127 
spect to such category of items and 
services. 
‘‘(4) BENEFICIARY
FINANCIAL
REQUIRE-
MENTS.— 
‘‘(A) NO BENEFICIARY FINANCIAL RE-
QUIREMENT.—If the plan or coverage 
does not include a beneficiary finan-
cial requirement (as defined in sub-
paragraph (C)) on substantially all 
medical and surgical benefits within 
a category of items and services (spec-
ified in paragraph (3)(C)), the plan or 
coverage may not impose such a bene-
ficiary financial requirement on men-
tal health or substance-related dis-
order benefits for items and services 
within such category. 
‘‘(B) BENEFICIARY
FINANCIAL
RE-
QUIREMENT.— 
‘‘(i) 
TREATMENT
OF 
DEDUCTIBLES, OUT-OF-POCKET
LIM-
ITS, 
AND
SIMILAR
FINANCIAL
RE-
QUIREMENTS.—If the plan or cov-
erage includes a deductible, a lim-
itation on out-of-pocket expenses, 
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smartinez on PRODPC61 with BILLS
128 
or similar beneficiary financial 
requirement that does not apply 
separately to individual items and 
services on substantially all med-
ical and surgical benefits within a 
category of items and services, the 
plan or coverage shall apply such 
requirement (or, if there is more 
than one such requirement for 
such category of items and serv-
ices, the predominant requirement 
for such category) both to medical 
and surgical benefits within such 
category and to mental health and 
substance-related disorder bene-
fits within such category and 
shall not distinguish in the appli-
cation of such requirement be-
tween such medical and surgical 
benefits and such mental health 
and 
substance-related 
disorder 
benefits. 
‘‘(ii) OTHER FINANCIAL REQUIRE-
MENTS.—If the plan or coverage in-
cludes a beneficiary financial re-
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smartinez on PRODPC61 with BILLS
129 
quirement not described in clause 
(i) on substantially all medical 
and surgical benefits within a cat-
egory of items and services, the 
plan or coverage may not impose 
such financial requirement on 
mental health or substance-re-
lated disorder benefits for items 
and services within such category 
in a way that is more costly to the 
participant or beneficiary than 
the predominant beneficiary fi-
nancial requirement applicable to 
medical and surgical benefits for 
items and services within such 
category. 
‘‘(C) BENEFICIARY
FINANCIAL
RE-
QUIREMENT DEFINED.—For purposes of 
this paragraph, the term ‘beneficiary 
financial requirement’ includes, with 
respect to a plan or coverage, any de-
ductible, 
coinsurance, 
co-payment, 
other cost sharing, and limitation on 
the total amount that may be paid by 
a participant or beneficiary with re-
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smartinez on PRODPC61 with BILLS
130 
spect to benefits under the plan or 
coverage, but does not include the ap-
plication of any aggregate lifetime 
limit or annual limit.’’; and 
(2) in subsection (b)— 
(A) by striking ‘‘construed—’’ and 
all that follows through ‘‘(1) as re-
quiring’’ and inserting ‘‘construed as 
requiring’’; 
(B) by striking ‘‘; or’’ and inserting 
a period; and 
(C) by striking paragraph (2). 
(b) EXPANSION TO SUBSTANCE-RELATED DIS-
ORDER BENEFITS AND REVISION OF DEFINITION.— 
Such section is further amended— 
(1) by striking ‘‘mental health bene-
fits’’ and inserting ‘‘mental health or sub-
stance-related 
disorder 
benefits’’ 
each 
place it appears; and 
(2) in paragraph (4) of subsection 
(e)— 
(A) by striking ‘‘MENTAL
HEALTH 
BENEFITS’’ 
and 
inserting 
‘‘MENTAL 
HEALTH
AND
SUBSTANCE-RELATED
DIS-
ORDER BENEFITS’’; 
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smartinez on PRODPC61 with BILLS
131 
(B) by striking ‘‘benefits with re-
spect to mental health services’’ and 
inserting ‘‘benefits with respect to 
services for mental health conditions 
or substance-related disorders’’; and 
(C) by striking ‘‘, but does not in-
clude benefits with respect to treat-
ment of substance abuse or chemical 
dependency’’. 
