Behavioral Health Coverage Transparency Act of 2022
This bill increases oversight of the insurance coverage parity requirements for mental health and substance use disorder, including providing a process for auditing insurance providers and filing formal complaints for violations of the requirements.
[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8512 Introduced in House (IH)]
<DOC>
117th CONGRESS
2d Session
H. R. 8512
To amend title XXVII of the Public Health Service Act, the Employee
Retirement Income Security Act of 1974, and the Internal Revenue Code
of 1986 to strengthen parity in mental health and substance use
disorder benefits.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 26, 2022
Ms. Porter (for herself, Mr. Cardenas, Mr. Fitzpatrick, Mr. Trone, Mr.
Doggett, Mr. Raskin, Ms. Barragan, Mr. Butterfield, Mr. McEachin, Mrs.
Napolitano, Ms. Jackson Lee, Ms. Jayapal, Mr. Michael F. Doyle of
Pennsylvania, Mr. Deutch, and Ms. Kuster) introduced the following
bill; which was referred to the Committee on Energy and Commerce, and
in addition to the Committees on Education and Labor, Ways and Means,
and Oversight and Reform, 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 title XXVII of the Public Health Service Act, the Employee
Retirement Income Security Act of 1974, and the Internal Revenue Code
of 1986 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 ``Behavioral Health Coverage
Transparency Act of 2022''.
SEC. 2. STRENGTHENING PARITY IN MENTAL HEALTH AND SUBSTANCE USE
DISORDER BENEFITS.
(a) Public Health Service Act.--Section 2726(a)(8) of the Public
Health Service Act (42 U.S.C. 300gg-26(a)(8)) is amended--
(1) in subparagraph (A), in the matter preceding clause
(i)--
(A) by inserting ``(including entities that provide
administrative services in connection with a group
health plan, such as third party administrators)''
after ``insurance coverage''; and
(B) by striking ``and, beginning 45 days after''
and all that follows through ``upon request,'' and
inserting ``and submit to the Secretary (or the
Secretary of Labor or the Secretary of the Treasury, as
applicable), on an annual basis (and at any other time
upon request of the Secretary), and to the applicable
State authority upon request,'';
(2) in subparagraph (B)--
(A) in the heading, by striking ``request'' and
inserting ``review'';
(B) in clause (i)--
(i) in the heading, by striking
``Submission upon request'' and inserting ``In
general'';
(ii) by striking ``shall request'' and all
that follows through ``coverage submit'' and
insert ``shall conduct a review of''; and
(iii) by striking ``shall request not fewer
than 20'' and inserting ``shall conduct a
review of not fewer than 60'';
(C) in clause (ii)--
(i) in the first sentence, by striking ``as
requested under clause (i)'' and inserting ``as
submitted under such subparagraph'';
(ii) in the first sentence, by striking
``to be responsive to the request under clause
(i) for'' and inserting ``to enable''; and
(iii) in the second sentence, by striking
``, as requested under clause (i)'';
(D) in clause (iii)--
(i) in subclause (I), by striking ``, as
requested under clause (i),''; and
(ii) by adding at the end of subclause (II)
the following new sentence: ``The preceding
sentence shall not apply with respect to
disclosures made on or after the date of the
enactment of this sentence.''; and
(E) in clause (iv)--
(i) in subclause (I)--
(I) by striking ``requested under
clause (i)'' and inserting ``reviewed
under clause (i)''; and
(II) by striking ``after the final
determination by the Secretary
described in clause (iii)(I)(bb)'' and
inserting ``by the Secretary as
described in clause (iii)(I)'';
(ii) in subclause (II), by striking ``the
comparative analyses requested under clause
(i)'' and inserting ``such comparative
analyses'';
(iii) in subclause (III), by striking ``the
comparative analyses requested under clause
(i)'' and inserting ``such comparative
analyses'';
(iv) in subclause (IV)--
(I) by striking ``the comparative
analyses requested under clause (i)''
and inserting ``such comparative
analyses''; and
(II) by striking ``and'' at the
end;
(v) in subclause (V), by striking the
period and inserting a semicolon; and
(vi) by adding at the end the following:
``(VI) the name of each group
health plan or health insurance issuer
found not to have submitted comparative
analyses in accordance with
subparagraph (A);
``(VII) the name of each group
health plan or health insurance issuer
whose comparative analyses were
reviewed under clause (i) and found not
to have submitted sufficient
information for the Secretary to
review; and
``(VIII) the name of any plan or
coverage with respect to which a
complaint has been submitted under
subparagraph (C) and for which a final
review finding has been issued.
