H. R. 1424—122 
‘‘(5) OUT-OF-NETWORK PROVIDERS.—In the case of a plan 
or coverage that provides both medical and surgical benefits 
and mental health or substance use disorder benefits, if the 
plan or coverage provides coverage for medical or surgical bene-
fits provided by out-of-network providers, the plan or coverage 
shall provide coverage for mental health or substance use dis-
order benefits provided by out-of-network providers in a manner 
that is consistent with the requirements of this section.’’; 
(2) in subsection (b), by amending paragraph (2) to read 
as follows: 
‘‘(2) in the case of a group health plan (or health insurance 
coverage offered in connection with such a plan) that provides 
mental health or substance use disorder benefits, as affecting 
the terms and conditions of the plan or coverage relating to 
such benefits under the plan or coverage, except as provided 
in subsection (a).’’; 
(3) in subsection (c)— 
(A) in paragraph (1), by inserting before the period 
the following: ‘‘(as defined in section 2791(e)(4), except that 
for purposes of this paragraph such term shall include 
employers with 1 employee in the case of an employer 
residing in a State that permits small groups to include 
a single individual)’’; and 
(B) by striking paragraph (2) and inserting the fol-
lowing: 
‘‘(2) COST EXEMPTION.— 
‘‘(A) IN GENERAL.—With respect to a group health plan 
(or health insurance coverage offered in connection with 
such a plan), if the application of this section to such 
plan (or coverage) results 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 use disorder benefits under the plan (as deter-
mined and certified under subparagraph (C)) by an amount 
that exceeds the applicable percentage described in 
subparagraph (B) of the actual total plan costs, the provi-
sions of this section shall not apply to such plan (or cov-
erage) during the following plan year, and such exemption 
shall apply to the plan (or coverage) for 1 plan year. An 
employer may elect to continue to apply mental health 
and substance use disorder parity pursuant to this section 
with respect to the group health plan (or coverage) involved 
regardless of any increase in total costs. 
‘‘(B) APPLICABLE PERCENTAGE.—With respect to a plan 
(or coverage), the applicable percentage described in this 
subparagraph shall be— 
‘‘(i) 2 percent in the case of the first plan year 
in which this section is applied; and 
‘‘(ii) 1 percent in the case of each subsequent plan 
year. 
‘‘(C) DETERMINATIONS BY ACTUARIES.—Determinations 
as to increases in actual costs under a plan (or coverage) 
for purposes of this section shall be made and certified 
by a qualified and licensed actuary who is a member in 
good standing of the American Academy of Actuaries. All 
such determinations shall be in a written report prepared
H. R. 1424—123 
by the actuary. The report, and all underlying documenta-
tion relied upon by the actuary, shall be maintained by 
the group health plan or health insurance issuer for a 
period of 6 years following the notification made under 
subparagraph (E). 
‘‘(D) 6-MONTH DETERMINATIONS.—If a group health plan 
(or a health insurance issuer offering coverage in connection 
with a group health plan) seeks an exemption under this 
paragraph, determinations under subparagraph (A) shall 
be made after such plan (or coverage) has complied with 
this section for the first 6 months of the plan year involved. 
‘‘(E) NOTIFICATION.— 
‘‘(i) IN GENERAL.—A group health plan (or a health 
insurance issuer offering coverage in connection with 
a group health plan) that, based upon a certification 
described under subparagraph (C), qualifies for an 
exemption under this paragraph, and elects to imple-
ment the exemption, shall promptly notify the Sec-
retary, the appropriate State agencies, and participants 
and beneficiaries in the plan of such election. 
‘‘(ii) REQUIREMENT.—A notification to the Secretary 
under clause (i) shall include— 
‘‘(I) a description of the number of covered 
lives under the plan (or coverage) involved at the 
time of the notification, and as applicable, at the 
time of any prior election of the cost-exemption 
under this paragraph by such plan (or coverage); 
‘‘(II) for both the plan year upon which a cost 
exemption is sought and the year prior, a descrip-
tion of the actual total costs of coverage with 
respect to medical and surgical benefits and 
mental health and substance use disorder benefits 
under the plan; and 
‘‘(III) for both the plan year upon which a 
cost exemption is sought and the year prior, the 
actual total costs of coverage with respect to 
mental health and substance use disorder benefits 
under the plan. 
