issuer in each service 
category and the conclusions reached 
with respect to whether the processes, 
strategies, evidentiary standards, or 
other factors used in applying the 
NQTLs to mental health or substance 
use disorder benefits are comparable 
to, and applied no more stringently 
than, the processes, strategies, evi-
dentiary standards, or other factors 
used in applying the NQTLs to med-
ical and surgical benefits in the same 
classification. 
‘‘(iii) GUIDANCE.—Not later than 6 
months after the date of enactment of this 
paragraph, the Secretary, in cooperation 
with the Secretaries of Labor and the 
Treasury, shall issue guidance to group 
health plans and health insurance issuers 
offering group or individual health insur-
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ance coverage on how to satisfy the re-
quirements of this section, with respect to 
making information available to current 
and 
potential 
participants 
and 
bene-
ficiaries. Such information shall include— 
‘‘(I) certificate of coverage docu-
ments and instruments under which 
the plan or coverage involved is ad-
ministered and operated that specify, 
include, or refer to procedures, for-
mulas, and methodologies applied to 
determine a participant’s or bene-
ficiary’s benefit under the plan or cov-
erage, regardless of whether such in-
formation is contained in a document 
designated as the ‘plan document’; 
and 
‘‘(II) a disclosure of how the plan 
or issuer involved has provided that 
processes, strategies, evidentiary stan-
dards, and other factors used in ap-
plying the NQTLs to mental health or 
substance use disorder benefits are 
comparable to, and applied no more 
stringently than, the processes, strate-
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gies, evidentiary standards, or other 
factors used in applying the NQTLs 
to medical and surgical benefits in the 
same classification. 
‘‘(iv) DEFINITIONS.—In this para-
graph and paragraph (7), the terms ‘non-
quantitative treatment limitations’, ‘com-
parable to’, and ‘applied no more strin-
gently than’ have the meanings given such 
terms in sections 146.136 and 147.160 of 
title 45, Code of Federal Regulations (or 
any successor regulation). 
‘‘(B) ENFORCEMENT.— 
‘‘(i) PROCESS FOR COMPLAINTS.—Not 
later than 6 months after the date of en-
actment of this paragraph, the Secretary, 
in cooperation with the Secretaries of 
Labor and the Treasury, shall, with re-
spect to group health plans and health in-
surance issuers offering group or indi-
vidual health insurance coverage, issue 
guidance to clarify the process and 
timeline for current and potential partici-
pants and beneficiaries (and authorized 
representatives and health care providers 
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of such participants and beneficiaries) with 
respect to such plans and coverage to file 
formal complaints of such plans or issuers 
being in violation of this section, including 
guidance, by plan type, on the relevant 
State, regional, and national offices with 
which such complaints should be filed. 
‘‘(ii) AUDITS.— 
‘‘(I) RANDOMIZED AUDITS.—Be-
ginning 1 year after the date of enact-
ment of this paragraph, the Secretary, 
in cooperation with the Secretaries of 
Labor and the Treasury, as applica-
ble, shall conduct randomized audits 
of group health plans and health in-
surance issuers offering group or indi-
vidual health insurance coverage to 
determine compliance with this sec-
tion. Such audits shall be conducted 
on no fewer than 12 plans or cov-
erages per plan year. 
‘‘(II) ADDITIONAL AUDITS.—Be-
ginning 1 year after the date of enact-
ment of this paragraph, in the case of 
a group health plan or health insur-
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ance issuer offering group or indi-
vidual health insurance coverage with 
respect to which any claim has been 
filed during a plan year, the Sec-
retary, in cooperation with the Secre-
taries of Labor and the Treasury, as 
applicable, may audit the books and 
records of such plan or issuer to de-
termine compliance with this section. 
‘‘(iii) DENIAL RATES.—The Secretary, 
in cooperation with the Secretaries of 
Labor and the Treasury, shall collect infor-
mation on the rates of and reasons for de-
nial by group health plans and health in-
surance issuers offering group or indi-
vidual health insurance coverage of claims 
for outpatient and inpatient mental health 
and substance use disorder benefits com-
pared to the rates of and reasons for de-
nial of claims for medical and surgical ben-
efits. For the first plan year that begins on 
or after the date that is 2 years after the 
date of enactment of this paragraph, and 
each subsequent plan year, the Secretary, 
in such cooperation, shall submit to the 
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Committee on Energy and Commerce of 
the House of Representatives and the 
Committee on Health, Education, Labor, 
and Pensions of the Senate the informa-
tion collected under the previous sentence 
with respect to the previous plan year. 
