,,ib ,union ,cal5d> ,no4 #ege #aaf?     
,,congress  #b;d ,session  ,h4 ,r4 #geci
 ,report ,no4 #aaf-fib1 ,"p ,i ,,9 ,,!  
,,h\se ,,( ,,repres5tatives  ,july #i1  
#bjbj,mr4 ,k5n$y 7= himself1 ,ms4       
,port]1 ,mr4 ,bilirakis1 & ,mr4 ,upton7 
introduc$ ! foll[+ bill2 :i* 0 ref]r$ to
 ! ,committee on ,en]gy & ,comm]ce1 & 9 
addition to ! ,committees on ,ways &    
,means1 & ,education & ,labor1 = a p]iod
 to be subsequ5tly det]m9$ by ! ,speak]1
 9 ea* case = consid]ation ( su*        
provisions z fall )9 ! jurisdiction ( ! 
committee conc]n$  ,decemb] #bd1        
#bjbj;,additional sponsors3 ,mr4 ,lujn1 
,mr4 ,soto1 & ,mr4 ,fitzpatrick         
,decemb] #bd1 #bjbj,report$ f !         
,committee on ,en]gy & ,comm]ce ) an    
amendment,strike out all aft] ! enact+  
clause & ins]t ! "p pr9t$ 9 italic      
,decemb] #bd1 #bjbj;,committees on ,ways
 & ,means & ,education & ,labor dis*>g$2
 committ$ to ! ,committee ( ! ,:ole     
,h\se on ! ,/ate ( ! ,union & ord]$ to  
be printed,for text ( introduc$ bill1   

see copy ( bill z introduc$ on ,july #i1
 #bjbj  ,a ,,bill  ,to /r5g!n p>ity 9   
m5tal heal? & sub/ance use disord]      
b5efits4  #a4 ,%ort title ,?is ,act may 
be cit$ z ! ,/r5g!n+ ,behavioral ,heal? 
,p>ity ,act4  #b4 ,/r5g!n+ p>ity 9 m5tal
 heal? & sub/ance use disord] b5efits   
7a7 ,,phsa  7#a7 ,9 g5]al ,title ,,xxvii
 ( ! ,public ,heal? ,s]vice ,act 7#db   
,u4,s4,c4 #cjj;gg-#aa et seq47 is am5d$ 
by add+ at ! end ! foll[+ new "p3  ,d   
,additional ,cov]age ,provisions        
#bgii;,a-#a4 ,p>ity 9 m5tal heal? &     
sub/ance use disord] b5efits  7a7 ,9    
,g5]al  7#a7 ,aggregate lifetime limits 
,9 ! case ( a gr\p heal? plan or a heal?
 insurance issu] (f]+ gr\p or individual
 heal? insurance cov]age t provides bo? 
m$ical & surgical b5efits & m5tal heal? 
or sub/ance use disord] b5efits-- 7,a7  
,no lifetime limit ,if ! plan or cov]age
 does n include an aggregate lifetime   
limit on sub/antially all m$ical &      
surgical b5efits1 ! plan or cov]age may 
n impose any aggregate lifetime limit on

 m5tal heal? or sub/ance use disord]    
b5efits4  7,b7 ,lifetime limit ,if !    
plan or cov]age includes an aggregate   
lifetime limit on sub/antially all      
m$ical & surgical b5efits 79 ?is        
p>agraph ref]r$ to z ! applicable       
lifetime limit71 ! plan or cov]age %all 
ei!r-- 7i7 apply ! applicable lifetime  
limit bo? to ! m$ical & surgical b5efits
 to :i* x o!rwise w\ld apply & to m5tal 
heal? & sub/ance use disord] b5efits & n
 di/+ui% 9 ! application ( su* limit    
betwe5 su* m$ical & surgical b5efits &  
m5tal heal? & sub/ance use disord]      
b5efits2 or  7ii7 n include any         
aggregate lifetime limit on m5tal heal? 
or sub/ance use disord] b5efits t is    
less ?an ! applicable lifetime limit4   
7,c7 ,rule 9 case ( diff]5t limits ,9 ! 
case ( a plan or cov]age t is n describ$
 9 subp>agraph 7,a7 or 7,b7 & t includes
 no or diff]5t aggregate lifetime limits
 on diff]5t categories ( m$ical &       
surgical b5efits1 ! ,secret>y %all      
e/abli% rules "u :i* subp>agraph 7,b7 is

 appli$ to su* plan or cov]age ) respect
 to m5tal heal? & sub/ance use disord]  
b5efits by sub/itut+ = ! applicable     
lifetime limit an av]age aggregate      
lifetime limit t is comput$ tak+ into   
acc\nt ! weight$ av]age ( ! aggregate   
lifetime limits applicable to su*       
categories4  7#b7 ,annual limits ,9 !   
case ( a gr\p heal? plan or a heal?     
insurance issu] (f]+ gr\p or individual 
heal? insurance cov]age t provides bo?  
m$ical & surgical b5efits & m5tal heal? 
or sub/ance use disord] b5efits-- 7,a7  
,no annual limit ,if ! plan or cov]age  
does n include an annual limit on       
sub/antially all m$ical & surgical      
b5efits1 ! plan or cov]age may n impose 
any annual limit on m5tal heal? or      
sub/ance use disord] b5efits4  7,b7     
,annual limit ,if ! plan or cov]age     
includes an annual limit on sub/antially
 all m$ical & surgical b5efits 79 ?is   
p>agraph ref]r$ to z ! applicable annual
 limit71 ! plan or cov]age %all ei!r--  
7i7 apply ! applicable annual limit bo? 

