‘‘(4) provide frequent opportunities for citizens, 
organizations, tribes, land management agencies, 
and other interested parties to participate openly 
and meaningfully, beginning at the early stages of 
the project development process under this title; 
‘‘(5)(A) monitor projects that have been ap-
proved under section 204; and 
‘‘(B) advise the designated Federal official on 
the progress of the monitoring efforts under sub-
paragraph (A); and 
‘‘(6) make recommendations to the Secretary 
concerned for any appropriate changes or adjust-
ments to the projects being monitored by the re-
source advisory committee. 
‘‘(c) APPOINTMENT BY THE SECRETARY.— 
‘‘(1) APPOINTMENT AND TERM.— 
‘‘(A) IN
GENERAL.—The Secretary con-
cerned, shall appoint the members of resource 
advisory committees for a term of 4 years be-
ginning on the date of appointment. 
‘‘(B) 
REAPPOINTMENT.—The 
Secretary 
concerned may reappoint members to subse-
quent 4-year terms. 
‘‘(2) BASIC
REQUIREMENTS.—The Secretary 
concerned shall ensure that each resource advisory 
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committee established meets the requirements of 
subsection (d). 
‘‘(3) INITIAL
APPOINTMENT.—Not later than 
180 days after the date of the enactment of this Act, 
the Secretary concerned shall make initial appoint-
ments to the resource advisory committees. 
‘‘(4) VACANCIES.—The Secretary concerned 
shall make appointments to fill vacancies on any re-
source advisory committee as soon as practicable 
after the vacancy has occurred. 
‘‘(5) COMPENSATION.—Members of the re-
source advisory committees shall not receive any 
compensation. 
‘‘(d) COMPOSITION OF ADVISORY COMMITTEE.— 
‘‘(1) NUMBER.—Each resource advisory com-
mittee shall be comprised of 15 members. 
‘‘(2) COMMUNITY INTERESTS REPRESENTED.— 
Committee members shall be representative of the 
interests of the following 3 categories: 
‘‘(A) 5 persons that— 
‘‘(i) represent organized labor or non- 
timber forest product harvester groups; 
‘‘(ii) 
represent 
developed 
outdoor 
recreation, off highway vehicle users, or 
commercial recreation activities; 
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‘‘(iii) represent— 
‘‘(I) energy and mineral develop-
ment interests; or 
‘‘(II) commercial or recreational 
fishing interests; 
‘‘(iv) represent the commercial timber 
industry; or 
‘‘(v) hold Federal grazing or other 
land use permits, or represent nonindus-
trial private forest land owners, within the 
area for which the committee is organized. 
‘‘(B) 5 persons that represent— 
‘‘(i) nationally recognized environ-
mental organizations; 
‘‘(ii) regionally or locally recognized 
environmental organizations; 
‘‘(iii) dispersed recreational activities; 
‘‘(iv) archaeological and historical in-
terests; or 
‘‘(v) nationally or regionally recog-
nized wild horse and burro interest groups, 
wildlife or hunting organizations, or water-
shed associations. 
‘‘(C) 5 persons that— 
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‘‘(i) hold State elected office (or a 
designee); 
‘‘(ii) hold county or local elected of-
fice; 
‘‘(iii) 
represent 
American 
Indian 
tribes within or adjacent to the area for 
which the committee is organized; 
‘‘(iv) are school officials or teachers; 
or 
‘‘(v) represent the affected public at 
large. 
‘‘(3) BALANCED
REPRESENTATION.—In ap-
pointing committee members from the 3 categories 
in paragraph (2), the Secretary concerned shall pro-
vide for balanced and broad representation from 
within each category. 
‘‘(4) GEOGRAPHIC DISTRIBUTION.—The mem-
bers of a resource advisory committee shall reside 
within the State in which the committee has juris-
diction and, to extent practicable, the Secretary con-
cerned shall ensure local representation in each cat-
egory in paragraph (2). 
‘‘(5) CHAIRPERSON.—A majority on each re-
source advisory committee shall select the chair-
person of the committee. 
