626 
(1) periodically review and update the model 
programs and materials identified or developed under 
subsection (a); and 
(2) disseminate the updated model programs and 
materials to the individuals described in subsection 
(a). 
(c) COORDINATION.—The Secretary shall carry out 
this section in coordination with the Director of the Office 
for Civil Rights within the Department of Health and 
Human Services, the Assistant Secretary for Mental Health 
and Substance Use, the Administrator of the Health Re-
sources and Services Administration, and the heads of other 
relevant agencies within the Department of Health and 
Human Services. 
(d) INPUT OF CERTAIN ENTITIES.—In identifying, re-
viewing, or updating the model programs and materials 
under subsections (a) and (b), the Secretary shall solicit the 
input of relevant national, State, and local associations; 
medical societies; licensing boards; providers of mental and 
substance use disorder treatment; organizations with exper-
tise on domestic violence, sexual assault, elder abuse, and 
child abuse; and organizations representing patients and 
consumers and the families of patients and consumers. 
(e) FUNDING.—There are authorized to be appro-
priated to carry out this section—
627 
(1) $4,000,000 for fiscal year 2018; 
(2) $2,000,000 for each of fiscal years 2019 and 
2020; and 
(3) $1,000,000 for each of fiscal years 2021 and 
2022. 
TITLE XII—MEDICAID MENTAL 
HEALTH COVERAGE 
SEC. 12001. RULE OF CONSTRUCTION RELATED TO MED-
ICAID COVERAGE OF MENTAL HEALTH SERV-
ICES AND PRIMARY CARE SERVICES FUR-
NISHED ON THE SAME DAY. 
Nothing in title XIX of the Social Security Act (42 
U.S.C. 1396 et seq.) shall be construed as prohibiting sepa-
rate payment under the State plan under such title (or 
under a waiver of the plan) for the provision of a mental 
health service or primary care service under such plan, with 
respect to an individual, because such service is— 
(1) a primary care service furnished to the indi-
vidual by a provider at a facility on the same day 
a mental health service is furnished to such indi-
vidual by such provider (or another provider) at the 
facility; or 
(2) a mental health service furnished to the indi-
vidual by a provider at a facility on the same day
628 
a primary care service is furnished to such individual 
by such provider (or another provider) at the facility. 
SEC. 12002. STUDY AND REPORT RELATED TO MEDICAID 
MANAGED CARE REGULATION. 
(a) STUDY.—The Secretary of Health and Human 
Services, acting through the Administrator of the Centers 
for Medicare & Medicaid Services, shall conduct a study 
on coverage under the Medicaid program under title XIX 
of the Social Security Act (42 U.S.C. 1396 et seq.) of serv-
ices provided through a medicaid managed care organiza-
tion (as defined in section 1903(m) of such Act (42 U.S.C. 
1396b(m)) or a prepaid inpatient health plan (as defined 
in section 438.2 of title 42, Code of Federal Regulations 
(or any successor regulation)) with respect to individuals 
over the age of 21 and under the age of 65 for the treatment 
of a mental health disorder in institutions for mental dis-
eases (as defined in section 1905(i) of such Act (42 U.S.C. 
1396d(i))). Such study shall include information on the fol-
lowing: 
(1) The extent to which States, including the 
District of Columbia and each territory or possession 
of the United States, are providing capitated pay-
ments to such organizations or plans for enrollees who 
are receiving services in institutions for mental dis-
eases.
629 
(2) The number of individuals receiving medical 
assistance under a State plan under such title XIX, 
or a waiver of such plan, who receive services in in-
stitutions for mental diseases through such organiza-
tions and plans. 
(3) The range of and average number of months, 
and the length of stay during such months, that such 
individuals are receiving such services in such insti-
tutions. 
(4) How such organizations or plans determine 
when to provide for the furnishing of such services 
through an institution for mental diseases in lieu of 
other benefits (including the full range of community- 
based services) under their contract with the State 
agency administering the State plan under such title 
XIX, or a waiver of such plan, to address psychiatric 
or substance use disorder treatment. 
(5) The extent to which the provision of services 
within such institutions has affected the capitated 
payments for such organizations or plans. 
(b) REPORT.—Not later than 3 years after the date 
of the enactment of this Act, the Secretary shall submit to 
Congress a report on the study conducted under subsection 
(a).
630 
SEC. 12003. GUIDANCE ON OPPORTUNITIES FOR INNOVA-
TION. 
Not later than 1 year after the date of the enactment 
of this Act, the Administrator of the Centers for Medicare 
& Medicaid Services shall issue a State Medicaid Director 
letter regarding opportunities to design innovative service 
delivery systems, including systems for providing commu-
nity-based services, for adults with a serious mental illness 
or children with a serious emotional disturbance who are 
receiving medical assistance under title XIX of the Social 
Security Act (42 U.S.C. 1396 et seq.). The letter shall in-
clude opportunities for demonstration projects under section 
1115 of such Act (42 U.S.C. 1315) to improve care for such 
adults and children. 