The requirements of this clause with respect to
plans or issuers shall also apply to entities
that provide administrative services in
connection with a group health plan, such as
third party administrators, if applicable.'';
(3) in subparagraph (C)(i), by striking ``requested''; and
(4) by adding at the end the following new subparagraphs:
``(D) Audit process.--Beginning 1 year after the
date of enactment of this subparagraph, the Secretary,
in cooperation with the Secretaries of Labor and the
Treasury, as applicable, shall, in addition to
conducting reviews in accordance with subparagraph (B),
conduct randomized audits of group health plans, health
insurance issuers offering group or individual health
insurance coverage, and entities that provide
administrative services in connection with a group
health plan, such as third party administrators, to
determine compliance with this section. Such audits
shall be conducted on no fewer than 40 plans or
coverages per calendar year (not including any reviews
conducted under such subparagraph). In addition, the
Secretary may, in cooperation with the Secretaries of
Labor and the Treasury, 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 or coverage
with respect to which a complaint has been submitted
under subparagraph (E) to determine compliance with
this section.
``(E) Complaint process.--Not later than 6 months
after the date of enactment of this subparagraph, the
Secretary, in cooperation with the Secretary of Labor
and the Secretary of the Treasury, shall, with respect
to group health plans and health insurance issuers
offering group or individual health insurance coverage
(including entities that provide administrative
services in connection with a group health plan, such
as third party administrators), issue guidance to
clarify the process and timeline for current and
potential participants and beneficiaries (and
authorized representatives and health care providers of
such participants and beneficiaries) with respect to
such plans and coverage to file formal complaints of
such plans or issuers being in violation of this
section, including guidance, by plan type, on the
relevant State, regional, and national offices with
which such complaints should be filed.
``(F) Coverage disparity information.--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 Secretary, in cooperation with the Secretaries of
Labor and the Treasury, shall submit to the Committee
on Energy and Commerce of the House of Representatives
and the Committee on Health, Education, Labor, and
Pensions of the Senate the following information with
respect to the preceding calendar year:
``(i) Denial rates.--Data comparing the
rates of and reasons for denial by group health
plans and health insurance issuers offering
group or individual health insurance coverage
(including entities that provide administrative
services in connection with a group health
plan, such as third party administrators) of
claims for mental health benefits, substance
use disorder 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 and health insurance issuers offering
group or individual health insurance coverage
(including entities that provide administrative
services in connection 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 providers
accepting new patients, and average wait times
between receiving initial treatment and
diagnosis and follow-up treatment.
``(iii) Reimbursement rates.--Data
comparing the reimbursement rates of group
health plans and health insurance issuers
offering group or individual health insurance
coverage (including entities that provide
administrative services in connection with a
group health plan, such as third party
administrators) for the 10 most commonly billed
mental health services, 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.''.
(b) Employee Retirement Income Security Act of 1974.--Section
712(a)(8) of the Employee Retirement Income Security Act of 1974 (29
U.S.C. 1185a(a)(8)) is amended--
(1) in subparagraph (A), in the matter preceding clause
(i)--
(A) by inserting ``(including entities that provide
administrative services in connection with a group
health plan, such as third party administrators)''
after ``insurance coverage''; and
(B) by striking ``and, beginning 45 days after''
and all that follows through ``upon request,'' and
inserting ``and submit to the Secretary (or the
Secretary of Health and Human Services or the Secretary
of the Treasury, as applicable), on an annual basis
(and at any other time upon request of the
Secretary),'';
(2) in subparagraph (B)--
(A) in the heading, by striking ``request'' and
inserting ``review'';
(B) in clause (i)--
(i) in the heading, by striking
``Submission upon request'' and inserting ``In
general'';
(ii) by striking ``shall request'' and all
that follows through ``coverage submit'' and
insert ``shall conduct a review of''; and
(iii) by striking ``shall request not fewer
than 20'' and inserting ``shall conduct a
review of not fewer than 60'';
(C) in clause (ii)--
(i) in the first sentence, by striking ``as
requested under clause (i)'' and inserting ``as
submitted under such subparagraph'';
(ii) in the first sentence, by striking
``to be responsive to the request under clause
(i) for'' and inserting ``to enable''; and
(iii) in the second sentence, by striking
``, as requested under clause (i)'';
(D) in clause (iii)--
(i) in subclause (I), by striking ``, as
requested under clause (i),''; and