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‘‘(e) APPROVAL PROCEDURES.— 
‘‘(1) IN GENERAL.—Subject to paragraph (3), 
each resource advisory committee shall establish pro-
cedures for proposing projects to the Secretary con-
cerned under this title. 
‘‘(2) QUORUM.—A quorum must be present to 
constitute an official meeting of the committee. 
‘‘(3) APPROVAL BY MAJORITY OF MEMBERS.— 
A project may be proposed by a resource advisory 
committee to the Secretary concerned under section 
203(a), if the project has been approved by a major-
ity of members of the committee from each of the 
3 categories in subsection (d)(2). 
‘‘(f) OTHER COMMITTEE AUTHORITIES
AND RE-
QUIREMENTS.— 
‘‘(1) STAFF ASSISTANCE.—A resource advisory 
committee may submit to the Secretary concerned a 
request for periodic staff assistance from Federal 
employees under the jurisdiction of the Secretary. 
‘‘(2) MEETINGS.—All meetings of a resource 
advisory committee shall be announced at least 1 
week in advance in a local newspaper of record and 
shall be open to the public. 
‘‘(3) RECORDS.—A resource advisory committee 
shall maintain records of the meetings of the com-
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mittee and make the records available for public in-
spection. 
‘‘SEC. 206. USE OF PROJECT FUNDS. 
‘‘(a) AGREEMENT REGARDING SCHEDULE AND COST 
OF PROJECT.— 
‘‘(1) AGREEMENT
BETWEEN
PARTIES.—The 
Secretary concerned may carry out a project sub-
mitted by a resource advisory committee under sec-
tion 203(a) using project funds or other funds de-
scribed in section 203(a)(2), if, as soon as prac-
ticable after the issuance of a decision document for 
the project and the exhaustion of all administrative 
appeals and judicial review of the project decision, 
the Secretary concerned and the resource advisory 
committee enter into an agreement addressing, at a 
minimum, the following: 
‘‘(A) The schedule for completing the 
project. 
‘‘(B) The total cost of the project, includ-
ing the level of agency overhead to be assessed 
against the project. 
‘‘(C) For a multiyear project, the esti-
mated cost of the project for each of the fiscal 
years in which it will be carried out. 
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‘‘(D) The remedies for failure of the Sec-
retary concerned to comply with the terms of 
the agreement consistent with current Federal 
law. 
‘‘(2) LIMITED USE OF FEDERAL FUNDS.—The 
Secretary concerned may decide, at the sole discre-
tion of the Secretary concerned, to cover the costs 
of a portion of an approved project using Federal 
funds appropriated or otherwise available to the Sec-
retary for the same purposes as the project. 
‘‘(b) TRANSFER OF PROJECT FUNDS.— 
‘‘(1) INITIAL TRANSFER REQUIRED.—As soon 
as practicable after the agreement is reached under 
subsection (a) with regard to a project to be funded 
in whole or in part using project funds, or other 
funds described in section 203(a)(2), the Secretary 
concerned shall transfer to the applicable unit of Na-
tional Forest System land or Bureau of Land Man-
agement District an amount of project funds equal 
to— 
‘‘(A) in the case of a project to be com-
pleted in a single fiscal year, the total amount 
specified in the agreement to be paid using 
project funds, or other funds described in sec-
tion 203(a)(2); or 
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‘‘(B) in the case of a multiyear project, the 
amount specified in the agreement to be paid 
using project funds, or other funds described in 
section 203(a)(2) for the first fiscal year. 
‘‘(2) CONDITION
ON
PROJECT
COMMENCE-
MENT.—The unit of National Forest System land or 
Bureau of Land Management District concerned, 
shall not commence a project until the project funds, 
or other funds described in section 203(a)(2) re-
quired to be transferred under paragraph (1) for the 
project, have been made available by the Secretary 
concerned. 
‘‘(3) SUBSEQUENT TRANSFERS FOR MULTIYEAR 
PROJECTS.— 
‘‘(A) IN GENERAL.—For the second and 
subsequent fiscal years of a multiyear project to 
be funded in whole or in part using project 
funds, the unit of National Forest System land 
or Bureau of Land Management District con-
cerned shall use the amount of project funds re-
quired to continue the project in that fiscal year 
according to the agreement entered into under 
subsection (a). 