SEC. 12004. STUDY AND REPORT ON MEDICAID EMERGENCY 
PSYCHIATRIC DEMONSTRATION PROJECT. 
(a) COLLECTION OF INFORMATION.—The Secretary of 
Health and Human Services, acting through the Adminis-
trator of the Centers for Medicare & Medicaid Services, 
shall, to the extent practical and data is available, with 
respect to each State that has participated in the dem-
onstration project established under section 2707 of the Pa-
tient Protection and Affordable Care Act (42 U.S.C. 1396a 
note), collect from each such State information on the fol-
lowing:
631 
(1) The number of institutions for mental dis-
eases (as defined in section 1905(i) of the Social Secu-
rity Act (42 U.S.C. 1396d(i))) and beds in such insti-
tutions that received payment for the provision of 
services to individuals who receive medical assistance 
under a State plan under the Medicaid program 
under title XIX of the Social Security Act (42 U.S.C. 
1396 et seq.) (or under a waiver of such plan) 
through the demonstration project in each such State 
as compared to the total number of institutions for 
mental diseases and beds in the State. 
(2) The extent to which there is a reduction in 
expenditures under the Medicaid program under title 
XIX of the Social Security Act (42 U.S.C. 1396 et 
seq.) or other spending on the full continuum of phys-
ical or mental health care for individuals who receive 
treatment in an institution for mental diseases under 
the demonstration project, including outpatient, inpa-
tient, emergency, and ambulatory care, that is attrib-
utable to such individuals receiving treatment in in-
stitutions for mental diseases under the demonstration 
project. 
(3) The number of forensic psychiatric hospitals, 
the number of beds in such hospitals, and the number 
of forensic psychiatric beds in other hospitals in such
632 
State, based on the most recent data available, to the 
extent practical, as determined by such Adminis-
trator. 
(4) The amount of any disproportionate share 
hospital payments under section 1923 of the Social 
Security Act (42 U.S.C. 1396r–4) that institutions 
for mental diseases in the State received during the 
period beginning on July 1, 2012, and ending on 
June 30, 2015, and the extent to which the dem-
onstration project reduced the amount of such pay-
ments. 
(5) The most recent data regarding all facilities 
or sites in the State in which any adults with a seri-
ous mental illness who are receiving medical assist-
ance under a State plan under the Medicaid program 
under title XIX of the Social Security Act (42 U.S.C. 
1396 et seq.) (or under a waiver of such plan) are 
treated during the period referred to in paragraph 
(4), to the extent practical, as determined by the Ad-
ministrator, including— 
(A) the types of such facilities or sites (such 
as an institution for mental diseases, a hospital 
emergency department, or other inpatient hos-
pital);
633 
(B) the average length of stay in such a fa-
cility 
or 
site 
by 
such 
an 
individual, 
disaggregated by facility type; and 
(C) the payment rate under the State plan 
(or a waivers of such plan) for services furnished 
to such an individual for that treatment, 
disaggregated by facility type, during the period 
in which the demonstration project is in oper-
ation. 
(6) The extent to which the utilization of hos-
pital emergency departments during the period in 
which the demonstration project was is in operation 
differed, with respect to individuals who are receiving 
medical assistance under a State plan under the Med-
icaid program under title XIX of the Social Security 
Act (42 U.S.C. 1396 et seq.) (or under a waiver of 
such plan), between— 
(A) those individuals who received treat-
ment in an institution for mental diseases under 
the demonstration project; 
(B) those individuals who met the eligibility 
requirements for the demonstration project but 
who did not receive treatment in an institution 
for mental diseases under the demonstration 
project; and
634 
(C) those adults with a serious mental ill-
ness who did not meet such eligibility require-
ments and did not receive treatment for such ill-
ness in an institution for mental diseases. 
(b) REPORT.—Not later than 2 years after the date 
of the enactment of this Act, the Secretary of Health and 
Human Services shall submit to Congress a report that 
summarizes and analyzes the information collected under 
subsection (a). Such report may be submitted as part of 
the report required under section 2707(f) of the Patient Pro-
tection and Affordable Care Act (42 U.S.C. 1396a note) or 
separately. 
SEC. 12005. PROVIDING EPSDT SERVICES TO CHILDREN IN 
IMDS. 
(a) IN GENERAL.—Section 1905(a)(16) of the Social 
Security Act (42 U.S.C. 1396d(a)(16)) is amended— 
(1) by striking ‘‘effective January 1, 1973’’ and 
inserting ‘‘(A) effective January 1, 1973’’; and 
(2) by inserting before the semicolon at the end 
the following: ‘‘, and, (B) for individuals receiving 
services described in subparagraph (A), early and 
periodic screening, diagnostic, and treatment services 
(as defined in subsection (r)), whether or not such 
screening, diagnostic, and treatment services are fur-
635 
nished by the provider of the services described in 
such subparagraph’’. 