(ii) by adding at the end of subclause (II)
the following new sentence: ``The preceding
sentence shall not apply with respect to
disclosures made on or after the date of the
enactment of this sentence.''; and
(E) in clause (iv)--
(i) in subclause (I)--
(I) by striking ``requested under
clause (i)'' and inserting ``reviewed
under clause (i)''; and
(II) by striking ``after the final
determination by the Secretary
described in clause (iii)(I)(bb)'' and
inserting ``by the Secretary as
described in clause (iii)(I)'';
(ii) in subclause (II), by striking ``the
comparative analyses requested under clause
(i)'' and inserting ``such comparative
analyses'';
(iii) in subclause (III), by striking ``the
comparative analyses requested under clause
(i)'' and inserting ``such comparative
analyses'';
(iv) in subclause (IV)--
(I) by striking ``the comparative
analyses requested under clause (i)''
and inserting ``such comparative
analyses''; and
(II) by striking ``and'' at the
end;
(v) in subclause (V), by striking the
period and inserting a semicolon; and
(vi) by adding at the end the following:
``(VI) the name of each group
health plan or health insurance issuer
found not to have submitted comparative
analyses in accordance with
subparagraph (A);
``(VII) the name of each group
health plan or health insurance issuer
whose comparative analyses were
reviewed under clause (i) and found not
to have submitted sufficient
information for the Secretary to
review; and
``(VIII) the name of any plan or
coverage with respect to which a
complaint has been submitted under
subparagraph (C) and for which a final
review finding has been issued.
The requirements of this clause with respect to
plans or issuers shall also apply to entities
that provide administrative services in
connection with a group health plan, such as
third party administrators, if applicable.'';
(3) in subparagraph (C)(i), by striking ``requested''; and
(4) by adding at the end the following new subparagraphs:
``(D) Audit process.--Beginning 1 year after the
date of enactment of this subparagraph, the Secretary,
in cooperation with the Secretaries of Health and Human
Services and the Treasury, as applicable, shall, in
addition to conducting reviews in accordance with
subparagraph (B), conduct randomized audits of group
health plans, health insurance issuers offering group
health insurance coverage, and entities that provide
administrative services in connection with a group
health plan, such as third party administrators, to
determine compliance with this section. Such audits
shall be conducted on no fewer than 40 plans or
coverages per calendar year (not including any reviews
conducted under such subparagraph). In addition, the
Secretary may, in cooperation with the Secretaries of
Health and Human Services and the Treasury, 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 or coverage with respect to which a complaint has
been submitted under subparagraph (E) to determine
compliance with this section.
``(E) Complaint process.--Not later than 6 months
after the date of enactment of this subparagraph, the
Secretary, in cooperation with the Secretary of Health
and Human Services and the Secretary of the Treasury,
shall, with respect to group health plans and health
insurance issuers offering group health insurance
coverage (including entities that provide
administrative services in connection with a group
health plan, such as third party administrators), issue
guidance to clarify the process and timeline for
current and potential participants and beneficiaries
(and authorized representatives and health care
providers of such participants and beneficiaries) with
respect to such plans and coverage to file formal
complaints of such plans or issuers being in violation
of this section, including guidance, by plan type, on
the relevant State, regional, and national offices with
which such complaints should be filed.
``(F) Coverage disparity information.--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 Secretary, in cooperation with the Secretaries of
Health and Human Services and the Treasury, shall
submit to the Committee on Energy and Commerce of the
House of Representatives and the Committee on Health,
Education, Labor, and Pensions of the Senate the
following information with respect to the preceding
calendar year:
``(i) Denial rates.--Data comparing the
rates of and reasons for denial by group health
plans and health insurance issuers offering
group health insurance coverage (including
entities that provide administrative services
in connection with a group health plan, such as
third party administrators) of claims for
mental health benefits, substance use disorder
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 and health insurance issuers offering
group health insurance coverage (including
entities that provide administrative services
in connection 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 providers accepting
new patients, and average wait times between
receiving initial treatment and diagnosis and
follow-up treatment.
``(iii) Reimbursement rates.--Data
comparing the reimbursement rates of group
health plans and health insurance issuers
offering group health insurance coverage
(including entities that provide administrative
services in connection with a group health
plan, such as third party administrators) for
the 10 most commonly billed mental health
services, 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.''.
