Mental Health
Parity and Addiction Equity Act of 2008
H.R.1424
Resolved, That the bill
from the House of Representatives (H.R. 1424) entitled `An Act to amend
section 712 of the Employee Retirement Income Security Act of 1974,
section 2705 of... (Engrossed Amendment as Agreed to by Senate)
Subtitle B--Paul Wellstone and Pete Domenici Mental Health
Parity and Addiction Equity Act of 2008
SEC. 511. SHORT TITLE.
This subtitle may be cited as the `Paul Wellstone and Pete
Domenici Mental Health Parity and Addiction Equity Act of 2008'.
SEC. 512. MENTAL HEALTH PARITY.
(a) Amendments to ERISA- Section 712 of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1185a) is amended--
(1) in subsection (a), by adding at the end the following:
`(3) FINANCIAL REQUIREMENTS AND TREATMENT LIMITATIONS-
`(A) IN GENERAL- 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, such plan or coverage shall
ensure that--
`(i) the financial requirements applicable
to such mental health or substance use disorder benefits are no more
restrictive than the predominant financial requirements applied to
substantially all medical and surgical benefits covered by the plan (or
coverage), and there are no separate cost sharing requirements that are
applicable only with respect to mental health or substance use disorder
benefits; and
`(ii) the treatment limitations applicable
to such mental health or substance use disorder benefits are no more
restrictive than the predominant treatment limitations applied to
substantially all medical and surgical benefits covered by the plan (or
coverage) and there are no separate treatment limitations that are
applicable only with respect to mental health or substance use disorder
benefits.
`(B) DEFINITIONS- In this paragraph:
`(i) FINANCIAL REQUIREMENT- The term
`financial requirement' includes deductibles, copayments, coinsurance,
and out-of-pocket expenses, but excludes an aggregate lifetime limit
and an annual limit subject to paragraphs (1) and (2),
`(ii) PREDOMINANT- A financial requirement
or treatment limit is considered to be predominant if it is the most
common or frequent of such type of limit or requirement.
`(iii) TREATMENT LIMITATION- The term
`treatment limitation' includes limits on the frequency of treatment,
number of visits, days of coverage, or other similar limits on the
scope or duration of treatment.
`(4) AVAILABILITY OF PLAN INFORMATION- The criteria
for medical necessity determinations made under the plan with respect
to mental health or substance use disorder benefits (or the health
insurance coverage offered in connection with the plan with respect to
such benefits) shall be made available by the plan administrator (or
the health insurance issuer offering such coverage) in accordance with
regulations to any current or potential participant, beneficiary, or
contracting provider upon request. The reason for any denial under the
plan (or coverage) of reimbursement or payment for services with
respect to mental health or substance use disorder benefits in the case
of any participant or beneficiary shall, on request or as otherwise
required, be made available by the plan administrator (or the health
insurance issuer offering such coverage) to the participant or
beneficiary in accordance with regulations.
`(5) OUT-OF-NETWORK PROVIDERS- In the case of a
plan or coverage that provides both medical and surgical benefits and
mental health or substance use disorder benefits, if the plan or
coverage provides coverage for medical or surgical benefits provided by
out-of-network providers, the plan or coverage shall provide coverage
for mental health or substance use disorder benefits provided by
out-of-network providers in a manner that is consistent with the
requirements of this section.';
(2) in subsection (b), by amending paragraph (2) to read as
follows:
`(2) in the case of a group health plan (or health
insurance coverage offered in connection with such a plan) that
provides mental health or substance use disorder benefits, as affecting
the terms and conditions of the plan or coverage relating to such
benefits under the plan or coverage, except as provided in subsection
(a).';
(A) in paragraph (1)(B)--
(i) by inserting `(or 1 in the case of an
employer residing in a State that permits small groups to include a
single individual)' after `at least 2' the first place that such
appears; and
(ii) by striking `and who employs at least 2 employees on
the first day of the plan year'; and
(B) by striking paragraph (2) and inserting the following:
`(A) IN GENERAL- With respect to a group health
plan (or health insurance coverage offered in connection with such a
plan), if the application of this section to such plan (or coverage)
results in an increase for the plan year involved of the actual total
costs of coverage with respect to medical and surgical benefits and
mental health and substance use disorder benefits under the plan (as
determined and certified under subparagraph (C)) by an amount that
exceeds the applicable percentage described in subparagraph (B) of the
actual total plan costs, the provisions of this section shall not apply
to such plan (or coverage) during the following plan year, and such
exemption shall apply to the plan (or coverage) for 1 plan year. An
employer may elect to continue to apply mental health and substance use
disorder parity pursuant to this section with respect to the group
health plan (or coverage) involved regardless of any increase in total
costs.
