I 
114TH CONGRESS 
1ST SESSION H. R. 4276 
To strengthen parity in mental health and substance use disorder benefits. 
IN THE HOUSE OF REPRESENTATIVES 
DECEMBER 16, 2015 
Mr. KENNEDY (for himself, Mr. TONKO, Ms. MATSUI, Ms. CLARKE of New 
York, and Ms. CASTOR of Florida) introduced the following bill; which 
was referred to the Committee on Energy and Commerce, and in addition 
to the Committees on Education and the Workforce and Ways and 
Means, for a period to be subsequently determined by the Speaker, in 
each case for consideration of such provisions as fall within the jurisdic-
tion of the committee concerned 
A BILL 
To strengthen parity in mental health and substance use 
disorder benefits. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Behavioral Health Cov-
erage Transparency Act of 2015’’. 
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SEC. 2. STRENGTHENING PARITY IN MENTAL HEALTH AND 
SUBSTANCE USE DISORDER BENEFITS. 
(a) 
PUBLIC
HEALTH
SERVICE
ACT.—Section 
2726(a) of the Public Health Service Act (42 U.S.C. 
300gg–26(a)) is amended by adding at the end the fol-
lowing new paragraphs: 
‘‘(6) DISCLOSURE
AND
ENFORCEMENT
RE-
QUIREMENTS.— 
‘‘(A) DISCLOSURE REQUIREMENTS.— 
‘‘(i) REGULATIONS.—Not later than 
June 30, 2016, the Secretary, in coopera-
tion with the Secretaries of Labor and the 
Treasury, as appropriate, shall issue addi-
tional regulations for carrying out this sec-
tion, including an explanation of docu-
ments that must be disclosed by plans and 
issuers, the process governing such disclo-
sures by plans and issuers, and analyses 
that must be conducted by plans and 
issuers by a group health plan or health in-
surance issuer offering health insurance 
coverage in the group or individual market 
in order for such plan or issuer to dem-
onstrate compliance with the provisions of 
this section. 
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‘‘(ii) DISCLOSURE REQUIREMENTS.— 
Documents required to be disclosed by a 
group health plan or health insurance 
issuer offering health insurance coverage in 
the group or individual market under 
clause (i) shall include an annual report 
that details the specific analyses performed 
to ensure compliance of such plan or cov-
erage with the law and regulations. At a 
minimum, with respect to the application 
of non-quantitative treatment limitations 
(in this paragraph referred to as NQTLs) 
to benefits under the plan or coverage, 
such report shall— 
‘‘(I) identify the specific factors 
the plan or coverage used in per-
forming its NQTL analysis; 
‘‘(II) identify and define the spe-
cific evidentiary standards relied on to 
evaluate the factors; 
‘‘(III) describe how the evi-
dentiary standards are applied to each 
service category for mental health, 
substance use disorders, medical bene-
fits, and surgical benefits; 
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‘‘(IV) disclose the results of the 
analyses of the specific evidentiary 
standards in each service category; 
and 
‘‘(V) disclose the specific findings 
of the plan or coverage in each service 
category and the conclusions reached 
with respect to whether the processes, 
strategies, evidentiary standards, or 
other factors used in applying the 
NQTL to mental health or substance 
use disorder benefits are comparable 
to, and applied no more stringently 
than, the processes, strategies, evi-
dentiary standards, or other factors 
used in applying the limitation with 
respect to medical and surgical bene-
fits in the same classification. 
‘‘(iii) GUIDANCE.—The Secretary, in 
cooperation with the Secretaries of Labor 
and the Treasury, as appropriate, shall 
issue guidance to group health plans and 
health insurance issuers offering health in-
surance coverage in the group or individual 
markets on how to satisfy the requirements 
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of this section with respect to making in-
formation available to current and poten-
tial participants and beneficiaries. Such in-
formation shall include certificate of cov-
erage documents and instruments under 
which the plan or coverage involved is ad-
ministered and operated that specify, in-
clude, or refer to procedures, formulas, and 
methodologies applied to determine a par-
ticipant or beneficiary’s benefit under the 
plan or coverage, regardless of whether 
such information is contained in a docu-
ment designated as the ‘plan document’. 
