IB 
Union Calendar No. 575 
116TH CONGRESS 
2D SESSION 
H. R. 7539 
[Report No. 116–692, Part I] 
To strengthen parity in mental health and substance use disorder benefits. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 9, 2020 
Mr. KENNEDY (for himself, Ms. PORTER, Mr. BILIRAKIS, and Mr. UPTON) 
introduced the following bill; which was referred to the Committee on En-
ergy and Commerce, and in addition to the Committees on Ways and 
Means, and Education and Labor, for a period to be subsequently deter-
mined by the Speaker, in each case for consideration of such provisions 
as fall within the jurisdiction of the committee concerned 
DECEMBER 24, 2020 
Additional sponsors: Mr. LUJA´N, Mr. SOTO, and Mr. FITZPATRICK 
DECEMBER 24, 2020 
Reported from the Committee on Energy and Commerce with an amendment 
[Strike out all after the enacting clause and insert the part printed in italic] 
DECEMBER 24, 2020 
Committees on Ways and Means and Education and Labor discharged; com-
mitted to the Committee of the Whole House on the State of the Union 
and ordered to be printed 
[For text of introduced bill, see copy of bill as introduced on July 9, 2020] 
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A BILL 
To strengthen parity in mental health and substance use 
disorder benefits. 
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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 ‘‘Strengthening Behav-
ioral Health Parity Act’’. 
SEC. 2. STRENGTHENING PARITY IN MENTAL HEALTH AND 
SUBSTANCE USE DISORDER BENEFITS. 
(a) PHSA.— 
(1) IN
GENERAL.—Title XXVII of the Public 
Health Service Act (42 U.S.C. 300gg–11 et seq.) is 
amended by adding at the end the following new part: 
‘‘PART D—ADDITIONAL COVERAGE PROVISIONS 
‘‘SEC. 2799A–1. PARITY IN MENTAL HEALTH AND SUB-
STANCE USE DISORDER BENEFITS. 
‘‘(a) IN GENERAL.— 
‘‘(1) AGGREGATE LIFETIME LIMITS.—In the case 
of a group health plan or a health insurance issuer 
offering group or individual health insurance cov-
erage that provides both medical and surgical benefits 
and mental health or substance use disorder bene-
fits— 
‘‘(A) NO LIFETIME LIMIT.—If the plan or 
coverage does not include an aggregate lifetime 
limit on substantially all medical and surgical 
benefits, the plan or coverage may not impose 
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any aggregate lifetime limit on mental health or 
substance use disorder benefits. 
‘‘(B) LIFETIME LIMIT.—If the plan or cov-
erage includes an aggregate lifetime limit on 
substantially all medical and surgical benefits 
(in this paragraph referred to as the ‘applicable 
lifetime limit’), the plan or coverage shall ei-
ther— 
‘‘(i) apply the applicable lifetime limit 
both to the medical and surgical benefits to 
which it otherwise would apply and to men-
tal health and substance use disorder bene-
fits and not distinguish in the application 
of such limit between such medical and sur-
gical benefits and mental health and sub-
stance use disorder benefits; or 
‘‘(ii) not include any aggregate lifetime 
limit on mental health or substance use dis-
order benefits that is less than the applica-
ble lifetime limit. 
‘‘(C) RULE IN CASE OF DIFFERENT LIM-
ITS.—In the case of a plan or coverage that is 
not described in subparagraph (A) or (B) and 
that includes no or different aggregate lifetime 
limits on different categories of medical and sur-
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gical benefits, the Secretary shall establish rules 
under which subparagraph (B) is applied to 
such plan or coverage with respect to mental 
health and substance use disorder benefits by 
substituting for the applicable lifetime limit an 
average aggregate lifetime limit that is computed 
taking into account the weighted average of the 
aggregate lifetime limits applicable to such cat-
egories. 
‘‘(2) ANNUAL LIMITS.—In the case of a group 
health plan or a health insurance issuer offering 
group or individual health insurance coverage that 
provides both medical and surgical benefits and men-
tal health or substance use disorder benefits— 
‘‘(A) NO
ANNUAL
LIMIT.—If the plan or 
coverage does not include an annual limit on 
substantially all medical and surgical benefits, 
the plan or coverage may not impose any annual 
limit on mental health or substance use disorder 
benefits. 
‘‘(B) ANNUAL LIMIT.—If the plan or cov-
erage includes an annual limit on substantially 
all medical and surgical benefits (in this para-
graph referred to as the ‘applicable annual 
limit’), the plan or coverage shall either— 
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‘‘(i) apply the applicable annual limit 
both to medical and surgical benefits to 
which it otherwise would apply and to men-
tal health and substance use disorder bene-
fits and not distinguish in the application 
of such limit between such medical and sur-
gical benefits and mental health and sub-
stance use disorder benefits; or 
‘‘(ii) not include any annual limit on 
mental health or substance use disorder ben-
efits that is less than the applicable annual 
limit. 
‘‘(C) RULE IN CASE OF DIFFERENT LIM-
ITS.—In the case of a plan or coverage that is 
not described in subparagraph (A) or (B) and 
that includes no or different annual limits on 
different categories of medical and surgical bene-
fits, the Secretary shall establish rules under 
which subparagraph (B) is applied to such plan 
or coverage with respect to mental health and 
substance use disorder benefits by substituting 
for the applicable annual limit an average an-
nual limit that is computed taking into account 
the weighted average of the annual limits appli-
cable to such categories. 
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‘‘(3) FINANCIAL REQUIREMENTS AND TREATMENT 
LIMITATIONS.— 
‘‘(A) IN GENERAL.—In the case of a group 
health plan or a health insurance issuer offering 
group or individual health insurance coverage 
that provides both medical and surgical benefits 
and mental health or substance use disorder ben-
efits, 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 restrictive 
than the predominant financial require-
ments 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 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 limitations 
applied to substantially all medical and 
surgical benefits covered by the plan (or 
coverage) and there are no separate treat-
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ment 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 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 common 
or frequent of such type of limit or require-
ment. 
‘‘(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 sub-
stance use disorder benefits (or the health insurance 
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coverage offered in connection with the plan with re-
spect to such benefits) shall be made available by the 
plan administrator (or the health insurance issuer of-
fering such coverage) in accordance with regulations 
to any current or potential participant, beneficiary, 
or contracting provider upon request. The reason for 
any denial under the plan (or coverage) of reimburse-
ment 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 (or the health insurance issuer offering 
such coverage) to the participant or beneficiary in ac-
cordance with regulations. 
‘‘(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 cov-
erage for medical or surgical benefits provided by out- 
of-network providers, the plan or coverage shall pro-
vide 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. 