`(B) APPLICABLE PERCENTAGE- With respect to a
plan (or coverage), the applicable percentage described in this
subparagraph shall be--
`(i) 2 percent in the case of the first plan year in which
this section is applied; and
`(ii) 1 percent in the case of each subsequent plan year.
`(C) DETERMINATIONS BY ACTUARIES-
Determinations as to increases in actual costs under a plan (or
coverage) for purposes of this section shall be made and certified by a
qualified and licensed actuary who is a member in good standing of the
American Academy of Actuaries. All such determinations shall be in a
written report prepared by the actuary. The report, and all underlying
documentation relied upon by the actuary, shall be maintained by the
group health plan or health insurance issuer for a period of 6 years
following the notification made under subparagraph (E).
`(D) 6-month DETERMINATIONS- If a group health
plan (or a health insurance issuer offering coverage in connection with
a group health plan) seeks an exemption under this paragraph,
determinations under subparagraph (A) shall be made after such plan (or
coverage) has complied with this section for the first 6 months of the
plan year involved.
`(i) IN GENERAL- A group health plan (or a
health insurance issuer offering coverage in connection with a group
health plan) that, based upon a certification described under
subparagraph (C), qualifies for an exemption under this paragraph, and
elects to implement the exemption, shall promptly notify the Secretary,
the appropriate State agencies, and participants and beneficiaries in
the plan of such election.
`(ii) REQUIREMENT- A notification to the Secretary under
clause (i) shall include--
`(I) a description of the number of
covered lives under the plan (or coverage) involved at the time of the
notification, and as applicable, at the time of any prior election of
the cost-exemption under this paragraph by such plan (or coverage);
`(II) for both the plan year upon which
a cost exemption is sought and the year prior, a description of the
actual total costs of coverage with respect to medical and surgical
benefits and mental health and substance use disorder benefits under
the plan; and
`(III) for both the plan year upon
which a cost exemption is sought and the year prior, the actual total
costs of coverage with respect to mental health and substance use
disorder benefits under the plan.
`(iii) CONFIDENTIALITY- A notification to
the Secretary under clause (i) shall be confidential. The Secretary
shall make available, upon request and on not more than an annual
basis, an anonymous itemization of such notifications, that includes--
`(I) a breakdown of States by the size and type of
employers submitting such notification; and
`(II) a summary of the data received under clause (ii).
`(F) AUDITS BY APPROPRIATE AGENCIES- To
determine compliance with this paragraph, the Secretary may audit the
books and records of a group health plan or health insurance issuer
relating to an exemption, including any actuarial reports prepared
pursuant to subparagraph (C), during the 6 year period following the
notification of such exemption under subparagraph (E). A State agency
receiving a notification under subparagraph (E) may also conduct such
an audit with respect to an exemption covered by such notification.';
(4) in subsection (e), by striking paragraph (4) and inserting
the following:
`(4) MENTAL HEALTH BENEFITS- The term `mental
health benefits' means benefits with respect to services for mental
health conditions, as defined under the terms of the plan and in
accordance with applicable Federal and State law.
`(5) SUBSTANCE USE DISORDER BENEFITS- The term
`substance use disorder benefits' means benefits with respect to
services for substance use disorders, as defined under the terms of the
plan and in accordance with applicable Federal and State law.';
(5) by striking subsection (f);
(6) by inserting after subsection (e) the following:
`(f) Secretary Report- The Secretary shall, by January
1, 2012, and every two years thereafter, submit to the appropriate
committees of Congress a report on compliance of group health plans
(and health insurance coverage offered in connection with such plans)
with the requirements of this section. Such report shall include the
results of any surveys or audits on compliance of group health plans
(and health insurance coverage offered in connection with such plans)
with such requirements and an analysis of the reasons for any failures
to comply.
