‘‘(VIII) the name of any plan 
with respect to which a complaint has 
been submitted under subparagraph 
(C) and for which a final review find-
ing has been issued. 
The requirements of this clause with re-
spect to plans shall also apply to entities 
that provide administrative services in con-
nection with a group health plan, such as 
third party administrators, if applicable.’’; 
(3) in subparagraph (C)(i), by striking ‘‘re-
quested’’; and 
(4) by adding at the end the following new sub-
paragraphs: 
‘‘(D) AUDIT PROCESS.—Beginning 1 year 
after the date of enactment of this subpara-
graph, the Secretary, in cooperation with the 
Secretaries of Health and Human Services and 
Labor, as applicable, shall, in addition to con-
ducting reviews in accordance with subpara-
graph (B), conduct randomized audits of group 
health plans and entities that provide adminis-
trative services in connection with a group 
health plan, such as third party administrators, 
to determine compliance with this section. Such 
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audits shall be conducted on no fewer than 40 
plans per calendar year (not including any re-
views conducted under such subparagraph). In 
addition, the Secretary may, in cooperation with 
the Secretaries of Health and Human Services 
and Labor, as applicable, and 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, as applicable, conduct audits on any 
such plan with respect to which a complaint has 
been submitted under subparagraph (E) to de-
termine compliance with this section. 
‘‘(E) COMPLAINT
PROCESS.—Not later 
than 6 months after the date of enactment of 
this subparagraph, the Secretary, in coopera-
tion with the Secretary of Health and Human 
Services and the Secretary of Labor, shall, with 
respect to group health plans (including entities 
that provide administrative services in connec-
tion with a group health plan, such as third 
party administrators), issue guidance to clarify 
the process and timeline for current and poten-
tial participants and beneficiaries (and author-
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ized representatives and health care providers 
of such participants and beneficiaries) with re-
spect to such plans to file formal complaints of 
such plans being in violation of this section, in-
cluding guidance, by plan type, on the relevant 
State, regional, and national offices with which 
such complaints should be filed. 
‘‘(F) 
COVERAGE
DISPARITY
INFORMA-
TION.—For the first calendar year that begins 
on or after the date that is 2 years after the 
date of the enactment of this subparagraph, 
and for each subsequent calendar year, the Sec-
retary, in cooperation with the Secretaries of 
Health and Human Services and Labor, shall 
submit to the Committee on Energy and Com-
merce of the House of Representatives and the 
Committee on Health, Education, Labor, and 
Pensions of the Senate the following informa-
tion with respect to the preceding calendar 
year: 
‘‘(i) DENIAL RATES.—Data comparing 
the rates of and reasons for denial by 
group health plans (including entities that 
provide administrative services in connec-
tion with a group health plan, such as 
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third party administrators) of claims for 
mental health benefits, substance use dis-
order benefits, and medical and surgical 
benefits, disaggregated by the following 
categories: 
‘‘(I) Inpatient, in-network claims. 
‘‘(II) Inpatient, out-of-network 
claims. 
‘‘(III) 
Outpatient, 
in-network 
claims. 
‘‘(IV) Outpatient, out-of-network 
claims. 
‘‘(V) Emergency services. 
‘‘(VI) Prescription drug claims. 
‘‘(ii) NETWORK
ADEQUACY
DATA.— 
Data comparing the network adequacy of 
group health plans (including entities that 
provide administrative services in connec-
tion with a group health plan, such as 
third party administrators) based on 
claims for outpatient and inpatient mental 
health benefits, substance use disorder 
benefits, and medical and surgical benefits, 
including out-of-network utilization rates, 
the number and percentage of in-network 
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providers accepting new patients, and aver-
age wait times between receiving initial 
treatment and diagnosis and follow-up 
treatment. 
‘‘(iii) REIMBURSEMENT RATES.—Data 
comparing the reimbursement rates of 
group health plans (including entities that 
provide administrative services in connec-
tion with a group health plan, such as 
third party administrators) for the 10 
most commonly billed mental health serv-
ices, substance use services, and medical 
and surgical services, each as a percentage 
of rates payable for such services under 
title XVIII of the Social Security Act, 
disaggregated by the following categories: 
‘‘(I) Inpatient, in-network claims. 
‘‘(II) Inpatient, out-of-network 
claims. 
‘‘(III) 
Outpatient, 
in-network 
claims. 
