Mental Health Transparency Act
Bill: H.R.8881 | Sponsor: Rep. Horsford, Steven (D-NV)
Policy area: Health

Summary:
Mental Health Transparency Act
This bill requires private health insurance plans to publish information about the number and percentage of behavioral health care and substance use disorder treatment providers located in the service area of the plan that are in-network. Additionally, the Department of Health and Human Services must establish designations to reflect the breadth of in-network coverage for each type of provider in a service area.

To amend the Public Health Service Act, the Employee Retirement Income 
Security Act of 1974, and the Internal Revenue Code of 1986 to require 
   group health plans and health insurance issuers offering group or 
 individual health insurance coverage to disclose the percentage of in-
    network participation for certain provider types, and for other 
                               purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Mental Health Transparency Act''.

SEC. 2. REQUIRING DISCLOSURE OF PERCENTAGE OF IN-NETWORK PARTICIPATION 
              FOR CERTAIN PROVIDER TYPES.

    (a) PHSA.--Part D of title XXVII of the Public Health Service Act 
(42 U.S.C. 300g-111 et seq.) is amended by adding at the end the 
following new section:

``SEC. 2799A-11. REQUIRED DISCLOSURE OF PERCENTAGE OF IN-NETWORK 
              PARTICIPATION FOR CERTAIN PROVIDER TYPES.

    ``(a) In General.--A group health plan and a health insurance 
issuer offering group or individual health insurance coverage shall, 
along with any summary of benefits and coverage provided under section 
2715 (and in accordance with the timing and manner specified under such 
section and the implementing regulations of such section), and on a 
public website, make available the following information with respect 
to each type of provider specified in subsection (b):
            ``(1) The number and percentage of providers of such type 
        located in the service area of such plan or coverage that have 
        a contractual relationship (as defined by the Secretary) in 
        effect with such plan or coverage for furnishing items and 
        services under such plan or coverage, determined in accordance 
        with information made available by the Secretary under 
        subsection (d).
            ``(2) The designation established by the Secretary under 
        subsection (c) corresponding to the percentage described in 
        paragraph (1).
    ``(b) Specified Providers.--For purposes of this section, the types 
of providers and facilities specified in this subsection are the 
following (as defined by the Secretary and broken down by subspecialty 
as specified by the Secretary):
            ``(1) Behavioral health care providers and facilities.
            ``(2) Substance use disorder treatment providers and 
        facilities.
    ``(c) Establishment of Designations of In-Network Participation.--
            ``(1) In general.--Not later than 1 year after the date of 
        the enactment of this section, the Secretary, in consultation 
        with the Secretaries of Labor and of the Treasury, shall 
        establish a system of designations (such as `high', `medium', 
        and `low', a star rating, or such other designation determined 
        appropriate by the Secretary) that correspond to ranges of 
        percentages (from 0 to 100) described in subsection (a)(1) to 
        qualitatively reflect the breadth of the networks of group 
        health plans and group and individual health insurance coverage 
        with respect to each type of provider specified in subsection 
        (b).
            ``(2) Variation permitted.--Designations corresponding to 
        percentage ranges established under paragraph (1) may vary by 
        type of service area (such as rural or urban), size of service 
        area, and other factors determined appropriate by the Secretary 
        in consultation with the Secretaries of Labor and of the 
        Treasury.
    ``(d) Information on Providers.--
            ``(1) In general.--Not later than June 30, 2025, the 
        Secretary, in consultation with the Secretaries of Labor and of 
        the Treasury, shall, based on information submitted under 
        section 2799B-10, post on a public website a list of each 
        specified provider in the country, along with the location of 
        each such provider in which such provider furnishes items and 
        services and each specialty designation (if any) of each such 
        provider. The Secretary shall update the information published 
        under the previous sentence not less frequently than annually.
            ``(2) Treatment of group practices.--For purposes of the 
        list described in paragraph (1), the Secretary shall list each 
        individual health care provider separately, regardless of 
        whether such provider is part of a group practice.
    ``(e) Service Area Definition.--For purposes of this section, the 
term `service area' means, with respect to a group health plan and 
group or individual health insurance coverage, the area or areas in 
which in-person participants and beneficiaries are covered, as 
determined by the plan or issuer of such coverage in accordance with 
rules specified by the Secretary in consultation with the Secretaries 
of Labor and of the Treasury.''.
    (b) ERISA.--
            (1) In general.--Subpart B of part 7 of subtitle B of title 
        I of the Employee Retirement Income Security Act of 1974 is 
        amended by adding at the end the following new section:

``SEC. 726. REQUIRED DISCLOSURE OF PERCENTAGE OF IN-NETWORK 
              PARTICIPATION FOR CERTAIN PROVIDER TYPES.

