,,ii  #aad? ,,congress  #b;d ,session   
,s4 #bfdg  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,m>* #g1 #bjaf ,ms4    
,w>r5 7= h]self1 ,mr4 ,br[n1 ,mr4       
,frank51 ,mr4 ,blum5?al1 & ,ms4 ,baldw97
 introduc$ ! foll[+ bill2 :i* 0 read    
twice & ref]r$ to ! ,committee on       
,heal?1 ,education1 ,labor1 & ,p5sions  
,a ,,bill  ,to /r5g!n p>ity 9 m5tal     
heal? & sub/ance use disord] b5efits4   
#a4 ,%ort title ,?is ,act may be cit$ z 
! ,behavioral ,heal? ,cov]age           
,transp>5cy ,act ( #bjaf4  #b4 ,/r5g!n+ 
p>ity 9 m5tal heal? & sub/ance use      
disord] b5efits  7a7 ,public ,heal?     
,s]vice ,act ,section #bgbf ( ! ,public 
,heal? ,s]vice ,act 7#db ,u4,s4,c4      
#cjj;gg-#bf7 is am5d$--  7#a7 9         
subsection 7a71 by add+ at ! end !      
foll[+3  7#f7 ,disclosure & en=cem5t    
requirem5ts  7,a7 ,disclosure           
requirem5ts  7i7 ,regulations ,n lat]   
?an ,septemb] #cj1 #bjaf1 ! ,secret>y1 9
 coop]ation ) ! ,secret>ies ( ,labor & !
 ,treasury1 z appropriate1 %all issue   

additional regulations = c>ry+ out ?is  
section1 includ+ an explanation (       
docum5ts t mu/ be disclos$ by gr\p heal?
 plans or heal? insurance issu]s (f]+   
gr\p or individual heal? insurance      
cov]age1 ! process gov]n+ ! disclosure (
 su* docum5ts1 & analyses t mu/ be      
conduct$ by su* plans & issu]s to comply
 ) ?is section4  7ii7 ,requirem5ts ,a   
gr\p heal? plan or a heal? insurance    
issu] (f]+ gr\p or individual heal?     
insurance cov]age %all disclose to !    
,secret>y 9 a /&>diz$ =mat docum5ts t   
include--  7,i7 ! specific analyses     
p]=m$ to ensure compliance ) ?is section
 & any regulations promulgat$ pursuant  
to ?is section2  7,,ii7 a description ( 
! application ( non-quantitative        
treatm5t limitations 79 ?is p>agraph    
ref]r$ to z ,n,q,t,ls7 to b5efits (f]$  
by su* plan or issu]1 includ+--  7aa7 ! 
specific factors ! plan or issu] us$ 9  
p]=m+ its ,n,q,t,ls analysis2  7bb7 !   
specific evid5ti>y /&>ds reli$ on to    
evaluate su* factors2  7cc7 h[ !        

evid5ti>y /&>ds are appli$ to ea* s]vice
 category = m5tal heal?1 sub/ance use   
disord]s1 m$ical b5efits1 & surgical    
b5efits2  7dd7 a disclosure ( ! results 
( ! analyses ( ! specific evid5ti>y     
/&>ds 9 ea* s]vice category2 &  7ee7 a  
disclosure ( ! specific f9d+s ( su* plan
 or issu] 9 ea* s]vice category & !     
conclusions rea*$ ) respect to :e!r !   
processes1 /rategies1 evid5ti>y /&>ds1  
or o!r factors us$ 9 apply+ ,n,q,t,ls to
 m5tal heal? or sub/ance use disord]    
b5efits are comp>able to1 & appli$ no m 
/r+5tly ?an1 ! processes1 /rategies1    
evid5ti>y /&>ds1 or o!r factors us$ 9   
apply+ ,n,q,t,ls ) respect to m$ical &  
surgical b5efits 9 ! same               
classification2 &  7,,iii7 ! rates ( &  
reasons = d5ial by ! plan or issu] =    
outpati5t & inpati5t m5tal heal? &      
sub/ance use disord] s]vices comp>$ to !
 rates ( & reasons = d5ial ( claims =   
m$ical & surgical s]vices4  7iii7       
,guidance ,! ,secret>y1 9 coop]ation ) !
 ,secret>ies ( ,labor & ! ,treasury1 z  

