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Code · BILL · 116th Congress · S. 1895 (Reported in Senate) — To lower health care costs. · Sec. 310

Sec. 310. Strengthening parity in mental health and substance use disorder benefits

1,037 words·~5 min read·/bill/116/s/1895/rs/section-310·

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Section 2726 of the Public Health Service Act ( 42 U.S.C. 300gg–26 ) is amended— in subsection (a), by adding at the end the following: In the case of a group health plan or a health insurance issuer offering group or individual health insurance coverage that provides both medical and surgical benefits and mental health or substance use disorder benefits, the plan or coverage shall perform comparative analyses about the design and application of nonquantitative treatment limitations (referred to in this paragraph as the NQTL ) in accordance with the following process, and make available to the Secretary upon request within 60 days beginning January 1, 2020, and within 30 days beginning January 1, 2021, the following information:
The specific plan or coverage language regarding the NQTL, that applies to such plan or coverage, and a description of all mental health or substance use disorder and medical/surgical services to which it applies in each respective benefits classification. The factors used to determine that an NQTL will apply to mental health or substance use disorder benefits and medical/surgical benefits. The evidentiary standard (both identified and deidentified) for the factors identified in clause
(ii)and any other evidence relied upon to design and apply the NQTL to mental health or substance use disorder benefits and medical/surgical benefits. The comparative analyses demonstrating that the processes and strategies used to design the NQTL, as written and in operation, and the as written processes and strategies used to apply the NQTL for mental health or substance use disorder benefits are comparable to, and are applied no more stringently than, the processes and strategies used to design the NQTL, as written and in operation, and the as written processes and strategies used to apply the NQTL to medical/surgical benefits. A disclosure of the specific findings and conclusions reached by the plan or coverage that the results of the analyses described in this subparagraph indicate that the plan or coverage is in compliance with this section. The Secretary shall request that a group health plan or a health insurance issuer offering group or individual health insurance coverage submit the comparative analyses described in subparagraph
(A)if the Secretary has received any complaints from plan participants or participating providers about such a plan or coverage that involve mental health or substance use disorder benefits. The Secretary shall request the comparative analyses described in subparagraph
(A)from no fewer than 50 plans or coverages selected at random, annually, and such plans or coverages shall not— be the same plans or coverages for which the comparative analyses are requested under clause (i); be the same plan or coverage being investigated by the Department regarding NQTLs or that has been investigated by the Department regarding NQTLs within the last 5 years; and be the same plan or coverage that has been selected under clause
(i)or
(ii)within the last 5 years. In instances in which the Secretary has concluded that the plan or coverage has not submitted sufficient information for the Secretary to review the comparative analyses described in subparagraph (A), as requested under clauses
(i)and (ii), the Secretary shall specify to the plan or coverage the information the plan or coverage must submit to be responsive to the request under clauses
(i)and
(ii)for the Secretary to review the comparative analyses described in subparagraph
(A)for compliance with this section. In instances in which the Secretary has reviewed the comparative analyses described in subparagraph (A), as requested under clauses
(i)and (ii), and determined that the plan or coverage is not in compliance with this section, the Secretary shall specify to the plan or coverage the actions the plan or coverage must take to be in compliance with this section. Documents or communications produced in connection with the Secretary’s recommendations to the plan or coverage shall not be subject to disclosure pursuant to section 552 of title 5, United States Code. Not later than 1 year after the date of enactment of this paragraph, and annually thereafter, the Secretary shall submit to the Committee on Education and Labor of the House of Representatives and the Committee on Health, Education, Labor, and Pensions of the Senate a report that contains— each of the comparative analyses requested under clauses
(i)and (ii), except that the identity of each plan or coverage and any contracted entity of a plan or coverage shall be redacted; the Secretary’s conclusions as to whether each plan or coverage submitted sufficient information for the Secretary to review the comparative analyses requested under clauses
(i)and
(ii)for compliance with this section; for each plan or coverage that did submit sufficient information for the Secretary to review the comparative analyses requested under clause (i), the Secretary’s conclusions as to whether and why the plan or coverage is in compliance with this section; the Secretary’s specifications described in clause
(iii)for each plan or coverage that the Secretary determined did not submit sufficient information for the Secretary to review the comparative analyses requested under clauses
(i)and
(ii)for compliance with this section; and the Secretary’s specifications described in clause
(iv)of the actions each plan or coverage that the Secretary determined is not in compliance with this section must take to be in compliance with this section, including the reason why the Secretary determined the plan or coverage is not in compliance. The Secretary shall include select instances of noncompliance that the Secretary discovers upon reviewing the comparative analyses requested under clauses
(i)and
(ii)of subparagraph
(B)in the compliance program guidance document described in section 2726(a)(6), as it is updated every 2 years, except that all instances shall be deidentified and such instances shall not disclose any protected health information or individually identifiable information. Not later than 18 months after the date of enactment of this paragraph, the Secretary shall finalize any draft or interim guidance and regulations relating to mental health parity under this section. Any instances of noncompliance the Secretary discovers upon reviewing the comparative analyses requested under clauses
(i)and
(ii)of subparagraph
(B)shall be shared with a State for coverage offered by a health insurance issuer in the group market, in accordance with section 2726(a)(6)(B)(iii)(II). .
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  • 42 USC 300gg–26
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Sec. 310
Strengthening parity in mental health and substance use disorder benefits
Cite42 USC 300gg–26
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