‘‘(B) SUSPENSION
OF
WORK.—The Sec-
retary concerned shall suspend work on the 
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project if the project funds required by the 
agreement in the second and subsequent fiscal 
years are not available. 
‘‘SEC. 207. AVAILABILITY OF PROJECT FUNDS. 
‘‘(a) SUBMISSION OF PROPOSED PROJECTS TO OBLI-
GATE FUNDS.—By September 30, 2008 (or as soon there-
after as the Secretary concerned determines is practicable) 
a resource advisory committee shall submit to the Sec-
retary concerned pursuant to section 203(a)(1) a suffi-
cient number of project proposals that, if approved, would 
result in the obligation of at least the full amount of the 
project funds reserved by the participating county in the 
preceding fiscal year. 
‘‘(b) 
USE
OR
TRANSFER
OF
UNOBLIGATED 
FUNDS.—Subject to section 208, if a resource advisory 
committee fails to comply with subsection (a) for a fiscal 
year, any project funds reserved by the participating coun-
ty in the preceding fiscal year and remaining unobligated 
shall be available for use as part of the project submissions 
in the next fiscal year. 
‘‘(c) EFFECT OF REJECTION OF PROJECTS.—Subject 
to section 208, any project funds reserved by a partici-
pating county in the preceding fiscal year that are unobli-
gated at the end of a fiscal year because the Secretary 
concerned has rejected one or more proposed projects shall 
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be available for use as part of the project submissions in 
the next fiscal year. 
‘‘(d) EFFECT OF COURT ORDERS.— 
‘‘(1) IN
GENERAL.—If an approved project 
under this Act is enjoined or prohibited by a Federal 
court, the Secretary concerned shall return the un-
obligated project funds related to the project to the 
participating county or counties that reserved the 
funds. 
‘‘(2) EXPENDITURE OF FUNDS.—The returned 
funds shall be available for the county to expend in 
the same manner as the funds reserved by the coun-
ty under subparagraph (B) or (C)(i) of section 
102(d)(1). 
‘‘SEC. 208. TERMINATION OF AUTHORITY. 
‘‘(a) IN GENERAL.—The authority to initiate projects 
under this title shall terminate on September 30, 2011. 
‘‘(b) DEPOSITS IN TREASURY.—Any project funds 
not obligated by September 30, 2012, shall be deposited 
in the Treasury of the United States. 
‘‘TITLE III—COUNTY FUNDS 
‘‘SEC. 301. DEFINITIONS. 
‘‘In this title: 
‘‘(1) COUNTY FUNDS.—The term ‘county funds’ 
means all funds an eligible county elects under sec-
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tion 102(d) to reserve for expenditure in accordance 
with this title. 
‘‘(2) PARTICIPATING COUNTY.—The term ‘par-
ticipating county’ means an eligible county that 
elects under section 102(d) to expend a portion of 
the Federal funds received under section 102 in ac-
cordance with this title. 
‘‘SEC. 302. USE. 
‘‘(a) AUTHORIZED USES.—A participating county, 
including any applicable agencies of the participating 
county, shall use county funds, in accordance with this 
title, only— 
‘‘(1) to carry out activities under the Firewise 
Communities program to provide to homeowners in 
fire-sensitive ecosystems education on, and assist-
ance with implementing, techniques in home siting, 
home construction, and home landscaping that can 
increase the protection of people and property from 
wildfires; 
‘‘(2) to reimburse the participating county for 
search and rescue and other emergency services, in-
cluding firefighting, that are— 
‘‘(A) performed on Federal land after the 
date on which the use was approved under sub-
section (b); 
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‘‘(B) paid for by the participating county; 
and 
‘‘(3) to develop community wildfire protection 
plans in coordination with the appropriate Secretary 
concerned. 