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‘‘(6) COMPLIANCE
PROGRAM
GUIDANCE
DOCU-
MENT.— 
‘‘(A) IN
GENERAL.—Not later than 12 
months after the date of enactment of the Help-
ing Families in Mental Health Crisis Reform 
Act of 2016, the Secretary, the Secretary of 
Labor, and the Secretary of the Treasury, in 
consultation with the Inspector General of the 
Department of Health and Human Services, the 
Inspector General of the Department of Labor, 
and the Inspector General of the Department of 
the Treasury, shall issue a compliance program 
guidance document to help improve compliance 
with this section, section 712 of the Employee 
Retirement Income Security Act of 1974, and 
section 9812 of the Internal Revenue Code of 
1986, as applicable. In carrying out this para-
graph, the Secretaries may take into consider-
ation the 2016 publication of the Department of 
Health and Human Services and the Depart-
ment of Labor, entitled ‘Warning Signs - Plan 
or Policy Non-Quantitative Treatment Limita-
tions (NQTLs) that Require Additional Analysis 
to Determine Mental Health Parity Compliance’. 
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‘‘(B) EXAMPLES ILLUSTRATING COMPLIANCE 
AND NONCOMPLIANCE.— 
‘‘(i) IN
GENERAL.—The compliance 
program guidance document required under 
this paragraph shall provide illustrative, 
de-identified examples (that do not disclose 
any protected health information or indi-
vidually identifiable information) of pre-
vious findings of compliance and non-
compliance with this section, section 712 of 
the Employee Retirement Income Security 
Act of 1974, or section 9812 of the Internal 
Revenue Code of 1986, as applicable, based 
on investigations of violations of such sec-
tions, including— 
‘‘(I) examples illustrating require-
ments for information disclosures and 
nonquantitative treatment limitations; 
and 
‘‘(II) descriptions of the violations 
uncovered during the course of such in-
vestigations. 
‘‘(ii) NONQUANTITATIVE
TREATMENT 
LIMITATIONS.—To the extent that any ex-
ample described in clause (i) involves a 
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finding of compliance or noncompliance 
with regard to any requirement for non-
quantitative treatment limitations, the ex-
ample shall provide sufficient detail to fully 
explain such finding, including a full de-
scription of the criteria involved for approv-
ing medical and surgical benefits and the 
criteria involved for approving mental 
health and substance use disorder benefits. 
‘‘(iii) ACCESS TO ADDITIONAL INFOR-
MATION
REGARDING
COMPLIANCE.—In de-
veloping and issuing the compliance pro-
gram guidance document required under 
this paragraph, the Secretaries specified in 
subparagraph (A)— 
‘‘(I) shall enter into interagency 
agreements with the Inspector General 
of the Department of Health and 
Human Services, the Inspector General 
of the Department of Labor, and the 
Inspector General of the Department of 
the Treasury to share findings of com-
pliance and noncompliance with this 
section, section 712 of the Employee 
Retirement Income Security Act of 
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1974, or section 9812 of the Internal 
Revenue Code of 1986, as applicable; 
and 
‘‘(II) shall seek to enter into an 
agreement with a State to share infor-
mation on findings of compliance and 
noncompliance with this section, sec-
tion 712 of the Employee Retirement 
Income Security Act of 1974, or section 
9812 of the Internal Revenue Code of 
1986, as applicable. 
‘‘(C) RECOMMENDATIONS.—The compliance 
program guidance document shall include rec-
ommendations to advance compliance with this 
section, section 712 of the Employee Retirement 
Income Security Act of 1974, or section 9812 of 
the Internal Revenue Code of 1986, as applica-
ble, and encourage the development and use of 
internal controls to monitor adherence to appli-
cable statutes, regulations, and program require-
ments. Such internal controls may include illus-
trative examples of nonquantitative treatment 
limitations on mental health and substance use 
disorder benefits, which may fail to comply with 
this section, section 712 of the Employee Retire-
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ment Income Security Act of 1974, or section 
9812 of the Internal Revenue Code of 1986, as 
applicable, in relation to nonquantitative treat-
ment limitations on medical and surgical bene-
fits. 
‘‘(D) UPDATING THE COMPLIANCE PROGRAM 
GUIDANCE DOCUMENT.—The Secretary, the Sec-
retary of Labor, and the Secretary of the Treas-
ury, in consultation with the Inspector General 
of the Department of Health and Human Serv-
ices, the Inspector General of the Department of 
Labor, and the Inspector General of the Depart-
ment of the Treasury, shall update the compli-
ance program guidance document every 2 years 
to include illustrative, de-identified examples 
(that do not disclose any protected health infor-
mation or individually identifiable information) 
of previous findings of compliance and non-
compliance with this section, section 712 of the 
Employee Retirement Income Security Act of 
1974, or section 9812 of the Internal Revenue 
Code of 1986, as applicable. 
‘‘(7) ADDITIONAL GUIDANCE.— 
‘‘(A) IN
GENERAL.—Not later than 12 
months after the date of enactment of the Help-
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ing Families in Mental Health Crisis Reform 
Act of 2016, the Secretary, the Secretary of 
Labor, and the Secretary of the Treasury shall 
issue guidance to group health plans and health 
insurance issuers offering group or individual 
health insurance coverage to assist such plans 
and issuers in satisfying the requirements of this 
section, section 712 of the Employee Retirement 
Income Security Act of 1974, or section 9812 of 
the Internal Revenue Code of 1986, as applica-
ble. 
‘‘(B) DISCLOSURE.— 
‘‘(i) 
GUIDANCE
FOR
PLANS
AND 
ISSUERS.—The guidance issued under this 
paragraph shall include clarifying informa-
tion and illustrative examples of methods 
that group health plans and health insur-
ance issuers offering group or individual 
health insurance coverage may use for dis-
closing information to ensure compliance 
with the requirements under this section, 
section 712 of the Employee Retirement In-
come Security Act of 1974, or section 9812 
of the Internal Revenue Code of 1986, as 
applicable, (and any regulations promul-
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gated pursuant to such sections, as applica-
ble). 
‘‘(ii) DOCUMENTS FOR PARTICIPANTS, 
BENEFICIARIES, CONTRACTING
PROVIDERS, 
OR
AUTHORIZED
REPRESENTATIVES.—The 
guidance issued under this paragraph shall 
include clarifying information and illus-
trative examples of methods that group 
health plans and health insurance issuers 
offering group or individual health insur-
ance coverage may use to provide any par-
ticipant, beneficiary, contracting provider, 
or authorized representative, as applicable, 
with documents containing information 
that the health plans or issuers are required 
to disclose to participants, beneficiaries, 
contracting providers, or authorized rep-
resentatives to ensure compliance with this 
section, section 712 of the Employee Retire-
ment Income Security Act of 1974, or sec-
tion 9812 of the Internal Revenue Code of 
1986, as applicable, compliance with any 
regulation issued pursuant to such respec-
tive section, or compliance with any other 
applicable law or regulation. Such guidance 
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shall include information that is compara-
tive in nature with respect to— 
‘‘(I) 
nonquantitative 
treatment 
limitations for both medical and sur-
gical benefits and mental health and 
substance use disorder benefits; 
‘‘(II) the processes, strategies, evi-
dentiary standards, and other factors 
used to apply the limitations described 
in subclause (I); and 
‘‘(III) the application of the limi-
tations described in subclause (I) to en-
sure that such limitations are applied 
in parity with respect to both medical 
and surgical benefits and mental 
health and substance use disorder bene-
fits. 
