I 
116TH CONGRESS 
1ST SESSION H. R. 3165 
To strengthen parity in mental health and substance use disorder benefits. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 10, 2019 
Ms. PORTER (for herself, Mr. BILIRAKIS, and Mr. NORCROSS) introduced the 
following bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committees on Ways and Means, and Edu-
cation 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. 
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 ‘‘Mental Health Parity 
Compliance Act’’. 
SEC. 2. STRENGTHENING PARITY IN MENTAL HEALTH AND 
SUBSTANCE USE DISORDER BENEFITS. 
(a) EMPLOYEE RETIREMENT INCOME SECURITY ACT 
OF 1974.—Section 712(a) of the Employee Retirement In-
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come Security Act of 1974 (29 U.S.C. 1185a(a)) is 
amended by adding at the end the following: 
‘‘(6) COMPLIANCE REQUIREMENTS.— 
‘‘(A) NONQUANTITATIVE TREATMENT LIM-
ITATION (NQTL) REQUIREMENTS.—In the case 
of a group health plan (or health insurance cov-
erage offered in connection with such a plan) 
that provides both medical and surgical benefits 
and mental health or substance use disorder 
benefits, the plan or coverage shall perform 
comparative analyses about the design and ap-
plication of nonquantitative treatment limita-
tions (referred to in this paragraph as the 
‘NQTL’) in accordance with the following proc-
ess, and make available to the Secretary upon 
request within 60 days beginning January 1, 
2020, and immediately upon request beginning 
January 1, 2021, the following information: 
‘‘(i) The specific plan or coverage lan-
guage regarding the NQTL and a descrip-
tion of all mental health or substance use 
disorder and medical/surgical services to 
which it applies in each respective benefits 
classification. 
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‘‘(ii) The factors used to determine 
that an NQTL will apply to mental health 
or substance use disorder benefits and 
medical/surgical benefits, including factors 
that were considered but rejected. 
‘‘(iii) The evidentiary standard (both 
identified and deidentified) for each of the 
factors identified in clause (ii) and any 
other evidence relied upon to design and 
apply the NQTL to mental health or sub-
stance use disorder benefits and medical/ 
surgical benefits. 
‘‘(iv) The comparative analyses dem-
onstrating that the processes and strate-
gies used to design the NQTL, as written, 
and the as written processes and strategies 
used to apply the NQTL for mental health 
or substance use disorder benefits are com-
parable to, and are applied no more strin-
gently than, the processes and strategies 
used to design the NQTL, as written, and 
the as written processes and strategies 
used to apply the NQTL to medical/sur-
gical benefits. 
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‘‘(v) The comparative analyses dem-
onstrating that the processes and strate-
gies used to apply the NQTL, in operation, 
for mental health and substance use dis-
order benefits are comparable to, and are 
applied no more stringently than, the proc-
esses and strategies used to apply each 
NQTL, in operation, for medical and sur-
gical benefits. 
‘‘(vi) A disclosure of the specific find-
ings and conclusions reached by the plan 
or coverage that the results of the analyses 
described in this subparagraph indicate 
that the plan or coverage is in compliance 
with this section. 
‘‘(B) SECRETARY REQUEST PROCESS.— 
‘‘(i) SUBMISSION UPON COMPLAINT.— 
The Secretary shall request that a group 
health plan (or health insurance coverage 
offered in connection with such a plan) 
submit the comparative analyses described 
in subparagraph (A) if the Secretary has 
received any complaints about such a plan 
or coverage that involve mental health or 
substance use disorder benefits. 
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‘‘(ii) 
RANDOM
SUBMISSIONS.—The 
Secretary shall request the comparative 
analyses described in subparagraph (A) 
from no fewer than 50 plans or coverages 
selected at random, annually, and such 
plans or coverages shall not be the same 
plans or coverages for which the compara-
tive analyses are requested under clause 
(i). 
‘‘(iii) ADDITIONAL INFORMATION.—In 
instances in which the Secretary has con-
cluded that the plan or coverage has not 
submitted sufficient information for the 
Secretary to review the comparative anal-
yses described in subparagraph (A), as re-
quested under clauses (i) and (ii), the Sec-
retary shall specify to the plan or coverage 
the additional information the plan or cov-
erage must submit for the Secretary to re-
view the comparative analyses described in 
subparagraph (A) for compliance with this 
section. 