‘‘(C) EFFECTIVE
DATE.—Any require-
ments of group health plans and health insur-
ance issuers offering group or individual health 
insurance coverage that are included in the reg-
ulations issued under subparagraph (A)(i), in-
cluding the requirement described in subpara-
graph (A)(ii) to disclose documents, shall have 
an effective date of 1 year after the date of en-
actment of this paragraph.’’. 
(b) EMPLOYEE RETIREMENT INCOME SECURITY ACT 
OF 1974.—Section 712(a) of the Employee Retirement In-
come Security Act of 1974 (29 U.S.C. 1185a(a)) is 
amended by adding at the end the following new para-
graph: 
‘‘(6) DISCLOSURE
AND
ENFORCEMENT
RE-
QUIREMENTS.— 
‘‘(A) DISCLOSURE REQUIREMENTS.— 
‘‘(i) REGULATIONS.—Not later than 6 
months after the date of enactment of this 
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paragraph, the Secretary, in cooperation 
with the Secretaries of Health and Human 
Services and the Treasury, shall issue reg-
ulations for carrying out this section, in-
cluding an explanation of documents that a 
group health plan (or health insurance 
issuer offering health insurance coverage in 
connection with such a plan) shall disclose 
in accordance with clause (ii), the process 
governing the disclosure of such docu-
ments, and analyses that such plans and 
issuers shall conduct in order to dem-
onstrate compliance with this section. 
‘‘(ii) DISCLOSURE REQUIREMENTS.— 
The documents required to be disclosed by 
a group health plan (or a health insurance 
issuer offering health insurance coverage in 
connection with such a plan) under clause 
(i) shall include an annual report that de-
tails the specific analyses performed to en-
sure compliance of such plan or issuer with 
this section, including any regulation pro-
mulgated pursuant to this section. At a 
minimum, with respect to the application 
of nonquantitative treatment limitations 
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NQTLs to mental health or substance 
use disorder benefits are comparable 
to, and applied no more stringently 
than, the processes, strategies, evi-
dentiary standards, or other factors 
used in applying the NQTLs to med-
ical and surgical benefits in the same 
classification. 
‘‘(iii) GUIDANCE.—Not later than 6 
months after the date of enactment of this 
paragraph, the Secretary, in cooperation 
with the Secretaries of Health and Human 
Services and the Treasury, shall issue 
guidance to group health plans (and health 
insurance issuers offering health insurance 
coverage in connection with such plans) on 
how to satisfy the requirements of this sec-
tion, with respect to making information 
available to current and potential partici-
pants and beneficiaries. Such information 
shall include— 
‘‘(I) certificate of coverage docu-
ments and instruments under which 
the plan or coverage involved is ad-
ministered and operated that specify, 
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include, or refer to procedures, for-
mulas, and methodologies applied to 
determine a participant’s or bene-
ficiary’s benefit under the plan or cov-
erage, regardless of whether such in-
formation is contained in a document 
designated as the ‘plan document’; 
and 
‘‘(II) a disclosure of how the plan 
or issuer involved has provided that 
processes, strategies, evidentiary stan-
dards, and other factors used in ap-
plying the NQTLs to mental health or 
substance use disorder benefits are 
comparable to, and applied no more 
stringently than, the processes, strate-
gies, evidentiary standards, or other 
factors used in applying the NQTLs 
to medical and surgical benefits in the 
same classification. 
‘‘(iv) DEFINITIONS.—In this para-
graph, the terms ‘nonquantitative treat-
ment limitations’, ‘comparable to’, and ‘ap-
plied no more stringently than’ have the 
meanings given such terms in sections 
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146.136 and 147.160 of title 45, Code of 
Federal Regulations (or any successor reg-
ulation). 
