Mental Health Parity Compliance Act

I 116TH CONGRESS 1ST SESSION H. R. 3165 To strengthen parity in mental health and substance use disorder benefits. IN THE HOUSE OF REPRESENTATIVES JUNE 10, 2019 Ms. PORTER (for herself, Mr. BILIRAKIS, and Mr. NORCROSS) introduced the following bill; which was referred to the Committee on Energy and Com- merce, and in addition to the Committees on Ways and Means, and Edu- cation 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 strengthen parity in mental health and substance use disorder benefits. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Mental Health Parity 4 Compliance Act’’. 5 SEC. 2. STRENGTHENING PARITY IN MENTAL HEALTH AND 6 SUBSTANCE USE DISORDER BENEFITS. 7 (a) EMPLOYEE RETIREMENT INCOME SECURITY ACT 8 OF 1974.—Section 712(a) of the Employee Retirement In- 9 VerDate Sep 11 2014 22:56 Jun 16, 2019 Jkt 034408 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3165.IH H3165 pbinns on DSK79D2C42PROD with BILLS 2 •HR 3165 IH come Security Act of 1974 (29 U.S.C. 1185a(a)) is 1 amended by adding at the end the following: 2 ‘‘(6) COMPLIANCE REQUIREMENTS.— 3 ‘‘(A) NONQUANTITATIVE TREATMENT LIM- 4 ITATION (NQTL) REQUIREMENTS.—In the case 5 of a group health plan (or health insurance cov- 6 erage offered in connection with such a plan) 7 that provides both medical and surgical benefits 8 and mental health or substance use disorder 9 benefits, the plan or coverage shall perform 10 comparative analyses about the design and ap- 11 plication of nonquantitative treatment limita- 12 tions (referred to in this paragraph as the 13 ‘NQTL’) in accordance with the following proc- 14 ess, and make available to the Secretary upon 15 request within 60 days beginning January 1, 16 2020, and immediately upon request beginning 17 January 1, 2021, the following information: 18 ‘‘(i) The specific plan or coverage lan- 19 guage regarding the NQTL and a descrip- 20 tion of all mental health or substance use 21 disorder and medical/surgical services to 22 which it applies in each respective benefits 23 classification. 24 VerDate Sep 11 2014 22:56 Jun 16, 2019 Jkt 034408 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3165.IH H3165 pbinns on DSK79D2C42PROD with BILLS 3 •HR 3165 IH ‘‘(ii) The factors used to determine 1 that an NQTL will apply to mental health 2 or substance use disorder benefits and 3 medical/surgical benefits, including factors 4 that were considered but rejected. 5 ‘‘(iii) The evidentiary standard (both 6 identified and deidentified) for each of the 7 factors identified in clause (ii) and any 8 other evidence relied upon to design and 9 apply the NQTL to mental health or sub- 10 stance use disorder benefits and medical/ 11 surgical benefits. 12 ‘‘(iv) The comparative analyses dem- 13 onstrating that the processes and strate- 14 gies used to design the NQTL, as written, 15 and the as written processes and strategies 16 used to apply the NQTL for mental health 17 or substance use disorder benefits are com- 18 parable to, and are applied no more strin- 19 gently than, the processes and strategies 20 used to design the NQTL, as written, and 21 the as written processes and strategies 22 used to apply the NQTL to medical/sur- 23 gical benefits. 24 VerDate Sep 11 2014 22:56 Jun 16, 2019 Jkt 034408 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3165.IH H3165 pbinns on DSK79D2C42PROD with BILLS 4 •HR 3165 IH ‘‘(v) The comparative analyses dem- 1 onstrating that the processes and strate- 2 gies used to apply the NQTL, in operation, 3 for mental health and substance use dis- 4 order benefits are comparable to, and are 5 applied no more stringently than, the proc- 6 esses and strategies used to apply each 7 NQTL, in operation, for medical and sur- 8 gical benefits. 9 ‘‘(vi) A disclosure of the specific find- 10 ings and conclusions reached by the plan 11 or coverage that the results of the analyses 12 described in this subparagraph indicate 13 that the plan or coverage is in compliance 14 with this section. 15 ‘‘(B) SECRETARY REQUEST PROCESS.— 16 ‘‘(i) SUBMISSION UPON COMPLAINT.— 17 The Secretary shall request that a group 18 health plan (or health insurance coverage 19 offered in connection with such a plan) 20 submit the comparative analyses described 21 in subparagraph (A) if the Secretary has 22 received any complaints about such a plan 23 or coverage that involve mental health or 24 substance use disorder benefits. 25 VerDate Sep 11 2014 22:56 Jun 16, 2019 Jkt 034408 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3165.IH H3165 pbinns on DSK79D2C42PROD with BILLS 5 •HR 3165 IH ‘‘(ii) RANDOM SUBMISSIONS.—The 1 Secretary shall request the comparative 2 analyses described in subparagraph (A) 3 from no fewer than 50 plans or coverages 4 selected at random, annually, and such 5 plans or coverages shall not be the same 6 plans or coverages for which the compara- 7 tive analyses are requested under clause 8 (i). 