‘‘(iv) 
REQUIRED
ACTION.—In 
in-
stances in which the Secretary has re-
viewed the comparative analyses described 
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in subparagraph (A), as requested under 
clauses (i) and (ii), and determined that 
the plan or coverage is not in compliance 
with this section, the Secretary shall speci-
fy to the plan or coverage the actions the 
plan or coverage must take to be in compli-
ance with this section. 
‘‘(v) REPORT.—Not later than 1 year 
after the date of enactment of this para-
graph, and annually thereafter, the Sec-
retary shall submit to the Committee on 
Education and Labor of the House of Rep-
resentatives and the Committee on Health, 
Education, Labor, and Pensions of the 
Senate a report that contains— 
‘‘(I) each of the comparative 
analyses requested under clauses (i) 
and (ii), except that the identity of 
each plan or coverage and any con-
tracted entity of a plan or coverage 
shall be redacted; 
‘‘(II) the Secretary’s conclusions 
as to whether each plan or coverage 
submitted sufficient information for 
the Secretary to review the compara-
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tive analyses requested under clauses 
(i) and (ii) for compliance with this 
section; 
‘‘(III) for each plan or coverage 
that did submit sufficient information 
for the Secretary to review the com-
parative analyses requested under 
clause (i), the Secretary’s conclusions 
as to whether the plan or coverage is 
in compliance with this section; 
‘‘(IV) the Secretary’s specifica-
tions described in clause (iii) for each 
plan or coverage that the Secretary 
determined did not submit sufficient 
information for the Secretary to re-
view the comparative analyses re-
quested under clauses (i) and (ii) for 
compliance with this section; and 
‘‘(V) the Secretary’s specifica-
tions described in clause (iv) of the 
actions each plan or coverage that the 
Secretary determined is not in compli-
ance with this section must take to be 
in compliance with this section. 
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‘‘(C) COMPLIANCE
PROGRAM
GUIDANCE 
DOCUMENT UPDATE PROCESS.— 
‘‘(i) IN
GENERAL.—The Secretary 
shall include select instances of noncompli-
ance that the Secretary discovers upon re-
viewing the comparative analyses requested 
under clauses (i) and (ii) of subparagraph 
(B) in the compliance program guidance 
document described in section 2726(a)(6) 
of the Public Health Service Act, as it is 
updated every 2 years, except that all in-
stances shall be deidentified and such in-
stances shall not disclose any protected 
health information or individually identifi-
able information. 
‘‘(ii) INSPECTOR GENERAL.—Any in-
stances of noncompliance the Secretary 
discovers upon reviewing the comparative 
analyses requested under clauses (i) and 
(ii) of subparagraph (B) shall be shared 
with the Inspector General of the Depart-
ment of Health and Human Services, the 
Inspector General of the Department of 
Labor, and the Inspector General of the 
Department of the Treasury, in accordance 
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with section 2726(a)(6)(B)(iii)(I) of the 
Public Health Service Act. 
‘‘(iii) STATE.—Any instances of non-
compliance the Secretary discovers upon 
reviewing the comparative analyses re-
quested under clauses (i) and (ii) of sub-
paragraph (B) shall be shared with a 
State, 
in 
accordance 
with 
section 
2726(a)(6)(B)(iii)(II) of the Public Health 
Service Act.’’. 
(b) INTERNAL REVENUE CODE OF 1986.—Section 
9812(a) of the Internal Revenue Code of 1986 is amended 
by adding at the end the following: 
‘‘(6) COMPLIANCE REQUIREMENTS.— 
‘‘(A) NONQUANTITATIVE TREATMENT LIM-
ITATION (NQTL) REQUIREMENTS.—In the case 
of a group health plan that provides both med-
ical and surgical benefits and mental health or 
substance use disorder benefits, the plan shall 
perform comparative analyses about the design 
and application of nonquantitative treatment 
limitations (referred to in this paragraph as the 
‘NQTL’) in accordance with the following proc-
ess, and make available to the Secretary upon 
request within 60 days beginning January 1, 
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‘‘(iv) 
REQUIRED
ACTION.—In 
in-
stances in which the Secretary has re-
viewed the comparative analyses described 
in subparagraph (A), as requested under 
clauses (i) and (ii), and determined that 
the plan is not in compliance with this sec-
tion, the Secretary shall specify to the plan 
the actions the plan must take to be in 
compliance with this section. 
