Bill Summary
The "Mental Health Parity Compliance Act" is a bill that aims to strengthen parity in mental health and substance use disorder benefits. It requires plans and coverages to perform comparative analyses of nonquantitative treatment limitations for these benefits and submit the information to the Secretary. The Secretary will review the analyses and address instances of noncompliance, and must report on the results to Congress annually.
Possible Impacts
1. Employees with mental health or substance use disorders may now have access to more comprehensive treatment through their group health plans, as nonquantitative treatment limitations will be subject to comparative analyses and potential revision.
2. The Secretary will have the authority to review and address instances of noncompliance with parity requirements, ensuring that individuals with mental health and substance use disorders are receiving equal treatment as those with medical and surgical benefits.
3. Congress will receive an annual report on the results of comparative analyses and any instances of noncompliance, allowing for transparency and accountability in the implementation of this legislation.
[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 1737 Introduced in Senate (IS)]
<DOC>
116th CONGRESS
1st Session
S. 1737
To strengthen parity in mental health and substance use disorder
benefits.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
June 5, 2019
Mr. Murphy (for himself and Mr. Cassidy) introduced the following bill;
which was read twice and referred to the Committee on Health,
Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To strengthen parity in mental health and substance use disorder
benefits.
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 Parity Compliance
Act''.
SEC. 2. STRENGTHENING PARITY IN MENTAL HEALTH AND SUBSTANCE USE
DISORDER BENEFITS.
(a) Employee Retirement Income Security Act of 1974.--Section
712(a) of the Employee Retirement Income Security Act of 1974 (29
U.S.C. 1185a(a)) is amended by adding at the end the following:
``(6) Compliance requirements.--
``(A) Nonquantitative treatment limitation (nqtl)
requirements.--In the case of a group health plan (or
health insurance coverage offered in connection with
such a plan) that provides both medical and surgical
benefits and mental health or substance use disorder
benefits, the plan or coverage shall perform
comparative analyses about the design and application
of nonquantitative treatment limitations (referred to
in this paragraph as the `NQTL') in accordance with the
following process, and make available to the Secretary
upon request within 60 days beginning January 1, 2020,
and immediately upon request beginning January 1, 2021
the following information:
``(i) The specific plan or coverage
language regarding the NQTL and a description
of all mental health or substance use disorder
and medical/surgical services to which it
applies in each respective benefits
classification.
``(ii) The factors used to determine that
an NQTL will apply to mental health or
substance use disorder benefits and medical/
surgical benefits, including factors that were
considered but rejected.
``(iii) The evidentiary standard (both
identified and deidentified) for each of the
factors identified in clause (ii) and any other
evidence relied upon to design and apply the
NQTL to mental health or substance use disorder
benefits and medical/surgical benefits.
``(iv) The comparative analyses
demonstrating that the processes and strategies
used to design the NQTL, as written, and the as
written processes and strategies used to apply
the NQTL for mental health or substance use
disorder benefits are comparable to, and are
applied no more stringently than, the processes
and strategies used to design the NQTL, as
written, and the as written processes and
strategies used to apply the NQTL to medical/
surgical benefits.
``(v) The comparative analyses
demonstrating that the processes and strategies
used to apply the NQTL, in operation, for
mental health and substance use disorder
benefits are comparable to, and are applied no
more stringently than, the processes and
strategies used to apply each NQTL, in
operation, for medical and surgical benefits.
``(vi) A disclosure of the specific
findings and conclusions reached by the plan or
coverage that the results of the analyses
described in this subparagraph indicate that
the plan or coverage is in compliance with this
section.
``(B) Secretary request process.--
``(i) Submission upon complaint.--The
Secretary shall request that a group health
plan (or health insurance coverage offered in
connection with such a plan) submit the
comparative analyses described in subparagraph
(A) if the Secretary has received any
complaints about such a plan or coverage that
involve mental health or substance use disorder
benefits.
``(ii) Random submissions.--The Secretary
shall request the comparative analyses
described in subparagraph (A) from no fewer
than 50 plans or coverages selected at random,
annually, and such plans or coverages shall not
be the same plans or coverages for which the
comparative analyses are requested under clause
(i).
``(iii) Additional information.--In
instances in which the Secretary has concluded
that the plan or coverage has not submitted
sufficient information for the Secretary to
review the comparative analyses described in
subparagraph (A), as requested under clauses
(i) and (ii), the Secretary shall specify to
the plan or coverage the additional information
the plan or coverage must submit for the
Secretary to review the comparative analyses
described in subparagraph (A) for compliance
with this section.