‘‘(b) PROPOSALS.—A participating county shall use 
county funds for a use described in subsection (a) only 
after a 45-day public comment period, at the beginning 
of which the participating county shall— 
‘‘(1) publish in any publications of local record 
a proposal that describes the proposed use of the 
county funds; and 
‘‘(2) submit the proposal to any resource advi-
sory committee established under section 205 for the 
participating county. 
‘‘SEC. 303. CERTIFICATION. 
‘‘(a) IN GENERAL.—Not later than February 1 of the 
year after the year in which any county funds were ex-
pended by a participating county, the appropriate official 
of the participating county shall submit to the Secretary 
concerned a certification that the county funds expended 
in the applicable year have been used for the uses author-
ized under section 302(a), including a description of the 
amounts expended and the uses for which the amounts 
were expended. 
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‘‘(b) REVIEW.—The Secretary concerned shall review 
the certifications submitted under subsection (a) as the 
Secretary concerned determines to be appropriate. 
‘‘SEC. 304. TERMINATION OF AUTHORITY. 
‘‘(a) IN GENERAL.—The authority to initiate projects 
under this title terminates on September 30, 2011. 
‘‘(b) AVAILABILITY.—Any county funds not obligated 
by September 30, 2012, shall be returned to the Treasury 
of the United States. 
‘‘TITLE IV—MISCELLANEOUS 
PROVISIONS 
‘‘SEC. 401. REGULATIONS. 
‘‘The Secretary of Agriculture and the Secretary of 
the Interior shall issue regulations to carry out the pur-
poses of this Act. 
‘‘SEC. 402. AUTHORIZATION OF APPROPRIATIONS. 
‘‘There are authorized to be appropriated such sums 
as are necessary to carry out this Act for each of fiscal 
years 2008 and 2009. 
‘‘SEC. 403. TREATMENT OF FUNDS AND REVENUES. 
‘‘(a) RELATION
TO
OTHER
APPROPRIATIONS.— 
Funds made available under section 402 and funds made 
available to a Secretary concerned under section 206 shall 
be in addition to any other annual appropriations for the 
Forest Service and the Bureau of Land Management. 
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‘‘(b) DEPOSIT OF REVENUES AND OTHER FUNDS.— 
All revenues generated from projects pursuant to title II, 
including any interest accrued from the revenues, shall be 
deposited in the Treasury of the United States.’’. 
(b) FOREST
RECEIPT
PAYMENTS
TO
ELIGIBLE 
STATES AND COUNTIES.— 
(1) ACT OF MAY 23, 1908.—The sixth paragraph 
under the heading ‘‘FOREST SERVICE’’ in the Act 
of May 23, 1908 (16 U.S.C. 500) is amended in the 
first sentence by striking ‘‘twenty-five percentum’’ 
and all that follows through ‘‘shall be paid’’ and in-
serting the following: ‘‘an amount equal to the an-
nual average of 25 percent of all amounts received 
for the applicable fiscal year and each of the pre-
ceding 6 fiscal years from each national forest shall 
be paid’’. 
(2) WEEKS
LAW.—Section 13 of the Act of 
March 1, 1911 (commonly known as the ‘‘Weeks 
Law’’) (16 U.S.C. 500) is amended in the first sen-
tence by striking ‘‘twenty-five percentum’’ and all 
that follows through ‘‘shall be paid’’ and inserting 
the following: ‘‘an amount equal to the annual aver-
age of 25 percent of all amounts received for the ap-
plicable fiscal year and each of the preceding 6 fiscal 
years from each national forest shall be paid’’. 
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(c) PAYMENTS IN LIEU OF TAXES.— 
(1) IN
GENERAL.—Section 6906 of title 31, 
United States Code, is amended to read as follows: 
‘‘§ 6906. Funding 
‘‘For each of fiscal years 2008 and 2009— 
‘‘(1) each county or other eligible unit of local 
government shall be entitled to payment under this 
chapter; and 
‘‘(2) sums shall be made available to the Sec-
retary of the Interior for obligation or expenditure in 
accordance with this chapter.’’. 
(2) CONFORMING AMENDMENT.—The table of 
sections for chapter 69 of title 31, United States 
Code, is amended by striking the item relating to 
section 6906 and inserting the following: 
‘‘6906. Funding.’’. 