appropriate1 %all issue guidance to gr\p
 heal? plans or heal? insurance issu]s  
(f]+ gr\p or individual heal? insurance 
cov]age on h[ to satisfy ! requirem5ts (
 ?is section ) respect to mak+ in=mation
 available to curr5t & pot5tial         
p>ticipants & b5efici>ies4 ,su*         
in=mation %all include c]tificate (     
cov]age docum5ts & in/rum5ts "u :i* !   
plan or cov]age involv$ is adm9i/]$ &   
op]at$ t specify1 include1 or ref] to   
proc$ures1 =mulas1 & me?odologies appli$
 to det]m9e a p>ticipant or b5efici>y's 
b5efit "u ! plan or cov]age1 reg>dless (
 :e!r su* in=mation is conta9$ 9 a      
docum5t designat$ z ! plan docum5t4 ,su*
 guidance %all include a disclosure ( h[
 ! plan or cov]age involv$ has          
demon/rat$ t processes1 /rategies1      
evid5ti>y /&>ds1 & o!r factors us$ 9    
apply+ ,n,q,t,ls to m5tal heal? or      
sub/ance use disord] b5efits are        
comp>able to1 & appli$ no m /r+5tly ?an1
 ! processes1 /rategies1 evid5ti>y      
/&>ds1 or o!r factors us$ 9 apply+      

,n,q,t,ls ) respect to m$ical & surgical
 b5efits 9 ! same classification4  7iv7 
,def9itions ,9 ?is p>agraph1 ! t]ms     
non-quantitative treatm5t limitations1  
comp>able to1 & appli$ no m /r+5tly ?an 
h ! mean+s giv5 su* t]ms 9 p>ts #adf &  
#adg ( title #de1 ,code ( ,f$]al        
,regulations 7or any successor          
regulation74  7,b7 ,en=cem5t  7i7       
,process = compla9ts ,! ,secret>y1 9    
coop]ation ) ! ,secret>ies ( ,labor & ! 
,treasury1 z appropriate1 %all issue    
guidance to cl>ify ! process & timel9e =
 curr5t & pot5tial p>ticipants &        
b5efici>ies 7& au?oriz$ repres5tatives &
 heal? c>e provid]s ( su* p>ticipants & 
b5efici>ies7 ( gr\p heal? plans or heal?
 insurance issu]s (f]+ gr\p or          
individual heal? insurance cov]age to   
file =mal compla9ts ( su* plans or      
issu]s be+ 9 violation ( ?is section1   
includ+ guidance1 by plan type1 on !    
relevant ,/ate1 regional1 & national    
(fices1 includ+ ! consum] p>ity unit    
e/abli%$ "u p>agraph 7#g71 ) :i* su*    

compla9ts %\ld be fil$4  7ii7 ,au?ority 
= public en=cem5t ,! ,secret>y1 9       
consultation ) ! ,secret>ies ( ,labor & 
! ,treasury1 %all make available to !   
public on ! website ( ! consum] p>ity   
unit e/abli%$ "u p>agraph 7#g7 in=mation
 on audits & inve/igations ( gr\p heal? 
plans & heal? insurance issu]s conduct$ 
"u ?is section4 ,su* in=mation %all n   
conta9 any p]sonally id5tifiable        
in=mation4  7iii7 ,audits  7,i7 ,r&omiz$
 audits ,! ,secret>y1 9 coop]ation ) !  
,secret>ies ( ,labor & ! ,treasury1 may 
conduct r&omiz$ audits ( gr\p heal?     
plans or heal? insurance issu]s (f]+    
gr\p or individual heal? insurance      
cov]age to det]m9e compliance ) ?is     
section4 ,su* audits %all be conduct$ on
 n few] ?an #ab plans & issu]s p] plan  
ye>4 ,in=mation f su* audits %all be    
made pla9ly available on ! website ( !  
consum] p>ity unit e/abli%$ "u p>agraph 
7#g74  7,,ii7 ,additional audits ,9 !   
case ( a gr\p heal? plan or heal?       
insurance issu] (f]+ gr\p or individual 