Such guidance shall include a disclosure of 
how the plan or coverage involved has pro-
vided that processes, strategies, evidentiary 
standards, and other factors used in apply-
ing the NQTL to mental health or sub-
stance use disorder benefits are com-
parable to, and applied no more stringently 
than, the processes, strategies, evidentiary 
standards, or other factors used in apply-
ing the limitation with respect to medical 
and surgical benefits in the same classi-
fication. 
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‘‘(iv) DEFINITIONS.—In this para-
graph and paragraph (7), the terms ‘non- 
quantitative treatment limitations’, ‘com-
parable to’, and ‘applied no more strin-
gently than’ have the meanings given such 
terms in sections 146 and 147 of title 45, 
Code of Federal Regulations (or any suc-
cessor regulation). 
‘‘(B) ENFORCEMENT.— 
‘‘(i) PROCESS FOR COMPLAINTS.—The 
Secretary, in cooperation with the Secre-
taries of Labor and the Treasury, as ap-
propriate, shall, with respect to group 
health plans and health insurance issuers 
offering health insurance coverage in the 
group or individual market, issue guidance 
to clarify the process and timeline for cur-
rent and potential participants and bene-
ficiaries (and authorized representatives 
and health care providers of such partici-
pants and beneficiaries) with respect to 
such plans and coverage to file formal 
complaints of such plans or issuers being 
in violation of this section, including guid-
ance, by plan type, on the relevant State, 
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regional, and national offices with which 
such complaints should be filed. 
‘‘(ii) AUTHORITY
FOR
PUBLIC
EN-
FORCEMENT.—The Secretary, in consulta-
tion with the Secretaries of Labor and the 
Treasury, shall make available to the pub-
lic on the Consumer Parity Portal website 
established under paragraph (7) de-identi-
fied information on audits and investiga-
tions of group health plans and health in-
surance issuers conducted under this sec-
tion. 
‘‘(iii) AUDITS.— 
‘‘(I) RANDOMIZED AUDITS.—The 
Secretary in cooperation with the Sec-
retaries of Labor and the Treasury, is 
authorized to conduct randomized au-
dits of group health plans and health 
insurance issuers offering health in-
surance coverage in the group or indi-
vidual market to determine compli-
ance with this section. Such audits 
shall be conducted on no fewer than 
twelve plans and issuers per plan 
year. Information from such audits 
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shall be made plainly available on the 
Consumer Parity Portal website es-
tablished under paragraph (7). 
‘‘(II) ADDITIONAL
AUDITS.—In 
the case of a group health plan or 
health insurance issuer offering health 
insurance coverage in the group or in-
dividual market with respect to which 
any claim has been filed during a plan 
year, the Secretary may audit the 
books and records of such plan or 
issuer to determine compliance with 
this section. Information detailing the 
results of the audit shall be made 
available on the Consumer Parity Por-
tal website established under para-
graph (7). 
‘‘(iv) DENIAL RATES.—The Secretary 
shall collect information on the rates of 
and reasons for denial by group health 
plans and health insurance issuers offering 
health insurance coverage in the group or 
individual market of claims for outpatient 
and inpatient mental health and substance 
use disorder services compared to the rates 
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of and reasons for denial of claims for 
medical and surgical services. For the first 
plan year beginning at least two years 
after the date of the enactment of this 
paragraph and each subsequent plan year, 
the Secretary shall submit to the Energy 
and Commerce Committee of the House of 
Representatives and the Committee on 
Health, Education, Labor, and Pensions of 
the Senate, and make plainly available on 
the Consumer Parity Portal website under 
paragraph (7), the information collected 
under the previous sentence with respect to 
the previous plan year. 