`(g) Notice and Assistance- The Secretary, in
cooperation with the Secretaries of Health and Human Services and
Treasury, as appropriate, shall publish and widely disseminate guidance
and information for group health plans, participants and beneficiaries,
applicable State and local regulatory bodies, and the National
Association of Insurance Commissioners concerning the requirements of
this section and shall provide assistance concerning such requirements
and the continued operation of applicable State law. Such guidance and
information shall inform participants and beneficiaries of how they may
obtain assistance under this section, including, where appropriate,
assistance from State consumer and insurance agencies.';
(7) by striking `mental health benefits' and
inserting `mental health and substance use disorder benefits' each
place it appears in subsections (a)(1)(B)(i), (a)(1)(C), (a)(2)(B)(i),
and (a)(2)(C); and
(8) by striking `mental health benefits' and
inserting `mental health or substance use disorder benefits' each place
it appears (other than in any provision amended by the previous
paragraph).
(b) Amendments to Public
Health Service Act- Section 2705 of the
Public Health Service Act (42 U.S.C. 300gg-5) is amended--
(1) in subsection (a), by adding at the end the following:
`(3) FINANCIAL REQUIREMENTS AND TREATMENT LIMITATIONS-
`(A) IN GENERAL- 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, such plan or coverage shall
ensure that--
`(i) the financial requirements applicable
to such mental health or substance use disorder benefits are no more
restrictive than the predominant financial requirements applied to
substantially all medical and surgical benefits covered by the plan (or
coverage), and there are no separate cost sharing requirements that are
applicable only with respect to mental health or substance use disorder
benefits; and
`(ii) the treatment limitations applicable
to such mental health or substance use disorder benefits are no more
restrictive than the predominant treatment limitations applied to
substantially all medical and surgical benefits covered by the plan (or
coverage) and there are no separate treatment limitations that are
applicable only with respect to mental health or substance use disorder
benefits.
`(B) DEFINITIONS- In this paragraph:
`(i) FINANCIAL REQUIREMENT- The term
`financial requirement' includes deductibles, copayments, coinsurance,
and out-of-pocket expenses, but excludes an aggregate lifetime limit
and an annual limit subject to paragraphs (1) and (2).
`(ii) PREDOMINANT- A financial requirement
or treatment limit is considered to be predominant if it is the most
common or frequent of such type of limit or requirement.
`(iii) TREATMENT LIMITATION- The term
`treatment limitation' includes limits on the frequency of treatment,
number of visits, days of coverage, or other similar limits on the
scope or duration of treatment.
`(4) AVAILABILITY OF PLAN INFORMATION- The criteria
for medical necessity determinations made under the plan with respect
to mental health or substance use disorder benefits (or the health
insurance coverage offered in connection with the plan with respect to
such benefits) shall be made available by the plan administrator (or
the health insurance issuer offering such coverage) in accordance with
regulations to any current or potential participant, beneficiary, or
contracting provider upon request. The reason for any denial under the
plan (or coverage) of reimbursement or payment for services with
respect to mental health or substance use disorder benefits in the case
of any participant or beneficiary shall, on request or as otherwise
required, be made available by the plan administrator (or the health
insurance issuer offering such coverage) to the participant or
beneficiary in accordance with regulations.
`(5) OUT-OF-NETWORK PROVIDERS- In the case of a
plan or coverage that provides both medical and surgical benefits and
mental health or substance use disorder benefits, if the plan or
coverage provides coverage for medical or surgical benefits provided by
out-of-network providers, the plan or coverage shall provide coverage
for mental health or substance use disorder benefits provided by
out-of-network providers in a manner that is consistent with the
requirements of this section.';
(2) in subsection (b), by amending paragraph (2) to read as
follows:
`(2) in the case of a group health plan (or health
insurance coverage offered in connection with such a plan) that
provides mental health or substance use disorder benefits, as affecting
the terms and conditions of the plan or coverage relating to such
benefits under the plan or coverage, except as provided in subsection
(a).';
(A) in paragraph (1), by inserting before the
period the following: `(as defined in section 2791(e)(4), except that
for purposes of this paragraph such term shall include employers with 1
employee in the case of an employer residing in a State that permits
small groups to include a single individual)'; and
(B) by striking paragraph (2) and inserting the following:
`(A) IN GENERAL- With respect to a group health
plan (or health insurance coverage offered in connection with such a
plan), if the application of this section to such plan (or coverage)
results in an increase for the plan year involved of the actual total
costs of coverage with respect to medical and surgical benefits and
mental health and substance use disorder benefits under the plan (as
determined and certified under subparagraph (C)) by an amount that
exceeds the applicable percentage described in subparagraph (B) of the
actual total plan costs, the provisions of this section shall not apply
to such plan (or coverage) during the following plan year, and such
exemption shall apply to the plan (or coverage) for 1 plan year. An
employer may elect to continue to apply mental health and substance use
disorder parity pursuant to this section with respect to the group
health plan (or coverage) involved regardless of any increase in total
costs.