(b) EFFECTIVE DATE.—The amendments made by sub-
section (a) shall apply with respect to items and services 
furnished in calendar quarters beginning on or after Janu-
ary 1, 2019. 
SEC. 12006. ELECTRONIC VISIT VERIFICATION SYSTEM RE-
QUIRED FOR PERSONAL CARE SERVICES AND 
HOME HEALTH CARE SERVICES UNDER MED-
ICAID. 
(a) IN GENERAL.—Section 1903 of the Social Security 
Act (42 U.S.C. 1396b) is amended by inserting after sub-
section (k) the following new subsection: 
‘‘(l)(1) Subject to paragraphs (3) and (4), with respect 
to any amount expended for personal care services or home 
health care services requiring an in-home visit by a pro-
vider that are provided under a State plan under this title 
(or under a waiver of the plan) and furnished in a calendar 
quarter beginning on or after January 1, 2019 (or, in the 
case of home health care services, on or after January 1, 
2023), unless a State requires the use of an electronic visit 
verification system for such services furnished in such quar-
ter under the plan or such waiver, the Federal medical as-
sistance percentage shall be reduced— 
‘‘(A) in the case of personal care services—
636 
‘‘(i) for calendar quarters in 2019 and 
2020, by .25 percentage points; 
‘‘(ii) for calendar quarters in 2021, by .5 
percentage points; 
‘‘(iii) for calendar quarters in 2022, by .75 
percentage points; and 
‘‘(iv) for calendar quarters in 2023 and 
each year thereafter, by 1 percentage point; and 
‘‘(B) in the case of home health care services— 
‘‘(i) for calendar quarters in 2023 and 
2024, by .25 percentage points; 
‘‘(ii) for calendar quarters in 2025, by .5 
percentage points; 
‘‘(iii) for calendar quarters in 2026, by .75 
percentage points; and 
‘‘(iv) for calendar quarters in 2027 and 
each year thereafter, by 1 percentage point. 
‘‘(2) Subject to paragraphs (3) and (4), in imple-
menting the requirement for the use of an electronic visit 
verification system under paragraph (1), a State shall— 
‘‘(A) consult with agencies and entities that pro-
vide personal care services, home health care services, 
or both under the State plan (or under a waiver of 
the plan) to ensure that such system— 
‘‘(i) is minimally burdensome;
637 
‘‘(ii) takes into account existing best prac-
tices and electronic visit verification systems in 
use in the State; and 
‘‘(iii) is conducted in accordance with the 
requirements of HIPAA privacy and security 
law (as defined in section 3009 of the Public 
Health Service Act); 
‘‘(B) take into account a stakeholder process that 
includes input from beneficiaries, family caregivers, 
individuals who furnish personal care services or 
home health care services, and other stakeholders, as 
determined by the State in accordance with guidance 
from the Secretary; and 
‘‘(C) ensure that individuals who furnish per-
sonal care services, home health care services, or both 
under the State plan (or under a waiver of the plan) 
are provided the opportunity for training on the use 
of such system. 
‘‘(3) Paragraphs (1) and (2) shall not apply in the 
case of a State that, as of the date of the enactment of this 
subsection, requires the use of any system for the electronic 
verification of visits conducted as part of both personal care 
services and home health care services, so long as the State 
continues to require the use of such system with respect to 
the electronic verification of such visits.
638 
‘‘(4)(A) In the case of a State described in subpara-
graph (B), the reduction under paragraph (1) shall not 
apply— 
‘‘(i) in the case of personal care services, for cal-
endar quarters in 2019; and 
‘‘(ii) in the case of home health care services, for 
calendar quarters in 2023. 
‘‘(B) For purposes of subparagraph (A), a State de-
scribed in this subparagraph is a State that demonstrates 
to the Secretary that the State— 
‘‘(i) has made a good faith effort to comply with 
the requirements of paragraphs (1) and (2) (includ-
ing by taking steps to adopt the technology used for 
an electronic visit verification system); and 
‘‘(ii) in implementing such a system, has en-
countered unavoidable system delays. 
‘‘(5) In this subsection: 
‘‘(A) The term ‘electronic visit verification sys-
tem’ means, with respect to personal care services or 
home health care services, a system under which visits 
conducted as part of such services are electronically 
verified with respect to— 
‘‘(i) the type of service performed; 
‘‘(ii) the individual receiving the service; 
‘‘(iii) the date of the service;
639 
‘‘(iv) the location of service delivery; 
‘‘(v) the individual providing the service; 
and 
‘‘(vi) the time the service begins and ends. 
‘‘(B) The term ‘home health care services’ means 
services described in section 1905(a)(7) provided 
under a State plan under this title (or under a waiv-
er of the plan). 
‘‘(C) The term ‘personal care services’ means 
personal care services provided under a State plan 
under this title (or under a waiver of the plan), in-
cluding services provided under section 1905(a)(24), 
1915(c), 1915(i), 1915(j), or 1915(k) or under a 
wavier under section 1115. 