(c) AVAILABILITY
OF
PLAN
INFORMATION 
ABOUT CRITERIA FOR MEDICAL NECESSITY.—Sub-
section (a) of such section, as amended by sub-
section (a)(1), is further amended by adding at 
the end the following new paragraph: 
‘‘(5) AVAILABILITY
OF
PLAN
INFORMA-
TION.—The criteria for medical necessity 
determinations made under the plan with 
respect to mental health and substance- 
related disorder benefits (or the health in-
surance coverage offered in connection 
with the plan with respect to such bene-
fits) shall be made available by the plan 
administrator (or the health insurance 
issuer offering such coverage) to any cur-
rent or potential participant, beneficiary, 
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smartinez on PRODPC61 with BILLS
132 
or contracting provider upon request. The 
reason for any denial under the plan (or 
coverage) of reimbursement or payment 
for services with respect to mental health 
and substance-related disorder benefits in 
the case of any participant or beneficiary 
shall, upon request, be made available by 
the plan administrator (or the health in-
surance issuer offering such coverage) to 
the participant or beneficiary.’’. 
(d) MINIMUM BENEFIT REQUIREMENTS.—Sub-
section (a) of such section is further amended 
by adding at the end the following new para-
graph: 
‘‘(6) MINIMUM SCOPE OF COVERAGE AND 
EQUITY IN OUT-OF-NETWORK BENEFITS.— 
‘‘(A) MINIMUM
SCOPE
OF
MENTAL 
HEALTH
AND
SUBSTANCE-RELATED
DIS-
ORDER
BENEFITS.—In the case of a 
group health plan (or health insur-
ance coverage offered in connection 
with such a plan) that provides any 
mental health or substance-related 
disorder benefits, the plan or coverage 
shall include benefits for any mental 
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smartinez on PRODPC61 with BILLS
133 
health condition or substance-related 
disorder included in the most recent 
edition of the Diagnostic and Statis-
tical Manual of Mental Disorders pub-
lished by the American Psychiatric As-
sociation. 
‘‘(B) EQUITY IN COVERAGE OF OUT- 
OF-NETWORK BENEFITS.— 
‘‘(i) IN GENERAL.—In the case of 
a group health plan (or health in-
surance coverage offered in con-
nection with such a plan) that 
provides both medical and sur-
gical benefits and mental health 
or substance-related disorder ben-
efits, if medical and surgical bene-
fits are provided for substantially 
all items and services in a cat-
egory specified in clause (ii) fur-
nished outside any network of pro-
viders established or recognized 
under such plan or coverage, the 
mental health and substance-re-
lated disorder benefits shall also 
be provided for items and services 
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smartinez on PRODPC61 with BILLS
134 
in such category furnished outside 
any network of providers estab-
lished or recognized under such 
plan or coverage in accordance 
with the requirements of this sec-
tion. 
‘‘(ii) CATEGORIES OF ITEMS AND 
SERVICES.—For purposes of clause 
(i), there shall be the following 
three categories of items and serv-
ices for benefits, whether medical 
and surgical benefits or mental 
health and substance-related dis-
order benefits, and all medical 
and surgical benefits and all men-
tal health and substance-related 
disorder benefits shall be classi-
fied into one of the following cat-
egories: 
‘‘(I) 
EMERGENCY.—Items 
and 
services, 
whether 
fur-
nished on an inpatient or out-
patient basis, required for the 
treatment of an emergency 
medical condition (including 
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smartinez on PRODPC61 with BILLS
135 
an emergency condition relat-
ing to mental health or sub-
stance-related disorders). 
‘‘(II) 
INPATIENT.—Items 
and services not described in 
subclause (I) furnished on an 
inpatient basis. 
‘‘(III) 
OUTPATIENT.—Items 
and services not described in 
subclause (I) furnished on an 
outpatient basis.’’. 