‘‘(7) CONSUMER
PARITY
PORTAL
WEBSITE.— 
The Secretary, in consultation with the Secretaries 
of Labor and the Treasury, shall establish a one- 
stop Internet website portal for— 
‘‘(A) submitting complaints and violations 
relating to this section, section 712 of the Em-
ployee Retirement Income Security Act of 1974, 
and section 9812 of the Internal Revenue Code 
of 1986; and 
‘‘(B) for each of such Secretaries to submit 
information in order to provide such informa-
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tion to health care consumers pursuant to para-
graph (6), section 712(a)(6) of the Employee 
Retirement Income Security Act of 1974, and 
section 9812(a)(6) of the Internal Revenue 
Code of 1986. 
Such portal shall have the ability to take basic infor-
mation related to the complaint, including name, 
contact information, and brief narrative, and trans-
mit such information in a timely fashion to the ap-
propriate State or Federal enforcement agency. Once 
the consumer information is submitted, such portal 
shall provide the consumer with contact information 
for the appropriate enforcement agency to follow-up 
on the complaint.’’. 
(b) EMPLOYEE RETIREMENT INCOME SECURITY ACT 
OF 1974.—Section 712(a) of the Employee Retirement In-
come Security Act of 1974 (29 U.S.C. 1185a(a)) is 
amended by adding at the end the following new para-
graph: 
‘‘(6) DISCLOSURE
AND
ENFORCEMENT
RE-
QUIREMENTS.— 
‘‘(A) DISCLOSURE REQUIREMENTS.— 
‘‘(i) REGULATIONS.—Not later than 
June 30, 2016, the Secretary, in coopera-
tion with the Secretaries of Health and 
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Human Services and the Treasury, as ap-
propriate, shall issue additional regulations 
for carrying out this section, including an 
explanation of documents that must be dis-
closed by plans and issuers, the process 
governing such disclosures by plans and 
issuers, and analyses that must be con-
ducted by plans and issuers by a group 
health plan (and health insurance coverage 
offered in connection with such a plan) in 
order for such plan or issuer to dem-
onstrate compliance with the provisions of 
this section. 
‘‘(ii) DISCLOSURE REQUIREMENTS.— 
Documents required to be disclosed by a 
group health plan (and health insurance 
coverage offered in connection with such a 
plan) under clause (i) shall include an an-
nual report that details the specific anal-
yses performed to ensure compliance of 
such plan or coverage with the law and 
regulations. At a minimum, with respect to 
the application of non-quantitative treat-
ment limitations (in this paragraph re-
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ferred to as NQTLs) to benefits under the 
plan or coverage, such report shall— 
‘‘(I) identify the specific factors 
the plan or coverage used in per-
forming its NQTL analysis; 
‘‘(II) identify and define the spe-
cific evidentiary standards relied on to 
evaluate the factors; 
‘‘(III) describe how the evi-
dentiary standards are applied to each 
service category for mental health, 
substance use disorders, medical bene-
fits, and surgical benefits; 
‘‘(IV) disclose the results of the 
analyses of the specific evidentiary 
standards in each service category; 
and 
‘‘(V) disclose the specific findings 
of the plan or coverage in each service 
category and the conclusions reached 
with respect to whether the processes, 
strategies, evidentiary standards, or 
other factors used in applying the 
NQTL to mental health or substance 
use disorder benefits are comparable 
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to, and applied no more stringently 
than, the processes, strategies, evi-
dentiary standards, or other factors 
used in applying the limitation with 
respect to medical and surgical bene-
fits in the same classification. 