`(B) APPLICABLE PERCENTAGE- With respect to a
plan (or coverage), the applicable percentage described in this
subparagraph shall be--
`(i) 2 percent in the case of the first plan year in which
this section is applied; and
`(ii) 1 percent in the case of each subsequent plan year.
`(C) DETERMINATIONS BY ACTUARIES-
Determinations as to increases in actual costs under a plan (or
coverage) for purposes of this section shall be made and certified by a
qualified and licensed actuary who is a member in good standing of the
American Academy of Actuaries. All such determinations shall be in a
written report prepared by the actuary. The report, and all underlying
documentation relied upon by the actuary, shall be maintained by the
group health plan or health insurance issuer for a period of 6 years
following the notification made under subparagraph (E).
`(D) 6-month DETERMINATIONS- If a group health
plan (or a health insurance issuer offering coverage in connection with
a group health plan) seeks an exemption under this paragraph,
determinations under subparagraph (A) shall be made after such plan (or
coverage) has complied with this section for the first 6 months of the
plan year involved.
`(i) IN GENERAL- A group health plan (or a
health insurance issuer offering coverage in connection with a group
health plan) that, based upon a certification described under
subparagraph (C), qualifies for an exemption under this paragraph, and
elects to implement the exemption, shall promptly notify the Secretary,
the appropriate State agencies, and participants and beneficiaries in
the plan of such election.
`(ii) REQUIREMENT- A notification to the Secretary under
clause (i) shall include--
`(I) a description of the number of
covered lives under the plan (or coverage) involved at the time of the
notification, and as applicable, at the time of any prior election of
the cost-exemption under this paragraph by such plan (or coverage);
`(II) for both the plan year upon which
a cost exemption is sought and the year prior, a description of the
actual total costs of coverage with respect to medical and surgical
benefits and mental health and substance use disorder benefits under
the plan; and
`(III) for both the plan year upon
which a cost exemption is sought and the year prior, the actual total
costs of coverage with respect to mental health and substance use
disorder benefits under the plan.
`(iii) CONFIDENTIALITY- A notification to the Secretary under
clause (i) shall be confidential.
All such determinations shall be in a written report prepared by the
actuary. The report, and all underlying documentation relied upon by
the actuary, shall be maintained by the group health plan or health
insurance issuer for a period of 6 years following the notification
made under subparagraph (E).
`(D) 6-month DETERMINATIONS- If a group
health plan (or a health insurance issuer offering coverage in
connection with a group health plan) seeks an exemption under this
paragraph, determinations under subparagraph (A) shall be made after
such plan (or coverage) has complied with this section for the first 6
months of the plan year involved.
`(i) IN GENERAL- A group health plan (or a
health insurance issuer offering coverage in connection with a group
health plan) that, based upon a certification described under
subparagraph (C), qualifies for an exemption under this paragraph, and
elects to implement the exemption, shall promptly notify the Secretary,
the appropriate State agencies, and participants and beneficiaries in
the plan of such election.
`(ii) REQUIREMENT- A notification to the Secretary under
clause (i) shall include--
`(I) a description of the number of
covered lives under the plan (or coverage) involved at the time of the
notification, and as applicable, at the time of any prior election of
the cost-exemption under this paragraph by such plan (or coverage);
`(II) for both the plan year upon which
a cost exemption is sought and the year prior, a description of the
actual total costs of coverage with respect to medical and surgical
benefits and mental health and substance use disorder benefits under
the plan; and
`(III) for both the plan year upon
which a cost exemption is sought and the year prior, the actual total
costs of coverage with respect to mental health and substance use
disorder benefits under the plan.
`(iii) CONFIDENTIALITY- A notification to
the Secretary under clause (i) shall be confidential. The Secretary
shall make available, upon request and on not more than an annual
basis, an anonymous itemization of such notifications, that includes--
`(I) a breakdown of States by the size and type of
employers submitting such notification; and
`(II) a summary of the data received under clause (ii).