9 ‘‘(iii) ADDITIONAL INFORMATION.—In 10 instances in which the Secretary has con- 11 cluded that the plan or coverage has not 12 submitted sufficient information for the 13 Secretary to review the comparative anal- 14 yses described in subparagraph (A), as re- 15 quested under clauses (i) and (ii), the Sec- 16 retary shall specify to the plan or coverage 17 the additional information the plan or cov- 18 erage must submit for the Secretary to re- 19 view the comparative analyses described in 20 subparagraph (A) for compliance with this 21 section. 22 ‘‘(iv) REQUIRED ACTION.—In in- 23 stances in which the Secretary has re- 24 viewed the comparative analyses described 25 VerDate Sep 11 2014 22:56 Jun 16, 2019 Jkt 034408 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3165.IH H3165 pbinns on DSK79D2C42PROD with BILLS 6 •HR 3165 IH in subparagraph (A), as requested under 1 clauses (i) and (ii), and determined that 2 the plan or coverage is not in compliance 3 with this section, the Secretary shall speci- 4 fy to the plan or coverage the actions the 5 plan or coverage must take to be in compli- 6 ance with this section. 7 ‘‘(v) REPORT.—Not later than 1 year 8 after the date of enactment of this para- 9 graph, and annually thereafter, the Sec- 10 retary shall submit to the Committee on 11 Education and Labor of the House of Rep- 12 resentatives and the Committee on Health, 13 Education, Labor, and Pensions of the 14 Senate a report that contains— 15 ‘‘(I) each of the comparative 16 analyses requested under clauses (i) 17 and (ii), except that the identity of 18 each plan or coverage and any con- 19 tracted entity of a plan or coverage 20 shall be redacted; 21 ‘‘(II) the Secretary’s conclusions 22 as to whether each plan or coverage 23 submitted sufficient information for 24 the Secretary to review the compara- 25 VerDate Sep 11 2014 22:56 Jun 16, 2019 Jkt 034408 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3165.IH H3165 pbinns on DSK79D2C42PROD with BILLS 7 •HR 3165 IH tive analyses requested under clauses 1 (i) and (ii) for compliance with this 2 section; 3 ‘‘(III) for each plan or coverage 4 that did submit sufficient information 5 for the Secretary to review the com- 6 parative analyses requested under 7 clause (i), the Secretary’s conclusions 8 as to whether the plan or coverage is 9 in compliance with this section; 10 ‘‘(IV) the Secretary’s specifica- 11 tions described in clause (iii) for each 12 plan or coverage that the Secretary 13 determined did not submit sufficient 14 information for the Secretary to re- 15 view the comparative analyses re- 16 quested under clauses (i) and (ii) for 17 compliance with this section; and 18 ‘‘(V) the Secretary’s specifica- 19 tions described in clause (iv) of the 20 actions each plan or coverage that the 21 Secretary determined is not in compli- 22 ance with this section must take to be 23 in compliance with this section. 24 VerDate Sep 11 2014 22:56 Jun 16, 2019 Jkt 034408 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H3165.IH H3165 pbinns on DSK79D2C42PROD with BILLS 8 •HR 3165 IH ‘‘(C) COMPLIANCE PROGRAM GUIDANCE 1 DOCUMENT UPDATE PROCESS.— 2 ‘‘(i) IN GENERAL.—The Secretary 3 shall include select instances of noncompli- 4 ance that the Secretary discovers upon re- 5 viewing the comparative analyses requested 6 under clauses (i) and (ii) of subparagraph 7 (B) in the compliance program guidance 8 document described in section 2726(a)(6) 9 of the Public Health Service Act, as it is 10 updated every 2 years, except that all in- 11 stances shall be deidentified and such in- 12 stances shall not disclose any protected 13 health information or individually identifi- 14 able information. 15 ‘‘(ii) INSPECTOR GENERAL.—Any in- 16 stances of noncompliance the Secretary 17 discovers upon reviewing the comparative 18 analyses requested under clauses (i) and 19 (ii) of subparagraph (B) shall be shared 20 with the Inspector General of the Depart- 21 ment of Health and Human Services, the 22 Inspector General of the Department of 23 Labor, and the Inspector General of the 24 Department of the Treasury, in accordance 25 VerDate Sep 11 2014 22:56 Jun 16, 2019 Jkt 034408 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H3165.IH H3165 pbinns on DSK79D2C42PROD with BILLS 9 •HR 3165 IH with section 2726(a)(6)(B)(iii)(I) of the 1 Public Health Service Act. 2 ‘‘(iii) STATE.—Any instances of non- 3 compliance the Secretary discovers upon 4 reviewing the comparative analyses re- 5 quested under clauses (i) and (ii) of sub- 6 paragraph (B) shall be shared with a 7 State, in accordance with section 8 2726(a)(6)(B)(iii)(II) of the Public Health 9 Service Act.’’. 10 (b) INTERNAL REVENUE CODE OF 1986.—Section 11 9812(a) of the Internal Revenue Code of 1986 is amended 12 by adding at the end the following: 13 ‘‘(6) COMPLIANCE REQUIREMENTS.