TITLE 
IV—PAUL 
WELLSTONE 
AND PETE DOMENICI MENTAL 
HEALTH PARITY AND ADDIC-
TION EQUITY ACT OF 2008 
SEC. 401. SHORT TITLE. 
This title may be cited as the ‘‘Paul Wellstone and 
Pete Domenici Mental Health Parity and Addiction Eq-
uity Act of 2008’’. 
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SEC. 402. MENTAL HEALTH PARITY. 
(a) AMENDMENTS TO ERISA.—Section 712 of the 
Employee Retirement Income Security Act of 1974 (29 
U.S.C. 1185a) is amended— 
(1) in subsection (a), by adding at the end the 
following: 
‘‘(3) FINANCIAL REQUIREMENTS AND TREAT-
MENT LIMITATIONS.— 
‘‘(A) IN GENERAL.—In the case of a group 
health plan (or health insurance coverage of-
fered in connection with such a plan) that pro-
vides both medical and surgical benefits and 
mental health or substance use disorder bene-
fits, such plan or coverage shall ensure that— 
‘‘(i) the financial requirements appli-
cable to such mental health or substance 
use disorder benefits are no more restric-
tive than the predominant financial re-
quirements applied to substantially all 
medical and surgical benefits covered by 
the plan (or coverage), and there are no 
separate cost sharing requirements that 
are applicable only with respect to mental 
health or substance use disorder benefits; 
and 
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‘‘(ii) the treatment limitations applica-
ble to such mental health or substance use 
disorder benefits are no more restrictive 
than the predominant treatment limita-
tions applied to substantially all medical 
and surgical benefits covered by the plan 
(or coverage) and there are no separate 
treatment limitations that are applicable 
only with respect to mental health or sub-
stance 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 ag-
gregate lifetime limit and an annual limit 
subject to paragraphs (1) and (2). 
‘‘(ii) PREDOMINANT.—A financial re-
quirement or treatment limit is considered 
to be predominant if it is the most com-
mon or frequent of such type of limit or 
requirement. 
‘‘(iii) TREATMENT LIMITATION.—The 
term ‘treatment limitation’ includes limits 
on the frequency of treatment, number of 
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visits, days of coverage, or other similar 
limits on the scope or duration of treat-
ment. 
‘‘(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 (or the health in-
surance coverage offered in connection with the plan 
with respect to such benefits) shall be made avail-
able by the plan administrator (or the health insur-
ance issuer offering such coverage) in accordance 
with regulations to any current or potential partici-
pant, beneficiary, or contracting provider upon re-
quest. The reason for any denial under the plan (or 
coverage) of reimbursement or payment for services 
with respect to mental health or substance use dis-
order benefits in the case of any participant or bene-
ficiary shall, on request or as otherwise required, be 
made available by the plan administrator (or the 
health insurance issuer offering such coverage) to 
the participant or beneficiary in accordance with 
regulations. 
‘‘(5) OUT-OF-NETWORK
PROVIDERS.—In the 
case of a plan or coverage that provides both med-
ical and surgical benefits and mental health or sub-
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(ii) by striking ‘‘and who employs at 
least 2 employees on the first day of the 
plan year’’; and 
(B) by striking paragraph (2) and insert-
ing the following: 
‘‘(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 cov-
erage) 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 determined and cer-
tified under subparagraph (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 fol-
lowing 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 
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group health plan (or coverage) involved regard-
less of any increase in total costs. 
‘‘(B) APPLICABLE PERCENTAGE.—With re-
spect 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 quali-
fied and licensed actuary who is a member in 
good standing of the American Academy of Ac-
tuaries. All such determinations shall be in a 
written report prepared by the actuary. The re-
port, and all underlying documentation 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). 
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‘‘(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 de-
scribed under subparagraph (C), qualifies 
for an exemption under this paragraph, 
and elects to implement the exemption, 
shall promptly notify the Secretary, the ap-
propriate State agencies, and participants 
and beneficiaries in the plan of such elec-
tion. 