(c) Internal Revenue Code of 1986.--Section 9812(a)(8) of the
Internal Revenue Code of 1986 is amended--
(1) in subparagraph (A), in the matter preceding clause
(i)--
(A) by inserting ``(including entities that provide
administrative services in connection with a group
health plan, such as third party administrators)''
after ``In the case of a group health plan''; and
(B) by striking ``and, beginning 45 days after''
and all that follows through ``upon request,'' and
inserting ``and submit to the Secretary (or the
Secretary of Health and Human Services or the Secretary
of Labor, as applicable), on an annual basis (and at
any other time upon request of the Secretary),'';
(2) in subparagraph (B)--
(A) in the heading, by striking ``request'' and
inserting ``review'';
(B) in clause (i)--
(i) in the heading, by striking
``Submission upon request'' and inserting ``In
general'';
(ii) by striking ``shall request'' and all
that follows through ``plan submit'' and insert
``shall conduct a review of''; and
(iii) by striking ``shall request not fewer
than 20'' and inserting ``shall conduct a
review of not fewer than 60'';
(C) in clause (ii)--
(i) in the first sentence, by striking ``as
requested under clause (i)'' and inserting ``as
submitted under such subparagraph'';
(ii) in the first sentence, by striking
``to be responsive to the request under clause
(i) for'' and inserting ``to enable''; and
(iii) in the second sentence, by striking
``, as requested under clause (i)'';
(D) in clause (iii)--
(i) in subclause (I), by striking ``, as
requested under clause (i),''; and
(ii) by adding at the end of subclause (II)
the following new sentence: ``The preceding
sentence shall not apply with respect to
disclosures made on or after the date of the
enactment of this sentence.''; and
(E) in clause (iv)--
(i) in subclause (I)--
(I) by striking ``requested under
clause (i)'' and inserting ``reviewed
under clause (i)''; and
(II) by striking ``after the final
determination by the Secretary
described in clause (iii)(I)(bb)'' and
inserting ``by the Secretary as
described in clause (iii)(I)'';
(ii) in subclause (II), by striking ``the
comparative analyses requested under clause
(i)'' and inserting ``such comparative
analyses'';
(iii) in subclause (III), by striking ``the
comparative analyses requested under clause
(i)'' and inserting ``such comparative
analyses'';
(iv) in subclause (IV)--
(I) by striking ``the comparative
analyses requested under clause (i)''
and inserting ``such comparative
analyses''; and
(II) by striking ``and'' at the
end;
(v) in subclause (V), by striking the
period and inserting a semicolon; and
(vi) by adding at the end the following:
``(VI) the name of each group
health plan found not to have submitted
comparative analyses in accordance with
subparagraph (A);
``(VII) the name of each group
health plan whose comparative analyses
were reviewed under clause (i) and
found not to have submitted sufficient
information for the Secretary to
review; and
``(VIII) the name of any plan with
respect to which a complaint has been
submitted under subparagraph (C) and
for which a final review finding has
been issued.
The requirements of this clause with respect to
plans shall also apply to entities that provide
administrative services in connection with a
group health plan, such as third party
administrators, if applicable.'';
(3) in subparagraph (C)(i), by striking ``requested''; and
(4) by adding at the end the following new subparagraphs:
``(D) Audit process.--Beginning 1 year after the
date of enactment of this subparagraph, the Secretary,
in cooperation with the Secretaries of Health and Human
Services and Labor, as applicable, shall, in addition
to conducting reviews in accordance with subparagraph
(B), conduct randomized audits of group health plans
and entities that provide administrative services in
connection with a group health plan, such as third
party administrators, to determine compliance with this
section. Such audits shall be conducted on no fewer
than 40 plans per calendar year (not including any
reviews 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 determine
compliance with this section.
``(E) Complaint process.--Not later than 6 months
after the date of enactment of this subparagraph, the
Secretary, in cooperation 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 connection with
a group health plan, such as third party
administrators), issue guidance to clarify the process
and timeline for current and potential participants and
beneficiaries (and authorized representatives and
health care providers of such participants and
beneficiaries) with respect to such plans to file
formal complaints of such plans being in violation of
this section, including guidance, by plan type, on the
relevant State, regional, and national offices with
which such complaints should be filed.
``(F) Coverage disparity information.--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 Secretary, in cooperation with the Secretaries of
Health and Human Services and Labor, shall submit to
the Committee on Energy and Commerce of the House of
Representatives and the Committee on Health, Education,
Labor, and Pensions of the Senate the following
information 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 connection with a
group health plan, such as third party
administrators) of claims for mental health
benefits, substance use disorder 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 connection 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
providers accepting new patients, and average
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 connection with a
group health plan, such as third party
administrators) for the 10 most commonly billed
mental health services, 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.''.