— 14 ‘‘(A) NONQUANTITATIVE TREATMENT LIM- 15 ITATION (NQTL) REQUIREMENTS.—In the case 16 of a group health plan that provides both med- 17 ical and surgical benefits and mental health or 18 substance use disorder benefits, the plan shall 19 perform comparative analyses about the design 20 and application of nonquantitative treatment 21 limitations (referred to in this paragraph as the 22 ‘NQTL’) in accordance with the following proc- 23 ess, and make available to the Secretary upon 24 request within 60 days beginning January 1, 25 VerDate Sep 11 2014 22:56 Jun 16, 2019 Jkt 034408 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3165.IH H3165 pbinns on DSK79D2C42PROD with BILLS 10 •HR 3165 IH 2020, and immediately upon request beginning 1 January 1, 2021, the following information: 2 ‘‘(i) The specific plan language re- 3 garding the NQTL and a description of all 4 mental health or substance use disorder 5 and medical/surgical services to which it 6 applies in each respective benefits classi- 7 fication. 8 ‘‘(ii) The factors used to determine 9 that an NQTL will apply to mental health 10 or substance use disorder benefits and 11 medical/surgical benefits, including factors 12 that were considered but rejected. 13 ‘‘(iii) The evidentiary standard (both 14 identified and deidentified) for each of the 15 factors identified in clause (ii) and any 16 other evidence relied upon to design and 17 apply the NQTL to mental health or sub- 18 stance use disorder benefits and medical/ 19 surgical benefits. 20 ‘‘(iv) The comparative analyses dem- 21 onstrating that the processes and strate- 22 gies used to design the NQTL, as written, 23 and the as written processes and strategies 24 used to apply the NQTL for mental health 25 VerDate Sep 11 2014 22:56 Jun 16, 2019 Jkt 034408 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H3165.IH H3165 pbinns on DSK79D2C42PROD with BILLS 11 •HR 3165 IH or substance use disorder benefits are com- 1 parable to, and are applied no more strin- 2 gently than, the processes and strategies 3 used to design the NQTL, as written, and 4 the as written processes and strategies 5 used to apply the NQTL to medical/sur- 6 gical benefits. 7 ‘‘(v) The comparative analyses dem- 8 onstrating that the processes and strate- 9 gies used to apply the NQTL, in operation, 10 for mental health and substance use dis- 11 order benefits are comparable to, and are 12 applied no more stringently than, the proc- 13 esses and strategies used to apply each 14 NQTL, in operation, for medical and sur- 15 gical benefits. 16 ‘‘(vi) A disclosure of the specific find- 17 ings and conclusions reached by the plan 18 that the results of the analyses described 19 in this subparagraph indicate that the plan 20 or coverage is in compliance with this sec- 21 tion. 22 ‘‘(B) SECRETARY REQUEST PROCESS.— 23 ‘‘(i) SUBMISSION UPON COMPLAINT.— 24 The Secretary shall request that a group 25 VerDate Sep 11 2014 22:56 Jun 16, 2019 Jkt 034408 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H3165.IH H3165 pbinns on DSK79D2C42PROD with BILLS 12 •HR 3165 IH health plan submit the comparative anal- 1 yses described in subparagraph (A) if the 2 Secretary has received any complaints 3 about such a plan that involve mental 4 health or substance use disorder benefits. 5 ‘‘(ii) RANDOM SUBMISSIONS.—The 6 Secretary shall request the comparative 7 analyses described in subparagraph (A) 8 from no fewer than 50 plans selected at 9 random, annually, and such plans shall not 10 be the same plans for which the compara- 11 tive analyses are requested under clause 12 (i). 13 ‘‘(iii) ADDITIONAL INFORMATION.—In 14 instances in which the Secretary has con- 15 cluded that the plan has not submitted suf- 16 ficient information for the Secretary to re- 17 view the comparative analyses described in 18 subparagraph (A), as requested under 19 clauses (i) and (ii), the Secretary shall 20 specify to the plan the additional informa- 21 tion the plan must submit for the Sec- 22 retary to review the comparative analyses 23 described in subparagraph (A) for compli- 24 ance with this section. 25 VerDate Sep 11 2014 22:56 Jun 16, 2019 Jkt 034408 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H3165.IH H3165 pbinns on DSK79D2C42PROD with BILLS 13 •HR 3165 IH ‘‘(iv) REQUIRED ACTION.—In in- 1 stances in which the Secretary has re- 2 viewed the comparative analyses described 3 in subparagraph (A), as requested under 4 clauses (i) and (ii), and determined that 5 the plan is not in compliance with this sec- 6 tion, the Secretary shall specify to the plan 7 the actions the plan must take to be in 8 compliance with this section. 9 ‘‘(v) REPORT.—Not later than 1 year 10 after the date of enactment of this para- 11 graph, and annually thereafter, th [Text truncated for display. 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