‘‘(C) NONQUANTITATIVE TREATMENT LIMI-
TATIONS.—The guidance issued under this para-
graph shall include clarifying information and 
illustrative examples of methods, processes, strat-
egies, evidentiary standards, and other factors 
that group health plans and health insurance 
issuers offering group or individual health insur-
ance coverage may use regarding the develop-
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ment and application of nonquantitative treat-
ment limitations to ensure compliance with this 
section, section 712 of the Employee Retirement 
Income Security Act of 1974, or section 9812 of 
the Internal Revenue Code of 1986, as applica-
ble, (and any regulations promulgated pursuant 
to such respective section), including— 
‘‘(i) examples of methods of deter-
mining appropriate types of nonquantita-
tive treatment limitations with respect to 
both medical and surgical benefits and men-
tal health and substance use disorder bene-
fits, including nonquantitative treatment 
limitations pertaining to— 
‘‘(I) medical management stand-
ards based on medical necessity or ap-
propriateness, or whether a treatment 
is experimental or investigative; 
‘‘(II) limitations with respect to 
prescription drug formulary design; 
and 
‘‘(III) use of fail-first or step ther-
apy protocols; 
‘‘(ii) examples of methods of deter-
mining— 
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‘‘(I) network admission standards 
(such as credentialing); and 
‘‘(II) factors used in provider re-
imbursement methodologies (such as 
service type, geographic market, de-
mand for services, and provider sup-
ply, practice size, training, experience, 
and licensure) as such factors apply to 
network adequacy; 
‘‘(iii) examples of sources of informa-
tion that may serve as evidentiary stand-
ards for the purposes of making determina-
tions regarding the development and appli-
cation of nonquantitative treatment limita-
tions; 
‘‘(iv) examples of specific factors, and 
the evidentiary standards used to evaluate 
such factors, used by such plans or issuers 
in performing a nonquantitative treatment 
limitation analysis; 
‘‘(v) examples of how specific evi-
dentiary standards may be used to deter-
mine whether treatments are considered ex-
perimental or investigative; 
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‘‘(vi) examples of how specific evi-
dentiary standards may be applied to each 
service category or classification of benefits; 
‘‘(vii) examples of methods of reaching 
appropriate coverage determinations for 
new mental health or substance use disorder 
treatments, such as evidence-based early 
intervention programs for individuals with 
a serious mental illness and types of med-
ical management techniques; 
‘‘(viii) examples of methods of reaching 
appropriate coverage determinations for 
which there is an indirect relationship be-
tween the covered mental health or sub-
stance use disorder benefit and a traditional 
covered medical and surgical benefit, such 
as residential treatment or hospitalizations 
involving voluntary or involuntary commit-
ment; and 
‘‘(ix) additional illustrative examples 
of methods, processes, strategies, evidentiary 
standards, and other factors for which the 
Secretary determines that additional guid-
ance is necessary to improve compliance 
with this section, section 712 of the Em-
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ployee Retirement Income Security Act of 
1974, or section 9812 of the Internal Rev-
enue Code of 1986, as applicable. 
‘‘(D) PUBLIC COMMENT.—Prior to issuing 
any final guidance under this paragraph, the 
Secretary shall provide a public comment period 
of not less than 60 days during which any mem-
ber of the public may provide comments on a 
draft of the guidance. 
‘‘(8) COMPLIANCE REQUIREMENTS.— 
‘‘(A) NONQUANTITATIVE TREATMENT LIMI-
TATION (NQTL) REQUIREMENTS.—In the case of a 
group health plan or a health insurance issuer 
offering group or individual health insurance 
coverage that provides both medical and surgical 
benefits and mental health or substance use dis-
order benefits and that imposes nonquantitative 
treatment limitations (referred to in this section 
as ‘NQTL’) on mental health or substance use 
disorder benefits, the plan or issuer offering 
health insurance coverage shall perform com-
parative analyses of the design and application 
of NQTLs in accordance with subparagraph (B), 
and, beginning 45 days after the date of enact-
ment of this paragraph, make available to the 
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eration processes and strategies as written 
and in operation that are used to apply the 
NQTL for mental health or substance use 
disorder benefits are comparable to, and are 
applied no more stringently than, the proc-
esses, strategies, evidentiary standards, and 
other factors used to design the NQTL, as 
written, and the operation processes and 
strategies as written and in operation that 
are used to apply the NQTL to medical or 
surgical benefits. 
‘‘(v) A disclosure of the specific find-
ings and conclusions reached by the plan or 
coverage that the results of the analyses de-
scribed in this subparagraph indicate that 
the plan or coverage is in compliance with 
this section. 
‘‘(B) SECRETARY REQUEST PROCESS.— 
‘‘(i) SUBMISSION
UPON
REQUEST.— 
The Secretary shall request that a group 
health plan or a health insurance issuer of-
fering group or individual health insurance 
coverage submit the comparative analyses 
described in subparagraph (A) for plans 
that involve potential violations of this sec-
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tion or complaints regarding noncompli-
ance with this section that concern NQTLs 
and any other instances in which the Sec-
retary determines appropriate. The Sec-
retary shall request not fewer than 20 such 
analyses per year. 
‘‘(ii) ADDITIONAL
INFORMATION.—In 
instances in which the Secretary has con-
cluded that the plan or coverage has not 
submitted sufficient information for the Sec-
retary to review the comparative analyses 
described in subparagraph (A), as requested 
under clause (i), the Secretary shall specify 
to the plan or coverage the information the 
plan or coverage must submit to be respon-
sive to the request under clause (i) for the 
Secretary to review the comparative anal-
yses described in subparagraph(A) for com-
pliance with this section. Nothing in this 
paragraph shall require the Secretary to 
conclude that a plan is in compliance with 
this section solely based upon the inspection 
of the comparative analyses described in 
subparagraph (A), as requested under clause 
(i). 
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‘‘(iii) REQUIRED ACTION.— 
‘‘(I) IN
GENERAL.—In instances 
in which the Secretary has reviewed 
the comparative analyses described in 
subparagraph (A), as requested under 
clause (i), and determined that the 
plan or coverage is not in compliance 
with this section, the plan or cov-
erage— 
‘‘(aa) shall specify to the Sec-
retary the actions the plan or cov-
erage will take to be in compli-
ance with this section and provide 
to 
the 
Secretary 
comparative 
analyses described in subpara-
graph (A) that demonstrate com-
pliance with this section not later 
than 45 days after the initial de-
termination by the Secretary that 
the plan or coverage is not in 
compliance; and 
‘‘(bb) following the 45-day 
corrective action period under 
item (aa), if the Secretary deter-
mines that the plan or coverage 
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still is not in compliance with 
this section, not later than 7 days 
after such determination, shall no-
tify all individuals enrolled in the 
plan or coverage that the plan or 
coverage has been determined to be 
not in compliance with this sec-
tion. 
‘‘(II) EXEMPTION FROM DISCLO-
SURE.—Documents or communications 
produced in connection with the Sec-
retary’s recommendations to the plan 
or coverage shall not be subject to dis-
closure pursuant to section 552 of title 
5, United States Code. 