heal? insurance cov]age ) respect to :i*
 any claim has be5 fil$ dur+ a plan ye>1
 ! ,secret>y may audit ! books & records
 ( su* plan or issu] to det]m9e         
compliance ) ?is section4 ,in=mation    
detail+ ! results ( ! audit %all be made
 available on ! website ( ! consum]     
p>ity unit e/abli%$ "u p>agraph 7#g74   
7#g7 ,consum] p>ity unit  7,a7 ,9 g5]al 
,! ,secret>y1 9 coop]ation ) !          
,secret>ies ( ,labor & ! ,treasury1 %all
 e/abli% a consum] p>ity unit 7ref]r$ to
 9 ?is p>agraph z ! unit7 ) functions t 
include--  7i7 develop+ & adm9i/]+ a    
s+le1 toll-free telephone numb]1 an     
,int]net website1 & a database1 or us+  
an exi/+ database1 to facilitate !      
c5traliz$ collection (1 monitor+ (1 &   
response to consum] compla9ts or        
inquiries reg>d+ violations ( ?is       
section1 section #gab ( ! ,employee     
,retirem5t ,income ,security ,act (     
#aigd or section #ihab7;a77#f7 ( !      
,int]nal ,rev5ue ,code ( #aihf2 &  7ii7 
provid+ in=mation to heal? c>e consum]s 

t is submitt$ to ! ,secret>y1 !         
,secret>y ( ,labor1 & ! ,secret>y ( !   
,treasury "u p>agraph 7#f71 section     
#gab7;a77#f7 ( ! ,employee ,retirem5t   
,income ,security ,act ( #aigd 7#bi     
,u4,s4,c4 #aahe;a7a77#f771 or section   
#ihab7;a77#f7 ( ! ,int]nal ,rev5ue ,code
 ( #aihf1 respectively4  7,b7 ,response 
to consum] compla9ts & inquiries  7i7   
,timely response to consum]s ,!         
,secret>y ( ,heal? & ,human ,s]vices1 9 
coop]ation ) ! ,secret>ies ( ,labor & ! 
,treasury1 %all e/abli% reasonable      
proc$ures to provide a timely response  
79 writ+ if appropriate7 to consum]s    
reg>d+ compla9ts receiv$ by ! unit      
aga9/1 or inquiries conc]n+1 a gr\p     
heal? plan or heal? insurance issu] (f]+
 gr\p or individual heal? insurance     
cov]age1 includ+--  7,i7 /eps t h be5   
tak5 by ! appropriate ,/ate or ,f$]al   
en=cem5t ag5cy 9 response to ! compla9t 
or inquiry ( ! consum]2  7,,ii7 any     
responses receiv$ by ! appropriate ,/ate
 or ,f$]al en=cem5t ag5cy f ! gr\p heal?

 plan or heal? insurance issu] (f]+ gr\p
 or individual heal? insurance cov]age2 
7,,iii7 any foll[-up actions or plann$  
foll[-up actions by ! appropriate       
regulator 9 response to ! compla9t or   
inquiry ( ! consum]2 &  7,,iv7 contact  
in=mation ( ! appropriate en=cem5t ag5cy
 = ! consum] to foll[ up on ! compla9t  
or inquiry4  7ii7 ,timely response to   
regulators ,a gr\p heal? plan or heal?  
insurance issu] (f]+ gr\p or individual 
heal? insurance cov]age %all provide a  
timely response 79 writ+ if appropriate7
 to ! appropriate ,/ate or ,f$]al       
en=cem5t ag5cy hav+ jurisdiction ov] su*
 plan or issu] conc]n+ a consum]        
compla9t or inquiry submitt$ to ! unit  
includ+--  7,i7 /eps t h be5 tak5 by !  
plan or issu] to respond to ! compla9t  
or inquiry ( ! consum]2  7,,ii7 any     
responses receiv$ by ! plan or issu] f !
 consum]2 &  7,,iii7 foll[-up actions or
 plann$ foll[-up actions by ! plan or   
issu] 9 response to ! compla9t or       
inquiry ( ! consum]4  2 &  7#b7 by add+ 