    ``(a) In General.--A group health plan and a health insurance 
issuer offering group health insurance coverage shall, along with any 
summary of benefits and coverage provided under section 2715 of the 
Public Health Service Act (and in accordance with the timing and manner 
specified under such section and the implementing regulations of such 
section), and on a public website, make available the following 
information with respect to each type of provider specified in 
subsection (b):
            ``(1) The number and percentage of providers of such type 
        located in the service area of such plan or coverage that have 
        a contractual relationship (as defined by the Secretary) in 
        effect with such plan or coverage for furnishing items and 
        services under such plan or coverage, determined in accordance 
        with information made available by the Secretary under 
        subsection (d).
            ``(2) The designation established by the Secretary under 
        subsection (c) corresponding to the percentage described in 
        paragraph (1).
    ``(b) Specified Providers.--For purposes of this section, the types 
of providers and facilities specified in this subsection are the 
following (as defined by the Secretary and broken down by subspecialty 
as specified by the Secretary):
            ``(1) Behavioral health care providers and facilities.
            ``(2) Substance use disorder treatment providers and 
        facilities.
    ``(c) Establishment of Designations of In-Network Participation.--
            ``(1) In general.--Not later than 1 year after the date of 
        the enactment of this section, the Secretary, in consultation 
        with the Secretaries of Health and Human Services and of the 
        Treasury, shall establish a system of designations (such as 
        `high', `medium', and `low', a star rating, or such other 
        designation determined appropriate by the Secretary) that 
        correspond to ranges of percentages (from 0 to 100) described 
        in subsection (a)(1) to qualitatively reflect the breadth of 
        the networks of group health plans and group health insurance 
        coverage with respect to each type of provider specified in 
        subsection (b).
            ``(2) Variation permitted.--Designations corresponding to 
        percentage ranges established under paragraph (1) may vary by 
        type of service area (such as rural or urban), size of service 
        area, and other factors determined appropriate by the Secretary 
        in consultation with the Secretaries of Health and Human 
        Services and of the Treasury.
    ``(d) Information on Providers.--
            ``(1) In general.--Not later than June 30, 2025, the 
        Secretary of Health and Human Services, in consultation with 
        the Secretaries of Labor and of the Treasury, shall, based on 
        the information submitted under section 2799B-10 of the Public 
        Health Service Act, post on a public website a list of each 
        specified provider in the country, along with the location of 
        each such provider in which such provider furnishes items and 
        services and each specialty designation (if any) of each such 
        provider. The Secretary of Health and Human Services shall 
        update the information published under the previous sentence 
        not less frequently than annually.
            ``(2) Treatment of group practices.--For purposes of the 
        list described in paragraph (1), the Secretary shall list each 
        individual health care provider separately, regardless of 
        whether such provider is part of a group practice.
    ``(e) Service Area Definition.--For purposes of this section, the 
term `service area' means, with respect to a group health plan and 
group health insurance coverage, the area or areas in which in-person 
participants and beneficiaries are covered, as determined by the plan 
or issuer of such coverage in accordance with rules specified by the 
Secretary in consultation with the Secretaries of Health and Human 
Services and of the Treasury.''.
            (2) Technical amendment.--The table of contents in section 
        1 of such Act is amended by inserting after the item relating 
        to section 725 the following new item:

``Sec. 726. Required disclosure of percentage of in-network 
                            participation for certain provider 
                            types.''.
    (c) IRC.--
            (1) In general.--Subchapter B of chapter 100 of the 
        Internal Revenue Code of 1986 is amended by adding at the end 
        the following new section:

``SEC. 9826. REQUIRED DISCLOSURE OF PERCENTAGE OF IN-NETWORK 
              PARTICIPATION FOR CERTAIN PROVIDER TYPES.