to m$ical & surgical b5efits to :i* x   
o!rwise w\ld apply & to m5tal heal? &   
sub/ance use disord] b5efits & n di/+ui%
 9 ! application ( su* limit betwe5 su* 
m$ical & surgical b5efits & m5tal heal? 
& sub/ance use disord] b5efits2 or  7ii7
 n include any annual limit on m5tal    
heal? or sub/ance use disord] b5efits t 
is less ?an ! applicable annual limit4  
7,c7 ,rule 9 case ( diff]5t limits ,9 ! 
case ( a plan or cov]age t is n describ$
 9 subp>agraph 7,a7 or 7,b7 & t includes
 no or diff]5t annual limits on diff]5t 
categories ( m$ical & surgical b5efits1 
! ,secret>y %all e/abli% rules "u :i*   
subp>agraph 7,b7 is appli$ to su* plan  
or cov]age ) respect to m5tal heal? &   
sub/ance use disord] b5efits by         
sub/itut+ = ! applicable annual limit an
 av]age annual limit t is comput$ tak+  
into acc\nt ! weight$ av]age ( ! annual 
limits applicable to su* categories4    
7#c7 ,f9ancial requirem5ts & treatm5t   
limitations  7,a7 ,9 g5]al ,9 ! case ( a
 gr\p heal? plan or a heal? insurance   

issu] (f]+ gr\p or individual heal?     
insurance cov]age t provides bo? m$ical 
& surgical b5efits & m5tal heal? or     
sub/ance use disord] b5efits1 su* plan  
or cov]age %all ensure t-- 7i7 !        
f9ancial requirem5ts applicable to su*  
m5tal heal? or sub/ance use disord]     
b5efits are no m re/rictive ?an !       
pr$om9ant f9ancial requirem5ts appli$ to
 sub/antially all m$ical & surgical     
b5efits cov]$ by ! plan 7or cov]age71 & 
!re are no sep>ate co/ %>+ requirem5ts t
 are applicable only ) respect to m5tal 
heal? or sub/ance use disord] b5efits2 &
  7ii7 ! treatm5t limitations applicable
 to su* m5tal heal? or sub/ance use     
disord] b5efits are no m re/rictive ?an 
! pr$om9ant treatm5t limitations appli$ 
to sub/antially all m$ical & surgical   
b5efits cov]$ by ! plan 7or cov]age7 &  
!re are no sep>ate treatm5t limitations 
t are applicable only ) respect to m5tal
 heal? or sub/ance use disord] b5efits4 
7,b7 ,def9itions ,9 ?is p>agraph3 7i7   
,f9ancial requirem5t ,! t]m f9ancial    

requirem5t includes d$uctibles1         
copaym5ts1 co9surance1 & out-(-pocket   
exp5ses1 b excludes an aggregate        
lifetime limit & an annual limit subject
 to p>agraphs 7#a7 & 7#b74  7ii7        
,pr$om9ant ,a f9ancial requirem5t or    
treatm5t limit is consid]$ to be        
pr$om9ant if x is ! mo/ common or       
frequ5t ( su* type ( limit or           
requirem5t4  7iii7 ,treatm5t limitation 
,! t]m treatm5t limitation includes     
limits on ! frequ5cy ( treatm5t1 numb] (
 visits1 days ( cov]age1 or o!r simil>  
limits on ! scope or duration (         
treatm5t4  7#d7 ,availability ( plan    
in=mation ,! crit]ia = m$ical necessity 
det]m9ations made "u ! plan ) respect to
 m5tal heal? or sub/ance use disord]    
b5efits 7or ! heal? insurance cov]age   
(f]$ 9 connection ) ! plan ) respect to 
su* b5efits7 %all be made available by !
 plan adm9i/rator 7or ! heal? insurance 
issu] (f]+ su* cov]age7 9 accordance )  
regulations to any curr5t or pot5tial   
p>ticipant1 b5efici>y1 or contract+     

provid] ^u reque/4 ,! reason = any d5ial
 "u ! plan 7or cov]age7 ( reimbursem5t  
or paym5t = s]vices ) respect to m5tal  
heal? or sub/ance use disord] b5efits 9 
! case ( any p>ticipant or b5efici>y    
%all1 on reque/ or z o!rwise requir$1 be
 made available by ! plan adm9i/rator   
7or ! heal? insurance issu] (f]+ su*    
cov]age7 to ! p>ticipant or b5efici>y 9 
accordance ) regulations4  7#e7         
,out-(-network provid]s ,9 ! case ( a   
plan or cov]age t provides bo? m$ical & 
surgical b5efits & m5tal heal? or       
sub/ance use disord] b5efits1 if ! plan 
or cov]age provides cov]age = m$ical or 
surgical b5efits provid$ by             
out-(-network provid]s1 ! plan or       
cov]age %all provide cov]age = m5tal    
heal? or sub/ance use disord] b5efits   
provid$ by out-(-network provid]s 9 a   
mann] t is consi/5t ) ! requirem5ts (   
?is section4  7#f7 ,compliance program  
guidance docum5t  7,a7 ,9 g5]al ,n lat] 
?an #ab mon?s aft] ! date ( enactm5t ( !
 ,help+ ,families 9 ,m5tal ,heal?       