‘‘(iv) REPORT.—Not later than 1 year 
after the date of enactment of this para-
graph, and not later than October 1 of each 
year thereafter, the Secretary shall submit 
to Congress, and make publicly available, a 
report that contains— 
‘‘(I) a summary of the compara-
tive analyses requested under clause 
(i), including the identity of each plan 
or coverage that is determined to be 
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not in compliance after the final deter-
mination by the Secretary described in 
clause (iii)(I)(bb); 
‘‘(II) the Secretary’s conclusions 
as to whether each plan or coverage 
submitted sufficient information for the 
Secretary to review the comparative 
analyses requested under clause (i) for 
compliance with this section; 
‘‘(III) for each plan or coverage 
that did submit sufficient information 
for the Secretary to review the com-
parative 
analyses 
requested 
under 
clause (i), the Secretary’s conclusions 
as to whether and why the plan or cov-
erage is in compliance with the re-
quirements under this section; 
‘‘(IV) the Secretary’s specifica-
tions described in clause (ii) for each 
plan or coverage that the Secretary de-
termined did not submit sufficient in-
formation for the Secretary to review 
the comparative analyses requested 
under clause (i) for compliance with 
this section; and 
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‘‘(V) the Secretary’s specifications 
described in clause (iii) of the actions 
each plan or coverage that the Sec-
retary determined is not in compliance 
with this section must take to be in 
compliance with this section, including 
the reason why the Secretary deter-
mined the plan or coverage is not in 
compliance. 
‘‘(C) 
COMPLIANCE
PROGRAM
GUIDANCE 
DOCUMENT UPDATE PROCESS.— 
‘‘(i) IN GENERAL.—The Secretary shall 
include instances of noncompliance that the 
Secretary discovers upon reviewing the com-
parative analyses requested under subpara-
graph (B)(i) in the compliance program 
guidance document described in paragraph 
(6), as it is updated every 2 years, except 
that such instances shall not disclose any 
protected health information or individually 
identifiable information. 
‘‘(ii) GUIDANCE AND REGULATIONS.— 
Not later than 18 months after the date of 
enactment of this paragraph, the Secretary 
shall finalize any draft or interim guidance 
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and regulations relating to mental health 
parity under this section. Such draft guid-
ance shall include guidance to clarify the 
process and timeline for current and poten-
tial participants and beneficiaries (and au-
thorized representatives and health care 
providers of such participants and bene-
ficiaries) with respect to plans to file com-
plaints of such plans or issuers being in 
violation of this section, including guidance, 
by plan type, on the relevant State, re-
gional, or national office with which such 
complaints should be filed. 
‘‘(iii) STATE.—The Secretary shall 
share information on findings of compliance 
and noncompliance discovered upon review-
ing the comparative analyses requested 
under subparagraph (B)(i) with the State 
where the group health plan is located or 
the State where the health insurance issuer 
is licensed to do business for coverage offered 
by a health insurance issuer in the group 
market, in accordance with paragraph 
(6)(B)(iii)(II). 
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‘‘(b) CONSTRUCTION.—Nothing in this section shall be 
construed— 
‘‘(1) as requiring a group health plan or a 
health insurance issuer offering group or individual 
health insurance coverage to provide any mental 
health or substance use disorder benefits; or 
‘‘(2) in the case of a group health plan or a 
health insurance issuer offering group or individual 
health insurance coverage 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). 
‘‘(c) EXEMPTIONS.— 
‘‘(1) SMALL EMPLOYER EXEMPTION.—This sec-
tion shall not apply to any group health plan and a 
health insurance issuer offering group or individual 
health insurance coverage for any plan year of a 
small employer (as defined in section 2791(e)(4), ex-
cept 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). 
‘‘(2) COST EXEMPTION.— 
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‘‘(A) IN GENERAL.—With respect to a group 
health plan or a health insurance issuer offering 
group or individual health insurance coverage, 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 determined and certified 
under subparagraph (C)) by an amount that ex-
ceeds the applicable percentage described in sub-
paragraph (B) of the actual total plan costs, the 
provisions of this section shall not apply to such 
plan (or coverage) during the following plan 
year, and such exemption shall apply to the plan 
(or coverage) for 1 plan year. An employer may 
elect to continue to apply mental health and sub-
stance use disorder parity pursuant to this sec-
tion with respect to the group health plan (or 
coverage) involved regardless of any increase in 
total costs. 
‘‘(B) APPLICABLE PERCENTAGE.—With re-
spect to a plan (or coverage), the applicable per-
centage described in this subparagraph shall 
be— 
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‘‘(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 sub-
sequent 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 re-
port prepared by the actuary. The report, 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 para-
graph, determinations under subparagraph (A) 
shall be made after such plan (or coverage) has 
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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 appro-
priate State agencies, and participants and 
beneficiaries in the plan of such election. 
‘‘(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 cov-
erage) involved at the time of the noti-
fication, and as applicable, at the time 
of any prior election of the cost-exemp-
tion under this paragraph by such 
plan (or coverage); 
‘‘(II) for both the plan year upon 
which a cost exemption is sought and 
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the year prior, a description of the ac-
tual total costs of coverage with respect 
to medical and surgical benefits and 
mental health and substance use dis-
order 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 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 submitting 
such notification; and 
‘‘(II) a summary of the data re-
ceived under clause (ii). 
‘‘(F) AUDITS BY APPROPRIATE AGENCIES.— 
To determine compliance with this paragraph, 
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the Secretary may audit the books and records of 
a group health plan or health insurance issuer 
relating to an exemption, including any actu-
arial reports prepared pursuant to subparagraph 
(C), during the 6 year period following the noti-
fication 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. 
‘‘(d) SEPARATE APPLICATION TO EACH OPTION OF-
FERED.—In the case of a group health plan that offers a 
participant or beneficiary two or more benefit package op-
tions under the plan, the requirements of this section shall 
be applied separately with respect to each such option. 
‘‘(e) DEFINITIONS.—For purposes of this section— 
‘‘(1) AGGREGATE
LIFETIME
LIMIT.—The term 
‘aggregate lifetime limit’ means, with respect to bene-
fits under a group health plan or health insurance 
coverage, a dollar limitation on the total amount that 
may be paid with respect to such benefits under the 
plan or health insurance coverage with respect to an 
individual or other coverage unit. 
‘‘(2) ANNUAL LIMIT.—The term ‘annual limit’ 
means, with respect to benefits under a group health 
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plan or health insurance coverage, a dollar limitation 
on the total amount of benefits that may be paid with 
respect to such benefits in a 12-month period under 
the plan or health insurance coverage with respect to 
an individual or other coverage unit. 
‘‘(3) MEDICAL
OR
SURGICAL
BENEFITS.—The 
term ‘medical or surgical benefits’ means benefits 
with respect to medical or surgical services, as defined 
under the terms of the plan or coverage (as the case 
may be), but does not include mental health or sub-
stance use disorder benefits. 
‘‘(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 applica-
ble Federal and State law. 