    ``(a) In General.--A group health plan shall, along with any 
summary of benefits and coverage provided under section 2715 of the 
Public Health Service Act (and in accordance with the timing and manner 
specified under such section and the implementing regulations of such 
section), and on a public website, make available the following 
information with respect to each type of provider specified in 
subsection (b):
            ``(1) The number and percentage of providers of such type 
        located in the service area of such plan that have a 
        contractual relationship (as defined by the Secretary) in 
        effect with such plan for furnishing items and services under 
        such plan, determined in accordance with information made 
        available by the Secretary under subsection (d).
            ``(2) The designation established by the Secretary under 
        subsection (c) corresponding to the percentage described in 
        paragraph (1).
    ``(b) Specified Providers.--For purposes of this section, the types 
of providers and facilities specified in this subsection are the 
following (as defined by the Secretary and broken down by subspecialty 
as specified by the Secretary):
            ``(1) Behavioral health care providers and facilities.
            ``(2) Substance use disorder treatment providers and 
        facilities.
    ``(c) Establishment of Designations of In-Network Participation.--
            ``(1) In general.--Not later than 1 year after the date of 
        the enactment of this section, the Secretary, in consultation 
        with the Secretaries of Health and Human Services and of Labor, 
        shall establish a system of designations (such as `high', 
        `medium', and `low', a star rating, or such other designation 
        determined appropriate by the Secretary) that correspond to 
        ranges of percentages (from 0 to 100) described in subsection 
        (a)(1) to qualitatively reflect the breadth of the networks of 
        group health plans with respect to each type of provider 
        specified in subsection (b).
            ``(2) Variation permitted.--Designations corresponding to 
        percentage ranges established under paragraph (1) may vary by 
        type of service area (such as rural or urban), size of service 
        area, and other factors determined appropriate by the Secretary 
        in consultation with the Secretaries of Health and Human 
        Services and of Labor.
    ``(d) Information on Providers.--
            ``(1) In general.--Not later than June 30, 2025, the 
        Secretary of Health and Human Services, in consultation with 
        the Secretaries of Labor and of the Treasury, shall, based on 
        the information submitted under section 2799B-10 of the Public 
        Health Service Act, post on a public website a list of each 
        specified provider in the country, along with the location of 
        each such provider in which such provider furnishes items and 
        services and each specialty designation (if any) of each such 
        provider. The Secretary of Health and Human Services shall 
        update the information published under the previous sentence 
        not less frequently than annually.
            ``(2) Treatment of group practices.--For purposes of the 
        list described in paragraph (1), the Secretary shall list each 
        individual health care provider separately, regardless of 
        whether such provider is part of a group practice.
    ``(e) Service Area Definition.--For purposes of this section, the 
term `service area' means, with respect to a group health plan, the 
area or areas in which in-person participants and beneficiaries are 
covered, as determined by the plan in accordance with rules specified 
by the Secretary in consultation with the Secretaries of Health and 
Human Services and of Labor.''.
            (2) Technical amendment.--The table of sections for such 
        subchapter is amended by adding at the end the following new 
        item:

``Sec. 9826. Required disclosure of percentage of in-network 
                            participation for certain provider 
                            types.''.
    (d) Provider Requirements.--Part E of title XXVII of the Public 
Health Service Act (42 U.S.C. 300gg-131 et seq.) is amended by adding 
at the end the following new section:

``SEC. 2799B-10. PROVISION OF CERTAIN INFORMATION TO THE SECRETARY.

    ``(a) In General.--Subject to subsection (b), in the case of a 
health care provider or health care facility that is a specified 
provider (as described in subsection (b) of section 2799A-11), such 
provider or facility shall, annually at a time and in a manner 
specified by the Secretary, provide to the Secretary such information 
as the Secretary determines necessary to carry out subsection (d) of 
such section.
    ``(b) Exception.--Subsection (a) shall not apply in the case of a 
specified provider that has not, during the 1-year period ending on the 
date that information described in subsection (a) would be required to 
be submitted to the Secretary by such provider without application of 
this subsection, submitted any claim for an item or service under a 
Federal health care program (as defined in section 1128B of the Social 
Security Act), the program established under chapter 89 of title 5, 
United States Code, or a group health plan or group or individual 
health insurance coverage.''.
    (e) Report.--Not later than December 31, 2026, and annually 
thereafter, the Secretary of Health and Human Services shall submit to 
Congress a report on the participation of behavioral health care and 
substance use disorder treatment providers in networks established by 
group health plan and health insurance issuers offering group or 
individual health insurance coverage (as such terms are defined in 
section 2791 of the Public Health Service Act (42 U.S.C. 300gg-91)). 
Each such report shall include data and analysis relating to service 
areas (as defined in section 2799A-11 of such Act) of such plans and 
issuers that the Secretary has identified as having low participation 
rates with respect to such providers' participation in such networks.
    (f) Implementation.--The Secretaries of Labor, Health and Human 
Services, and the Treasury may implement the amendments made by this 
section through interim final rule, subregulatory guidance, program 
instruction, or otherwise.
    (g) Funding.--In addition to amounts otherwise available for such 
purposes, there is appropriated $15,000,000, to remain available until 
expended, for purposes of carrying out this section.
    (h) Effective Date.--The amendments made by this section shall 
apply with respect to plan years beginning on or after January 1, 2026.
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