at ! end ! foll[+3  7f7 ,annual reports 
7#a7 ,provision ( in=mation by ,/ates ,n
 lat] ?an ,decemb] #ca1 #bjag1 &        
annually !reaft]1 ea* ,/ate heal?       
insurance commission] %all submit to !  
,secret>y a report on compliance ) ?is  
section ( gr\p heal? plans or heal?     
insurance issu]s (f]+ gr\p or individual
 heal? insurance cov]age 9 su* ,/ate4   
7#b7 ,requirem5t ( comp>ison ,to ensure 
t gr\p heal? plans or heal? insurance   
issu]s (f]+ gr\p or individual heal?    
insurance cov]age provide comp>able     
cov]age = m5tal heal? & sub/ance use    
disord] b5efits 9 accordance ) ?is      
section1 z "p ( ! report submitt$ "u    
p>agraph 7#a71 a ,/ate heal? insurance  
commission] %all comp>e ! f9ancial      
requirem5ts & treatm5t limitations      
impos$ by su* issu]s & plans = m5tal    
heal? & sub/ance use disord] s]vices &  
^? requirem5ts & limitations impos$ by  
su* issu]s & plans on m$ical & surgical 
b5efits4  7#c7 ,cont5ts ( reports ,!    
reports submitt$ "u p>agraph 7#a7 %all  

be made publicly available on ! website 
( ! consum] p>ity unit e/abli%$ "u      
subsection 7a77#g7 & include ! foll[+   
in=mation1 brok5 d[n = ea* gr\p heal?   
plan or heal? insurance issu] (f]+ gr\p 
or individual heal? insurance cov]age3  
7,a7 ,! m5tal heal? & sub/ance use      
disord] b5efits provid$ by ! plan or    
issu]4  7,b7 ,new m5tal heal? or        
sub/ance use disord] treatm5ts t h be5  
approv$ = cov]age4  7,c7 ,/&>ds =       
admission to plan provid] networks1     
includ+ reimbursem5t rates1 & an        
accurate1 up-to-date provid] network    
li/+1 includ+ in=mation on :i* provid]s 
are accept+ new pati5ts4  7,d7          
,non-quantitative treatm5t limitations  
on cov]age1 includ+-- 7i7 m$ical        
managem5t /&>ds limit+ or exclud+       
b5efits bas$ on m$ical necessity or     
m$ical appropriat5ess1 or bas$ on :e!r a
 treatm5t is exp]im5tal or inve/igative2
  7ii7 =mul>y design = prescription     
drugs2  7iii7 plan me?ods us$ to det]m9e
 usual1 cu/om>y1 & reasonable fee *>ges2

  7iv7 refusal to pay = high]-co/       
!rapies until x c be %[n t a l[]-co/    
!rapy is n effective 7also kn[n z       
fail-fir/ policies or /ep !rapy         
protocols72  7v7 exclusions bas$ on     
failure to complete a c\rse ( treatm5t2 
&  7vi7 re/rictions bas$ on geographic  
location1 facility type1 provid]        
specialty1 & o!r crit]ia t might o!rwise
 limit ! scope or duration ( b5efits4   
7,e7 ,in=mation ne$$ to calculate       
out-(-pocket co/s4  4  7b7 ,employee    
,retirem5t ,income ,security ,act (     
#aigd ,section #gab7;a7 ( ! ,employee   
,retirem5t ,income ,security ,act (     
#aigd 7#bi ,u4,s4,c4 #aahe;a7a77 is     
am5d$ by add+ at ! end ! foll[+3  7#f7  
,disclosure & en=cem5t requirem5ts  7,a7
 ,disclosure requirem5ts  7i7           
,regulations ,n lat] ?an ,june #cj1     
#bjaf1 ! ,secret>y1 9 coop]ation ) !    
,secret>ies ( ,heal? & ,human ,s]vices &
 ! ,treasury1 z appropriate1 %all issue 
additional regulations = c>ry+ out ?is  
section1 includ+ an explanation (       