‘‘(ii) REQUIREMENT.—A notification 
to the Secretary under clause (i) shall in-
clude— 
‘‘(I) a description of the number 
of covered lives under the plan (or 
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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 description of the ac-
tual total costs of coverage with re-
spect 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 men-
tal health and substance use disorder 
benefits under the plan. 
‘‘(iii) CONFIDENTIALITY.—A notifica-
tion to the Secretary under clause (i) shall 
be confidential. The Secretary shall make 
available, upon request and on not more 
than an annual basis, an anonymous 
itemization of such notifications, that in-
cludes— 
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‘‘(I) a breakdown of States by 
the size and type of employers submit-
ting such notification; and 
‘‘(II) a summary of the data re-
ceived under clause (ii). 
‘‘(F) AUDITS
BY
APPROPRIATE
AGEN-
CIES.—To determine compliance with this para-
graph, the Secretary may audit the books and 
records of a group health plan or health insur-
ance issuer relating to an exemption, including 
any actuarial reports prepared pursuant to sub-
paragraph (C), during the 6-year period fol-
lowing 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 ex-
emption 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. 
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‘‘(5) SUBSTANCE USE DISORDER BENEFITS.— 
The term ‘substance 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 inserting after subsection (e) the fol-
lowing: 
‘‘(f) SECRETARY REPORT.—The Secretary shall, by 
January 1, 2012, and every two years thereafter, submit 
to the appropriate committees of Congress a report on 
compliance of group health plans (and health insurance 
coverage offered in connection with such plans) with the 
requirements of this section. Such report shall include the 
results of any surveys or audits on compliance of group 
health plans (and health insurance coverage offered in 
connection with such plans) with such requirements and 
an analysis of the reasons for any failures to comply. 
‘‘(g) NOTICE AND ASSISTANCE.—The Secretary, in 
cooperation with the Secretaries of Health and Human 
Services and Treasury, as appropriate, shall publish and 
widely disseminate guidance and information for group 
health plans, participants and beneficiaries, applicable 
State and local regulatory bodies, and the National Asso-
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ciation of Insurance Commissioners concerning the re-
quirements of this section and shall provide assistance 
concerning such requirements and the continued operation 
of applicable State law. Such guidance and information 
shall inform participants and beneficiaries of how they 
may obtain assistance under this section, including, where 
appropriate, assistance from State consumer and insur-
ance agencies.’’; 
(7) by striking ‘‘mental health benefits’’ and in-
serting ‘‘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 
(8) by striking ‘‘mental health benefits’’ and in-
serting ‘‘mental health or substance use disorder 
benefits’’ each place it appears (other than in any 
provision amended by the previous paragraph). 
(b) AMENDMENTS
TO PUBLIC HEALTH SERVICE 
ACT.—Section 2705 of the Public Health Service Act (42 
U.S.C. 300gg–5) is amended— 
(1) in subsection (a), by adding at the end the 
following: 
‘‘(3) FINANCIAL REQUIREMENTS AND TREAT-
MENT LIMITATIONS.— 
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‘‘(A) IN GENERAL.—In the case of a group 
health plan (or health insurance coverage of-
fered in connection with such a plan) that pro-
vides both medical and surgical benefits and 
mental health or substance use disorder bene-
fits, such plan or coverage shall ensure that— 
‘‘(i) the financial requirements appli-
cable to such mental health or substance 
use disorder benefits are no more restric-
tive than the predominant financial re-
quirements applied to substantially all 
medical and surgical benefits covered by 
the plan (or coverage), and there are no 
separate cost sharing requirements that 
are applicable only with respect to mental 
health or substance use disorder benefits; 
and 
‘‘(ii) the treatment limitations applica-
ble to such mental health or substance use 
disorder benefits are no more restrictive 
than the predominant treatment limita-
tions applied to substantially all medical 
and surgical benefits covered by the plan 
(or coverage) and there are no separate 
treatment limitations that are applicable 
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only with respect to mental health or sub-
stance 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 ag-
gregate lifetime limit and an annual limit 
subject to paragraphs (1) and (2), 
‘‘(ii) PREDOMINANT.—A financial re-
quirement or treatment limit is considered 
to be predominant if it is the most com-
mon or frequent of such type of limit or 
requirement. 