‘‘(iii) GUIDANCE.—The Secretary, in 
cooperation with the Secretaries of Health 
and Human Services and the Treasury, as 
appropriate, shall issue guidance to group 
health plans (and health insurance cov-
erage offered in connection with such a 
plan) on how to satisfy the requirements of 
this section with respect to making infor-
mation available to current and potential 
participants and beneficiaries. Such infor-
mation shall include certificate of coverage 
documents and instruments under which 
the plan or coverage involved is adminis-
tered and operated that specify, include, or 
refer to procedures, formulas, and meth-
odologies applied to determine a partici-
pant or beneficiary’s benefit under the plan 
or coverage, regardless of whether such in-
formation is contained in a document des-
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ignated as the ‘plan document’. Such guid-
ance shall include a disclosure of how the 
plan or coverage involved has provided that 
processes, strategies, evidentiary stand-
ards, and other factors used in applying 
the NQTL to mental health or substance 
use disorder benefits are comparable to, 
and applied no more stringently than, the 
processes, strategies, evidentiary stand-
ards, or other factors used in applying the 
limitation with respect to medical and sur-
gical benefits in the same classification. 
‘‘(iv) DEFINITIONS.—In this para-
graph, the terms ‘non-quantitative treat-
ment limitations’, ‘comparable to’, and ‘ap-
plied no more stringently than’ have the 
meanings given such terms in sections 146 
and 147 of title 45, Code of Federal Regu-
lations (or any successor regulation). 
‘‘(B) ENFORCEMENT.— 
‘‘(i) PROCESS FOR COMPLAINTS.—The 
Secretary, in cooperation with the Secre-
taries of Health and Human Services and 
the Treasury, as appropriate, shall, with 
respect to group health plans (and health 
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insurance coverage offered in connection 
with such a plan), issue guidance to clarify 
the process and timeline for current and 
potential participants and beneficiaries 
(and authorized representatives and health 
care providers of such participants and 
beneficiaries) with respect to such plans 
(and coverage) to file formal complaints of 
such plans (or coverage) being in violation 
of this section, including guidance, by plan 
type, on the relevant State, regional, and 
national offices with which such complaints 
should be filed. 
‘‘(ii) AUTHORITY
FOR
PUBLIC
EN-
FORCEMENT.—The Secretary, in consulta-
tion with the Secretaries of Labor and the 
Treasury, shall make available to the pub-
lic on the Consumer Parity Portal website 
established under section 2726(a)(7) of the 
Public Health Service Act de-identified in-
formation on audits and investigations of 
group health plans (and health insurance 
coverage offered in connection with such a 
plan) conducted under this section. 
‘‘(iii) AUDITS.— 
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‘‘(I) RANDOMIZED AUDITS.—The 
Secretary in cooperation with the Sec-
retaries of Health and Human Serv-
ices and the Treasury, is authorized 
to conduct randomized audits of 
group health plans (and health insur-
ance coverage offered in connection 
with such a plan) to determine com-
pliance with this section. Such audits 
shall be conducted on no fewer than 
twelve plans and coverage per plan 
year. Information from such audits 
shall be made plainly available on the 
Consumer Parity Portal website es-
tablished under section 2726(a)(7) of 
the Public Health Service Act. 
‘‘(II) ADDITIONAL
AUDITS.—In 
the case of a group health plan (and 
health insurance coverage offered in 
connection with such a plan) with re-
spect to which any claim has been 
filed during a plan year, the Secretary 
may audit the books and records of 
such plan (or coverage) to determine 
compliance with this section. Informa-
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tion detailing the results of the audit 
shall be made available on the Con-
sumer Parity Portal website estab-
lished under section 2726(a)(7) of the 
Public Health Service Act. 
‘‘(iv) DENIAL RATES.—The Secretary 
shall collect information on the rates of 
and reasons for denial by group health 
plans (and health insurance coverage of-
fered in connection with such a plan) of 
claims for outpatient and inpatient mental 
health and substance use disorder services 
compared to the rates of and reasons for 
denial of claims for medical and surgical 
services. For the first plan year beginning 
at least two years after the date of the en-
actment of this paragraph and each subse-
quent plan year, the Secretary shall submit 
to the Energy and Commerce Committee 
of the House of Representatives and the 
Committee on Health, Education, Labor, 
and Pensions of the Senate, and make 
plainly available on the Consumer Parity 
Portal website under section 2726(a)(7) of 
the Public Health Service Act, the infor-
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mation collected under the previous sen-
tence with respect to the previous plan 
year.’’. 