‘‘(6)(A) In the case in which a State requires personal 
care service and home health care service providers to utilize 
an electronic visit verification system operated by the State 
or a contractor on behalf of the State, the Secretary shall 
pay to the State, for each quarter, an amount equal to 90 
per centum of so much of the sums expended during such 
quarter as are attributable to the design, development, or 
installation of such system, and 75 per centum of so much 
of the sums for the operation and maintenance of such sys-
tem.
640 
‘‘(B) Subparagraph (A) shall not apply in the case 
in which a State requires personal care service and home 
health care service providers to utilize an electronic visit 
verification system that is not operated by the State or a 
contractor on behalf of the State.’’. 
(b) COLLECTION AND DISSEMINATION OF BEST PRAC-
TICES.—Not later than January 1, 2018, the Secretary of 
Health and Human Services shall, with respect to electronic 
visit verification systems (as defined in subsection (l)(5) of 
section 1903 of the Social Security Act (42 U.S.C. 1396b), 
as inserted by subsection (a)), collect and disseminate best 
practices to State Medicaid Directors with respect to— 
(1) training individuals who furnish personal 
care services, home health care services, or both under 
the State plan under title XIX of such Act (or under 
a waiver of the plan) on such systems and the oper-
ation of such systems and the prevention of fraud 
with respect to the provision of personal care services 
or home health care services (as defined in such sub-
section (l)(5)); and 
(2) the provision of notice and educational mate-
rials to family caregivers and beneficiaries with re-
spect to the use of such electronic visit verification 
systems and other means to prevent such fraud. 
(c) RULES OF CONSTRUCTION.—
641 
(1) NO EMPLOYER-EMPLOYEE RELATIONSHIP ES-
TABLISHED.—Nothing in the amendment made by 
this section may be construed as establishing an em-
ployer-employee relationship between the agency or 
entity that provides for personal care services or home 
health care services and the individuals who, under a 
contract with such an agency or entity, furnish such 
services for purposes of part 552 of title 29, Code of 
Federal Regulations (or any successor regulations). 
(2) NO PARTICULAR OR UNIFORM ELECTRONIC 
VISIT VERIFICATION SYSTEM REQUIRED.—Nothing in 
the amendment made by this section shall be con-
strued to require the use of a particular or uniform 
electronic visit verification system (as defined in sub-
section (l)(5) of section 1903 of the Social Security 
Act (42 U.S.C. 1396b), as inserted by subsection (a)) 
by all agencies or entities that provide personal care 
services or home health care under a State plan under 
title XIX of the Social Security Act (or under a waiv-
er of the plan) (42 U.S.C. 1396 et seq.). 
(3) NO LIMITS ON PROVISION OF CARE.—Nothing 
in the amendment made by this section may be con-
strued to limit, with respect to personal care services 
or home health care services provided under a State 
plan under title XIX of the Social Security Act (or
642 
under a waiver of the plan) (42 U.S.C. 1396 et seq.), 
provider selection, constrain beneficiaries’ selection of 
a caregiver, or impede the manner in which care is 
delivered. 
(4) NO PROHIBITION ON STATE QUALITY MEAS-
URES REQUIREMENTS.—Nothing in the amendment 
made by this section shall be construed as prohibiting 
a State, in implementing an electronic visit 
verification system (as defined in subsection (l)(5) of 
section 1903 of the Social Security Act (42 U.S.C. 
1396b), as inserted by subsection (a)), from estab-
lishing requirements related to quality measures for 
such system. 
TITLE XIII—MENTAL HEALTH 
PARITY 
SEC. 
13001. 
ENHANCED 
COMPLIANCE 
WITH 
MENTAL 
HEALTH AND SUBSTANCE USE DISORDER 
COVERAGE REQUIREMENTS. 
(a) COMPLIANCE PROGRAM GUIDANCE DOCUMENT.— 
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: 
‘‘(6) COMPLIANCE
PROGRAM
GUIDANCE
DOCU-
MENT.—
643 
‘‘(A) IN
GENERAL.—Not later than 12 
months after the date of enactment of the Help-
ing Families in Mental Health Crisis Reform 
Act of 2016, the Secretary, the Secretary of 
Labor, and the Secretary of the Treasury, in 
consultation with the Inspector General of the 
Department of Health and Human Services, the 
Inspector General of the Department of Labor, 
and the Inspector General of the Department of 
the Treasury, shall issue a compliance program 
guidance document to help improve compliance 
with this section, section 712 of the Employee 
Retirement Income Security Act of 1974, and 
section 9812 of the Internal Revenue Code of 
1986, as applicable. In carrying out this para-
graph, the Secretaries may take into consider-
ation the 2016 publication of the Department of 
Health and Human Services and the Depart-
ment of Labor, entitled ‘Warning Signs - Plan 
or Policy Non-Quantitative Treatment Limita-
tions (NQTLs) that Require Additional Analysis 
to Determine Mental Health Parity Compliance’. 