‘‘(5) SUBSTANCE
USE
DISORDER
BENEFITS.— 
The term ‘substance use disorder benefits’ means bene-
fits with respect to services for substance use dis-
orders, as defined under the terms of the plan and in 
accordance with applicable Federal and State law.’’. 
(2) SUNSET.—Section 2726 of the Public Health 
Service Act (42 U.S.C. 300gg–26) is amended by add-
ing at the end the following new subsection 
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‘‘(f) SUNSET.—The provisions of this section shall have 
no force or effect after the date of the enactment of the 
Strengthening Behavioral Health Parity Act.’’. 
(3) 
ADMINISTRATION; 
CONFORMING
AMEND-
MENTS.— 
(A) 
APPLICATION
OF
IMPLEMENTATION 
REGULATIONS.—The 
provisions 
of 
sections 
146.136 and 147.160 of title 45, Code of Federal 
Regulations shall apply to section 2799A–1 of 
the Public Health Service Act, as added by para-
graph (1), in the same manner as such provi-
sions applied to section 2726 of the Public 
Health Service Act (42 U.S.C. 300gg–26) before 
the date of the enactment of this Act. 
(B) CONFORMING AMENDMENTS.— 
(i) Section 2722 of the Public Health 
Service Act (42 U.S.C. 300gg–21) is amend-
ed— 
(I) in subsection (a)(1), by insert-
ing ‘‘and part D’’ after ‘‘subparts 1 
and 2’’; 
(II) in subsection (b), by inserting 
‘‘and part D’’ after ‘‘subparts 1 and 
2’’; 
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(III) in subsection (c)(1), by in-
serting ‘‘and part D’’ after ‘‘subparts 1 
and 2’’; 
(IV) in subsection (c)(2), by in-
serting ‘‘and part D’’ after ‘‘subparts 1 
and 2’’; 
(V) in subsection (c)(3), by insert-
ing ‘‘and part D’’ after ‘‘this part’’; 
and 
(VI) in subsection (d), in the mat-
ter preceding paragraph (1), by insert-
ing ‘‘and part D’’ after ‘‘this part’’. 
(ii) Section 2723 of the Public Health 
Service Act (42 U.S.C. 300gg–22) is amend-
ed— 
(I) in subsection (a)(1), by insert-
ing ‘‘and part D’’ after ‘‘this part’’; 
(II) in subsection (a)(2), by in-
serting ‘‘or part D’’ after ‘‘this part’’; 
(III) in subsection (b)(1), by in-
serting ‘‘or part D’’ after ‘‘this part’’; 
(IV) in subsection (b)(2)(A), by 
inserting ‘‘or part D’’ after ‘‘this 
part’’; and 
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(V) in subsection (b)(2)(C)(ii), by 
inserting ‘‘and part D’’ after ‘‘this 
part’’. 
(iii) Section 2724 of the Public Health 
Service Act (42 U.S.C. 300gg–23) is amend-
ed— 
(I) in subsection (a)(1)— 
(aa) by striking ‘‘this part 
and part C insofar as it relates to 
this part’’ and inserting ‘‘this 
part, part D, and part C insofar 
as it relates to this part or part 
D’’; and 
(bb) by inserting ‘‘or part D’’ 
after ‘‘requirement of this part’’; 
(II) in subsection (a)(2), by in-
serting ‘‘or part D’’ after ‘‘this part’’; 
and 
(III) in subsection (c), by insert-
ing ‘‘or part D’’ after ‘‘this part (other 
than section 2704)’’. 
(b) ERISA.—Section 712(a) of the Employee Retire-
ment Income Security Act of 1974 (1185a(a)) is amended 
by adding at the end the following new paragraphs: 
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‘‘(6) COMPLIANCE
PROGRAM
GUIDANCE
DOCU-
MENT.— 
‘‘(A) IN
GENERAL.—Not later than 12 
months after the date of enactment of the Help-
ing Families in Mental Health Crisis Reform 
Act of 2016, the Secretary, the Secretary of 
Health and Human Services, and the Secretary 
of the Treasury, in consultation with the Inspec-
tor General of the Department of Health and 
Human Services, the Inspector General of the 
Department of Labor, and the Inspector General 
of the Department of the Treasury, shall issue a 
compliance program guidance document to help 
improve compliance with this section, section 
2799A–1 of the Public Health Service Act, and 
section 9812 of the Internal Revenue Code of 
1986, as applicable. In carrying out this para-
graph, the Secretaries may take into consider-
ation the 2016 publication of the Department of 
Health and Human Services and the Depart-
ment of Labor, entitled ‘Warning Signs - Plan 
or Policy Non-Quantitative Treatment Limita-
tions (NQTLs) that Require Additional Analysis 
to Determine Mental Health Parity Compliance’. 
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‘‘(B) EXAMPLES ILLUSTRATING COMPLIANCE 
AND NONCOMPLIANCE.— 
‘‘(i) IN
GENERAL.—The compliance 
program guidance document required under 
this paragraph shall provide illustrative, 
de-identified examples (that do not disclose 
any protected health information or indi-
vidually identifiable information) of pre-
vious findings of compliance and non-
compliance 
with 
this 
section, 
section 
2799A–1 of the Public Health Service Act, 
or section 9812 of the Internal Revenue 
Code of 1986, as applicable, based on inves-
tigations of violations of such sections, in-
cluding— 
‘‘(I) examples illustrating require-
ments for information disclosures and 
nonquantitative treatment limitations; 
and 
‘‘(II) descriptions of the violations 
uncovered during the course of such in-
vestigations. 
‘‘(ii) NONQUANTITATIVE
TREATMENT 
LIMITATIONS.—To the extent that any ex-
ample described in clause (i) involves a 
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finding of compliance or noncompliance 
with regard to any requirement for non-
quantitative treatment limitations, the ex-
ample shall provide sufficient detail to fully 
explain such finding, including a full de-
scription of the criteria involved for approv-
ing medical and surgical benefits and the 
criteria involved for approving mental 
health and substance use disorder benefits. 
‘‘(iii) ACCESS TO ADDITIONAL INFOR-
MATION
REGARDING
COMPLIANCE.—In de-
veloping and issuing the compliance pro-
gram guidance document required under 
this paragraph, the Secretaries specified in 
subparagraph (A)— 
‘‘(I) shall enter into interagency 
agreements with the Inspector General 
of the Department of Health and 
Human Services, the Inspector General 
of the Department of Labor, and the 
Inspector General of the Department of 
the Treasury to share findings of com-
pliance and noncompliance with this 
section, section 2799A–1 of the Public 
Health Service Act, or section 9812 of 
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the Internal Revenue Code of 1986, as 
applicable; and 
‘‘(II) shall seek to enter into an 
agreement with a State to share infor-
mation on findings of compliance and 
noncompliance with this section, sec-
tion 2799A–1 of the Public Health 
Service Act, or section 9812 of the In-
ternal Revenue Code of 1986, as appli-
cable. 