SEC. 3. CONSUMER PARITY UNIT FOR MENTAL HEALTH AND SUBSTANCE USE
DISORDER PARITY VIOLATIONS.
(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 Service 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 paragraph (4).
(3) Creditable coverage.--The term ``creditable 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 Retirement Income
Security Act of 1974 (29 U.S.C. 1185a);
(C) section 9812 of the Internal Revenue Code of
1986; or
(D) any other Federal law that applies the
requirements under any of the sections described in
subparagraph (A), (B), or (C), or requirements that are
substantially similar to the requirements under any
such section, as determined 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 individual
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 Security 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 established
under chapter 89 of title 5, United States Code.
(b) Establishment.--Not later than 6 months after the date of
enactment of this Act, the Secretary, in consultation 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 include
enhancing a website portal in existence on the date of
enactment of this Act; and
(2) providing information to health care consumers
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)), section 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.
(c) Website Portal.--The Secretary, in consultation 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 investigations 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 insurance issuer (including entities that provide
administrative services in connection with a group 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 submitted NQTL
analyses in accordance with such sections (or to have
submitted incomplete NQTL analyses).
(d) Response to Consumer Complaints and Inquiries.--
(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 reasonable procedures for the consumer parity unit
established 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 discretion of the applicable
agency, which shall at minimum include--
(A) steps that have been taken by the appropriate
State or Federal enforcement agency 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 enforcement agency from
the covered plan;
(C) any follow-up actions or planned follow-up
actions by the appropriate State or Federal enforcement
agency in response to the complaint 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 inquiry.
(2) Timely response to regulators.--A specified covered
plan shall provide a response (in writing if appropriate)
within 7 days to the appropriate 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 Services) concerning a consumer
complaint or inquiry submitted to the consumer parity unit
established under this section including--
(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 consumers.--
(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 obtained from such covered plan within 7
days of receipt of such request.
(B) Exceptions.--Notwithstanding subparagraph (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.--
(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 provisions 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 adding 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 Transparency Act of 2022.''.
(ii) Medicaid.--Section 1902(a) of the
Social Security Act (42 U.S.C. 1396a(a)) is
amended--
(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 provisions 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 administration or supervision
of such plan shall ensure that such plan complies with
the provisions 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 received by the consumer parity unit established
under 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 established under subsection (b)(1)(B).
(f) Data Sharing.--Subject to any applicable standards for Federal
or State agencies with respect to protecting personally identifiable
information and data security 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 information 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 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 section and the Secretary,
in consultation with the Secretary 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 information about a consumer from the records of
the covered plan, except--
(A) if the records are reasonably described in a
request by the consumer parity unit established under
this section, and the consumer provides appropriate
consent for the disclosure and use of such information
by the covered plan to such unit; or
(B) as may be specifically permitted or required
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 applicable agencies, shall enter into a
memorandum of understanding 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 extent 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 satisfied
any conditions of participation that the unit may
establish, including treatment of personally
identifiable information and sharing of information on
complaint resolution or related compliance procedures
and resources; and
(C) participation by the applicable State authority
includes measures necessary to protect personally
identifiable information in accordance 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 Treasury, and the heads of any
other applicable agencies, shall provide assistance to States
to increase the capacity of State governments to work with the
Federal 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 appropriated 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.
(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 SUBSTANCE USE DISORDER BENEFITS.
(a) In General.--The Secretary of Health and Human Services
(referred to in this section as the ``Secretary'') 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 assistance; 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 ombudsman, that, directly or in
coordination with State private and public health insurance
regulators and consumer assistance organizations, receives and
responds to inquiries and complaints concerning health
insurance coverage with respect to Federal health insurance
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 established 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 appeals,
including filing appeals with the internal appeal or grievance
process of the group health plan or health insurance issuer,
Medicaid program, and Children's Health Insurance Program
involved, relating to mental health or substance use disorder
benefits, and providing information about the external appeal
process;
(2) collect, track, and quantify problems and inquiries
encountered by consumers;
(3) educate consumers on their rights and responsibilities
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 information, 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 required 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 consumers 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
regulators, the Secretary of Labor, and the Secretary of the Treasury
for use in the enforcement activities of such agencies.
(e) Funding.--
(1) Initial funding.--There is hereby appropriated 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.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Labor, Ways and Means, and Oversight and Reform, 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.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Labor, Ways and Means, and Oversight and Reform, 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.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Labor, Ways and Means, and Oversight and Reform, 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.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Labor, Ways and Means, and Oversight and Reform, 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.
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