‘‘(B) EXAMPLES ILLUSTRATING COMPLIANCE 
AND NONCOMPLIANCE.—
644 
‘‘(i) IN
GENERAL.—The compliance 
program guidance document required under 
this paragraph shall provide illustrative, 
de-identified examples (that do not disclose 
any protected health information or indi-
vidually identifiable information) of pre-
vious findings of compliance and non-
compliance with this section, section 712 of 
the Employee Retirement Income Security 
Act of 1974, or section 9812 of the Internal 
Revenue Code of 1986, as applicable, based 
on investigations of violations of such sec-
tions, including— 
‘‘(I) examples illustrating require-
ments for information disclosures and 
nonquantitative treatment limitations; 
and 
‘‘(II) descriptions of the violations 
uncovered during the course of such in-
vestigations. 
‘‘(ii) NONQUANTITATIVE
TREATMENT 
LIMITATIONS.—To the extent that any ex-
ample described in clause (i) involves a 
finding of compliance or noncompliance 
with regard to any requirement for non-
645 
quantitative treatment limitations, the ex-
ample shall provide sufficient detail to fully 
explain such finding, including a full de-
scription of the criteria involved for approv-
ing medical and surgical benefits and the 
criteria involved for approving mental 
health and substance use disorder benefits. 
‘‘(iii) ACCESS TO ADDITIONAL INFOR-
MATION
REGARDING
COMPLIANCE.—In de-
veloping and issuing the compliance pro-
gram guidance document required under 
this paragraph, the Secretaries specified in 
subparagraph (A)— 
‘‘(I) shall enter into interagency 
agreements with the Inspector General 
of the Department of Health and 
Human Services, the Inspector General 
of the Department of Labor, and the 
Inspector General of the Department of 
the Treasury to share findings of com-
pliance and noncompliance with this 
section, section 712 of the Employee 
Retirement Income Security Act of 
1974, or section 9812 of the Internal
646 
Revenue Code of 1986, as applicable; 
and 
‘‘(II) shall seek to enter into an 
agreement with a State to share infor-
mation on findings of compliance and 
noncompliance with this section, sec-
tion 712 of the Employee Retirement 
Income Security Act of 1974, or section 
9812 of the Internal Revenue Code of 
1986, as applicable. 
‘‘(C) RECOMMENDATIONS.—The compliance 
program guidance document shall include rec-
ommendations to advance compliance with this 
section, section 712 of the Employee Retirement 
Income Security Act of 1974, or section 9812 of 
the Internal Revenue Code of 1986, as applica-
ble, and encourage the development and use of 
internal controls to monitor adherence to appli-
cable statutes, regulations, and program require-
ments. Such internal controls may include illus-
trative examples of nonquantitative treatment 
limitations on mental health and substance use 
disorder benefits, which may fail to comply with 
this section, section 712 of the Employee Retire-
ment Income Security Act of 1974, or section
647 
9812 of the Internal Revenue Code of 1986, as 
applicable, in relation to nonquantitative treat-
ment limitations on medical and surgical bene-
fits. 
‘‘(D) UPDATING THE COMPLIANCE PROGRAM 
GUIDANCE DOCUMENT.—The Secretary, the Sec-
retary of Labor, and the Secretary of the Treas-
ury, in consultation with the Inspector General 
of the Department of Health and Human Serv-
ices, the Inspector General of the Department of 
Labor, and the Inspector General of the Depart-
ment of the Treasury, shall update the compli-
ance program guidance document every 2 years 
to include illustrative, de-identified examples 
(that do not disclose any protected health infor-
mation or individually identifiable information) 
of previous findings of compliance and non-
compliance with this section, section 712 of the 
Employee Retirement Income Security Act of 
1974, or section 9812 of the Internal Revenue 
Code of 1986, as applicable.’’. 
(b) ADDITIONAL GUIDANCE.—Section 2726(a) of the 
Public Health Service Act (42 U.S.C. 300gg–26(a)), as 
amended by subsection (a), is further amended by adding 
at the end the following:
648 
‘‘(7) ADDITIONAL GUIDANCE.— 
‘‘(A) IN
GENERAL.—Not later than 12 
months after the date of enactment of the Help-
ing Families in Mental Health Crisis Reform 
Act of 2016, the Secretary, the Secretary of 
Labor, and the Secretary of the Treasury shall 
issue guidance to group health plans and health 
insurance issuers offering group or individual 
health insurance coverage to assist such plans 
and issuers in satisfying the requirements of this 
section, section 712 of the Employee Retirement 
Income Security Act of 1974, or section 9812 of 
the Internal Revenue Code of 1986, as applica-
ble. 