(e) REVISION
OF INCREASED COST EXEMP-
TION.—Paragraph (2) of subsection (c) of such 
section is amended to read as follows: 
‘‘(2) INCREASED COST EXEMPTION.— 
‘‘(A) IN GENERAL.—With respect to 
a group health plan (or health insur-
ance coverage offered in connection 
with such a plan), if the application 
of this section to such plan (or cov-
erage) results in an increase for the 
plan year involved of the actual total 
costs of coverage with respect to med-
ical and surgical benefits and mental 
health and substance-related disorder 
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smartinez on PRODPC61 with BILLS
136 
benefits under the plan (as deter-
mined and certified under subpara-
graph (C)) by an amount that exceeds 
the applicable percentage described 
in subparagraph (B) of the actual 
total plan costs, the provisions of this 
section shall not apply to such plan 
(or coverage) during the following 
plan year, and such exemption shall 
apply to the plan (or coverage) for 1 
plan year. 
‘‘(B) 
APPLICABLE
PERCENTAGE.— 
With respect to a plan (or coverage), 
the applicable percentage described 
in this paragraph shall be— 
‘‘(i) 2 percent in the case of the 
first plan year to which this para-
graph applies; and 
‘‘(ii) 1 percent in the case of 
each subsequent plan year. 
‘‘(C) 
DETERMINATIONS
BY
ACTU-
ARIES.—Determinations as to increases 
in actual costs under a plan (or cov-
erage) for purposes of this subsection 
shall be made by a qualified and li-
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smartinez on PRODPC61 with BILLS
137 
censed actuary who is a member in 
good standing of the American Acad-
emy of Actuaries. Such determinations 
shall be certified by the actuary and 
be made available to the general pub-
lic. 
‘‘(D) 6-MONTH DETERMINATIONS.—If 
a group health plan (or a health in-
surance issuer offering coverage in 
connection with such a plan) seeks an 
exemption under this paragraph, de-
terminations under subparagraph (A) 
shall be made after such plan (or cov-
erage) has complied with this section 
for the first 6 months of the plan year 
involved. 
‘‘(E) 
NOTIFICATION.—A 
group 
health plan under this part shall com-
ply with the notice requirement under 
section 712(c)(2)(E) of the Employee 
Retirement Income Security Act of 
1974 with respect to a modification of 
mental health and substance-related 
disorder benefits as permitted under 
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smartinez on PRODPC61 with BILLS
138 
this paragraph as if such section ap-
plied to such plan.’’. 
(f) CHANGE IN EXCLUSION FOR SMALLEST EM-
PLOYERS.—Subsection (c)(1)(B) of such section 
is amended— 
(1) by inserting ‘‘(or 1 in the case of an 
employer residing in a State that permits 
small groups to include a single indi-
vidual)’’ after ‘‘at least 2’’ the first place it 
appears; and 
(2) by striking ‘‘and who employs at 
least 2 employees on the first day of the 
plan year’’. 
(g) ELIMINATION
OF SUNSET PROVISION.— 
Such section is amended by striking out sub-
section (f). 
(h) 
CLARIFICATION
REGARDING
PREEMP-
TION.—Such section is further amended by in-
serting after subsection (e) the following new 
subsection: 
‘‘(f) 
PREEMPTION, 
RELATION
TO
STATE 
LAWS.— 
‘‘(1) IN GENERAL.—Nothing in this sec-
tion shall be construed to preempt any 
State law that provides greater consumer 
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smartinez on PRODPC61 with BILLS
139 
protections, benefits, methods of access to 
benefits, rights or remedies that are great-
er than the protections, benefits, methods 
of access to benefits, rights or remedies 
provided under this section. 
‘‘(2) CONSTRUCTION.—Nothing in this 
section shall be construed to affect or 
modify the provisions of section 2723 with 
respect to group health plans.’’. 
(i) CONFORMING AMENDMENT TO HEADING.— 
The heading of such section is amended to 
read as follows: 
‘‘SEC. 2705. EQUITY IN MENTAL HEALTH AND SUBSTANCE- 
RELATED DISORDER BENEFITS.’’. 
(j) EFFECTIVE DATE.— 
(1) IN GENERAL.—Except as otherwise 
provided in this subsection, the amend-
ments made by this section shall apply 
with respect to plan years beginning on or 
after January 1, 2008. 