‘‘(IV) Outpatient, out-of-network 
claims. 
‘‘(V) Emergency services. 
‘‘(VI) Prescription drug claims.’’. 
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SEC. 3. CONSUMER PARITY UNIT FOR MENTAL HEALTH 
AND SUBSTANCE USE DISORDER PARITY VIO-
LATIONS. 
(a) DEFINITIONS.—In this section: 
(1) APPLICABLE STATE AUTHORITY.—The term 
‘‘applicable State authority’’ has the meaning given 
the term in section 2791 of the Public Health Serv-
ice Act (42 U.S.C. 300gg–91). 
(2) COVERED PLAN.—The term ‘‘covered plan’’ 
means any creditable coverage that is subject to any 
of the mental health parity laws described in para-
graph (4). 
(3) CREDITABLE COVERAGE.—The term ‘‘cred-
itable coverage’’ has the meaning given the term in 
section 2704(c) of the Public Health Service Act (42 
U.S.C. 300gg–3(c)). 
(4) MENTAL HEALTH PARITY LAW.—The term 
‘‘mental health parity law’’ means— 
(A) section 2726 of the Public Health 
Service Act (42 U.S.C. 300gg–26); 
(B) section 712 of the Employee Retire-
ment Income Security Act of 1974 (29 U.S.C. 
1185a); 
(C) section 9812 of the Internal Revenue 
Code of 1986; or 
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(D) any other Federal law that applies the 
requirements under any of the sections de-
scribed in subparagraph (A), (B), or (C), or re-
quirements that are substantially similar to the 
requirements under any such section, as deter-
mined by the Secretary, to creditable coverage. 
(5) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(6) SPECIFIED
COVERED
PLAN.—The term 
‘‘specified covered plan’’ means a covered plan that 
is any of the following: 
(A) A group health plan or group or indi-
vidual health insurance coverage (as such terms 
are defined in section 2791 of the Public 
Health Service Act (42 U.S.C. 300gg–91)). 
(B) A Medicare Advantage plan offered 
under part C of title XVIII of the Social Secu-
rity Act (42 U.S.C. 1395w–21 et seq.). 
(C) A State plan (or waiver of such plan) 
under title XIX of the Social Security Act (42 
U.S.C. 1396 et seq.). 
(D) A plan offered under the program es-
tablished under chapter 89 of title 5, United 
States Code. 
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(b) ESTABLISHMENT.—Not later than 6 months after 
the date of enactment of this Act, the Secretary, in con-
sultation with the Secretary of Labor, the Secretary of the 
Treasury, and the heads of any other applicable agencies, 
shall establish a consumer parity unit with functions that 
include— 
(1) facilitating the centralized collection of, 
monitoring of, and response to consumer complaints 
(including provider complaints) regarding violations 
of mental health parity laws through developing and 
administering, in accordance with subsection (d)— 
(A) a single, toll-free telephone number; 
and 
(B) a public website portal, which may in-
clude enhancing a website portal in existence on 
the date of enactment of this Act; and 
(2) providing information to health care con-
sumers regarding the disclosure requirements and 
enforcement under section 2726(a)(8) of the Public 
Health Service Act (42 U.S.C. 300gg–26(a)(8)), sec-
tion 712(a)(8) of the Employee Retirement Income 
Security Act of 1974 (29 U.S.C. 1185a(a)(8)), and 
section 9812(a)(8) of the Internal Revenue Code of 
1986. 
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(c) WEBSITE PORTAL.—The Secretary, in consulta-
tion with the Secretary of Labor, the Secretary of the 
Treasury, and the heads of any other applicable agencies, 
shall make available on the website portal established 
under subsection (b)(1)(B)— 
(1) any guidance and any reports issued by the 
Secretary, the Secretary of Labor, or the Secretary 
of the Treasury, under section 2726 of the Public 
Health Service Act (42 U.S.C. 300gg–26), section 
712 of the Employee Retirement Income Security 
Act of 1974 (29 U.S.C. 1185a), or section 9812 of 
the Internal Revenue Code of 1986, respectively; 
(2) any information obtained under subsection 
(b)(1) that it is in the public interest to disclose, 
through aggregated reported or other appropriate 
formats designed to protect confidential information 
in accordance with subsection (g); and 
(3) information on the results of, or progress 
on, any concluded or ongoing audits or investiga-
tions of the Secretary, the Secretary of Labor, or the 
Secretary of the Treasury, as applicable, under such 
section 2726, 712, or 9812, respectively, including 
the identity of each group health plan or health in-
surance issuer (including entities that provide ad-
ministrative services in connection with a group 
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health plan, such as third party administrators) 
that— 
(A) was the subject of a concluded audit or 
investigation; or 
(B) that is the subject of an ongoing audit 
or investigation and which was found, pursuant 
to such audit or investigation, not to have sub-
mitted NQTL analyses in accordance with such 
sections (or to have submitted incomplete 
NQTL analyses). 