‘‘(B) DISCLOSURE.— 
‘‘(i) 
GUIDANCE
FOR
PLANS
AND 
ISSUERS.—The guidance issued under this 
paragraph shall include clarifying informa-
tion and illustrative examples of methods 
that group health plans and health insur-
ance issuers offering group or individual 
health insurance coverage may use for dis-
closing information to ensure compliance 
with the requirements under this section, 
section 712 of the Employee Retirement In-
649 
come Security Act of 1974, or section 9812 
of the Internal Revenue Code of 1986, as 
applicable, (and any regulations promul-
gated pursuant to such sections, as applica-
ble). 
‘‘(ii) DOCUMENTS FOR PARTICIPANTS, 
BENEFICIARIES, CONTRACTING
PROVIDERS, 
OR
AUTHORIZED
REPRESENTATIVES.—The 
guidance issued under this paragraph shall 
include clarifying information and illus-
trative examples of methods that group 
health plans and health insurance issuers 
offering group or individual health insur-
ance coverage may use to provide any par-
ticipant, beneficiary, contracting provider, 
or authorized representative, as applicable, 
with documents containing information 
that the health plans or issuers are required 
to disclose to participants, beneficiaries, 
contracting providers, or authorized rep-
resentatives to ensure compliance with this 
section, section 712 of the Employee Retire-
ment Income Security Act of 1974, or sec-
tion 9812 of the Internal Revenue Code of 
1986, as applicable, compliance with any
650 
regulation issued pursuant to such respec-
tive section, or compliance with any other 
applicable law or regulation. Such guidance 
shall include information that is compara-
tive in nature with respect to— 
‘‘(I) 
nonquantitative 
treatment 
limitations for both medical and sur-
gical benefits and mental health and 
substance use disorder benefits; 
‘‘(II) the processes, strategies, evi-
dentiary standards, and other factors 
used to apply the limitations described 
in subclause (I); and 
‘‘(III) the application of the limi-
tations described in subclause (I) to en-
sure that such limitations are applied 
in parity with respect to both medical 
and surgical benefits and mental 
health and substance use disorder bene-
fits. 
‘‘(C) NONQUANTITATIVE TREATMENT LIMI-
TATIONS.—The guidance issued under this para-
graph shall include clarifying information and 
illustrative examples of methods, processes, strat-
egies, evidentiary standards, and other factors
651 
that group health plans and health insurance 
issuers offering group or individual health insur-
ance coverage may use regarding the develop-
ment and application of nonquantitative treat-
ment limitations to ensure compliance with this 
section, section 712 of the Employee Retirement 
Income Security Act of 1974, or section 9812 of 
the Internal Revenue Code of 1986, as applica-
ble, (and any regulations promulgated pursuant 
to such respective section), including— 
‘‘(i) examples of methods of deter-
mining appropriate types of nonquantita-
tive treatment limitations with respect to 
both medical and surgical benefits and men-
tal health and substance use disorder bene-
fits, including nonquantitative treatment 
limitations pertaining to— 
‘‘(I) medical management stand-
ards based on medical necessity or ap-
propriateness, or whether a treatment 
is experimental or investigative; 
‘‘(II) limitations with respect to 
prescription drug formulary design; 
and
652 
‘‘(III) use of fail-first or step ther-
apy protocols; 
‘‘(ii) examples of methods of deter-
mining— 
‘‘(I) network admission standards 
(such as credentialing); and 
‘‘(II) factors used in provider re-
imbursement methodologies (such as 
service type, geographic market, de-
mand for services, and provider sup-
ply, practice size, training, experience, 
and licensure) as such factors apply to 
network adequacy; 
‘‘(iii) examples of sources of informa-
tion that may serve as evidentiary stand-
ards for the purposes of making determina-
tions regarding the development and appli-
cation of nonquantitative treatment limita-
tions; 
‘‘(iv) examples of specific factors, and 
the evidentiary standards used to evaluate 
such factors, used by such plans or issuers 
in performing a nonquantitative treatment 
limitation analysis;
653 
‘‘(v) examples of how specific evi-
dentiary standards may be used to deter-
mine whether treatments are considered ex-
perimental or investigative; 
‘‘(vi) examples of how specific evi-
dentiary standards may be applied to each 
service category or classification of benefits; 
‘‘(vii) examples of methods of reaching 
appropriate coverage determinations for 
new mental health or substance use disorder 
treatments, such as evidence-based early 
intervention programs for individuals with 
a serious mental illness and types of med-
ical management techniques; 
‘‘(viii) examples of methods of reaching 
appropriate coverage determinations for 
which there is an indirect relationship be-
tween the covered mental health or sub-
stance use disorder benefit and a traditional 
covered medical and surgical benefit, such 
as residential treatment or hospitalizations 
involving voluntary or involuntary commit-
ment; and 
‘‘(ix) additional illustrative examples 
of methods, processes, strategies, evidentiary
654 
standards, and other factors for which the 
Secretary determines that additional guid-
ance is necessary to improve compliance 
with this section, section 712 of the Em-
ployee Retirement Income Security Act of 
1974, or section 9812 of the Internal Rev-
enue Code of 1986, as applicable. 