docum5ts t mu/ be disclos$ by gr\p heal?
 plans 7or heal? insurance cov]age (f]$ 
9 connection ) su* plans71 ! process    
gov]n+ ! disclosure ( su* docum5ts1 &   
analyses t mu/ be conduct$ by su* plans 
or cov]age to comply ) ?is section4     
7ii7 ,requirem5ts ,a gr\p heal? plan 7or
 heal? insurance cov]age (f]$ 9         
connection ) su* a plan7 %all disclose  
to ! ,secret>y 9 a /&>diz$ =mat docum5ts
 t include--  7,i7 ! specific analyses  
p]=m$ to ensure compliance ) ?is section
 & any regulations promulgat$ pursuant  
to ?is section2  7,,ii7 a description ( 
! application ( non-quantitative        
treatm5t limitations 79 ?is p>agraph    
ref]r$ to z ,n,q,t,ls7 to b5efits "u su*
 plan or cov]age1 includ+--  7aa7 !     
specific factors ! plan or cov]age us$ 9
 p]=m+ its ,n,q,t,ls analysis2  7bb7 !  
specific evid5ti>y /&>ds reli$ on to    
evaluate su* factors2  7cc7 h[ !        
evid5ti>y /&>ds are appli$ to ea* s]vice
 category = m5tal heal?1 sub/ance use   
disord]s1 m$ical b5efits1 & surgical    

b5efits2  7dd7 a disclosure ( ! results 
( ! analyses ( ! specific evid5ti>y     
/&>ds 9 ea* s]vice category2 &  7ee7 a  
disclosure ( ! specific f9d+s ( su* plan
 or cov]age 9 ea* s]vice category & !   
conclusions rea*$ ) respect to :e!r !   
processes1 /rategies1 evid5ti>y /&>ds1  
or o!r factors us$ 9 apply+ ,n,q,t,ls to
 m5tal heal? or sub/ance use disord]    
b5efits are comp>able to1 & appli$ no m 
/r+5tly ?an1 ! processes1 /rategies1    
evid5ti>y /&>ds1 or o!r factors us$ 9   
apply+ ,n,q,t,ls ) respect to m$ical &  
surgical b5efits 9 ! same               
classification2 &  7,,iii7 ! rates ( &  
reasons = d5ial by ! plan or cov]age =  
outpati5t & inpati5t m5tal heal? &      
sub/ance use disord] s]vices comp>$ to !
 rates ( & reasons = d5ial ( claims =   
m$ical & surgical s]vices4  7iii7       
,guidance ,! ,secret>y1 9 coop]ation ) !
 ,secret>ies ( ,heal? & ,human ,s]vices 
& ! ,treasury1 z appropriate1 %all issue
 guidance to gr\p heal? plans 7& heal?  
insurance cov]age (f]$ 9 connection )   

su* plans7 on h[ to satisfy !           
requirem5ts ( ?is section ) respect to  
mak+ in=mation available to curr5t &    
pot5tial p>ticipants & b5efici>ies4 ,su*
 in=mation %all include c]tificate (    
cov]age docum5ts & in/rum5ts "u :i* !   
plan or cov]age involv$ is adm9i/]$ &   
op]at$ t specify1 include1 or ref] to   
proc$ures1 =mulas1 & me?odologies appli$
 to det]m9e a p>ticipant or b5efici>y's 
b5efit "u ! plan or cov]age1 reg>dless (
 :e!r su* in=mation is conta9$ 9 a      
docum5t designat$ z ! plan docum5t4 ,su*
 guidance %all include a disclosure ( h[
 ! plan or cov]age involv$ has provid$ t
 processes1 /rategies1 evid5ti>y /&>ds1 
& o!r factors us$ 9 apply+ ! ,,nqtl to  
m5tal heal? or sub/ance use disord]     
b5efits are comp>able to1 & appli$ no m 
/r+5tly ?an1 ! processes1 /rategies1    
evid5ti>y /&>ds1 or o!r factors us$ 9   
apply+ ! limitation ) respect to m$ical 
& surgical b5efits 9 ! same             
classification4  7iv7 ,def9itions ,9 ?is
 p>agraph1 ! t]ms non-quantitative      