‘‘(iii) TREATMENT LIMITATION.—The 
term ‘treatment limitation’ includes limits 
on the frequency of treatment, number of 
visits, days of coverage, or other similar 
limits on the scope or duration of treat-
ment. 
‘‘(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 (or the health in-
surance coverage offered in connection with the plan 
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with respect to such benefits) shall be made avail-
able by the plan administrator (or the health insur-
ance issuer offering such coverage) in accordance 
with regulations to any current or potential partici-
pant, beneficiary, or contracting provider upon re-
quest. The reason for any denial under the plan (or 
coverage) of reimbursement or payment for services 
with respect to mental health or substance use dis-
order benefits in the case of any participant or bene-
ficiary shall, on request or as otherwise required, be 
made available by the plan administrator (or the 
health insurance issuer offering such coverage) to 
the participant or beneficiary in accordance with 
regulations. 
‘‘(5) OUT-OF-NETWORK
PROVIDERS.—In the 
case of a plan or coverage that provides both med-
ical and surgical benefits and mental health or sub-
stance use disorder benefits, if the plan or coverage 
provides coverage for medical or surgical benefits 
provided by out-of-network providers, the plan or 
coverage 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.’’; 
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(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 sub-
stance 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 re-
siding in a State that permits small groups to 
include a single individual)’’; and 
(B) by striking paragraph (2) and insert-
ing the following: 
‘‘(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 cov-
erage) results in an increase for the plan year 
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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 determined and cer-
tified under subparagraph (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 fol-
lowing 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 regard-
less of any increase in total costs. 
‘‘(B) APPLICABLE PERCENTAGE.—With re-
spect 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. 
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‘‘(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 quali-
fied and licensed actuary who is a member in 
good standing of the American Academy of Ac-
tuaries. All such determinations shall be in a 
written report prepared by the actuary. The re-
port, and all underlying documentation 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 
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plan) that, based upon a certification de-
scribed under subparagraph (C), qualifies 
for an exemption under this paragraph, 
and elects to implement the exemption, 
shall promptly notify the Secretary, the ap-
propriate State agencies, and participants 
and beneficiaries in the plan of such elec-
tion. 
‘‘(ii) REQUIREMENT.—A notification 
to the Secretary under clause (i) shall in-
clude— 
‘‘(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 description of the ac-
tual total costs of coverage with re-
spect to medical and surgical benefits 
and mental health and substance use 
disorder benefits under the plan; and 
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‘‘(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 men-
tal health and substance use disorder 
benefits under the plan. 
‘‘(iii) CONFIDENTIALITY.—A notifica-
tion to the Secretary under clause (i) shall 
be confidential. The Secretary shall make 
available, upon request and on not more 
than an annual basis, an anonymous 
itemization of such notifications, that in-
cludes— 
‘‘(I) a breakdown of States by 
the size and type of employers submit-
ting such notification; and 
‘‘(II) a summary of the data re-
ceived under clause (ii). 
‘‘(F) AUDITS
BY
APPROPRIATE
AGEN-
CIES.—To determine compliance with this para-
graph, the Secretary may audit the books and 
records of a group health plan or health insur-
ance issuer relating to an exemption, including 
any actuarial reports prepared pursuant to sub-
paragraph (C), during the 6-year period fol-
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lowing 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 ex-
emption 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 ‘substance 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 in-
serting ‘‘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 
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(7) by striking ‘‘mental health benefits’’ and in-
serting ‘‘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 TREAT-
MENT LIMITATIONS.— 
‘‘(A) IN GENERAL.—In the case of a group 
health plan that provides both medical and sur-
gical benefits and mental health or substance 
use disorder benefits, such plan shall ensure 
that— 
‘‘(i) the financial requirements appli-
cable to such mental health or substance 
use disorder benefits are no more restric-
tive than the predominant financial re-
quirements applied to substantially all 
medical and surgical benefits covered by 
the plan, and there are no separate cost 
sharing requirements that are applicable 
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100 
only with respect to mental health or sub-
stance use disorder benefits; and 
‘‘(ii) the treatment limitations applica-
ble to such mental health or substance use 
disorder benefits are no more restrictive 
than the predominant treatment limita-
tions applied to substantially all medical 
and surgical benefits covered by the plan 
and there are no separate treatment limi-
tations that are applicable only with re-
spect 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 ag-
gregate lifetime limit and an annual limit 
subject to paragraphs (1) and (2), 
‘‘(ii) PREDOMINANT.—A financial re-
quirement or treatment limit is considered 
to be predominant if it is the most com-
mon or frequent of such type of limit or 
requirement. 