``(iv) Required action.--In instances in
which the Secretary has reviewed the
comparative analyses described in subparagraph
(A), as requested under clauses (i) and (ii),
and determined that the plan or coverage is not
in compliance with this section, the Secretary
shall specify to the plan or coverage the
actions the plan or coverage must take to be in
compliance with this section.
``(v) Report.--Not later than 1 year after
the date of enactment of this paragraph, and
annually thereafter, the Secretary shall submit
to the Committee on Education and Labor of the
House of Representatives and the Committee on
Health, Education, Labor, and Pensions of the
Senate a report that contains--
``(I) each of the comparative
analyses requested under clauses (i)
and (ii), except that the identity of
each plan or coverage and any
contracted entity of a plan or coverage
shall be redacted;
``(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 clauses (i)
and (ii) for compliance with this
section;
``(III) for each plan or coverage
that did submit sufficient information
for the Secretary to review the
comparative analyses requested under
clause (i), the Secretary's conclusions
as to whether the plan or coverage is
in compliance with this section;
``(IV) the Secretary's
specifications described in clause
(iii) for each plan or coverage that
the Secretary determined did not submit
sufficient information for the
Secretary to review the comparative
analyses requested under clauses (i)
and (ii) for compliance with this
section; and
``(V) the Secretary's
specifications described in clause (iv)
of the actions each plan or coverage
that the Secretary determined is not in
compliance with this section must take
to be in compliance with this section.
``(C) Compliance program guidance document update
process.--
``(i) In general.--The Secretary shall
include select instances of noncompliance that
the Secretary discovers upon reviewing the
comparative analyses requested under clauses
(i) and (ii) of subparagraph (B) in the
compliance program guidance document described
in section 2726(a)(6) of the Public Health
Service Act, as it is updated every 2 years,
except that all instances shall be deidentified
and such instances shall not disclose any
protected health information or individually
identifiable information.
``(ii) Inspector general.--Any instances of
noncompliance the Secretary discovers upon
reviewing the comparative analyses requested
under clauses (i) and (ii) of subparagraph (B)
shall be shared with 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, in accordance with section
2726(a)(6)(B)(iii)(I) of the Public Health
Service Act.
``(iii) State.--Any instances of
noncompliance the Secretary discovers upon
reviewing the comparative analyses requested
under clauses (i) and (ii) of subparagraph (B)
shall be shared with a State, in accordance
with section 2726(a)(6)(B)(iii)(II) of the
Public Health Service Act.''.
(b) Internal Revenue Code of 1986.--Section 9812(a) of the Internal
Revenue Code of 1986 is amended by adding at the end the following:
``(6) Compliance requirements.--
``(A) Nonquantitative treatment limitation (nqtl)
requirements.--In the case of a group health plan that
provides both medical and surgical benefits and mental
health or substance use disorder benefits, the plan
shall perform comparative analyses about the design and
application of nonquantitative treatment limitations
(referred to in this paragraph as the `NQTL') in
accordance with the following process, and make
available to the Secretary upon request within 60 days
beginning January 1, 2020, and immediately upon request
beginning January 1, 2021 the following information:
``(i) The specific plan language regarding
the NQTL and a description of all mental health
or substance use disorder and medical/surgical
services to which it applies in each respective
benefits classification.
``(ii) The factors used to determine that
an NQTL will apply to mental health or
substance use disorder benefits and medical/
surgical benefits, including factors that were
considered but rejected.
``(iii) The evidentiary standard (both
identified and deidentified) for each of the
factors identified in clause (ii) and any other
evidence relied upon to design and apply the
NQTL to mental health or substance use disorder
benefits and medical/surgical benefits.
``(iv) The comparative analyses
demonstrating that the processes and strategies
used to design the NQTL, as written, and the as
written processes and strategies used to apply
the NQTL for mental health or substance use
disorder benefits are comparable to, and are
applied no more stringently than, the processes
and strategies used to design the NQTL, as
written, and the as written processes and
strategies used to apply the NQTL to medical/
surgical benefits.
``(v) The comparative analyses
demonstrating that the processes and strategies
used to apply the NQTL, in operation, for
mental health and substance use disorder
benefits are comparable to, and are applied no
more stringently than, the processes and
strategies used to apply each NQTL, in
operation, for medical and surgical benefits.
``(vi) A disclosure of the specific
findings and conclusions reached by the plan
that the results of the analyses described in
this subparagraph indicate that the plan or
coverage is in compliance with this section.