‘‘(B) ENFORCEMENT.— 
‘‘(i) PROCESS FOR COMPLAINTS.—Not 
later than 6 months after the date of en-
actment of this paragraph, the Secretary, 
in cooperation with the Secretaries of 
Health and Human Services and the 
Treasury, shall, with respect to group 
health plans (and health insurance issuers 
offering health insurance coverage in con-
nection with such plans), issue guidance to 
clarify the process and timeline for current 
and potential participants and beneficiaries 
(and authorized representatives and health 
care providers of such participants and 
beneficiaries) with respect to such plans 
and coverage to file formal complaints of 
such plans or issuers being in violation of 
this section, including guidance, by plan 
type, on the relevant State, regional, and 
national offices with which such complaints 
should be filed. 
‘‘(ii) AUDITS.— 
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‘‘(I) RANDOMIZED AUDITS.—Be-
ginning 1 year after the date of enact-
ment of this paragraph, the Secretary, 
in cooperation with the Secretaries of 
Health and Human Services and the 
Treasury, as applicable, shall conduct 
randomized audits of group health 
plans (and health insurance issuers 
offering health insurance coverage in 
connection with such plans) to deter-
mine compliance with this section. 
Such audits shall be conducted on no 
fewer than 12 plans or coverages per 
plan year. 
‘‘(II) ADDITIONAL AUDITS.—Be-
ginning 1 year after the date of enact-
ment of this paragraph, in the case of 
a group health plan (or health insur-
ance issuer offering health insurance 
coverage in connection with such a 
plan) with respect to which any claim 
has been filed during a plan year, the 
Secretary, in cooperation with the 
Secretaries of Health and Human 
Services and the Treasury, as applica-
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ble, may audit the books and records 
of such plan or issuer to determine 
compliance with this section. 
‘‘(iii) DENIAL RATES.—The Secretary, 
in cooperation with the Secretaries of 
Health and Human Services and the 
Treasury, shall collect information on the 
rates of and reasons for denial by group 
health plans (and health insurance issuers 
offering health insurance coverage in con-
nection with such plans) of claims for out-
patient and inpatient mental health and 
substance use disorder benefits compared 
to the rates of and reasons for denial of 
claims for medical and surgical benefits. 
For the first plan year that begins on or 
after the date that is 2 years after the date 
of enactment of this paragraph, and each 
subsequent plan year, the Secretary, in 
such cooperation, shall submit to the Com-
mittee on Energy and Commerce of the 
House of Representatives and the Com-
mittee on Health, Education, Labor, and 
Pensions of the Senate the information col-
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lected under the previous sentence with re-
spect to the previous plan year. 
‘‘(C) EFFECTIVE
DATE.—Any require-
ments of group health plans (or health insur-
ance issuers offering health insurance coverage 
in connection with such plans) that are included 
in the regulations issued under subparagraph 
(A)(i), including the requirement described in 
subparagraph (A)(ii) to disclose documents, 
shall have an effective date of 1 year after the 
date of enactment of this paragraph.’’. 
(c) INTERNAL REVENUE CODE OF 1986.—Section 
9812(a) of the Internal Revenue Code of 1986 is amended 
by adding at the end the following new paragraph: 
‘‘(6) DISCLOSURE
AND
ENFORCEMENT
RE-
QUIREMENTS.— 
‘‘(A) DISCLOSURE REQUIREMENTS.— 
‘‘(i) REGULATIONS.—Not later than 6 
months after the date of enactment of this 
paragraph, the Secretary, in cooperation 
with the Secretaries of Health and Human 
Services and Labor, shall issue regulations 
for carrying out this section, including an 
explanation of documents that group 
health plans shall disclose in accordance 
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with clause (ii), the process governing the 
disclosure of such documents, and analyses 
that such plans shall conduct in order to 
demonstrate compliance with this section. 
‘‘(ii) DISCLOSURE REQUIREMENTS.— 
The documents required to be disclosed by 
a group health plan under clause (i) shall 
include an annual report that details the 
specific analyses performed to ensure com-
pliance of such plan with this section, in-
cluding any regulation promulgated pursu-
ant to such section. At a minimum, with 
respect to the application of nonquantita-
tive treatment limitations (in this para-
graph referred to as ‘NQTLs’) to benefits 
under the plan, such report shall— 
‘‘(I) identify the specific factors 
the plan used in performing its 
NQTLs analysis; 
‘‘(II) identify and define the spe-
cific evidentiary standards relied on to 
evaluate such factors; 
‘‘(III) describe how the evi-
dentiary standards are applied to each 
service category for mental health 
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benefits, substance use disorder bene-
fits, medical benefits, and surgical 
benefits; 
‘‘(IV) disclose the results of the 
analyses of the specific evidentiary 
standards in each service category; 
and 
‘‘(V) disclose the specific findings 
of the plan in each service category 
and the conclusions reached with re-
spect to whether the processes, strate-
gies, evidentiary standards, or other 
factors used in applying the NQTLs 
to mental health or substance use dis-
order benefits are comparable to, and 
applied no more stringently than, the 
processes, strategies, evidentiary stan-
dards, or other factors used in apply-
ing the NQTLs to medical and sur-
gical benefits in the same classifica-
tion. 