(2) 
ELIMINATION
OF
SUNSET.—The 
amendment made by subsection (g) shall 
apply to benefits for services furnished 
after December 31, 2007. 
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smartinez on PRODPC61 with BILLS
140 
(3) SPECIAL RULE FOR COLLECTIVE BAR-
GAINING
AGREEMENTS.—In the case of a 
group health plan maintained pursuant 
to one or more collective bargaining 
agreements between employee representa-
tives and one or more employers ratified 
before the date of the enactment of this 
Act, the amendments made by this section 
shall not apply to plan years beginning 
before the later of— 
(A) the date on which the last of 
the collective bargaining agreements 
relating to the plan terminates (deter-
mined without regard to any exten-
sion thereof agreed to after the date of 
the enactment of this Act), or 
(B) January 1, 2010. 
For purposes of subparagraph (A), any 
plan amendment made pursuant to a col-
lective bargaining agreement relating to 
the plan which amends the plan solely to 
conform 
to 
any 
requirement 
imposed 
under an amendment under this section 
shall not be treated as a termination of 
such collective bargaining agreement. 
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smartinez on PRODPC61 with BILLS
141 
(k) CONSTRUCTION REGARDING USE OF MED-
ICAL MANAGEMENT TOOLS.—Nothing in this Act 
shall be construed to prohibit a group health 
plan or health insurance issuer from using 
medical management tools as long as such 
management tools are based on valid medical 
evidence and are relevant to the patient whose 
medical treatment is under review. 
SEC. 4. AMENDMENTS TO THE INTERNAL REVENUE CODE 
OF 1986. 
(a) EXTENSION
OF PARITY
TO TREATMENT 
LIMITS
AND BENEFICIARY FINANCIAL REQUIRE-
MENTS.—Section 9812 of the Internal Revenue 
Code of 1986 is amended— 
(1) in subsection (a), by adding at the 
end the following new paragraphs: 
‘‘(3) TREATMENT LIMITS.— 
‘‘(A) NO TREATMENT LIMIT.—If the 
plan does not include a treatment 
limit (as defined in subparagraph 
(D)) on substantially all medical and 
surgical benefits in any category of 
items or services (specified in sub-
paragraph (C)), the plan may not im-
pose any treatment limit on mental 
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smartinez on PRODPC61 with BILLS
142 
health and substance-related disorder 
benefits that are classified in the 
same category of items or services. 
‘‘(B) TREATMENT LIMIT.—If the plan 
includes a treatment limit on substan-
tially all medical and surgical bene-
fits in any category of items or serv-
ices, the plan may not impose such a 
treatment limit on mental health and 
substance-related disorder benefits for 
items and services within such cat-
egory that are more restrictive than 
the predominant treatment limit that 
is applicable to medical and surgical 
benefits for items and services within 
such category. 
‘‘(C) CATEGORIES
OF
ITEMS
AND 
SERVICES
FOR
APPLICATION
OF
TREAT-
MENT
LIMITS
AND
BENEFICIARY
FINAN-
CIAL
REQUIREMENTS.—For purposes of 
this paragraph and paragraph (4), 
there shall be the following four cat-
egories of items and services for bene-
fits, whether medical and surgical 
benefits or mental health and sub-
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smartinez on PRODPC61 with BILLS
143 
stance-related disorder benefits, and 
all medical and surgical benefits and 
all mental health and substance re-
lated benefits shall be classified into 
one of the following categories: 
‘‘(i) INPATIENT, IN-NETWORK.— 
Items and services furnished on 
an inpatient basis and within a 
network of providers established 
or recognized under such plan or 
coverage. 
‘‘(ii) 
INPATIENT, 
OUT-OF-NET-
WORK.—Items 
and 
services 
fur-
nished on an inpatient basis and 
outside any network of providers 
established or recognized under 
such plan or coverage. 
‘‘(iii) 
OUTPATIENT, 
IN-NET-
WORK.—Items 
and 
services 
fur-
nished on an outpatient basis and 
within a network of providers es-
tablished 
or 
recognized 
under 
such plan or coverage. 