‘‘(iii) CONFIDENTIALITY.—A notification to the Sec-
retary under clause (i) shall be confidential. The Sec-
retary shall make available, upon request and on not 
more than an annual basis, an anonymous itemization 
of such notifications, that includes— 
‘‘(I) a breakdown of States by the size and 
type of employers submitting such notification; and 
‘‘(II) a summary of the data received under 
clause (ii). 
‘‘(F) AUDITS BY APPROPRIATE AGENCIES.—To determine 
compliance with this paragraph, the Secretary may audit 
the books and records of a group health plan or health 
insurance issuer relating to an exemption, including any 
actuarial reports prepared pursuant to subparagraph (C), 
during the 6 year period following the notification of such 
exemption under subparagraph (E). A State agency 
receiving a notification under subparagraph (E) may also 
conduct such an audit with respect to an exemption covered 
by such notification.’’;
H. R. 1424—124 
(4) in subsection (e), by striking paragraph (4) and inserting 
the following: 
‘‘(4) MENTAL HEALTH BENEFITS.—The term ‘mental health 
benefits’ means benefits with respect to services for mental 
health conditions, as defined under the terms of the plan and 
in accordance with applicable Federal and State law. 
‘‘(5) SUBSTANCE USE DISORDER BENEFITS.—The term ‘sub-
stance use disorder benefits’ means benefits with respect to 
services for substance use disorders, as defined under the terms 
of the plan and in accordance with applicable Federal and 
State law.’’; 
(5) by striking subsection (f); 
(6) by striking ‘‘mental health benefits’’ and inserting 
‘‘mental health and substance use disorder benefits’’ each place 
it appears in subsections (a)(1)(B)(i), (a)(1)(C), (a)(2)(B)(i), and 
(a)(2)(C); and 
(7) by striking ‘‘mental health benefits’’ and inserting 
‘‘mental health or substance use disorder benefits’’ each place 
it appears (other than in any provision amended by the previous 
paragraph). 
(c) AMENDMENTS TO INTERNAL REVENUE CODE.—Section 9812 
of the Internal Revenue Code of 1986 is amended— 
(1) in subsection (a), by adding at the end the following: 
‘‘(3) FINANCIAL
REQUIREMENTS
AND
TREATMENT
LIMITA-
TIONS.— 
‘‘(A) IN GENERAL.—In the case of a group health plan 
that provides both medical and surgical benefits and mental 
health or substance use disorder benefits, such plan shall 
ensure that— 
‘‘(i) the financial requirements applicable to such 
mental health or substance use disorder benefits are 
no more restrictive than the predominant financial 
requirements applied to substantially all medical and 
surgical benefits covered by the plan, and there are 
no separate cost sharing requirements that are 
applicable only with respect to mental health or sub-
stance use disorder benefits; and 
‘‘(ii) the treatment limitations applicable to such 
mental health or substance use disorder benefits are 
no more restrictive than the predominant treatment 
limitations applied to substantially all medical and 
surgical benefits covered by the plan and there are 
no separate treatment limitations that are applicable 
only with respect to mental health or substance use 
disorder benefits. 
‘‘(B) DEFINITIONS.—In this paragraph: 
‘‘(i) FINANCIAL REQUIREMENT.—The term ‘financial 
requirement’ 
includes 
deductibles, 
copayments, 
coinsurance, and out-of-pocket expenses, but excludes 
an aggregate lifetime limit and an annual limit subject 
to paragraphs (1) and (2), 
‘‘(ii) PREDOMINANT.—A financial requirement or 
treatment limit is considered to be predominant if it 
is the most common or frequent of such type of limit 
or requirement. 
‘‘(iii) TREATMENT
LIMITATION.—The term ‘treat-
ment limitation’ includes limits on the frequency of
H. R. 1424—125 
treatment, number of visits, days of coverage, or other 
similar limits on the scope or duration of treatment. 