‘‘(v) REPORT.—Not later than 1 year 
after the date of enactment of this para-
graph, and annually thereafter, the Sec-
retary shall submit to the Committee on 
Ways and Means of the House of Rep-
resentatives and the Committee on Finance 
of the Senate a report that contains— 
‘‘(I) each of the comparative 
analyses requested under clauses (i) 
and (ii), except that the identity of 
each plan and any contracted entity of 
a plan shall be redacted; 
‘‘(II) the Secretary’s conclusions 
as to whether each plan submitted 
sufficient information for the Sec-
retary to review the comparative anal-
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yses requested under clauses (i) and 
(ii) for compliance with this section; 
‘‘(III) for each plan that did sub-
mit sufficient information for the Sec-
retary to review the comparative anal-
yses requested under clause (i), the 
Secretary’s conclusions as to whether 
the plan is in compliance with this 
section; 
‘‘(IV) the Secretary’s specifica-
tions described in clause (iii) for each 
plan that the Secretary determined 
did not submit sufficient information 
for the Secretary to review the com-
parative analyses requested under 
clauses (i) and (ii) for compliance 
with this section; and 
‘‘(V) the Secretary’s specifica-
tions described in clause (iv) of the 
actions each plan that the Secretary 
determined is not in compliance with 
this section must take to be in compli-
ance with this section. 
‘‘(C) COMPLIANCE
PROGRAM
GUIDANCE 
DOCUMENT UPDATE PROCESS.— 
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‘‘(i) IN
GENERAL.—The Secretary 
shall include select instances of noncompli-
ance that the Secretary discovers upon re-
viewing the comparative analyses requested 
under clauses (i) and (ii) of subparagraph 
(B) in the compliance program guidance 
document described in section 2726(a)(6) 
of the Public Health Service Act, as it is 
updated every 2 years, except that all in-
stances shall be deidentified and such in-
stances shall not disclose any protected 
health information or individually identifi-
able information. 
‘‘(ii) INSPECTOR GENERAL.—Any in-
stances of noncompliance the Secretary 
discovers upon reviewing the comparative 
analyses requested under clauses (i) and 
(ii) of subparagraph (B) shall be shared 
with the Inspector General of the Depart-
ment of Health and Human Services, the 
Inspector General of the Department of 
Labor, and the Inspector General of the 
Department of the Treasury, in accordance 
with section 2726(a)(6)(B)(iii)(I) of the 
Public Health Service Act. 
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‘‘(iii) STATE.—Any instances of non-
compliance the Secretary discovers upon 
reviewing the comparative analyses re-
quested under clauses (i) and (ii) of sub-
paragraph (B) shall be shared with a 
State, 
in 
accordance 
with 
section 
2726(a)(6)(B)(iii)(II) of the Public Health 
Service Act.’’. 
(c) PUBLIC HEALTH SERVICE ACT.—Section 2726 of 
the Public Health Service Act (42 U.S.C. 300gg–26) is 
amended— 
(1) in subsection (a), by adding at the end the 
following: 
‘‘(8) COMPLIANCE REQUIREMENTS.— 
‘‘(A) NONQUANTITATIVE TREATMENT LIM-
ITATION (NQTL) REQUIREMENTS.—In the case 
of a group health plan or a health insurance 
issuer offering group or individual health insur-
ance coverage that provides both medical and 
surgical benefits and mental health or sub-
stance use disorder benefits, the plan or issuer 
offering group or individual health insurance 
coverage shall perform comparative analyses 
about the design and application of non-
quantitative treatment limitations (referred to 
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in this paragraph as the ‘NQTL’) in accordance 
with the following process, and make available 
to State, or to the Secretary as permitted under 
subsections (a)(2) and (b)(1) of section 2723, 
upon request within 60 days beginning January 
1, 2020, and immediately upon request begin-
ning January 1, 2021, the following informa-
tion: 
‘‘(i) The specific plan or coverage lan-
guage regarding the NQTL and a descrip-
tion of all mental health or substance use 
disorder and medical/surgical services to 
which it applies in each respective benefits 
classification. 
‘‘(ii) The factors used to determine 
that an NQTL will apply to mental health 
or substance use disorder benefits and 
medical/surgical benefits, including factors 
that were considered but rejected. 
‘‘(iii) The evidentiary standard (both 
identified and deidentified) for each of the 
factors identified in clause (ii) and any 
other evidence relied upon to design and 
apply the NQTL to mental health or sub-
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stance use disorder benefits and medical/ 
surgical benefits. 