(d) RESPONSE TO CONSUMER COMPLAINTS AND IN-
QUIRIES.— 
(1) TIMELY RESPONSE TO CONSUMERS.—The 
Secretary, in consultation with the Secretary of 
Labor, the Secretary of the Treasury, and the heads 
of any other applicable agencies, shall establish rea-
sonable procedures for the consumer parity unit es-
tablished under this section to provide a response (in 
writing if appropriate) within 90 days to consumers 
regarding complaints received by the unit against, or 
inquiries concerning, a covered plan, at the discre-
tion of the applicable agency, which shall at min-
imum include— 
(A) steps that have been taken by the ap-
propriate State or Federal enforcement agency 
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in response to the complaint or inquiry of the 
consumer; 
(B) in the case such complaint relates to 
a specified covered plan, any responses received 
by the appropriate State or Federal enforce-
ment agency from the covered plan; 
(C) any follow-up actions or planned fol-
low-up actions by the appropriate State or Fed-
eral enforcement agency in response to the com-
plaint or inquiry of the consumer; and 
(D) contact information of the appropriate 
enforcement agency for the consumer to obtain 
additional information on the complaint or in-
quiry. 
(2) TIMELY
RESPONSE
TO
REGULATORS.—A 
specified covered plan shall provide a response (in 
writing if appropriate) within 7 days to the appro-
priate State or Federal enforcement agency having 
jurisdiction over such plan (or, in the case such plan 
is a State plan (or wavier of such plan) under title 
XIX of the Social Security Act (42 U.S.C. 1396 et 
seq.), to the Secretary of Health and Human Serv-
ices) concerning a consumer complaint or inquiry 
submitted to the consumer parity unit established 
under this section including— 
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(A) steps that have been taken by the plan 
to respond to the complaint or inquiry of the 
consumer; 
(B) any responses received by the plan 
from the consumer; and 
(C) follow-up actions or planned follow-up 
actions by the plan in response to the complaint 
or inquiry of the consumer. 
(3) PROVISION
OF
INFORMATION
TO
CON-
SUMERS.— 
(A) IN
GENERAL.—A covered plan shall 
comply with a consumer request for information 
in the control or possession of such covered 
plan concerning the coverage the consumer ob-
tained from such covered plan within 7 days of 
receipt of such request. 
(B) EXCEPTIONS.—Notwithstanding sub-
paragraph (A), a covered plan, and any agency 
or entity having jurisdiction over a covered 
plan, may not be required by this paragraph to 
make available to the consumer any information 
required to be kept confidential by any other 
provision of law. 
(4) ENFORCEMENT.— 
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(A) PRIVATE INSURANCE.—The provisions 
of paragraphs (2) and (3) shall apply to group 
health plans and group and individual health 
insurance coverage (as such terms are defined 
in section 2791 of the Public Health Service 
Act (42 U.S.C. 300gg–91)) as if such provi-
sions were included in part D of title XXVII of 
such Act (42 U.S.C. 300g–111 et seq.), part 7 
of title I of the Employee Retirement Act of 
1974 (29 U.S.C. 1181 et seq.), and chapter 
100 of the Internal Revenue Code of 1986. 
(B) OTHER SPECIFIED COVERED PLANS.— 
(i) MEDICARE ADVANTAGE PLANS.— 
Section 1852 of the Social Security Act 
(42 U.S.C. 1395w–22) is amended by add-
ing at the end the following new section: 
‘‘(o) APPLICATION OF CERTAIN MENTAL HEALTH 
PARITY COMPLAINT REQUIREMENTS.—An MA plan shall 
comply with the requirements of paragraphs (2) and (3) 
of section 3(d) of the Behavioral Health Coverage Trans-
parency Act of 2022.’’. 