‘‘(D) PUBLIC COMMENT.—Prior to issuing 
any final guidance under this paragraph, the 
Secretary shall provide a public comment period 
of not less than 60 days during which any mem-
ber of the public may provide comments on a 
draft of the guidance.’’. 
(c) AVAILABILITY OF PLAN INFORMATION.— 
(1) SOLICITATION OF PUBLIC FEEDBACK.—Not 
later than 6 months after the date of enactment of this 
Act, the Secretary of Health and Human Services, the 
Secretary of Labor, and the Secretary of the Treasury 
shall solicit feedback from the public on how the dis-
closure request process for documents containing in-
formation that health plans or health insurance 
issuers are required under Federal or State law to 
disclose to participants, beneficiaries, contracting pro-
viders, or authorized representatives to ensure compli-
ance with existing mental health parity and addic-
655 
tion equity requirements can be improved while con-
tinuing to ensure consumers’ rights to access all infor-
mation required by Federal or State law to be dis-
closed. 
(2) PUBLIC AVAILABILITY.—Not later than 12 
months after the date of the enactment of this Act, the 
Secretary of Health and Human Services, the Sec-
retary of Labor, and the Secretary of the Treasury 
shall make such feedback publicly available. 
(3) NAIC.—The Secretary of Health and 
Human Services, the Secretary of Labor, and the Sec-
retary of the Treasury shall share feedback obtained 
pursuant to paragraph (1) directly with the National 
Association of Insurance Commissioners to the extent 
such feedback includes recommendations for the devel-
opment of simplified information disclosure tools to 
provide consistent information for consumers. Such 
feedback may be taken into consideration by the Na-
tional Association of Insurance Commissioners and 
other appropriate entities for the voluntary develop-
ment and voluntary use of common templates and 
other sample standardized forms to improve consumer 
access to plan information. 
(d) IMPROVING COMPLIANCE.—
656 
(1) IN GENERAL.—In the case that the Secretary 
of Health and Human Services, the Secretary of 
Labor, or the Secretary of the Treasury determines 
that a group health plan or health insurance issuer 
offering group or individual health insurance cov-
erage has violated, at least 5 times, section 2726 of 
the Public Health Service Act (42 U.S.C. 300gg–26), 
section 712 of the Employee Retirement Income Secu-
rity Act of 1974 (29 U.S.C. 1185a), or section 9812 
of the Internal Revenue Code of 1986, respectively, the 
appropriate Secretary shall audit plan documents for 
such health plan or issuer in the plan year following 
the Secretary’s determination in order to help im-
prove compliance with such section. 
(2) RULE OF CONSTRUCTION.—Nothing in this 
subsection shall be construed to limit the authority, as 
in effect on the day before the date of enactment of 
this Act, of the Secretary of Health and Human Serv-
ices, the Secretary of Labor, or the Secretary of the 
Treasury to audit documents of health plans or health 
insurance issuers. 
SEC. 13002. ACTION PLAN FOR ENHANCED ENFORCEMENT 
OF MENTAL HEALTH AND SUBSTANCE USE 
DISORDER COVERAGE. 
(a) PUBLIC MEETING.—
657 
(1) IN GENERAL.—Not later than 6 months after 
the date of enactment of this Act, the Secretary of 
Health and Human Services shall convene a public 
meeting of stakeholders described in paragraph (2) to 
produce an action plan for improved Federal and 
State coordination related to the enforcement of sec-
tion 2726 of the Public Health Service Act (42 U.S.C. 
300gg–26), section 712 of the Employee Retirement 
Income Security Act of 1974 (29 U.S.C. 1185a), and 
section 9812 of the Internal Revenue Code of 1986, 
and any comparable provisions of State law (in this 
section such sections and provisions are collectively 
referred to as ‘‘mental health parity and addiction eq-
uity requirements’’). 
(2) STAKEHOLDERS.—The stakeholders described 
in this paragraph shall include each of the following: 
(A) The Federal Government, including rep-
resentatives from— 
(i) the Department of Health and 
Human Services; 
(ii) the Department of the Treasury; 
(iii) the Department of Labor; and 
(iv) the Department of Justice. 
(B) State governments, including—
658 
(i) State health insurance commis-
sioners; 
(ii) appropriate State agencies, includ-
ing agencies on public health or mental 
health; and 
(iii) State attorneys general or other 
representatives of State entities involved in 
the enforcement of mental health parity and 
addiction equity requirements. 
(C) Representatives from key stakeholder 
groups, including— 
(i) the National Association of Insur-
ance Commissioners; 
(ii) health insurance issuers; 
(iii) providers of mental health and 
substance use disorder treatment; 
(iv) employers; and 
(v) patients or their advocates. 
(b) ACTION PLAN.—Not later than 6 months after the 
conclusion of the public meeting under subsection (a), the 
Secretary of Health and Human Services shall finalize the 
action plan described in such subsection and make it plain-
ly available on the Internet website of the Department of 
Health and Human Services.