(c) INTERNAL REVENUE CODE OF 1986.—Section 
9812(a) of the Internal Revenue Code of 1986 is amended 
by adding at the end the following new paragraph: 
‘‘(6) DISCLOSURE
AND
ENFORCEMENT
RE-
QUIREMENTS.— 
‘‘(A) DISCLOSURE REQUIREMENTS.— 
‘‘(i) REGULATIONS.—Not later than 
June 30, 2016, the Secretary, in coopera-
tion with the Secretaries of Health and 
Human Services and Labor, as appro-
priate, shall issue additional regulations for 
carrying out this section, including an ex-
planation of documents that must be dis-
closed by plans and issuers, the process 
governing such disclosures by plans and 
issuers, and analyses that must be con-
ducted by plans and issuers by a group 
health plan in order for such plan to dem-
onstrate compliance with the provisions of 
this section. 
‘‘(ii) DISCLOSURE REQUIREMENTS.— 
Documents required to be disclosed by a 
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group health plan under clause (i) shall in-
clude an annual report that details the spe-
cific analyses performed to ensure compli-
ance of such plan with the law and regula-
tions. At a minimum, with respect to the 
application of non-quantitative treatment 
limitations (in this paragraph referred to 
as NQTLs) to benefits under the plan, 
such report shall— 
‘‘(I) identify the specific factors 
the plan used in performing its NQTL 
analysis; 
‘‘(II) identify and define the spe-
cific evidentiary standards relied on to 
evaluate the factors; 
‘‘(III) describe how the evi-
dentiary standards are applied to each 
service category for mental health, 
substance use disorders, medical bene-
fits, and surgical benefits; 
‘‘(IV) disclose the results of the 
analyses of the specific evidentiary 
standards in each service category; 
and 
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‘‘(V) disclose the specific findings 
of the plan in each service category 
and the conclusions reached with re-
spect to whether the processes, strate-
gies, evidentiary standards, or other 
factors used in applying the NQTL to 
mental health or substance use dis-
order benefits are comparable to, and 
applied no more stringently than, the 
processes, 
strategies, 
evidentiary 
standards, or other factors used in ap-
plying the limitation with respect to 
medical and surgical benefits in the 
same classification. 
‘‘(iii) GUIDANCE.—The Secretary, in 
cooperation with the Secretaries of Health 
and Human Services and Labor, as appro-
priate, shall issue guidance to group health 
plans on how to satisfy the requirements of 
this section with respect to making infor-
mation available to current and potential 
participants and beneficiaries. Such infor-
mation shall include certificate of coverage 
documents and instruments under which 
the plan involved is administered and oper-
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ated that specify, include, or refer to pro-
cedures, formulas, and methodologies ap-
plied to determine a participant or bene-
ficiary’s benefit under the plan, regardless 
of whether such information is contained 
in a document designated as the ‘plan doc-
ument’. Such guidance shall include a dis-
closure of how the plan involved has pro-
vided that processes, strategies, evidentiary 
standards, and other factors used in apply-
ing the NQTL to mental health or sub-
stance use disorder benefits are com-
parable to, and applied no more stringently 
than, the processes, strategies, evidentiary 
standards, or other factors used in apply-
ing the limitation with respect to medical 
and surgical benefits in the same classi-
fication. 
‘‘(iv) DEFINITIONS.—In this para-
graph, the terms ‘non-quantitative treat-
ment limitations’, ‘comparable to’, and ‘ap-
plied no more stringently than’ have the 
meanings given such terms in sections 146 
and 147 of title 45, Code of Federal Regu-
lations (or any successor regulation). 
