II 118th CONGRESS 2d Session S. 4331 IN THE SENATE OF THE UNITED STATES May 14, 2024 Mrs. Shaheen (for herself and Ms. Baldwin ) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to require that group health plans and health insurance issuers offering group or individual health insurance that provide coverage for mental health services and substance use disorder services provide such services without the imposition of cost-sharing from the diagnosis of pregnancy through the 1-year period following such pregnancy, and for other purposes.

1. Short title This Act may be cited as the Mental Health and Making Access More Affordable Act of 2024 or the Mental Health and MAMA Act of 2024 . 2. Cost-sharing with respect to mental health services and substance use disorder services for pregnant and postpartum individuals (a) PHSA (1) In general Part D of title XXVII of the Public Health Service Act ( 42 U.S.C. 300gg–111 et seq. ) is amended by adding at the end the following new section: 2799A–11. Cost-sharing requirements with respect to mental health services and substance use disorder services for pregnant and postpartum individuals (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 a benefit for mental health services or substance use disorder services (including such services which are telehealth services and are provided under such plan or coverage) with respect to plan years beginning on or after the date that is 2 years after the date of enactment of this section, the plan or coverage shall not impose any cost-sharing requirement for such services that are furnished by an in-network provider to a participant, beneficiary, or enrollee under the plan or coverage from the diagnosis of pregnancy (as defined by the Secretary) through the 1-year period beginning on the day after the last day of such pregnancy of such participant, beneficiary, or enrollee (or, in the case of an individual enrolled in such plan or coverage for a portion of such period, during such portion). (b) Definitions In this section: (1) The terms mental health services and substance use disorder services have the meaning given such terms for purposes of section 2726. (2) The term telehealth service means a service that is furnished through telehealth technologies (as defined in section 330I(a)). . (2) Continuity of care Section 2799A–3 of the Public Health Service Act ( 42 U.S.C. 300gg–113 ) is amended— (A) in subsection (a)(2)(C), by inserting , in the case of a continuing care patient described in subsection (b)(1)(D)(ii), the date on which such individual is no longer such a continuing care patient with respect to such provider or facility, or in the case of a continuing care patient described in subsection (b)(1) other than in subparagraph (D)(ii) of such subsection, after is provided and ending on ; and (B) by amending subsection (b)(1)(D) to read as follows: (D) (i) is pregnant and undergoing a course of treatment for the pregnancy from the provider or facility; or (ii) (I) requires mental health services or substance use disorder services from a provider or facility following a pregnancy; (II) received a course of mental health or substance use disorder treatment from such provider or facility while pregnant; and (III) the last day of such pregnancy occurred during the previous 1-year period; or . (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: 726. Cost-sharing requirements with respect to mental health services and substance use disorder services for pregnant and postpartum individuals (a) In general In the case of a group health plan or a health insurance issuer offering group health insurance coverage that provides a benefit for mental health services or substance use disorder services (including such services which are telehealth services and are provided under such plan or coverage) with respect to plan years beginning on or after the date that is 2 years after the date of enactment of this section, the plan or coverage shall not impose any cost-sharing requirement for such services that are furnished by an in-network provider to a participant or beneficiary under the plan or coverage from the diagnosis of pregnancy (as defined by the Secretary) through the 1-year period beginning on the day after the last day of such pregnancy of such participant or beneficiary (or, in the case of an individual enrolled in such plan or coverage for a portion of such period, during such portion). (b) Definitions In this section: (1) The terms mental health services and substance use disorder services have the meaning given such terms for purposes of section 712. (2) The term telehealth service means a service that is furnished through telehealth technologies (as defined in section 330I(a) of the Public Health Service Act). . (2) Continuity of care Section 718 of the Employee Retirement Income Security Act of 1974 ( 29 U.S.C. 1185g ) is amended— (A) in subsection (a)(2)(C), by inserting , in the case of a continuing care patient described in subsection (b)(1)(D)(ii), the date on which such individual is no longer such a continuing care patient with respect to such provider or facility, or in the case of a continuing care patient described in subsection (b)(1) other than in subparagraph (D)(ii) of such subsection, after is provided and ending on ; and (B) by amending subsection (b)(1)(D) to read as follows: (D) (i) is pregnant and undergoing a course of treatment for the pregnancy from the provider or facility; or (ii) (I) requires mental health services or substance use disorder services from a provider or facility following a pregnancy; (II) received a course of mental health or substance use disorder treatment from such provider or facility while pregnant; and (III) the last day of such pregnancy occurred during the previous 1-year period; or . (3) Clerical amendment The table of contents in section 1 of the Employee Retirement Income Security Act of 1974 ( 29 U.S.C. 1001 et seq. ) is amended by inserting after the item relating to section 725 the following new item: Sec. 726. Cost-sharing requirements with respect to mental health services and substance use disorder services for pregnant and postpartum individuals. . (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: 9826. Cost-sharing requirements with respect to mental health services and substance use disorder services for pregnant and postpartum individuals (a) In general In the case of a group health plan that provides a benefit for mental health services or substance use disorder services (including such services which are telehealth services and are provided under such plan) with respect to plan years beginning on or after the date that is 2 years after the date of enactment of this section, the plan shall not impose any cost-sharing requirement for such services that are furnished by an in-network provider to a participant or beneficiary under the plan from the diagnosis of pregnancy (as defined by the Secretary) through the 1-year period beginning on the day after the last day of such pregnancy of such participant or beneficiary (or, in the case of an individual enrolled in such plan for a portion of such period, during such portion). (b) Definitions In this section: (1) The terms mental health services and substance use disorder services have the meaning given such terms for purposes of section 9812. (2) The term telehealth service means a service that is furnished through telehealth technologies (as defined in section 330I(a) of the Public Health Service Act). . (2) Continuity of care Section 9818 of the Internal Revenue Code of 1986 is amended— (A) in subsection (a)(2)(C), by inserting , in the case of a continuing care patient described in subsection (b)(1)(D)(ii), the date on which such individual is no longer such a continuing care patient with respect to such provider or facility, or in the case of a continuing care patient described in subsection (b)(1) other than in subparagraph (D)(ii) of such subsection, after is provided and ending on ; and (B) by amending subsection (b)(1)(D) to read as follows: (D) (i) is pregnant and undergoing a course of treatment for the pregnancy from the provider or facility; or (ii) (I) requires mental health services or substance use disorder services from a provider or facility following a pregnancy; (II) received a course of mental health or substance use disorder treatment from such provider or facility while pregnant; and (III) the last day of such pregnancy occurred during the previous 1-year period; or . (3) Clerical amendment The table of sections for subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following new item: Sec. 9826. Cost-sharing requirements with respect to mental health services and substance use disorder services for pregnant and postpartum individuals. . (d) Effective date The amendments made by subsections (a), (b), and (c) shall apply with respect to plan years beginning on or after the date that is 2 years after the date of enactment of this Act. (e) FEHBP (1) In general Section 8902(p) of title 5, United States Code, is amended— (A) by striking and 2799A–7 and inserting 2799A–7, and 2799A–11 ; (B) by striking and 722 and inserting 722, and 726 ; and (C) by striking and 9822 and inserting 9822, and 9826 . (2) Effective date The amendments made by paragraph (1) shall apply with respect to contracts entered into or renewed for contract years beginning on or after the date that is 2 years after the date of enactment of this Act.