‘‘(C) RECOMMENDATIONS.—The compliance 
program guidance document shall include rec-
ommendations to advance compliance with this 
section, section 2799A–1 of the Public Health 
Service Act, or section 9812 of the Internal Rev-
enue Code of 1986, as applicable, and encourage 
the development and use of internal controls to 
monitor adherence to applicable statutes, regula-
tions, and program requirements. Such internal 
controls may include illustrative examples of 
nonquantitative treatment limitations on mental 
health and substance use disorder benefits, which 
may fail to comply with this section, section 
2799A–1 of the Public Health Service Act, or 
section 9812 of the Internal Revenue Code of 
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1986, as applicable, in relation to nonquantita-
tive treatment limitations on medical and sur-
gical benefits. 
‘‘(D) UPDATING THE COMPLIANCE PROGRAM 
GUIDANCE DOCUMENT.—The Secretary, the Sec-
retary of Health and Human Services, and the 
Secretary of the Treasury, in consultation with 
the Inspector General of the Department of 
Health and Human Services, the Inspector Gen-
eral of the Department of Labor, and the Inspec-
tor General of the Department of the Treasury, 
shall update the compliance program guidance 
document every 2 years to include illustrative, 
de-identified examples (that do not disclose any 
protected health information or individually 
identifiable information) of previous findings of 
compliance and noncompliance with this section, 
section 2799A–1 of the Public Health Service 
Act, or section 9812 of the Internal Revenue 
Code of 1986, as applicable. 
‘‘(7) ADDITIONAL GUIDANCE.— 
‘‘(A) IN
GENERAL.—Not later than 12 
months after the date of enactment of the Help-
ing Families in Mental Health Crisis Reform 
Act of 2016, the Secretary, the Secretary of 
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Health and Human Services, and the Secretary 
of the Treasury shall issue guidance to group 
health plans and health insurance issuers offer-
ing group or individual health insurance cov-
erage to assist such plans and issuers in satis-
fying the requirements of this section, section 
2799A–1 of the Public Health Service Act, or 
section 9812 of the Internal Revenue Code of 
1986, as applicable. 
‘‘(B) DISCLOSURE.— 
‘‘(i) 
GUIDANCE
FOR
PLANS
AND 
ISSUERS.—The guidance issued under this 
paragraph shall include clarifying informa-
tion and illustrative examples of methods 
that group health plans and health insur-
ance issuers offering group or individual 
health insurance coverage may use for dis-
closing information to ensure compliance 
with the requirements under this section, 
section 2799A–1 of the Public Health Serv-
ice Act, or section 9812 of the Internal Rev-
enue Code of 1986, as applicable, (and any 
regulations promulgated pursuant to such 
sections, as applicable). 
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‘‘(ii) DOCUMENTS FOR PARTICIPANTS, 
BENEFICIARIES, CONTRACTING
PROVIDERS, 
OR
AUTHORIZED
REPRESENTATIVES.—The 
guidance issued under this paragraph shall 
include clarifying information and illus-
trative examples of methods that group 
health plans and health insurance issuers 
offering group or individual health insur-
ance coverage may use to provide any par-
ticipant, beneficiary, contracting provider, 
or authorized representative, as applicable, 
with documents containing information 
that the health plans or issuers are required 
to disclose to participants, beneficiaries, 
contracting providers, or authorized rep-
resentatives to ensure compliance with this 
section, section 2799A–1 of the Public 
Health Service Act, or section 9812 of the 
Internal Revenue Code of 1986, as applica-
ble, compliance with any regulation issued 
pursuant to such respective section, or com-
pliance with any other applicable law or 
regulation. Such guidance shall include in-
formation that is comparative in nature 
with respect to— 
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‘‘(I) 
nonquantitative 
treatment 
limitations for both medical and sur-
gical benefits and mental health and 
substance use disorder benefits; 
‘‘(II) the processes, strategies, evi-
dentiary standards, and other factors 
used to apply the limitations described 
in subclause (I); and 
‘‘(III) the application of the limi-
tations described in subclause (I) to en-
sure that such limitations are applied 
in parity with respect to both medical 
and surgical benefits and mental 
health and substance use disorder bene-
fits. 
‘‘(C) NONQUANTITATIVE TREATMENT LIMI-
TATIONS.—The guidance issued under this para-
graph shall include clarifying information and 
illustrative examples of methods, processes, strat-
egies, evidentiary standards, and other factors 
that group health plans and health insurance 
issuers offering group or individual health insur-
ance coverage may use regarding the develop-
ment and application of nonquantitative treat-
ment limitations to ensure compliance with this 
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section, section 2799A–1 of the Public Health 
Service Act, or section 9812 of the Internal Rev-
enue Code of 1986, as applicable, (and any regu-
lations promulgated pursuant to such respective 
section), including— 
‘‘(i) examples of methods of deter-
mining appropriate types of nonquantita-
tive treatment limitations with respect to 
both medical and surgical benefits and men-
tal health and substance use disorder bene-
fits, including nonquantitative treatment 
limitations pertaining to— 
‘‘(I) medical management stand-
ards based on medical necessity or ap-
propriateness, or whether a treatment 
is experimental or investigative; 
‘‘(II) limitations with respect to 
prescription drug formulary design; 
and 
‘‘(III) use of fail-first or step ther-
apy protocols; 
‘‘(ii) examples of methods of deter-
mining— 
‘‘(I) network admission standards 
(such as credentialing); and 
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‘‘(II) factors used in provider re-
imbursement methodologies (such as 
service type, geographic market, de-
mand for services, and provider sup-
ply, practice size, training, experience, 
and licensure) as such factors apply to 
network adequacy; 
‘‘(iii) examples of sources of informa-
tion that may serve as evidentiary stand-
ards for the purposes of making determina-
tions regarding the development and appli-
cation of nonquantitative treatment limita-
tions; 
‘‘(iv) examples of specific factors, and 
the evidentiary standards used to evaluate 
such factors, used by such plans or issuers 
in performing a nonquantitative treatment 
limitation analysis; 
‘‘(v) examples of how specific evi-
dentiary standards may be used to deter-
mine whether treatments are considered ex-
perimental or investigative; 
‘‘(vi) examples of how specific evi-
dentiary standards may be applied to each 
service category or classification of benefits; 
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‘‘(vii) examples of methods of reaching 
appropriate coverage determinations for 
new mental health or substance use disorder 
treatments, such as evidence-based early 
intervention programs for individuals with 
a serious mental illness and types of med-
ical management techniques; 
‘‘(viii) examples of methods of reaching 
appropriate coverage determinations for 
which there is an indirect relationship be-
tween the covered mental health or sub-
stance use disorder benefit and a traditional 
covered medical and surgical benefit, such 
as residential treatment or hospitalizations 
involving voluntary or involuntary commit-
ment; and 
‘‘(ix) additional illustrative examples 
of methods, processes, strategies, evidentiary 
standards, and other factors for which the 
Secretary determines that additional guid-
ance is necessary to improve compliance 
with this section, section 2799A–1 of the 
Public Health Service Act, or section 9812 
of the Internal Revenue Code of 1986, as 
applicable. 