‘‘(4) AVAILABILITY OF PLAN INFORMATION.—The criteria for 
medical necessity determinations made under the plan with 
respect to mental health or substance use disorder benefits 
shall be made available by the plan administrator in accordance 
with regulations to any current or potential participant, bene-
ficiary, or contracting provider upon request. The reason for 
any denial under the plan of reimbursement or payment for 
services with respect to mental health or substance use disorder 
benefits in the case of any participant or beneficiary shall, 
on request or as otherwise required, be made available by 
the plan administrator to the participant or beneficiary in 
accordance with regulations. 
‘‘(5) OUT-OF-NETWORK PROVIDERS.—In the case of a plan 
that provides both medical and surgical benefits and mental 
health or substance use disorder benefits, if the plan provides 
coverage for medical or surgical benefits provided by out-of- 
network providers, the plan shall provide coverage for mental 
health or substance use disorder benefits provided by out-of- 
network providers in a manner that is consistent with the 
requirements of this section.’’; 
(2) in subsection (b), by amending paragraph (2) to read 
as follows: 
‘‘(2) in the case of a group health plan that provides mental 
health or substance use disorder benefits, as affecting the terms 
and conditions of the plan relating to such benefits under 
the plan, except as provided in subsection (a).’’; 
(3) in subsection (c)— 
(A) by amending paragraph (1) 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 employer. 
‘‘(B) SMALL EMPLOYER.—For purposes 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 employer 
residing in a State that permits small groups to include 
a single individual) but not more than 50 employees on 
business days during the preceding calendar year. For pur-
poses of the preceding sentence, all persons treated as 
a single employer under subsection (b), (c), (m), or (o) 
of section 414 shall be treated as 1 employer and rules 
similar to rules of subparagraphs (B) and (C) of section 
4980D(d)(2) shall apply.’’; and 
(B) by striking paragraph (2) and inserting the fol-
lowing: 
‘‘(2) COST EXEMPTION.— 
‘‘(A) IN GENERAL.—With respect to a group health plan, 
if the application of this section to such plan results in 
an increase for the plan year involved of the actual total 
costs of coverage with respect to medical and surgical bene-
fits and mental health and substance use disorder benefits 
under the plan (as determined 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
H. R. 1424—126 
apply to such plan during the following plan year, and 
such exemption shall apply to the plan for 1 plan year. 
An employer may elect to continue to apply mental health 
and substance use disorder parity pursuant to this section 
with respect to the group health plan involved regardless 
of any increase in total costs. 
‘‘(B) APPLICABLE PERCENTAGE.—With respect to a plan, 
the applicable percentage described in this subparagraph 
shall be— 
‘‘(i) 2 percent in the case of the first plan year 
in which this section is applied; and 
‘‘(ii) 1 percent in the case of each subsequent plan 
year. 
‘‘(C) DETERMINATIONS BY ACTUARIES.—Determinations 
as to increases in actual costs under a plan for purposes 
of this section shall be made and certified by a qualified 
and licensed actuary who is a member in good standing 
of the American Academy of Actuaries. All such determina-
tions shall be in a written report prepared by the actuary. 
The report, and all underlying documentation relied upon 
by the actuary, shall be maintained by the group health 
plan for a period of 6 years following the notification made 
under subparagraph (E). 
‘‘(D) 6-MONTH DETERMINATIONS.—If a group health plan 
seeks an exemption under this paragraph, determinations 
under subparagraph (A) shall be made after such plan 
has complied with this section for the first 6 months of 
the plan year involved. 
‘‘(E) NOTIFICATION.— 
‘‘(i) IN GENERAL.—A group health plan that, based 
upon a certification described under subparagraph (C), 
qualifies for an exemption under this paragraph, and 
elects to implement the exemption, shall promptly 
notify the Secretary, the appropriate State agencies, 
and participants and beneficiaries in the plan of such 
election. 
‘‘(ii) REQUIREMENT.—A notification to the Secretary 
under clause (i) shall include— 
‘‘(I) a description of the number of covered 
lives under the plan involved at the time of the 
notification, and as applicable, at the time of any 
prior election of the cost-exemption under this 
paragraph by such plan; 
‘‘(II) for both the plan year upon which a cost 
exemption is sought and the year prior, a descrip-
tion of the actual total costs of coverage with 
respect to medical and surgical benefits and 
mental health and substance use disorder benefits 
under the plan; and 
‘‘(III) for both the plan year upon which a 
cost exemption is sought and the year prior, the 
actual total costs of coverage with respect to 
mental health and substance use disorder benefits 
under the plan. 