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101 
‘‘(iii) TREATMENT LIMITATION.—The 
term ‘treatment limitation’ includes limits 
on the frequency of treatment, number of 
visits, days of coverage, or other similar 
limits on the scope or duration of treat-
ment. 
‘‘(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 partici-
pant, beneficiary, 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 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 bene-
ficiary in accordance with regulations. 
‘‘(5) OUT-OF-NETWORK
PROVIDERS.—In the 
case of a plan that provides both medical and sur-
gical benefits and mental health or substance use 
disorder benefits, if the plan provides coverage for 
medical or surgical benefits provided by out-of-net-
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102 
work providers, the plan shall provide coverage for 
mental health or substance use disorder benefits pro-
vided 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 aver-
age 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 individual) but not 
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103 
more than 50 employees on business days dur-
ing the preceding calendar year. For purposes 
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 subpara-
graphs (B) and (C) of section 4980D(d)(2) 
shall apply.’’; and 
(B) by striking paragraph (2) and insert-
ing the following: 
‘‘(2) COST EXEMPTION.— 
‘‘(A) IN
GENERAL.—With respect to a 
group health plan, if the application of this sec-
tion 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 
benefits and mental health and substance use 
disorder benefits under the plan (as determined 
and certified under subparagraph (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 during the fol-
lowing plan year, and such exemption shall 
apply to the plan for 1 plan year. An employer 
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104 
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 re-
spect to a plan, the applicable percentage de-
scribed 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 li-
censed actuary who is a member in good stand-
ing of the American Academy of Actuaries. All 
such determinations 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). 
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105 
‘‘(D) 6-MONTH
DETERMINATIONS.—If a 
group health plan seeks an exemption under 
this paragraph, determinations under subpara-
graph (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 de-
scribed under subparagraph (C), qualifies 
for an exemption under this paragraph, 
and elects to implement the exemption, 
shall promptly notify the Secretary, the ap-
propriate State agencies, and participants 
and beneficiaries in the plan of such elec-
tion. 
‘‘(ii) REQUIREMENT.—A notification 
to the Secretary under clause (i) shall in-
clude— 
‘‘(I) a description of the number 
of covered lives under the plan in-
volved 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; 
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106 
‘‘(II) for both the plan year upon 
which a cost exemption is sought and 
the year prior, a description of the ac-
tual total costs of coverage with re-
spect 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 men-
tal health and substance use disorder 
benefits under the plan. 
‘‘(iii) CONFIDENTIALITY.—A notifica-
tion to the Secretary under clause (i) shall 
be confidential. The Secretary shall make 
available, upon request and on not more 
than an annual basis, an anonymous 
itemization of such notifications, that in-
cludes— 
‘‘(I) a breakdown of States by 
the size and type of employers submit-
ting such notification; and 
‘‘(II) a summary of the data re-
ceived under clause (ii). 
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107 
‘‘(F) AUDITS
BY
APPROPRIATE
AGEN-
CIES.—To determine compliance with this para-
graph, the Secretary may audit the books and 
records of a group health plan relating to an 
exemption, including any actuarial reports pre-
pared 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 sub-
paragraph (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 ‘substance 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.’’; 
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108 
(5) by striking subsection (f); 
(6) by striking ‘‘mental health benefits’’ and in-
serting ‘‘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 in-
serting ‘‘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 sub-
sections (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 enactment of this Act, re-
gardless 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 cer-
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E:\BILLS\H7202.IH
H7202
bajohnson on PROD1PC77 with BILLS