(ii) MEDICAID.—Section 1902(a) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396a(a)) is amended— 
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(I) in paragraph (86), by striking 
‘‘; and’’ at the end; 
(II) in paragraph (87)(D), by 
striking the period and inserting ‘‘; 
and’’; and 
(III) by inserting after paragraph 
(87) the following new paragraph: 
‘‘(88) provide for compliance with the provi-
sions of paragraphs (2) and (3) of section 3(d) of 
the Behavioral Health Coverage Transparency Act 
of 2022.’’. 
(C) OTHER COVERED PLANS.—In the case 
of a covered plan that is not a specified covered 
plan, the Federal agency charged with the ad-
ministration or supervision of such plan shall 
ensure that such plan complies with the provi-
sions of paragraph (3). 
(e) REPORTS.— 
(1) IN GENERAL.—Not later than December 31 
of each year, the Secretary, in consultation with the 
Secretary of Labor, the Secretary of the Treasury, 
and the heads of any other applicable agencies, shall 
submit a report to Congress on the complaints re-
ceived by the consumer parity unit established under 
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this section in the prior year regarding covered 
plans. 
(2) CONTENTS.—Each such report shall include 
information and analysis about complaint numbers, 
complaint types, and, where applicable, information 
about the resolution of complaints, including the 
identity of the group health plan or health insurance 
issuer that is the subject of such a complaint. 
(3) CONSUMER
PARITY
UNIT
POSTING.—The 
Secretary shall submit such reports to the consumer 
parity unit established under this section, and such 
unit shall post the reports on the website portal es-
tablished under subsection (b)(1)(B). 
(f) DATA SHARING.—Subject to any applicable stand-
ards for Federal or State agencies with respect to pro-
tecting personally identifiable information and data secu-
rity and integrity, including the regulations under part 2 
of title 42, Code of Federal Regulations— 
(1) the consumer parity unit established under 
this section shall share consumer complaint informa-
tion with the Secretary, and the head of any other 
applicable Federal or State agency; and 
(2) the Secretary, and the head of any other 
applicable Federal or State agency, shall share data 
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relating to consumer complaints regarding covered 
plans with such unit. 
(g) PRIVACY CONSIDERATIONS.— 
(1) IN GENERAL.—In carrying out this section, 
the consumer parity unit established under this sec-
tion and the Secretary, in consultation with the Sec-
retary of Labor, the Secretary of the Treasury, and 
the head of any other applicable agency, shall take 
measures to ensure that proprietary, personal, or 
confidential consumer information that is protected 
from public disclosure under section 552(b) or 552a 
of title 5, United States Code, or any other provision 
of law, is not made public under this section. 
(2) EXCEPTIONS.—The consumer parity unit 
established under this section may not obtain from 
a covered plan any personally identifiable informa-
tion about a consumer from the records of the cov-
ered plan, except— 
(A) if the records are reasonably described 
in a request by the consumer parity unit estab-
lished under this section, and the consumer pro-
vides appropriate consent for the disclosure and 
use of such information by the covered plan to 
such unit; or 
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(B) as may be specifically permitted or re-
quired under other applicable provisions of law, 
including the regulations under part 2 of title 
42, Code of Federal Regulations. 
(h) COLLABORATION.— 
(1) AGREEMENTS
WITH
OTHER
AGENCIES.— 
The Secretary, the Secretary of Labor, the Secretary 
of the Treasury, and the heads of any other applica-
ble agencies, shall enter into a memorandum of un-
derstanding with any affected Federal regulatory 
agency regarding procedures by which any covered 
plan, and any other agency having jurisdiction over 
a covered plan, shall comply with this section. 
(2) AGREEMENTS WITH STATES.—To the ex-
tent practicable, an applicable State authority may 
receive appropriate complaints from the consumer 
parity unit established under this section, if— 
(A) the applicable State authority has the 
functional capacity to receive calls or electronic 
reports routed by the unit; 
(B) the applicable State authority has sat-
isfied any conditions of participation that the 
unit may establish, including treatment of per-
sonally identifiable information and sharing of 
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information on complaint resolution or related 
compliance procedures and resources; and 
(C) participation by the applicable State 
authority includes measures necessary to pro-
tect personally identifiable information in ac-
cordance with standards that apply to Federal 
agencies with respect to protecting personally 
identifiable information and data security and 
integrity. 