‘‘(iii) CONFIDENTIALITY.—A notification to the Sec-
retary under clause (i) shall be confidential. The Sec-
retary shall make available, upon request and on not
H. R. 1424—127 
more than an annual basis, an anonymous itemization 
of such notifications, that includes— 
‘‘(I) a breakdown of States by the size and 
type of employers submitting such notification; and 
‘‘(II) a summary of the data received under 
clause (ii). 
‘‘(F) AUDITS BY APPROPRIATE AGENCIES.—To determine 
compliance with this paragraph, the Secretary may audit 
the books and records of a group health plan relating 
to an exemption, including any actuarial reports prepared 
pursuant to subparagraph (C), during the 6 year period 
following the notification of such exemption under subpara-
graph (E). A State agency receiving a notification under 
subparagraph (E) may also conduct such an audit with 
respect to an exemption covered by such notification.’’; 
(4) in subsection (e), by striking paragraph (4) and inserting 
the following: 
‘‘(4) MENTAL HEALTH BENEFITS.—The term ‘mental health 
benefits’ means benefits with respect to services for mental 
health conditions, as defined under the terms of the plan and 
in accordance with applicable Federal and State law. 
‘‘(5) SUBSTANCE USE DISORDER BENEFITS.—The term ‘sub-
stance use disorder benefits’ means benefits with respect to 
services for substance use disorders, as defined under the terms 
of the plan and in accordance with applicable Federal and 
State law.’’; 
(5) by striking subsection (f); 
(6) by striking ‘‘mental health benefits’’ and inserting 
‘‘mental health and substance use disorder benefits’’ each place 
it appears in subsections (a)(1)(B)(i), (a)(1)(C), (a)(2)(B)(i), and 
(a)(2)(C); and 
(7) by striking ‘‘mental health benefits’’ and inserting 
‘‘mental health or substance use disorder benefits’’ each place 
it appears (other than in any provision amended by the previous 
paragraph). 
(d) REGULATIONS.—Not later than 1 year after the date of 
enactment of this Act, the Secretaries of Labor, Health and Human 
Services, and the Treasury shall issue regulations to carry out 
the amendments made by subsections (a), (b), and (c), respectively. 
(e) EFFECTIVE DATE.— 
(1) IN GENERAL.—The amendments made by this section 
shall apply with respect to group health plans for plan years 
beginning after the date that is 1 year after the date of enact-
ment of this Act, regardless of whether regulations have been 
issued to carry out such amendments by such effective date, 
except that the amendments made by subsections (a)(5), (b)(5), 
and (c)(5), relating to striking of certain sunset provisions, 
shall take effect on January 1, 2009. 
(2) SPECIAL
RULE
FOR
COLLECTIVE
BARGAINING
AGREE-
MENTS.—In the case of a group health plan maintained pursu-
ant to one or more collective bargaining agreements between 
employee representatives 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—
H. R. 1424—128 
(A) the date on which the last of the collective bar-
gaining agreements relating to the plan terminates (deter-
mined without regard to any extension thereof agreed to 
after the date of the enactment of this Act), or 
(B) January 1, 2009. 
For purposes of subparagraph (A), any plan amendment made 
pursuant to a collective bargaining agreement relating to the 
plan which amends the plan solely to conform to any require-
ment added by this section shall not be treated as a termination 
of such collective bargaining agreement. 
(f) ASSURING COORDINATION.—The Secretary of Health and 
Human Services, the Secretary of Labor, and the Secretary of 
the Treasury may ensure, through the execution or revision of 
an interagency memorandum of understanding among such Secre-
taries, that— 
(1) regulations, rulings, and interpretations issued by such 
Secretaries relating to the same matter over which two or 
more such Secretaries have responsibility under this section 
(and the amendments made by this section) are administered 
so as to have the same effect at all times; and 
(2) coordination of policies relating to enforcing the same 
requirements through such Secretaries in order to have a 
coordinated enforcement strategy that avoids duplication of 
enforcement efforts and assigns priorities in enforcement. 