treatm5t limitations1 comp>able to1 &   
appli$ no m /r+5tly ?an h ! mean+s giv5 
su* t]ms 9 p>ts #adf & #adg ( title #de1
 ,code ( ,f$]al ,regulations 7or any    
successor regulation74  7,b7 ,en=cem5t  
7i7 ,process = compla9ts ,! ,secret>y1 9
 coop]ation ) ! ,secret>ies ( ,heal? &  
,human ,s]vices & ! ,treasury1 z        
appropriate1 %all issue guidance to     
cl>ify ! process & timel9e = curr5t &   
pot5tial p>ticipants & b5efici>ies 7&   
au?oriz$ repres5tatives & heal? c>e     
provid]s ( su* p>ticipants &            
b5efici>ies7 ( gr\p heal? plans 7or     
heal? insurance cov]age (f]$ 9          
connection ) su* a plan7 to file =mal   
compla9ts ( su* plans or cov]age be+ 9  
violation ( ?is section1 includ+        
guidance1 by plan type1 on ! relevant   
,/ate1 regional1 & national (fices ) :i*
 su* compla9ts %\ld be fil$4  7ii7      
,au?ority = public en=cem5t ,!          
,secret>y1 9 consultation ) !           
,secret>ies ( ,labor & ! ,treasury1 %all
 make available to ! public on ! website

 ( ! consum] p>ity unit e/abli%$ "u     
section #bgbf7;a77#g7 ( ! ,public ,heal?
 ,s]vice ,act in=mation on audits &     
inve/igations ( gr\p heal? plans 7&     
heal? insurance cov]age (f]$ 9          
connection ) su* plans7 conduct$ "u ?is 
section4 ,su* in=mation %all n conta9   
any p]sonally id5tifiable in=mation4    
7iii7 ,audits  7,i7 ,r&omiz$ audits ,!  
,secret>y1 9 coop]ation ) ! ,secret>ies 
( ,heal? & ,human ,s]vices & !          
,treasury1 may conduct r&omiz$ audits ( 
gr\p heal? plans 7& heal? insurance     
cov]age (f]$ 9 connection ) su* plans7  
to det]m9e compliance ) ?is section4    
,su* audits %all be conduct$ on n few]  
?an #ab plans & cov]ages p] plan ye>4   
,in=mation f su* audits %all be made    
pla9ly available on ! website ( !       
consum] p>ity unit e/abli%$ "u section  
#bgbf7;a77#g7 ( ! ,public ,heal? ,s]vice
 ,act4  7,,ii7 ,additional audits ,9 !  
case ( a gr\p heal? plan 7& heal?       
insurance cov]age (f]$ 9 connection )   
su* a plan7 ) respect to :i* any claim  

has be5 fil$ dur+ a plan ye>1 !         
,secret>y may audit ! books & records ( 
su* plan or cov]age to det]m9e          
compliance ) ?is section4 ,in=mation    
detail+ ! results ( ! audit %all be made
 available on ! website ( ! consum]     
p>ity unit e/abli%$ "u section          
#bgbf7;a77#g7 ( ! ,public ,heal? ,s]vice
 ,act4  4  7c7 ,int]nal ,rev5ue ,code ( 
#aihf ,section #ihab7;a7 ( ! ,int]nal   
,rev5ue ,code ( #aihf is am5d$ by add+  
at ! end ! foll[+3  7#f7 ,disclosure &  
en=cem5t requirem5ts  7,a7 ,disclosure  
requirem5ts  7i7 ,regulations ,n lat]   
?an ,june #cj1 #bjaf1 ! ,secret>y1 9    
coop]ation ) ! ,secret>ies ( ,heal? &   
,human ,s]vices & ,labor1 z appropriate1
 %all issue additional regulations =    
c>ry+ out ?is section1 includ+ an       
explanation ( docum5ts t mu/ be disclos$
 by gr\p heal? plans1 ! process gov]n+ !
 disclosure ( su* docum5ts1 & analyses t
 mu/ be conduct$ by su* plans to comply 
) ?is section4  7ii7 ,requirem5ts ,a    
gr\p heal? plan %all disclose to !      