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‘‘(B) ENFORCEMENT.— 
‘‘(i) PROCESS FOR COMPLAINTS.—The 
Secretary, in cooperation with the Secre-
taries of Health and Human Services and 
Labor, as appropriate, shall, with respect 
to group health plans, issue guidance to 
clarify the process and timeline for current 
and potential participants and beneficiaries 
(and authorized representatives and health 
care providers of such participants and 
beneficiaries) with respect to such plans to 
file formal complaints of such plans being 
in violation of this section, including guid-
ance, by plan type, on the relevant State, 
regional, and national offices with which 
such complaints should be filed. 
‘‘(ii) AUTHORITY
FOR
PUBLIC
EN-
FORCEMENT.—The Secretary, in consulta-
tion with the Secretaries of Labor and the 
Treasury, shall make available to the pub-
lic on the Consumer Parity Portal website 
established under section 2726(a)(7) of the 
Public Health Service Act de-identified in-
formation on audits and investigations of 
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group health plans conducted under this 
section. 
‘‘(iii) AUDITS.— 
‘‘(I) RANDOMIZED AUDITS.—The 
Secretary in cooperation with the Sec-
retaries of Health and Human Serv-
ices and Labor, is authorized to con-
duct randomized audits of group 
health plans to determine compliance 
with this section. Such audits shall be 
conducted on no fewer than twelve 
plans per plan year. Information from 
such audits shall be made plainly 
available on the Consumer Parity Por-
tal website established under section 
2726(a)(7) of the Public Health Serv-
ice Act. 
‘‘(II) ADDITIONAL
AUDITS.—In 
the case of a group health plan with 
respect to which any claim has been 
filed during a plan year, the Secretary 
may audit the books and records of 
such plan to determine compliance 
with this section. Information detail-
ing the results of the audit shall be 
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made available on the Consumer Par-
ity Portal website established under 
section 2726(a)(7) of the Public 
Health Service Act. 
‘‘(iv) DENIAL RATES.—The Secretary 
shall collect information on the rates of 
and reasons for denial by group health 
plans of claims for outpatient and inpa-
tient mental health and substance use dis-
order services compared to the rates of and 
reasons for denial of claims for medical 
and surgical services. For the first plan 
year beginning at least two years after the 
date of the enactment of this paragraph 
and each subsequent plan year, the Sec-
retary shall submit to the Energy and 
Commerce Committee of the House of 
Representatives and the Committee on 
Health, Education, Labor, and Pensions of 
the Senate, and make plainly available on 
the Consumer Parity Portal website under 
section 2726(a)(7) of the Public Health 
Service Act, the information collected 
under the previous sentence with respect to 
the previous plan year.’’. 
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(d) GAO STUDY ON MENTAL HEALTH AND SUB-
STANCE USE PARITY ENFORCEMENT EFFORTS.—Not 
later than one year after the date of enactment of this 
Act, the Comptroller General of the United States, in con-
sultation with the Secretary of Health and Human Serv-
ices, the Secretary of Labor, and the Secretary of the 
Treasury, shall submit to Congress, and make plainly 
available on the Consumer Parity Portal website under 
paragraph (7) of section 2726(a) of the Public Health 
Service Act (42 U.S.C. 300gg–26(a)), as added by sub-
section (a), a report detailing the enforcement efforts of 
the responsible departments and agencies in implementing 
sections 2726 of the Public Health Service Act 42 U.S.C. 
300gg–26), 712 of the Employee Retirement Income Se-
curity Act of 1974 (29 U.S.C. 1185a), and 9812 of the 
Internal Revenue Code of 1986, including— 
(1) the number of investigations and audits 
that have been conducted into potential parity viola-
tions; and 
(2) details on the investigation, audits, or en-
forcement action that was carried out as a result of 
such investigations that would not identify the sub-
ject of such investigation or enforcement. 
(e) AUTHORIZATION OF APPROPRIATIONS.—There is 
authorized to be appropriated $2,000,000 for each of fis-
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cal years 2016 through 2020 to carry out this section, in-
cluding the amendments made by this section. 
Æ 
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