`(F) AUDITS BY APPROPRIATE AGENCIES- To
determine compliance with this paragraph, the Secretary may audit the
books and records of a group health plan or health insurance issuer
relating to an exemption, including any actuarial reports prepared
pursuant to subparagraph (C), during the 6 year period following the
notification of such exemption under subparagraph (E). A State agency
receiving a notification under subparagraph (E) may also conduct such
an audit with respect to an exemption covered by such notification.';
(4) in subsection (e), by striking paragraph (4) and inserting
the following:
`(4) MENTAL HEALTH BENEFITS- The term `mental
health benefits' means benefits with respect to services for mental
health conditions, as defined under the terms of the plan and in
accordance with applicable Federal and State law.
`(5) SUBSTANCE USE DISORDER BENEFITS- The term
`substance use disorder benefits' means benefits with respect to
services for substance use disorders, as defined under the terms of the
plan and in accordance with applicable Federal and State law.';
(5) by striking subsection (f);
(6) by striking `mental health benefits' and
inserting `mental health and substance use disorder benefits' each
place it appears in subsections (a)(1)(B)(i), (a)(1)(C), (a)(2)(B)(i),
and (a)(2)(C); and
(7) by striking `mental health benefits' and
inserting `mental health or substance use disorder benefits' each place
it appears (other than in any provision amended by the previous
paragraph).
(c) Amendments to Internal
Revenue Code- Section 9812 of the
Internal Revenue Code of 1986 is amended--
(1) in subsection (a), by adding at the end the following:
`(3) FINANCIAL REQUIREMENTS AND TREATMENT LIMITATIONS-
`(A) IN GENERAL- In the case of a group health
plan that provides both medical and surgical benefits and mental health
or substance use disorder benefits, such plan shall ensure that--
`(i) the financial requirements applicable
to such mental health or substance use disorder benefits are no more
restrictive than the predominant financial requirements applied to
substantially all medical and surgical benefits covered by the plan,
and there are no separate cost sharing requirements that are applicable
only with respect to mental health or substance use disorder benefits;
and
`(ii) the treatment limitations applicable
to such mental health or substance use disorder benefits are no more
restrictive than the predominant treatment limitations applied to
substantially all medical and surgical benefits covered by the plan and
there are no separate treatment limitations that are applicable only
with respect to mental health or substance use disorder benefits.
`(B) DEFINITIONS- In this paragraph:
`(i) FINANCIAL REQUIREMENT- The term
`financial requirement' includes deductibles, copayments, coinsurance,
and out-of-pocket expenses, but excludes an aggregate lifetime limit
and an annual limit subject to paragraphs (1) and (2),
`(ii) PREDOMINANT- A financial requirement
or treatment limit is considered to be predominant if it is the most
common or frequent of such type of limit or requirement.
`(iii) TREATMENT LIMITATION- The term
`treatment limitation' includes limits on the frequency of treatment,
number of visits, days of coverage, or other similar limits on the
scope or duration of treatment.
`(4) AVAILABILITY OF PLAN INFORMATION- The criteria
for medical necessity determinations made under the plan with respect
to mental health or substance use disorder benefits shall be made
available by the plan administrator in accordance with regulations to
any current or potential participant, beneficiary, or contracting
provider upon request. The reason for any denial under the plan of
reimbursement or payment for services with respect to mental health or
substance use disorder benefits in the case of any participant or
beneficiary shall, on request or as otherwise required, be made
available by the plan administrator to the participant or beneficiary
in accordance with regulations.
`(5) OUT-OF-NETWORK PROVIDERS- In the case of a
plan that provides both medical and surgical benefits and mental health
or substance use disorder benefits, if the plan provides coverage for
medical or surgical benefits provided by out-of-network providers, the
plan shall provide coverage for mental health or substance use disorder
benefits provided by out-of-network providers in a manner that is
consistent with the requirements of this section.';
(2) in subsection (b), by amending paragraph (2) to read as
follows:
`(2) in the case of a group health plan that
provides mental health or substance use disorder benefits, as affecting
the terms and conditions of the plan relating to such benefits under
the plan, except as provided in subsection (a).';
(A) by amending paragraph (1) to read as follows:
`(1) SMALL EMPLOYER EXEMPTION-
`(A) IN GENERAL- This section shall not apply to any group
health plan for any plan year of a small employer.