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‘‘(D) PUBLIC COMMENT.—Prior to issuing 
any final guidance under this paragraph, the 
Secretary shall provide a public comment period 
of not less than 60 days during which any mem-
ber of the public may provide comments on a 
draft of the guidance. 
‘‘(8) COMPLIANCE REQUIREMENTS.— 
‘‘(A) NONQUANTITATIVE TREATMENT LIMI-
TATION (NQTL) REQUIREMENTS.—Beginning 45 
days after the date of enactment of this para-
graph, in the case of a group health plan or a 
health insurance issuer offering group health in-
surance coverage that provides both medical and 
surgical benefits and mental health or substance 
use disorder benefits and that imposes non-
quantitative treatment limitations (referred to in 
this section as ‘NQTL’) on mental health or sub-
stance use disorder benefits, the plan or issuer of-
fering health insurance coverage shall perform 
comparative analyses of the design and applica-
tion of NQTLs in accordance with subparagraph 
(B), and make available to the applicable State 
authority (or, as applicable, the Secretary), upon 
request, the following information: 
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‘‘(i) The specific plan or coverage 
terms regarding the NQTL, that applies to 
such plan or coverage, and a description of 
all mental health or substance use disorder 
and medical or surgical benefits to which it 
applies in each respective benefits classifica-
tion. 
‘‘(ii) The factors used to determine that 
the NQTL will apply to mental health or 
substance use disorder benefits and medical 
or surgical benefits. 
‘‘(iii) The evidentiary standards used 
for the factors identified in clause (ii), when 
applicable, provided that every factor shall 
be defined and any other source or evidence 
relied upon to design and apply the NQTL 
to mental health or substance use disorder 
benefits and medical or surgical benefits. 
‘‘(iv) The comparative analyses dem-
onstrating that the processes, strategies, evi-
dentiary standards, and other factors used 
to design the NQTL, as written, and the op-
eration processes and strategies as written 
and in operation that are used to apply the 
NQTL for mental health or substance use 
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disorder benefits are comparable to, and are 
applied no more stringently than, the proc-
esses, strategies, evidentiary standards, and 
other factors used to design the NQTL, as 
written, and the operation processes and 
strategies as written and in operation that 
are used to apply the NQTL to medical or 
surgical benefits. 
‘‘(v) A disclosure of the specific find-
ings and conclusions reached by the plan or 
coverage that the results of the analyses de-
scribed in this subparagraph indicate that 
the plan or coverage is in compliance with 
this section. 
‘‘(B) SECRETARY REQUEST PROCESS.— 
‘‘(i) SUBMISSION
UPON
REQUEST.— 
The Secretary shall request that a group 
health plan or a health insurance issuer of-
fering group health insurance coverage sub-
mit the comparative analyses described in 
subparagraph (A) for plans that involve po-
tential violations of this section or com-
plaints regarding noncompliance with this 
section that concern NQTLs and any other 
instances in which the Secretary determines 
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plan or coverage that the plan or 
coverage has been determined to be 
not in compliance with this sec-
tion. 
‘‘(II) EXEMPTION FROM DISCLO-
SURE.—Documents or communications 
produced in connection with the Sec-
retary’s recommendations to the plan 
or coverage shall not be subject to dis-
closure pursuant to section 552 of title 
5, United States Code. 
‘‘(iv) REPORT.—Not later than 1 year 
after the date of enactment of this para-
graph, and not later than October 1 of each 
year thereafter, the Secretary shall submit 
to Congress, and make publicly available, a 
report that contains— 
‘‘(I) a summary of the compara-
tive analyses requested under clause 
(i), including the identity of each plan 
or coverage that is determined to be 
not in compliance after the final deter-
mination by the Secretary described in 
clause (iii)(I)(bb); 
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‘‘(II) the Secretary’s conclusions 
as to whether each plan or coverage 
submitted sufficient information for the 
Secretary to review the comparative 
analyses requested under clause (i) for 
compliance with this section; 
‘‘(III) for each plan or coverage 
that did submit sufficient information 
for the Secretary to review the com-
parative 
analyses 
requested 
under 
clause (i), the Secretary’s conclusions 
as to whether and why the plan or cov-
erage is in compliance with the re-
quirements under this section; 
‘‘(IV) the Secretary’s specifica-
tions described in clause (ii) for each 
plan or coverage that the Secretary de-
termined did not submit sufficient in-
formation for the Secretary to review 
the comparative analyses requested 
under clause (i) for compliance with 
this section; and 
‘‘(V) the Secretary’s specifications 
described in clause (iii) of the actions 
each plan or coverage that the Sec-
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retary determined is not in compliance 
with this section must take to be in 
compliance with this section, including 
the reason why the Secretary deter-
mined the plan or coverage is not in 
compliance. 
‘‘(C) 
COMPLIANCE
PROGRAM
GUIDANCE 
DOCUMENT UPDATE PROCESS.— 
‘‘(i) IN GENERAL.—The Secretary shall 
include instances of noncompliance that the 
Secretary discovers upon reviewing the com-
parative analyses requested under subpara-
graph (B)(i) in the compliance program 
guidance document described in paragraph 
(6), as it is updated every 2 years, except 
that such instances shall not disclose any 
protected health information or individually 
identifiable information. 
‘‘(ii) GUIDANCE AND REGULATIONS.— 
Not later than 18 months after the date of 
enactment of this paragraph, the Secretary 
shall finalize any draft or interim guidance 
and regulations relating to mental health 
parity under this section. Such draft guid-
ance shall include guidance to clarify the 
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process and timeline for current and poten-
tial participants and beneficiaries (and au-
thorized representatives and health care 
providers of such participants and bene-
ficiaries) with respect to plans to file com-
plaints of such plans or issuers being in 
violation of this section, including guidance, 
by plan type, on the relevant State, re-
gional, or national office with which such 
complaints should be filed. 
‘‘(iii) STATE.—The Secretary shall 
share information on findings of compliance 
and noncompliance discovered upon review-
ing the comparative analyses requested 
under subparagraph (B)(i) with the State 
where the group health plan is located or 
the State where the health insurance issuer 
is licensed to do business for coverage offered 
by a health insurance issuer in the group 
market, in accordance with paragraph 
(6)(B)(iii)(II).’’. 
(c) IRC.—Section 9812 of the Internal Revenue Code 
of 1986 is amended by adding at the end the following new 
paragraphs: 
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‘‘(6) COMPLIANCE
PROGRAM
GUIDANCE
DOCU-
MENT.— 
‘‘(A) IN
GENERAL.—Not later than 12 
months after the date of enactment of the Help-
ing Families in Mental Health Crisis Reform 
Act of 2016, the Secretary, the Secretary of 
Labor, and the Secretary of Health and Human 
Services, in consultation with the Inspector Gen-
eral of the Department of Health and Human 
Services, the Inspector General of the Depart-
ment of Labor, and the Inspector General of the 
Department of the Treasury, shall issue a com-
pliance program guidance document to help im-
prove compliance with this section, section 712 of 
the Employee Retirement Income Security Act of 
1974, and section 2799A–1 of the Public Health 
Service Act, as applicable. In carrying out this 
paragraph, the Secretaries may take into consid-
eration the 2016 publication of the Department 
of Health and Human Services and the Depart-
ment of Labor, entitled ‘Warning Signs - Plan 
or Policy Non-Quantitative Treatment Limita-
tions (NQTLs) that Require Additional Analysis 
to Determine Mental Health Parity Compliance’. 