‘‘(iv) OUTPATIENT, OUT-OF-NET-
WORK.—Items 
and 
services 
fur-
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smartinez on PRODPC61 with BILLS
144 
nished on an outpatient basis and 
outside any network of providers 
established or recognized under 
such plan or coverage. 
‘‘(D) TREATMENT
LIMIT
DEFINED.— 
For purposes of this paragraph, the 
term ‘treatment limit’ means, with re-
spect to a plan, limitation on the fre-
quency of treatment, number of visits 
or days of coverage, or other similar 
limit on the duration or scope of treat-
ment under the plan. 
‘‘(E) PREDOMINANCE.—For purposes 
of this subsection, a treatment limit or 
financial requirement with respect to 
a category of items and services is 
considered to be predominant if it is 
the most common or frequent of such 
type of limit or requirement with re-
spect to such category of items and 
services. 
‘‘(4) BENEFICIARY
FINANCIAL
REQUIRE-
MENTS.— 
‘‘(A) NO BENEFICIARY FINANCIAL RE-
QUIREMENT.—If the plan does not in-
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smartinez on PRODPC61 with BILLS
145 
clude a beneficiary financial require-
ment (as defined in subparagraph 
(C)) on substantially all medical and 
surgical benefits within a category of 
items and services (specified in para-
graph (3)(C)), the plan may not im-
pose such a beneficiary financial re-
quirement on mental health and sub-
stance-related disorder benefits for 
items and services within such cat-
egory. 
‘‘(B) BENEFICIARY
FINANCIAL
RE-
QUIREMENT.— 
‘‘(i) 
TREATMENT
OF 
DEDUCTIBLES, OUT-OF-POCKET
LIM-
ITS, 
AND
SIMILAR
FINANCIAL
RE-
QUIREMENTS.—If the plan or cov-
erage includes a deductible, a lim-
itation on out-of-pocket expenses, 
or similar beneficiary financial 
requirement that does not apply 
separately to individual items and 
services on substantially all med-
ical and surgical benefits within a 
category of items and services, the 
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smartinez on PRODPC61 with BILLS
146 
plan or coverage shall apply such 
requirement (or, if there is more 
than one such requirement for 
such category of items and serv-
ices, the predominant requirement 
for such category) both to medical 
and surgical benefits within such 
category and to mental health and 
substance-related disorder bene-
fits within such category and 
shall not distinguish in the appli-
cation of such requirement be-
tween such medical and surgical 
benefits and such mental health 
and 
substance-related 
disorder 
benefits. 
‘‘(ii) OTHER FINANCIAL REQUIRE-
MENTS.—If the plan includes a 
beneficiary financial requirement 
not described in clause (i) on sub-
stantially all medical and sur-
gical benefits within a category of 
items and services, the plan may 
not impose such financial require-
ment on mental health and sub-
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smartinez on PRODPC61 with BILLS
147 
stance-related 
disorder 
benefits 
for items and services within such 
category in a way that is more 
costly to the participant or bene-
ficiary than the predominant ben-
eficiary financial requirement ap-
plicable to medical and surgical 
benefits for items and services 
within such category. 
‘‘(C) BENEFICIARY
FINANCIAL
RE-
QUIREMENT DEFINED.—For purposes of 
this paragraph, the term ‘beneficiary 
financial requirement’ includes, with 
respect to a plan, any deductible, coin-
surance, co-payment, other cost shar-
ing, 
and 
limitation 
on 
the 
total 
amount that may be paid by a partici-
pant or beneficiary with respect to 
benefits under the plan, but does not 
include the application of any aggre-
gate lifetime limit or annual limit.’’; 
and 
(2) in subsection (b)— 
(A) by striking ‘‘construed—’’ and 
all that follows through ‘‘(1) as re-
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smartinez on PRODPC61 with BILLS
148 
quiring’’ and inserting ‘‘construed as 
requiring’’; 
(B) by striking ‘‘; or’’ and inserting 
a period; and 
(C) by striking paragraph (2). 
