Mental Health Transparency Act

Bill: 117-hr-8881
Sponsor: full_name: Rep. Horsford, Steven [D-NV-4]
Introduced: 2022-09-19
Policy area: Health
Latest action: action_date: 2022-09-20
text: Referred to the Subcommittee on Health.

Summaries:
action_date: 2022-09-19
action_desc: Introduced in House
text: <p><b>Mental Health Transparency Act</b></p> <p>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.</p>

tv_txt: I 117th CONGRESS 2d Session H. R. 8881 IN THE HOUSE OF REPRESENTATIVES September 19, 2022 Mr. Horsford (for himself and Mr. Buchanan ) introduced the following bill; which was referred to the Committee on Energy and Commerce , and in addition to the Committees on Ways and Means , and Education and Labor , for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 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 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.

1. Short title This Act may be cited as the Mental Health Transparency Act . 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: 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: 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: 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: 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.