,secret>y 9 a /&>diz$ =mat docum5ts t   
include--  7,i7 ! specific analyses     
p]=m$ to ensure compliance ) ?is section
 & any regulations promulgat$ pursuant  
to ?is section2  7,,ii7 a description ( 
! application ( non-quantitative        
treatm5t limitations 79 ?is p>agraph    
ref]r$ to z ,n,q,t,ls7 to b5efits "u su*
 gr\p heal? plan1 includ+--  7aa7 !     
specific factors ! plan us$ 9 p]=m+ its 
,n,q,t,ls analysis2  7bb7 ! specific    
evid5ti>y /&>ds reli$ on to evaluate su*
 factors2  7cc7 h[ ! evid5ti>y /&>ds are
 appli$ to ea* s]vice category = m5tal  
heal?1 sub/ance use disord]s1 m$ical    
b5efits1 & surgical b5efits2  7dd7 a    
disclosure ( ! results ( ! analyses ( ! 
specific evid5ti>y /&>ds 9 ea* s]vice   
category2 &  7ee7 a disclosure ( !      
specific f9d+s ( su* plan 9 ea* s]vice  
category & ! conclusions rea*$ ) respect
 to :e!r ! processes1 /rategies1        
evid5ti>y /&>ds1 or o!r factors us$ 9   
apply+ ,n,q,t,ls to m5tal heal? or      
sub/ance use disord] b5efits are        

comp>able to1 & appli$ no m /r+5tly ?an1
 ! processes1 /rategies1 evid5ti>y      
/&>ds1 or o!r factors us$ 9 apply+      
,n,q,t,ls ) respect to m$ical & surgical
 b5efits 9 ! same classification2 &     
7,,iii7 ! rates ( & reasons = d5ial by !
 plan = outpati5t & inpati5t m5tal heal?
 & sub/ance use disord] s]vices comp>$  
to ! rates ( & reasons = d5ial ( claims 
= m$ical & surgical s]vices4  7iii7     
,guidance ,! ,secret>y1 9 coop]ation ) !
 ,secret>ies ( ,heal? & ,human ,s]vices 
& ,labor1 z appropriate1 %all issue     
guidance to gr\p heal? plans on h[ to   
satisfy ! requirem5ts ( ?is section )   
respect to mak+ in=mation available to  
curr5t & pot5tial p>ticipants &         
b5efici>ies4 ,su* in=mation %all include
 c]tificate ( cov]age docum5ts &        
in/rum5ts "u :i* ! plan involv$ is      
adm9i/]$ & op]at$ t specify1 include1 or
 ref] to proc$ures1 =mulas1 &           
me?odologies appli$ to det]m9e a        
p>ticipant or b5efici>y's b5efit "u !   
plan1 reg>dless ( :e!r su* in=mation is 

conta9$ 9 a docum5t designat$ z ! plan  
docum5t4 ,su* guidance %all include a   
disclosure ( h[ ! plan involv$ has      
demon/rat$ t processes1 /rategies1      
evid5ti>y /&>ds1 & o!r factors us$ 9    
apply+ ,n,q,t,ls to m5tal heal? or      
sub/ance use disord] b5efits are        
comp>able to1 & appli$ no m /r+5tly ?an1
 ! processes1 /rategies1 evid5ti>y      
/&>ds1 or o!r factors us$ 9 apply+      
,n,q,t,ls ) respect to m$ical & surgical
 b5efits 9 ! same classification4  7iv7 
,def9itions ,9 ?is p>agraph1 ! t]ms     
non-quantitative treatm5t limitations1  
comp>able to1 & appli$ no m /r+5tly ?an 
h ! mean+s giv5 su* t]ms 9 p>ts #adf &  
#adg ( title #de1 ,code ( ,f$]al        
,regulations 7or any successor          
regulation74  7,b7 ,en=cem5t  7i7       
,process = compla9ts ,! ,secret>y1 9    
coop]ation ) ! ,secret>ies ( ,heal? &   
,human ,s]vices & ,labor1 z appropriate1
 %all1 ) respect to gr\p heal? plans1   
issue guidance to cl>ify ! process &    
timel9e = curr5t & pot5tial p>ticipants 