(b) EXPANSION TO SUBSTANCE-RELATED DIS-
ORDER BENEFITS AND REVISION OF DEFINITION.— 
Such section is further amended— 
(1) by striking ‘‘mental health bene-
fits’’ and inserting ‘‘mental health and 
substance-related disorder benefits’’ each 
place it appears; and 
(2) in paragraph (4) of subsection 
(e)— 
(A) by striking ‘‘MENTAL
HEALTH 
BENEFITS’’ in the heading and insert-
ing ‘‘MENTAL HEALTH AND SUBSTANCE- 
RELATED DISORDER BENEFITS’’; 
(B) by striking ‘‘benefits with re-
spect to mental health services’’ and 
inserting ‘‘benefits with respect to 
services for mental health conditions 
or substance-related disorders’’; and 
(C) by striking ‘‘, but does not in-
clude benefits with respect to treat-
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smartinez on PRODPC61 with BILLS
149 
ment of substances abuse or chemical 
dependency’’. 
(c) AVAILABILITY
OF
PLAN
INFORMATION 
ABOUT CRITERIA FOR MEDICAL NECESSITY.—Sub-
section (a) of such section, as amended by sub-
section (a)(1), is further amended by adding at 
the end the following new paragraph: 
‘‘(5) AVAILABILITY
OF
PLAN
INFORMA-
TION.—The criteria for medical necessity 
determinations made under the plan with 
respect to mental health and substance- 
related disorder benefits shall be made 
available by the plan administrator to 
any current or potential participant, ben-
eficiary, or contracting provider upon re-
quest. The reason for any denial under 
the plan of reimbursement or payment for 
services with respect to mental health and 
substance-related disorder benefits in the 
case of any participant or beneficiary 
shall, upon request, be made available by 
the plan administrator to the participant 
or beneficiary.’’. 
(d) MINIMUM BENEFIT REQUIREMENTS.—Sub-
section (a) of such section is further amended 
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smartinez on PRODPC61 with BILLS
150 
by adding at the end the following new para-
graph: 
‘‘(6) MINIMUM SCOPE OF COVERAGE AND 
EQUITY IN OUT-OF-NETWORK BENEFITS.— 
‘‘(A) MINIMUM
SCOPE
OF
MENTAL 
HEALTH
AND
SUBSTANCE-RELATED
DIS-
ORDER
BENEFITS.—In the case of a 
group health plan (or health insur-
ance coverage offered in connection 
with such a plan) that provides any 
mental health and substance-related 
disorder benefits, the plan or coverage 
shall include benefits for any mental 
health condition or substance-related 
disorder for which benefits are pro-
vided under the benefit plan option of-
fered under chapter 89 of title 5, 
United States Code, with the highest 
average enrollment as of the begin-
ning of the most recent year beginning 
on or before the beginning of the plan 
year involved. 
‘‘(B) EQUITY IN COVERAGE OF OUT- 
OF-NETWORK BENEFITS.— 
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‘‘(i) IN GENERAL.—In the case of 
a plan that provides both medical 
and surgical benefits and mental 
health and substance-related dis-
order benefits, if medical and sur-
gical benefits are provided for 
substantially all items and serv-
ices in a category specified in 
clause (ii) furnished outside any 
network of providers established 
or recognized under such plan or 
coverage, the mental health and 
substance-related disorder bene-
fits shall also be provided for 
items and services in such cat-
egory furnished outside any net-
work of providers established or 
recognized under such plan in ac-
cordance with the requirements of 
this section. 
‘‘(ii) CATEGORIES OF ITEMS AND 
SERVICES.—For purposes of clause 
(i), there shall be the following 
three categories of items and serv-
ices for benefits, whether medical 
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and surgical benefits or mental 
health and substance-related dis-
order benefits, and all medical 
and surgical benefits and all men-
tal health and substance-related 
disorder benefits shall be classi-
fied into one of the following cat-
egories: 
‘‘(I) 
EMERGENCY.—Items 
and 
services, 
whether 
fur-
nished on an inpatient or out-
patient basis, required for the 
treatment of an emergency 
medical condition (including 
an emergency condition relat-
ing to mental health and sub-
stance-related disorders). 
