Sec. 4. Strengthening mental health and substance use disorder parity requirements
2,240 words·~10 min read·
/bill/117/s/5093/is/section-4A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Section 2726(a) of the Public Health Service Act ( 42 U.S.C. 300gg–26(a) ) is amended by adding at the end the following: The Secretary, the Secretary of Labor, and the Secretary of the Treasury shall issue regulations establishing national quantitative standards for mental health and substance use disorder network adequacy. Such standards shall consider— the ratio of in-network mental health providers, separated by professional type of mental health provider, to participants, beneficiaries, and enrollees in a group health plan or health insurance coverage; the ratio of in-network substance use disorder providers, separated by professional type of substance use disorder provider, to participants, beneficiaries, and enrollees in a group health plan or health insurance coverage; separately, for each of mental health services and substance use disorder services— geographic accessibility of providers; geographic variation and population dispersion; waiting times for appointments with participating providers; hours of operation for participating providers; the ability of the network to meet the needs of participants, beneficiaries, and enrollees, including low-income individuals, individuals who are members of a racial or ethnic minority, individuals who live in a health professional shortage area, children and adults with serious, chronic, and complex health conditions, individuals with physical or mental disabilities or substance use disorders, pediatric populations, and individuals with limited English proficiency; the availability of in-person services, telehealth services, and hybrid services to serve the needs of participants, beneficiaries, and enrollees; and the percentage of in-network providers who have submitted a claim for payment during the previous 6 months; and other standards as determined by the Secretary, the Secretary of Labor, and the Secretary of the Treasury.
The Secretary, the Secretary of Labor, and the Secretary of the Treasury shall— issue proposed regulations required under subparagraph
(A)not later than 2 years after the date of enactment of the Behavioral Health Network and Directory Improvement Act ; and issue final regulations under subparagraph
(A)not later than 1 year thereafter. The regulations promulgated under this paragraph shall take effect in the first plan year that begins after the date on which such final regulations are issued. The Secretary, the Secretary of Labor, and the Secretary of the Treasury shall conduct annual, targeted audits of not fewer than 10 group health plans and health insurance issuers offering group or individual health insurance coverage that the Secretaries determine to be the subject of the greatest number of complaints about mental health and substance use disorder network adequacy to ensure compliance with the requirements of this paragraph. Such audits shall begin not earlier than one year after the final regulations implementing this paragraph begin to apply to group health plans and health insurance issuers. . Paragraphs
(4)and
(5)of section 2726(e) of the Public Health Service Act ( 42 U.S.C. 300gg–26(e) ) are amended to read as follows: The term mental health benefits means benefits with respect to services related to a mental health condition, defined consistently with generally recognized independent standards of current medical practice, such as the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association. The term substance use disorder benefits means benefits with respect to services related to a substance use disorder, defined consistently with generally recognized independent standards of current medical practice, such as the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association. . Section 2726(a) of the Public Health Service Act ( 42 U.S.C. 300gg–26(a) ), as amended by paragraph (1), is further amended by adding at the end the following: Not later than 2 years after the date of enactment of the Behavioral Health Network and Directory Improvement Act , the Secretary, the Secretary of Labor, and the Secretary of the Treasury shall issue regulations on a standard for parity in reimbursement rates for mental health or substance use disorder benefits and medical and surgical benefits, based on a comparative analysis conducted by such Secretaries using data submitted by group health plans and health insurance issuers, provider associations, and other experts related to the cost of care delivery for mental health and substance use disorder benefits. Group health plans and health insurance issuers shall comply with any request for data issued by the Secretary, the Secretary of Labor, and the Secretary of the Treasury for purposes of developing the standards under subparagraph (A). The regulations promulgated under subparagraph
(A)shall apply to group health plans and health insurance issuers offering group or individual health insurance coverage beginning in the first plan year that begins after issuance of the final regulations. . Section 712(a) of the Employee Retirement Income Security Act of 1974 ( 29 U.S.C. 1185a(a) ) is amended by adding at the end the following: The Secretary, the Secretary of Health and Human Services, and the Secretary of the Treasury shall issue regulations establishing national quantitative standards for mental health and substance use disorder network adequacy. Such standards shall consider— the ratio of in-network mental health providers, separated by professional type of mental health provider, to participants, beneficiaries, and enrollees in a group health plan or health insurance coverage; the ratio of in-network substance use disorder providers, separated by professional type of substance use disorder provider, to participants, beneficiaries, and enrollees in a group health plan or health insurance coverage; separately, for each of mental health services and substance use disorder services— geographic accessibility of providers; geographic variation and population dispersion; waiting times for appointments with participating providers; hours of operation for participating providers; the ability of the network to meet the needs of participants, beneficiaries, and enrollees, including low-income individuals, individuals who are members of a racial or ethnic minority, individuals who live in a health professional shortage area, children and adults with serious, chronic, and complex health conditions, individuals with physical or mental disabilities or substance use disorders, pediatric populations, and individuals with limited English proficiency; the availability of in-person services, telehealth services, and hybrid services to serve the needs of participants, beneficiaries, and enrollees; and the percentage of in-network providers who have submitted a claim for payment during the previous 6 months; and other standards as determined by the Secretary, the Secretary of Health and Human Services, and the Secretary of the Treasury. The Secretary, the Secretary of Health and Human Services, and the Secretary of the Treasury shall— issue proposed regulations required under subparagraph
(A)not later than 2 years after the date of enactment of the Behavioral Health Network and Directory Improvement Act ; and issue final regulations under subparagraph