`(B) SMALL EMPLOYER- For purposes of
subparagraph (A), the term `small employer' means, with respect to a
calendar year and a plan year, an employer who employed an average of
at least 2 (or 1 in the case of an employer residing in a State that
permits small groups to include a single individual) but not more than
50 employees on business days during the preceding calendar year. For
purposes of the preceding sentence, all persons treated as a single
employer under subsection (b), (c), (m), or (o) of section 414 shall be
treated as 1 employer and rules similar to rules of subparagraphs (B)
and (C) of section 4980D(d)(2) shall apply.'; and
(B) by striking paragraph (2) and inserting the following:
`(A) IN GENERAL- With respect to a group health
plan, if the application of this section to such plan results in an
increase for the plan year involved of the actual total costs of
coverage with respect to medical and surgical benefits and mental
health and substance use disorder benefits under the plan (as
determined and certified under subparagraph (C)) by an amount that
exceeds the applicable percentage described in subparagraph (B) of the
actual total plan costs, the provisions of this section shall not apply
to such plan during the following plan year, and such exemption shall
apply to the plan for 1 plan year. An employer may elect to continue to
apply mental health and substance use disorder parity pursuant to this
section with respect to the group health plan involved regardless of
any increase in total costs.
`(B) APPLICABLE PERCENTAGE- With respect to a plan, the
applicable percentage described in this subparagraph shall be--
`(i) 2 percent in the case of the first plan year in which
this section is applied; and
`(ii) 1 percent in the case of each subsequent plan year.
`(C) DETERMINATIONS BY ACTUARIES-
Determinations as to increases in actual costs under a plan for
purposes of this section shall be made and certified by a qualified and
licensed actuary who is a member in good standing of the American
Academy of Actuaries. All such determinations shall be in a written
report prepared by the actuary. The report, and all underlying
documentation relied upon by the actuary, shall be maintained by the
group health plan for a period of 6 years following the notification
made under subparagraph (E).
`(D) 6-month DETERMINATIONS- If a group health
plan seeks an exemption under this paragraph, determinations under
subparagraph (A) shall be made after such plan has complied with this
section for the first 6 months of the plan year involved.
`(i) IN GENERAL- A group health plan that,
based upon a certification described under subparagraph (C), qualifies
for an exemption under this paragraph, and elects to implement the
exemption, shall promptly notify the Secretary, the appropriate State
agencies, and participants and beneficiaries in the plan of such
election.
`(ii) REQUIREMENT- A notification to the Secretary under
clause (i) shall include--
`(I) a description of the number of
covered lives under the plan involved at the time of the notification,
and as applicable, at the time of any prior election of the
cost-exemption under this paragraph by such plan;
`(II) for both the plan year upon which
a cost exemption is sought and the year prior, a description of the
actual total costs of coverage with respect to medical and surgical
benefits and mental health and substance use disorder benefits under
the plan; and
`(III) for both the plan year upon
which a cost exemption is sought and the year prior, the actual total
costs of coverage with respect to mental health and substance use
disorder benefits under the plan.
`(iii) CONFIDENTIALITY- A notification to
the Secretary under clause (i) shall be confidential. The Secretary
shall make available, upon request and on not more than an annual
basis, an anonymous itemization of such notifications, that includes--
`(I) a breakdown of States by the size and type of
employers submitting such notification; and
`(II) a summary of the data received under clause (ii).
`(F) AUDITS BY APPROPRIATE AGENCIES- To
determine compliance with this paragraph, the Secretary may audit the
books and records of a group health plan relating to an exemption,
including any actuarial reports prepared pursuant to subparagraph (C),
during the 6 year period following the notification of such exemption
under subparagraph (E). A State agency receiving a notification under
subparagraph (E) may also conduct such an audit with respect to an
exemption covered by such notification.';
(4) in subsection (e), by striking paragraph (4) and inserting
the following:
`(4) MENTAL HEALTH BENEFITS- The term `mental
health benefits' means benefits with respect to services for mental
health conditions, as defined under the terms of the plan and in
accordance with applicable Federal and State law.
`(5) SUBSTANCE USE DISORDER BENEFITS- The term
`substance use disorder benefits' means benefits with respect to
services for substance use disorders, as defined under the terms of the
plan and in accordance with applicable Federal and State law.';
(5) by striking subsection (f);
(6) by striking `mental health benefits' and
inserting `mental health and substance use disorder benefits' each
place it appears in subsections (a)(1)(B)(i), (a)(1)(C), (a)(2)(B)(i),
and (a)(2)(C); and
(7) by striking `mental health benefits' and
inserting `mental health or substance use disorder benefits' each place
it appears (other than in any provision amended by the previous
paragraph).