``(B) Secretary request process.--
``(i) Submission upon complaint.--The
Secretary shall request that a group health
plan submit the comparative analyses described
in subparagraph (A) if the Secretary has
received any complaints about such a plan that
involve mental health or substance use disorder
benefits.
``(ii) Random submissions.--The Secretary
shall request the comparative analyses
described in subparagraph (A) from no fewer
than 50 plans selected at random, annually, and
such plans shall not be the same plans for
which the comparative analyses are requested
under clause (i).
``(iii) Additional information.--In
instances in which the Secretary has concluded
that the plan has not submitted sufficient
information for the Secretary to review the
comparative analyses described in subparagraph
(A), as requested under clauses (i) and (ii),
the Secretary shall specify to the plan the
additional information the plan must submit for
the Secretary to review the comparative
analyses described in subparagraph (A) for
compliance with this section.
``(iv) Required action.--In instances in
which the Secretary has reviewed the
comparative analyses described in subparagraph
(A), as requested under clauses (i) and (ii),
and determined that the plan is not in
compliance with this section, the Secretary
shall specify to the plan the actions the plan
must take to be in compliance with this
section.
``(v) Report.--Not later than 1 year after
the date of enactment of this paragraph, and
annually thereafter, the Secretary shall submit
to the Committee on Ways and Means of the House
of Representatives and the Committee on Finance
of the Senate a report that contains--
``(I) each of the comparative
analyses requested under clauses (i)
and (ii), except that the identity of
each plan and any contracted entity of
a plan shall be redacted;
``(II) the Secretary's conclusions
as to whether each plan submitted
sufficient information for the
Secretary to review the comparative
analyses requested under clauses (i)
and (ii) for compliance with this
section;
``(III) for each plan that did
submit sufficient information for the
Secretary to review the comparative
analyses requested under clause (i),
the Secretary's conclusions as to
whether the plan is in compliance with
this section;
``(IV) the Secretary's
specifications described in clause
(iii) for each plan that the Secretary
determined did not submit sufficient
information for the Secretary to review
the comparative analyses requested
under clauses (i) and (ii) for
compliance with this section; and
``(V) the Secretary's
specifications described in clause (iv)
of the actions each plan that the
Secretary determined is not in
compliance with this section must take
to be in compliance with this section.
``(C) Compliance program guidance document update
process.--
``(i) In general.--The Secretary shall
include select instances of noncompliance that
the Secretary discovers upon reviewing the
comparative analyses requested under clauses
(i) and (ii) of subparagraph (B) in the
compliance program guidance document described
in section 2726(a)(6) of the Public Health
Service Act, as it is updated every 2 years,
except that all instances shall be deidentified
and such instances shall not disclose any
protected health information or individually
identifiable information.
``(ii) Inspector general.--Any instances of
noncompliance the Secretary discovers upon
reviewing the comparative analyses requested
under clauses (i) and (ii) of subparagraph (B)
shall be shared with 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, in accordance with section
2726(a)(6)(B)(iii)(I) of the Public Health
Service Act.
``(iii) State.--Any instances of
noncompliance the Secretary discovers upon
reviewing the comparative analyses requested
under clauses (i) and (ii) of subparagraph (B)
shall be shared with a State, in accordance
with section 2726(a)(6)(B)(iii)(II) of the
Public Health Service Act.''.
(c) Public Health Service Act.--Section 2726 of the Public Health
Service Act (42 U.S.C. 300gg-26) is amended--
(1) in subsection (a), by adding at the end the following:
``(8) Compliance requirements.--
``(A) Nonquantitative treatment limitation (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 disorder benefits, the plan or issuer offering
group or individual health insurance coverage shall
perform comparative analyses about the design and
application of nonquantitative treatment limitations
(referred to in this paragraph as the `NQTL') in
accordance with the following process, and make
available to State, or to the Secretary as permitted
under subsections (a)(2) and (b)(1) of section 2723,
upon request within 60 days beginning January 1, 2020,
and immediately upon request beginning January 1, 2021,
the following information:
``(i) The specific plan or coverage
language regarding the NQTL and a description
of all mental health or substance use disorder
and medical/surgical services to which it
applies in each respective benefits
classification.
``(ii) The factors used to determine that
an NQTL will apply to mental health or
substance use disorder benefits and medical/
surgical benefits, including factors that were
considered but rejected.
``(iii) The evidentiary standard (both
identified and deidentified) for each of the
factors identified in clause (ii) and any other
evidence relied upon to design and apply the
NQTL to mental health or substance use disorder
benefits and medical/surgical benefits.