(A)not later than 1 year thereafter. The regulations promulgated under this paragraph shall take effect in the first plan year that begins after the date on which such final regulations are issued. The Secretary, the Secretary of Health and Human Services, and the Secretary of the Treasury shall conduct annual, targeted audits of not fewer than 10 group health plans and health insurance issuers offering group health insurance coverage that the Secretaries determine to be the subject of the greatest number of complaints about mental health and substance use disorder network adequacy to ensure compliance with the requirements of this paragraph. Such audits shall begin not earlier than one year after the final regulations implementing this paragraph begin to apply to group health plans and health insurance issuers. . Paragraphs
(4)and
(5)of section 712(e) of the Employee Retirement Income Security Act of 1974 ( 29 U.S.C. 1185a(e) ) are amended to read as follows: The term mental health benefits means benefits with respect to services related to a mental health condition, defined consistently with generally recognized independent standards of current medical practice, such as the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association. The term substance use disorder benefits means benefits with respect to services related to a substance use disorder, defined consistently with generally recognized independent standards of current medical practice, such as the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association. . Section 712(a) of the Employee Retirement Income Security Act of 1974 ( 29 U.S.C. 1185a(a) ), as amended by paragraph (1), is further amended by adding at the end the following: Not later than 2 years after the date of enactment of the Behavioral Health Network and Directory Improvement Act , the Secretary, the Secretary of Health and Human Services, and the Secretary of the Treasury shall issue regulations on a standard for parity in reimbursement rates for mental health or substance use disorder benefits and medical and surgical benefits, based on a comparative analysis conducted by such Secretaries using data submitted by group health plans and health insurance issuers, provider associations, and other experts related to the cost of care delivery for mental health and substance use disorder benefits. Group health plans and health insurance issuers shall comply with any request for data issued by the Secretary, the Secretary of Health and Human Services, and the Secretary of the Treasury for purposes of developing the standards under subparagraph (A). The regulations promulgated under subparagraph
(A)shall apply to group health plans and health insurance issuers offering group health insurance coverage beginning in the first plan year that begins after issuance of the final regulations. . Section 9812(a) of the Internal Revenue Code of 1986 is amended by adding at the end the following: The Secretary, the Secretary of Health and Human Services, and the Secretary of Labor shall issue regulations establishing national quantitative standards for mental health and substance use disorder network adequacy. Such standards shall consider— the ratio of in-network mental health providers, separated by professional type of mental health provider, to participants, beneficiaries, and enrollees in a group health plan; the ratio of in-network substance use disorder providers, separated by professional type of substance use disorder provider, to participants, beneficiaries, and enrollees in a group health plan; separately, for each of mental health services and substance use disorder services— geographic accessibility of providers; geographic variation and population dispersion; waiting times for appointments with participating providers; hours of operation for participating providers; the ability of the network to meet the needs of participants, beneficiaries, and enrollees, including low-income individuals, individuals who are members of a racial or ethnic minority, individuals who live in a health professional shortage area, children and adults with serious, chronic, and complex health conditions, individuals with physical or mental disabilities or substance use disorders, pediatric populations, and individuals with limited English proficiency; the availability of in-person services, telehealth services, and hybrid services to serve the needs of participants, beneficiaries, and enrollees; and the percentage of in-network providers who have submitted a claim for payment during the previous 6 months; and other standards as determined by the Secretary, the Secretary of Health and Human Services, and the Secretary of Labor. The Secretary, the Secretary of Health and Human Services, and the Secretary of Labor shall— issue proposed regulations required under subparagraph
(A)not later than 2 years after the date of enactment of the Behavioral Health Network and Directory Improvement Act ; and issue final regulations under subparagraph
(A)not later than 1 year thereafter. The regulations promulgated under this paragraph shall take effect in the first plan year that begins after the date on which such final regulations are issued. The Secretary, the Secretary of Health and Human Services, and the Secretary of Labor shall conduct annual, targeted audits of not fewer than 10 group health plans that the Secretaries determine to be the subject of the greatest number of complaints about mental health and substance use disorder network adequacy to ensure compliance with the requirements of this paragraph. Such audits shall begin not earlier than one year after the final regulations implementing this paragraph begin to apply to group health plans. . Paragraphs
(4)and
(5)of section 9812(e) of the Internal Revenue Code of 1986 are amended to read as follows: The term mental health benefits means benefits with respect to services related to a mental health condition, defined consistently with generally recognized independent standards of current medical practice, such as the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association. The term substance use disorder benefits means benefits with respect to services related to a substance use disorder, defined consistently with generally recognized independent standards of current medical practice, such as the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association. . Section 9812(a) of the Internal Revenue Code of 1986, as amended by paragraph (1), is further amended by adding at the end the following: Not later than 2 years after the date of enactment of the Behavioral Health Network and Directory Improvement Act , the Secretary, the Secretary of Health and Human Services, and the Secretary of Labor shall issue regulations on a standard for parity in reimbursement rates for mental health or substance use disorder benefits and medical and surgical benefits, based on a comparative analysis conducted by such Secretaries using data submitted by group health plans, provider associations, and other experts related to the cost of care delivery for mental health and substance use disorder benefits. Group health plans shall comply with any request for data issued by the Secretary, the Secretary of Health and Human Services, and the Secretary of Labor for purposes of developing the standards under subparagraph (A). The regulations promulgated under subparagraph
(A)shall apply to group health plans beginning in the first plan year that begins after issuance of the final regulations. .
Connectionstraces to 1
Traces to 1 document
2 references not yet in our index
- 42 USC 300gg–26(a)
- 42 USC 300gg–26(e)
Citation graph
cites case law
Sec. 4
Strengthening mental health and substance use disorder parity requirements
Cite42 USC 300gg–26(a)
Cite42 USC 300gg–26(e)
Cites 3Cited by 0 across 0 sources