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‘‘(B) EXAMPLES ILLUSTRATING COMPLIANCE 
AND NONCOMPLIANCE.— 
‘‘(i) IN
GENERAL.—The compliance 
program guidance document required under 
this paragraph shall provide illustrative, 
de-identified examples (that do not disclose 
any protected health information or indi-
vidually identifiable information) of pre-
vious findings of compliance and non-
compliance with this section, section 712 of 
the Employee Retirement Income Security 
Act of 1974, or section 2799A–1 of the Pub-
lic Health Service Act, as applicable, based 
on investigations of violations of such sec-
tions, including— 
‘‘(I) examples illustrating require-
ments for information disclosures and 
nonquantitative treatment limitations; 
and 
‘‘(II) descriptions of the violations 
uncovered during the course of such in-
vestigations. 
‘‘(ii) NONQUANTITATIVE
TREATMENT 
LIMITATIONS.—To the extent that any ex-
ample described in clause (i) involves a 
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finding of compliance or noncompliance 
with regard to any requirement for non-
quantitative treatment limitations, the ex-
ample shall provide sufficient detail to fully 
explain such finding, including a full de-
scription of the criteria involved for approv-
ing medical and surgical benefits and the 
criteria involved for approving mental 
health and substance use disorder benefits. 
‘‘(iii) ACCESS TO ADDITIONAL INFOR-
MATION
REGARDING
COMPLIANCE.—In de-
veloping and issuing the compliance pro-
gram guidance document required under 
this paragraph, the Secretaries specified in 
subparagraph (A)— 
‘‘(I) shall enter into interagency 
agreements with the Inspector General 
of the Department of Health and 
Human Services, the Inspector General 
of the Department of Labor, and the 
Inspector General of the Department of 
the Treasury to share findings of com-
pliance and noncompliance with this 
section, section 712 of the Employee 
Retirement Income Security Act of 
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1974, or section 2799A–1 of the Public 
Health Service Act, as applicable; and 
‘‘(II) shall seek to enter into an 
agreement with a State to share infor-
mation on findings of compliance and 
noncompliance with this section, sec-
tion 712 of the Employee Retirement 
Income Security Act of 1974, or section 
2799A–1 of the Public Health Service 
Act, as applicable. 
‘‘(C) RECOMMENDATIONS.—The compliance 
program guidance document shall include rec-
ommendations to advance compliance with this 
section, section 712 of the Employee Retirement 
Income Security Act of 1974, or section 2799A– 
1 of the Public Health Service Act, as applicable, 
and encourage the development and use of inter-
nal controls to monitor adherence to applicable 
statutes, regulations, and program requirements. 
Such internal controls may include illustrative 
examples of nonquantitative treatment limita-
tions on mental health and substance use dis-
order benefits, which may fail to comply with 
this section, section 712 of the Employee Retire-
ment Income Security Act of 1974, or section 
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2799A–1 of the Public Health Service Act, as ap-
plicable, in relation to nonquantitative treat-
ment limitations on medical and surgical bene-
fits. 
‘‘(D) UPDATING THE COMPLIANCE PROGRAM 
GUIDANCE DOCUMENT.—The Secretary, the Sec-
retary of Labor, and the Secretary of Health and 
Human Services, in consultation with the In-
spector General of the Department of Health and 
Human Services, the Inspector General of the 
Department of Labor, and the Inspector General 
of the Department of the Treasury, shall update 
the compliance program guidance document 
every 2 years to include illustrative, de-identified 
examples (that do not disclose any protected 
health information or individually identifiable 
information) of previous findings of compliance 
and noncompliance with this section, section 712 
of the Employee Retirement Income Security Act 
of 1974, or section 2799A–1 of the Public Health 
Service Act, as applicable. 
‘‘(7) ADDITIONAL GUIDANCE.— 
‘‘(A) IN
GENERAL.—Not later than 12 
months after the date of enactment of the Help-
ing Families in Mental Health Crisis Reform 
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Act of 2016, the Secretary, the Secretary of 
Labor, and the Secretary of Health and Human 
Services shall issue guidance to group health 
plans and health insurance issuers offering 
group or individual health insurance coverage to 
assist such plans and issuers in satisfying the re-
quirements of this section, section 712 of the Em-
ployee Retirement Income Security Act of 1974, 
or section 2799A–1 of the Public Health Service 
Act, as applicable. 
‘‘(B) DISCLOSURE.— 
‘‘(i) 
GUIDANCE
FOR
PLANS
AND 
ISSUERS.—The guidance issued under this 
paragraph shall include clarifying informa-
tion and illustrative examples of methods 
that group health plans and health insur-
ance issuers offering group or individual 
health insurance coverage may use for dis-
closing information to ensure compliance 
with the requirements under this section, 
section 712 of the Employee Retirement In-
come Security Act of 1974, or section 
2799A–1 of the Public Health Service Act, 
(and any regulations promulgated pursuant 
to such sections, as applicable). 
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‘‘(ii) DOCUMENTS FOR PARTICIPANTS, 
BENEFICIARIES, CONTRACTING
PROVIDERS, 
OR
AUTHORIZED
REPRESENTATIVES.—The 
guidance issued under this paragraph shall 
include clarifying information and illus-
trative examples of methods that group 
health plans and health insurance issuers 
offering group or individual health insur-
ance coverage may use to provide any par-
ticipant, beneficiary, contracting provider, 
or authorized representative, as applicable, 
with documents containing information 
that the health plans or issuers are required 
to disclose to participants, beneficiaries, 
contracting providers, or authorized rep-
resentatives to ensure compliance with this 
section, section 712 of the Employee Retire-
ment Income Security Act of 1974, or sec-
tion 2799A–1 of the Public Health Service 
Act, as applicable, compliance with any 
regulation issued pursuant to such respec-
tive section, or compliance with any other 
applicable law or regulation. Such guidance 
shall include information that is compara-
tive in nature with respect to— 
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‘‘(I) 
nonquantitative 
treatment 
limitations for both medical and sur-
gical benefits and mental health and 
substance use disorder benefits; 
‘‘(II) the processes, strategies, evi-
dentiary standards, and other factors 
used to apply the limitations described 
in subclause (I); and 
‘‘(III) the application of the limi-
tations described in subclause (I) to en-
sure that such limitations are applied 
in parity with respect to both medical 
and surgical benefits and mental 
health and substance use disorder bene-
fits. 
‘‘(C) NONQUANTITATIVE TREATMENT LIMI-
TATIONS.—The guidance issued under this para-
graph shall include clarifying information and 
illustrative examples of methods, processes, strat-
egies, evidentiary standards, and other factors 
that group health plans and health insurance 
issuers offering group or individual health insur-
ance coverage may use regarding the develop-
ment and application of nonquantitative treat-
ment limitations to ensure compliance with this 
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