‘‘(iii) GUIDANCE.—Not later than 6 
months after the date of enactment of this 
paragraph, the Secretary, in cooperation 
with the Secretaries of Health and Human 
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Services and Labor, shall issue guidance to 
group health plans on how to satisfy the 
requirements of this section, with respect 
to making information available to current 
and 
potential 
participants 
and 
bene-
ficiaries. Such information shall include— 
‘‘(I) certificate of coverage docu-
ments and instruments under which 
the plan involved is administered and 
operated that specify, include, or refer 
to procedures, formulas, and meth-
odologies applied to determine a par-
ticipant’s 
or 
beneficiary’s 
benefit 
under the plan, regardless of whether 
such information is contained in a 
document designated as the ‘plan doc-
ument’; and 
‘‘(II) a disclosure of how the plan 
involved has provided that processes, 
strategies, evidentiary standards, and 
other factors used in applying the 
NQTLs to mental health or substance 
use disorder benefits are comparable 
to, and applied no more stringently 
than, the processes, strategies, evi-
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dentiary standards, or other factors 
used in applying the NQTLs to med-
ical and surgical benefits in the same 
classification. 
‘‘(iv) DEFINITIONS.—In this para-
graph, the terms ‘nonquantitative treat-
ment limitations’, ‘comparable to’, and ‘ap-
plied no more stringently than’ have the 
meanings given such terms in sections 
146.136 and 147.160 of title 45, Code of 
Federal Regulations (or any successor reg-
ulation). 
‘‘(B) ENFORCEMENT.— 
‘‘(i) PROCESS FOR COMPLAINTS.—Not 
later than 6 months after the date of en-
actment of this paragraph, the Secretary, 
in cooperation with the Secretaries of 
Health and Human Services and Labor, 
shall, with respect to group health plans, 
issue guidance to clarify the process and 
timeline for current and potential partici-
pants and beneficiaries (and authorized 
representatives and health care providers 
of such participants and beneficiaries) with 
respect to such plans to file formal com-
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plaints of such plans being in violation of 
this section, including guidance, by plan 
type, on the relevant State, regional, and 
national offices with which such complaints 
should be filed. 
‘‘(ii) AUDITS.— 
‘‘(I) RANDOMIZED AUDITS.—Be-
ginning 1 year after the date of enact-
ment of this paragraph, the Secretary, 
in cooperation with the Secretaries of 
Health and Human Services and 
Labor, as applicable, shall conduct 
randomized audits of group health 
plans to determine compliance with 
this section. Such audits shall be con-
ducted on no fewer than 12 plans per 
plan year. 
‘‘(II) ADDITIONAL AUDITS.—Be-
ginning 1 year after the date of enact-
ment of this paragraph, in the case of 
a group health plan with respect to 
which any claim has been filed during 
a plan year, the Secretary, in coopera-
tion with the Secretaries of Health 
and Human Services and Labor, as 
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applicable, may audit the books and 
records of such plan to determine 
compliance with this section. 
‘‘(iii) DENIAL RATES.—The Secretary, 
in cooperation with the Secretaries of 
Health and Human Services and Labor, 
shall collect information on the rates of 
and reasons for denial by group health 
plans of claims for outpatient and inpa-
tient mental health and substance use dis-
order benefits compared to the rates of 
and reasons for denial of claims for med-
ical and surgical benefits. For the first 
plan year that begins on or after the date 
that is 2 years after the date of enactment 
of this paragraph, and each subsequent 
plan year, the Secretary, in such coopera-
tion, shall submit to the Committee on En-
ergy and Commerce of the House of Rep-
resentatives and the Committee on Health, 
Education, Labor, and Pensions of the 
Senate the information collected under the 
previous sentence with respect to the pre-
vious plan year. 
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