(3) ASSISTANCE
TO
STATES.—The Secretary, 
the Secretary of Labor, the Secretary of the Treas-
ury, and the heads of any other applicable agencies, 
shall provide assistance to States to increase the ca-
pacity of State governments to work with the Fed-
eral parity unit under this section, including through 
the provision of training and technical assistance, 
and identification of violations of mental health and 
substance use disorder parity protections. 
(i) FUNDING.— 
(1) INITIAL FUNDING.—There is hereby appro-
priated to the Secretary, out of any funds in the 
Treasury not otherwise appropriated, $30,000,000 
for the first fiscal year for which this section applies 
to carry out this section. Such amount shall remain 
available until expended. 
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(2) 
AUTHORIZATION
FOR
SUBSEQUENT 
YEARS.—There is authorized to be appropriated to 
the Secretary for each fiscal year following the fiscal 
year described in paragraph (1), such sums as may 
be necessary to carry out this section. 
SEC. 4. GRANTS FOR HEALTH INSURANCE INFORMATION 
CONCERNING MENTAL HEALTH AND SUB-
STANCE USE DISORDER BENEFITS. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services (referred to in this section as the ‘‘Sec-
retary’’) shall award grants to States to enable such 
States (or the Exchanges established under the Patient 
Protection and Affordable Care Act (Public Law 111– 
148) operating in such States) to establish, expand, or 
provide support for— 
(1) offices of health insurance consumer assist-
ance; or 
(2) health insurance ombudsman programs, 
in order to enable such offices and programs to carry out 
the activities described in subsection (c). 
(b) ELIGIBILITY.— 
(1) IN GENERAL.—To be eligible to receive a 
grant, a State shall designate an independent office 
of health insurance consumer assistance, or an om-
budsman, that, directly or in coordination with State 
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private and public health insurance regulators and 
consumer assistance organizations, receives and re-
sponds to inquiries and complaints concerning health 
insurance coverage with respect to Federal health in-
surance requirements and under State law relating 
to mental health or substance use disorder benefits. 
(2) CRITERIA.—A State that receives a grant 
under this section shall comply with criteria estab-
lished by the Secretary for carrying out activities 
under such grant. 
(c) USE OF FUNDS.—Funds received from a grant 
awarded under this section shall be used by an office of 
health insurance consumer assistance or health insurance 
ombudsman described in subsection (a) to— 
(1) assist with the filing of complaints and ap-
peals, including filing appeals with the internal ap-
peal or grievance process of the group health plan or 
health insurance issuer, Medicaid program, and 
Children’s Health Insurance Program involved, re-
lating to mental health or substance use disorder 
benefits, and providing information about the exter-
nal appeal process; 
(2) collect, track, and quantify problems and in-
quiries encountered by consumers; 
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(3) educate consumers on their rights and re-
sponsibilities with respect to group health plans and 
health insurance coverage, Medicaid, and Children’s 
Health Insurance Program relating to mental health 
or substance use disorder benefits; 
(4) assist consumers with enrollment in a group 
health plan or health insurance coverage, Medicaid, 
and the Children’s Health Insurance Program by 
providing information, referral, and assistance; and 
(5) assist consumers in resolving problems with 
obtaining premium tax credits under section 36B of 
the Internal Revenue Code of 1986 by providing in-
formation, referral, and assistance. 
(d) DATA COLLECTION.—As a condition of receiving 
a grant under subsection (a), an office of health insurance 
consumer assistance or ombudsman program shall be re-
quired to collect and report data to the Secretary and 
State public and private health insurance regulators on 
the types of problems and inquiries encountered by con-
sumers relating to mental health or substance use disorder 
benefits. The Secretary shall utilize such data to identify 
areas where more enforcement action is necessary and 
shall share such information with State insurance regu-
lators, the Secretary of Labor, and the Secretary of the 
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Treasury for use in the enforcement activities of such 
agencies. 
(e) FUNDING.— 
(1) INITIAL FUNDING.—There is hereby appro-
priated to the Secretary, out of any funds in the 
Treasury not otherwise appropriated, $25,000,000 
for the first fiscal year for which this section applies 
to carry out this section. Such amount shall remain 
available until expended. 
(2) 
AUTHORIZATION
FOR
SUBSEQUENT 
YEARS.—There is authorized to be appropriated to 
the Secretary for each fiscal year following the fiscal 
year described in paragraph (1), such sums as may 
be necessary to carry out this section. 
Æ 
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