‘‘(iv) The comparative analyses dem-
onstrating that the processes and strate-
gies used to design the NQTL, as written, 
and the as written processes and strategies 
used to apply the NQTL for mental health 
or substance use disorder benefits are com-
parable to, and are applied no more strin-
gently than, the processes and strategies 
used to design the NQTL, as written, and 
the as written processes and strategies 
used to apply the NQTL to medical/sur-
gical benefits. 
‘‘(v) The comparative analyses dem-
onstrating that the processes and strate-
gies used to apply the NQTL, in operation, 
for mental health and substance use dis-
order benefits are comparable to, and are 
applied no more stringently than, the proc-
esses and strategies used to apply each 
NQTL, in operation, for medical and sur-
gical benefits. 
‘‘(vi) A disclosure of the specific find-
ings and conclusions reached by the plan 
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the same plans or issuers for which the 
comparative analyses are requested under 
clause (i). 
‘‘(iii) ADDITIONAL INFORMATION.—In 
instances in which the Secretary has con-
cluded that the plan or issuer has not sub-
mitted sufficient information for the Sec-
retary to review the comparative analyses 
described in subparagraph (A), as re-
quested under clauses (i) and (ii), the Sec-
retary shall specify to the plan or issuer 
the additional information the plan or 
issuer must submit for the Secretary to re-
view the comparative analyses described in 
subparagraph (A) for compliance with this 
section. 
‘‘(iv) 
REQUIRED
ACTION.—In 
in-
stances in which the Secretary has re-
viewed the comparative analyses described 
in subparagraph (A), as requested under 
clauses (i) and (ii), and determined that 
the plan or issuer is not in compliance with 
this section, the Secretary shall specify to 
the plan or issuer the actions the plan or 
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issuer must take to be in compliance with 
this section. 
‘‘(v) REPORT.—Not later than 1 year 
after the date of enactment of this para-
graph, and annually thereafter, the Sec-
retary shall submit to the Committee on 
Energy and Commerce of the House of 
Representatives and the Committee on 
Health, Education, Labor, and Pensions of 
the Senate a report that contains— 
‘‘(I) each of the comparative 
analyses requested under clauses (i) 
and (ii), except that the identity of 
each plan or issuer and any con-
tracted entity of a plan or issuer shall 
be redacted; 
‘‘(II) the Secretary’s conclusions 
as to whether each plan or issuer sub-
mitted sufficient information for the 
Secretary to review the comparative 
analyses requested under clauses (i) 
and (ii) for compliance with this sec-
tion; 
‘‘(III) for each plan or issuer 
that did submit sufficient information 
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for the Secretary to review the com-
parative analyses requested under 
clause (i), the Secretary’s conclusions 
as to whether the plan or issuer is in 
compliance with this section; 
‘‘(IV) the Secretary’s specifica-
tions described in clause (iii) for each 
plan or issuer that the Secretary de-
termined did not submit sufficient in-
formation for the Secretary to review 
the comparative analyses requested 
under clauses (i) and (ii) for compli-
ance with this section; and 
‘‘(V) the Secretary’s specifica-
tions described in clause (iv) of the 
actions each plan or issuer that the 
Secretary determined is not in compli-
ance with this section must take to be 
in compliance with this section. 
‘‘(C) COMPLIANCE
PROGRAM
GUIDANCE 
DOCUMENT UPDATE PROCESS.— 
‘‘(i) IN
GENERAL.—The Secretary 
shall include select instances of noncompli-
ance that the Secretary discovers upon re-
viewing the comparative analyses requested 
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under clauses (i) and (ii) of subparagraph 
(B) in the compliance program guidance 
document described in subsection (a)(6), as 
it is updated every 2 years, except that all 
instances shall be deidentified and such in-
stances shall not disclose any protected 
health information or individually identifi-
able information. 
‘‘(ii) INSPECTOR GENERAL.—Any in-
stances of noncompliance the Secretary 
discovers upon reviewing the comparative 
analyses requested under clauses (i) and 
(ii) of subparagraph (B) shall be shared 
with the Inspector General of the Depart-
ment of Health and Human Services, the 
Inspector General of the Department of 
Labor, and the Inspector General of the 
Department of the Treasury, in accordance 
with subsection (a)(6)(B)(iii)(I). 
‘‘(iii) STATE.—Any instances of non-
compliance the Secretary discovers upon 
reviewing the comparative analyses re-
quested under clauses (i) and (ii) of sub-
paragraph (B) shall be shared with a 
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State, 
in 
accordance 
with 
subsection 
(a)(6)(B)(iii)(II).’’. 
Æ 
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