659 
(c) CONTENT.—The action plan under this section 
shall— 
(1) take into consideration the recommendations 
of the Mental Health and Substance Use Disorder 
Parity Task Force in its final report issued in Octo-
ber of 2016, and any subsequent Federal and State 
actions in relation to such recommendations; 
(2) reflect the input of the stakeholders partici-
pating in the public meeting under subsection (a); 
(3) identify specific strategic objectives regarding 
how the various Federal and State agencies charged 
with enforcement of mental health parity and addic-
tion equity requirements will collaborate to improve 
enforcement of such requirements; 
(4) provide a timeline for implementing the ac-
tion plan; and 
(5) provide specific examples of how such objec-
tives may be met, which may include— 
(A) providing common educational infor-
mation and documents, such as the Consumer 
Guide to Disclosure Rights, to patients about 
their rights under mental health parity and ad-
diction equity requirements; 
(B) facilitating the centralized collection of, 
monitoring of, and response to patient com-
660 
plaints or inquiries relating to mental health 
parity and addiction equity requirements, which 
may be through the development and adminis-
tration of— 
(i) a single, toll-free telephone number; 
and 
(ii) a new parity website— 
(I) to help consumers find the ap-
propriate Federal or State agency to 
assist with their parity complaints, 
appeals, and other actions; and 
(II) that takes into consideration, 
but is not duplicative of, the parity 
beta site being tested, and released for 
public comment, by the Department of 
Health and Human Services as of the 
date of the enactment of this Act; 
(C) Federal and State law enforcement 
agencies entering into memoranda of under-
standing to better coordinate enforcement respon-
sibilities and information sharing— 
(i) including whether such agencies 
should make the results of enforcement ac-
tions related to mental health parity and
661 
addiction 
equity 
requirements 
publicly 
available; and 
(ii) which may include State Policy 
Academies on Parity Implementation for 
State Officials and other forums to bring to-
gether national experts to provide technical 
assistance to teams of State officials on 
strategies to advance compliance with men-
tal health parity and addiction equity re-
quirements in both the commercial market, 
and in the Medicaid program under title 
XIX of the Social Security Act and the 
State Children’s Health Insurance Program 
under title XXI of such Act; and 
(D) recommendations to the Congress re-
garding the need for additional legal authority 
to improve enforcement of mental health parity 
and addiction equity requirements, including the 
need for additional legal authority to ensure that 
nonquantitative treatment limitations are ap-
plied, and the extent and frequency of the appli-
cations of such limitations, both to medical and 
surgical benefits and to mental health and sub-
stance use disorder benefits in a comparable 
manner.
662 
SEC. 13003. REPORT ON INVESTIGATIONS REGARDING PAR-
ITY IN MENTAL HEALTH AND SUBSTANCE USE 
DISORDER BENEFITS. 
(a) IN GENERAL.—Not later than 1 year after the date 
of enactment of this Act, and annually thereafter for the 
subsequent 5 years, the Assistant Secretary of Labor of the 
Employee Benefits Security Administration, in collabora-
tion with the Administrator of the Centers for Medicare & 
Medicaid Services and the Secretary of the Treasury, 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 sum-
marizing the results of all closed Federal investigations 
completed during the preceding 12-month period with find-
ings of any serious violation regarding compliance with 
mental health and substance use disorder coverage require-
ments under section 2726 of the Public Health Service Act 
(42 U.S.C. 300gg–26), section 712 of the Employee Retire-
ment Income Security Act of 1974 (29 U.S.C. 1185a), and 
section 9812 of the Internal Revenue Code of 1986. 
(b) CONTENTS.—Subject to subsection (c), a report 
under subsection (a) shall, with respect to investigations de-
scribed in such subsection, include each of the following: 
(1) The number of closed Federal investigations 
conducted during the covered reporting period.
738 
part, the term ‘nonprofit organization’ means an 
organization 
that 
is 
described 
in 
section 
501(c)(3) of the Internal Revenue Code of 1986 
and is exempt from taxation under section 
501(a) of such Code. 
‘‘(B) PROHIBITION.—The Attorney General 
may not award a grant under this part to a 
nonprofit organization that holds money in off-
shore accounts for the purpose of avoiding pay-
ing the tax described in section 511(a) of the In-
ternal Revenue Code of 1986. 
‘‘(C) DISCLOSURE.—Each nonprofit organi-
zation that is awarded a grant under this section 
and uses the procedures prescribed in regulations 
to create a rebuttable presumption of reasonable-
ness for the compensation of its officers, direc-
tors, trustees, and key employees, shall disclose to 
the Attorney General, in the application for the 
grant, the process for determining such com-
pensation, including the independent persons in-
volved in reviewing and approving such com-
pensation, the comparability data used, and con-
temporaneous substantiation of the deliberation 
and decision. Upon request, the Attorney General