(g) CONFORMING CLERICAL AMENDMENTS.— 
(1) ERISA HEADING.— 
(A) IN GENERAL.—The heading of section 712 of the 
Employee Retirement Income Security Act of 1974 is 
amended to read as follows: 
‘‘SEC. 712. PARITY IN MENTAL HEALTH AND SUBSTANCE USE DIS-
ORDER BENEFITS.’’. 
(B) CLERICAL AMENDMENT.—The table of contents in 
section 1 of such Act is amended by striking the item 
relating to section 712 and inserting the following new 
item: 
‘‘Sec. 712. Parity in mental health and substance use disorder benefits.’’. 
(2) PHSA HEADING.—The heading of section 2705 of the 
Public Health Service Act is amended to read as follows: 
‘‘SEC. 2705. PARITY IN MENTAL HEALTH AND SUBSTANCE USE DIS-
ORDER BENEFITS.’’. 
(3) IRC HEADING.— 
(A) IN GENERAL.—The heading of section 9812 of the 
Internal Revenue Code of 1986 is amended to read as 
follows: 
‘‘SEC. 9812. PARITY IN MENTAL HEALTH AND SUBSTANCE USE DIS-
ORDER BENEFITS.’’. 
(B) CLERICAL AMENDMENT.—The table of sections for 
subchapter B of chapter 100 of such Code is amended 
by striking the item relating to section 9812 and inserting 
the following new item: 
‘‘Sec. 9812. Parity in mental health and substance use disorder benefits.’’. 
(h) GAO STUDY
ON COVERAGE
AND EXCLUSION
OF MENTAL 
HEALTH AND SUBSTANCE USE DISORDER DIAGNOSES.—
H. R. 1424—129 
(1) IN GENERAL.—The Comptroller General of the United 
States shall conduct a study that analyzes the specific rates, 
patterns, and trends in coverage and exclusion of specific 
mental health and substance use disorder diagnoses by health 
plans and health insurance. The study shall include an analysis 
of— 
(A) specific coverage rates for all mental health condi-
tions and substance use disorders; 
(B) which diagnoses are most commonly covered or 
excluded; 
(C) whether implementation of this Act has affected 
trends in coverage or exclusion of such diagnoses; and 
(D) the impact of covering or excluding specific 
diagnoses on participants’ and enrollees’ health, their 
health care coverage, and the costs of delivering health 
care. 
(2) REPORTS.—Not later than 3 years after the date of 
the enactment of this Act, and 2 years after the date of submis-
sion the first report under this paragraph, the Comptroller 
General shall submit to Congress a report on the results of 
the study conducted under paragraph (1). 
TITLE VI—OTHER PROVISIONS 
SEC. 601. SECURE RURAL SCHOOLS AND COMMUNITY SELF-DETER-
MINATION PROGRAM. 
(a) REAUTHORIZATION
OF
THE SECURE RURAL SCHOOLS
AND 
COMMUNITY SELF-DETERMINATION ACT OF 2000.—The Secure Rural 
Schools and Community Self-Determination Act of 2000 (16 U.S.C. 
500 note; Public Law 106–393) is amended by striking sections 
1 through 403 and inserting the following: 
‘‘SEC. 1. SHORT TITLE. 
‘‘This Act may be cited as the ‘Secure Rural Schools and 
Community Self-Determination Act of 2000’. 
‘‘SEC. 2. PURPOSES. 
‘‘The purposes of this Act are— 
‘‘(1) to stabilize and transition payments to counties to 
provide funding for schools and roads that supplements other 
available funds; 
‘‘(2) to make additional investments in, and create addi-
tional employment opportunities through, projects that— 
‘‘(A)(i) improve the maintenance of existing infrastruc-
ture; 
‘‘(ii) implement stewardship objectives that enhance 
forest ecosystems; and 
‘‘(iii) restore and improve land health and water 
quality; 
‘‘(B) enjoy broad-based support; and 
‘‘(C) have objectives that may include— 
‘‘(i) road, trail, and infrastructure maintenance or 
obliteration; 
‘‘(ii) soil productivity improvement; 
‘‘(iii) improvements in forest ecosystem health; 
‘‘(iv) watershed restoration and maintenance;