‘‘(II) 
INPATIENT.—Items 
and services not described in 
subclause (I) furnished on an 
inpatient basis. 
‘‘(III) 
OUTPATIENT.—Items 
and services not described in 
subclause (I) furnished on an 
outpatient basis.’’. 
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153 
(e) REVISION
OF INCREASED COST EXEMP-
TION.—Paragraph (2) of subsection (c) of such 
section is amended to read as follows: 
‘‘(2) INCREASED COST EXEMPTION.— 
‘‘(A) IN GENERAL.—With respect to 
a group health plan, if the applica-
tion of this section to such plan re-
sults in an increase for the plan year 
involved of the actual total costs of 
coverage with respect to medical and 
surgical benefits and mental health 
and substance-related disorder bene-
fits under the plan (as determined 
and certified under subparagraph 
(C)) by an amount that exceeds the ap-
plicable percentage described in sub-
paragraph (B) of the actual total plan 
costs, the provisions of this section 
shall not apply to such plan during 
the following plan year, and such ex-
emption shall apply to the plan for 1 
plan year. 
‘‘(B) 
APPLICABLE
PERCENTAGE.— 
With respect to a plan, the applicable 
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percentage described in this para-
graph shall be— 
‘‘(i) 2 percent in the case of the 
first plan year which begins after 
the date of the enactment of the 
Paul Wellstone Mental Health and 
Addiction Equity Act of 2007; and 
‘‘(ii) 1 percent in the case of 
each subsequent plan year. 
‘‘(C) 
DETERMINATIONS
BY
ACTU-
ARIES.—Determinations as to increases 
in actual costs under a plan for pur-
poses of this subsection shall be made 
by a qualified actuary who is a mem-
ber in good standing of the American 
Academy of Actuaries. Such deter-
minations shall be certified by the ac-
tuary and be made available to the 
general public. 
‘‘(D) 6-MONTH DETERMINATIONS.—If 
a group health plan seeks an exemp-
tion under this paragraph, determina-
tions under subparagraph (A) shall be 
made after such plan has complied 
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with this section for the first 6 months 
of the plan year involved.’’. 
(f) CHANGE IN EXCLUSION FOR SMALLEST EM-
PLOYERS.—Subsection (c)(1) of such section is 
amended to read as follows: 
‘‘(1) SMALL EMPLOYER EXEMPTION.— 
‘‘(A) 
IN
GENERAL.—This 
section 
shall not apply to any group health 
plan for any plan year of a small em-
ployer. 
‘‘(B) SMALL
EMPLOYER.—For pur-
poses of subparagraph (A), the term 
‘small employer’ means, with respect 
to a calendar year and a plan year, 
an employer who employed an average 
of at least 2 (or 1 in the case of an em-
ployer residing in a State that permits 
small groups to include a single indi-
vidual) but not more than 50 employ-
ees on business days during the pre-
ceding calendar year. For purposes of 
the preceding sentence, all persons 
treated as a single employer under 
subsection (b), (c), (m), or (o) of sec-
tion 414 shall be treated as 1 employer 
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and rules similar to rules of subpara-
graphs 
(B) 
and 
(C) 
of 
section 
4980D(d)(2) shall apply.’’. 
(g) ELIMINATION
OF SUNSET PROVISION.— 
Such section is amended by striking subsection 
(f). 
(h) CONFORMING AMENDMENTS
TO HEAD-
ING.— 
(1) IN GENERAL.—The heading of such 
section is amended to read as follows: 
‘‘SEC. 9812. Equity in mental health and substance-related dis-
order benefits.’’. 
(2) CLERICAL
AMENDMENT.—The table 
of sections for subchapter B of chapter 
100 of the Internal Revenue Code of 1986 
is amended by striking the item relating 
to section 9812 and inserting the following 
new item: 
‘‘Sec. 9812. Equity in mental health and substance-related dis-
order benefits.’’. 
(i) 
EFFECTIVE
DATE.—The 
amendments 
made by this section shall apply with respect 
to plan years beginning on or after January 1, 
2008. 
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