(d) Regulations- Not later than 1 year after the date
of enactment of this Act, the Secretaries of Labor, Health and Human
Services, and the Treasury shall issue regulations to carry out the
amendments made by subsections (a), (b), and (c), respectively.
(1) IN GENERAL- The amendments made by this section
shall apply with respect to group health plans for plan years beginning
after the date that is 1 year after the date of enactment of this Act,
regardless of whether regulations have been issued to carry out such
amendments by such effective date, except that the amendments made by
subsections (a)(5), (b)(5), and (c)(5), relating to striking of certain
sunset provisions, shall take effect on January 1, 2009.
(2) SPECIAL RULE FOR COLLECTIVE BARGAINING
AGREEMENTS- In the case of a group health plan maintained pursuant to
one or more collective bargaining agreements between employee
representatives and one or more employers ratified before the date of
the enactment of this Act, the amendments made by this section shall
not apply to plan years beginning before the later of--
(A) the date on which the last of the
collective bargaining agreements relating to the plan terminates
(determined without regard to any extension thereof agreed to after the
date of the enactment of this Act), or
For purposes of subparagraph (A), any plan amendment
made pursuant to a collective bargaining agreement relating to the plan
which amends the plan solely to conform to any requirement added by
this section shall not be treated as a termination of such collective
bargaining agreement.
(f) Assuring Coordination- The Secretary of Health and
Human Services, the Secretary of Labor, and the Secretary of the
Treasury may ensure, through the execution or revision of an
interagency memorandum of understanding among such Secretaries, that--
(1) regulations, rulings, and interpretations
issued by such Secretaries relating to the same matter over which two
or more such Secretaries have responsibility under this section (and
the amendments made by this section) are administered so as to have the
same effect at all times; and
(2) coordination of policies relating to enforcing
the same requirements through such Secretaries in order to have a
coordinated enforcement strategy that avoids duplication of enforcement
efforts and assigns priorities in enforcement.
(g) Conforming Clerical Amendments-
(A) IN GENERAL- The heading of section 712 of
the Employee Retirement Income Security Act of 1974 is amended to read
as follows:
`SEC. 712. PARITY IN MENTAL HEALTH AND SUBSTANCE USE DISORDER
BENEFITS.'.
(B) CLERICAL AMENDMENT- The table of contents
in section 1 of such Act is amended by striking the item relating to
section 712 and inserting the following new item:
`Sec. 712. Parity in mental health and substance use disorder
benefits.'.
(2) PHSA HEADING- The heading of section 2705 of the Public
Health Service Act is amended to read as follows:
`SEC. 2705. PARITY IN MENTAL HEALTH AND SUBSTANCE USE DISORDER
BENEFITS.'.
(A) IN GENERAL- The heading of section 9812 of the Internal
Revenue Code of 1986 is amended to read as follows:
`SEC. 9812. PARITY IN MENTAL HEALTH AND SUBSTANCE USE DISORDER
BENEFITS.'.
(B) CLERICAL AMENDMENT- The table of sections
for subchapter B of chapter 100 of such Code is amended by striking the
item relating to section 9812 and inserting the following new item:
`Sec. 9812. Parity in mental health and substance use disorder
benefits.'.
(h) GAO Study on Coverage and Exclusion of Mental Health and
Substance Use Disorder Diagnoses-
(1) IN GENERAL- The Comptroller General of the
United States shall conduct a study that analyzes the specific rates,
patterns, and trends in coverage and exclusion of specific mental
health and substance use disorder diagnoses by health plans and health
insurance.
The study shall include an analysis of--
(A) specific coverage rates for all mental health conditions
and substance use disorders;
(B) which diagnoses are most commonly covered or excluded;
(C) whether implementation of this Act has affected trends
in coverage or exclusion of such diagnoses; and
(D) the impact of covering or excluding
specific diagnoses on participants' and enrollees' health, their health
care coverage, and the costs of delivering health care.
(2) REPORTS- Not later than 3 years after the date
of the enactment of this Act, and 2 years after the date of submission
the first report under this paragraph, the Comptroller General shall
submit to Congress a report on the results of the study conducted under
paragraph (1).
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