& b5efici>ies 7& au?oriz$ repres5tatives
 & heal? c>e provid]s ( su* p>ticipants 
& b5efici>ies7 ) respect to su* plans to
 file =mal compla9ts ( su* plans be+ 9  
violation ( ?is section1 includ+        
guidance1 by plan type1 on ! relevant   
,/ate1 regional1 & national (fices ) :i*
 su* compla9ts %\ld be fil$4  7ii7      
,au?ority = public en=cem5t ,!          
,secret>y1 9 consultation ) !           
,secret>ies ( ,labor & ! ,treasury1 %all
 make available to ! public on ! website
 ( ! consum] p>ity unit e/abli%$ "u     
section #bgbf7;a77#g7 ( ! ,public ,heal?
 ,s]vice ,act in=mation on audits &     
inve/igations ( gr\p heal? plans        
conduct$ "u ?is section4 ,su* in=mation 
%all n conta9 any p]sonally id5tifiable 
in=mation4  7iii7 ,audits  7,i7 ,r&omiz$
 audits ,! ,secret>y1 9 coop]ation ) !  
,secret>ies ( ,heal? & ,human ,s]vices &
 ,labor1 is au?oriz$ to conduct r&omiz$ 
audits ( gr\p heal? plans to det]m9e    
compliance ) ?is section4 ,su* audits   
%all be conduct$ on n few] ?an #ab plans

 p] plan ye>4 ,in=mation f su* audits   
%all be made pla9ly available on !      
website ( ! consum] p>ity unit e/abli%$ 
"u section #bgbf7;a77#g7 ( ! ,public    
,heal? ,s]vice ,act4  7,,ii7 ,additional
 audits ,9 ! case ( a gr\p heal? plan ) 
respect to :i* any claim has be5 fil$   
dur+ a plan ye>1 ! ,secret>y may audit !
 books & records ( su* plan to det]m9e  
compliance ) ?is section4 ,in=mation    
detail+ ! results ( ! audit %all be made
 available on ! website ( ! consum]     
p>ity unit e/abli%$ "u section          
#bgbf7;a77#g7 ( ! ,public ,heal? ,s]vice
 ,act4  4  7d7 ,,gao ,/udy on ,m5tal    
,heal? & ,sub/ance ,use ,p>ity ,en=cem5t
 ,ef=ts ,n lat] ?an #a ye> aft] ! date (
 enactm5t ( ?is ,act1 ! ,comptroll]     
,g5]al ( ! ,unit$ ,/ates1 9 consultation
 ) ! ,secret>y ( ,heal? & ,human        
,s]vices1 ! ,secret>y ( ,labor1 & !     
,secret>y ( ! ,treasury1 %all submit to 
,congress1 & make pla9ly available on ! 
website ( ! consum] p>ity unit e/abli%$ 
"u section #bgbf7;a77#g7 ( ! ,public    

,heal? ,s]vice ,act 7#db ,u4,s4,c4      
#cjj;gg-#bf7;a77#g771 z add$ by         
subsection 7a71 a report detail+ !      
en=cem5t ef=ts ( ! responsible dep>tm5ts
 & ag5cies 9 implem5t+ sections #bgbf ( 
! ,public ,heal? ,s]vice ,act1 #gab ( ! 
,employee ,retirem5t ,income ,security  
,act ( #aigd 7#bi ,u4,s4,c4 #aahe;a71 & 
#ihab ( ! ,int]nal ,rev5ue ,code (      
#aihf1 includ+--  7#a7 ! numb] (        
inve/igations & audits t h be5 conduct$ 
into pot5tial p>ity violations2  7#b7 ! 
numb] ( en=cem5t actions c>ri$ out z a  
result ( any su* inve/igation or audit2 
&  7#c7 details on any su* inve/igation1
 audit1 or en=cem5t action t d n conta9 
any p]sonally id5tifiable in=mation4    
7e7 ,au?orization ( appropriations ,!re 
is au?oriz$ to be appropriat$ #b1jjj1jjj
 = ea* ( fiscal ye>s #bjaf ?r\gh #bjbj  
to c>ry out ?is section1 includ+ !      
am5dm5ts made by ?is section4