``(iv) The comparative analyses
demonstrating that the processes and strategies
used to design the NQTL, as written, and the as
written processes and strategies used to apply
the NQTL for mental health or substance use
disorder benefits are comparable to, and are
applied no more stringently than, the processes
and strategies used to design the NQTL, as
written, and the as written processes and
strategies used to apply the NQTL to medical/
surgical benefits.
``(v) The comparative analyses
demonstrating that the processes and strategies
used to apply the NQTL, in operation, for
mental health and substance use disorder
benefits are comparable to, and are applied no
more stringently than, the processes and
strategies used to apply each NQTL, in
operation, for medical and surgical benefits.
``(vi) A disclosure of the specific
findings and conclusions reached by the plan or
health insurance issuer offering group or
individual health insurance coverage that the
results of the analyses described in this
subparagraph indicate that the plan or coverage
is in compliance with this section.
``(B) Secretary request process.--
``(i) Submission upon complaint.--As
permitted under subsections (a)(2) and (b)(1)
of section 2723, the Secretary shall request
that a group health plan or a health insurance
issuer offering group or individual health
insurance coverage submit the comparative
analyses described in subparagraph (A) if the
Secretary has received any complaints about
such a plan or issuer that involve mental
health or substance use disorder benefits.
``(ii) Random submissions.--As permitted
under subsections (a)(2) and (b)(1) of section
2723, the Secretary shall request the
comparative analyses described in subparagraph
(A) from no fewer than 50 plans or issuers
selected at random, annually, and such plans or
issuers shall not be the same plans or issuers
for which the comparative analyses are
requested under clause (i).
``(iii) Additional information.--In
instances in which the Secretary has concluded
that the plan or issuer has not submitted
sufficient information for the Secretary to
review the comparative analyses described in
subparagraph (A), as requested under clauses
(i) and (ii), the Secretary shall specify to
the plan or issuer the additional information
the plan or issuer must submit for the
Secretary to review the comparative analyses
described in subparagraph (A) for compliance
with this section.
``(iv) Required action.--In instances in
which the Secretary has reviewed the
comparative analyses described in subparagraph
(A), as requested under clauses (i) and (ii),
and determined that the plan or issuer is not
in compliance with this section, the Secretary
shall specify to the plan or issuer the actions
the plan or issuer must take to be in
compliance with this section.
``(v) Report.--Not later than 1 year after
the date of enactment of this paragraph, and
annually thereafter, the Secretary shall submit
to the Committee on Education and Labor of the
House of Representatives and the Committee on
Health, Education, Labor, and Pensions of the
Senate a report that contains--
``(I) each of the comparative
analyses requested under clauses (i)
and (ii), except that the identity of
each plan or issuer and any contracted
entity of a plan or issuer shall be
redacted;
``(II) the Secretary's conclusions
as to whether each plan or issuer
submitted sufficient information for
the Secretary to review the comparative
analyses requested under clauses (i)
and (ii) for compliance with this
section;
``(III) for each plan or issuer
that did submit sufficient information
for the Secretary to review the
comparative analyses requested under
clause (i), the Secretary's conclusions
as to whether the plan or issuer is in
compliance with this section;
``(IV) the Secretary's
specifications described in clause
(iii) for each plan or issuer that the
Secretary determined did not submit
sufficient information for the
Secretary to review the comparative
analyses requested under clauses (i)
and (ii) for compliance with this
section; and
``(V) the Secretary's
specifications described in clause (iv)
of the actions each plan or issuer that
the Secretary determined is not in
compliance with this section must take
to be in compliance with this section.
``(C) Compliance program guidance document update
process.--
``(i) In general.--The Secretary shall
include select instances of noncompliance that
the Secretary discovers upon reviewing the
comparative analyses requested under clauses
(i) and (ii) of subparagraph (B) in the
compliance program guidance document described
in subsection (a)(6), as it is updated every 2
years, except that all instances shall be
deidentified and such instances shall not
disclose any protected health information or
individually identifiable information.
``(ii) Inspector general.--Any instances of
noncompliance the Secretary discovers upon
reviewing the comparative analyses requested
under clauses (i) and (ii) of subparagraph (B)
shall be shared with 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, in accordance with subsection
(a)(6)(B)(iii)(I).
``(iii) State.--Any instances of
noncompliance the Secretary discovers upon
reviewing the comparative analyses requested
under clauses (i) and (ii) of subparagraph (B)
shall be shared with a State, in accordance
with subsection (a)(6)(B)(iii)(II).''.
<all>