,crisis ,re=m ,act ( #bjaf1 ! ,secret>y1
 ! ,secret>y ( ,labor1 & ! ,secret>y ( !
 ,treasury1 9 consultation ) !          
,inspector ,g5]al ( ! ,dep>tm5t ( ,heal?
 & ,human ,s]vices1 ! ,inspector ,g5]al 
( ! ,dep>tm5t ( ,labor1 & ! ,inspector  
,g5]al ( ! ,dep>tm5t ( ! ,treasury1 %all
 issue a compliance program guidance    
docum5t to help improve compliance ) ?is
 section1 section #gab ( ! ,employee    
,retirem5t ,income ,security ,act (     
#aigd1 & section #ihab ( ! ,int]nal     
,rev5ue ,code ( #aihf1 z applicable4 ,9 
c>ry+ out ?is p>agraph1 ! ,secret>ies   
may take into consid]ation ! #bjaf      
publication ( ! ,dep>tm5t ( ,heal? &    
,human ,s]vices & ! ,dep>tm5t ( ,labor1 
entitl$ ,w>n+ ,signs - ,plan or ,policy 
,non-,quantitative ,treatm5t            
,limitations 7,n,q,t,ls7 t ,require     
,additional ,analysis to ,det]m9e ,m5tal
 ,heal? ,p>ity ,compliance4  7,b7       
,examples illu/rat+ compliance &        
noncompliance  7i7 ,9 g5]al ,!          
compliance program guidance docum5t     

requir$ "u ?is p>agraph %all provide    
illu/rative1 de-id5tifi$ examples 7t d n
 disclose any protect$ heal? in=mation  
or individually id5tifiable in=mation7 (
 previ\s f9d+s ( compliance &           
noncompliance ) ?is section1 section    
#gab ( ! ,employee ,retirem5t ,income   
,security ,act ( #aigd1 or section #ihab
 ( ! ,int]nal ,rev5ue ,code ( #aihf1 z  
applicable1 bas$ on inve/igations (     
violations ( su* sections1 includ+--    
7,i7 examples illu/rat+ requirem5ts =   
in=mation disclosures & nonquantitative 
treatm5t limitations2 &  7,,ii7         
descriptions ( ! violations uncov]$ dur+
 ! c\rse ( su* inve/igations4  7ii7     
,nonquantitative treatm5t limitations   
,to ! ext5t t any example describ$ 9    
clause 7i7 involves a f9d+ ( compliance 
or noncompliance ) reg>d to any         
requirem5t = nonquantitative treatm5t   
limitations1 ! example %all provide     
suffici5t detail to fully expla9 su*    
f9d+1 includ+ a full description ( !    
crit]ia involv$ = approv+ m$ical &      

surgical b5efits & ! crit]ia involv$ =  
approv+ m5tal heal? & sub/ance use      
disord] b5efits4  7iii7 ,access to      
additional in=mation reg>d+ compliance  
,9 develop+ & issu+ ! compliance program
 guidance docum5t requir$ "u ?is        
p>agraph1 ! ,secret>ies specifi$ 9      
subp>agraph 7,a7-- 7,i7 %all ent] into  
int]ag5cy agreem5ts ) ! ,inspector      
,g5]al ( ! ,dep>tm5t ( ,heal? & ,human  
,s]vices1 ! ,inspector ,g5]al ( !       
,dep>tm5t ( ,labor1 & ! ,inspector      
,g5]al ( ! ,dep>tm5t ( ! ,treasury to   
%>e f9d+s ( compliance & noncompliance )
 ?is section1 section #gab ( ! ,employee
 ,retirem5t ,income ,security ,act (    
#aigd1 or section #ihab ( ! ,int]nal    
,rev5ue ,code ( #aihf1 z applicable2 &  
7,,ii7 %all seek to ent] into an        
agreem5t ) a ,/ate to %>e in=mation on  
f9d+s ( compliance & noncompliance ) ?is
 section1 section #gab ( ! ,employee    
,retirem5t ,income ,security ,act (     
#aigd1 or section #ihab ( ! ,int]nal    
,rev5ue ,code ( #aihf1 z applicable4    

7,c7 ,recomm5dations ,! compliance      
program guidance docum5t %all include   
recomm5dations to advance compliance )  
?is section1 section #gab ( ! ,employee 
,retirem5t ,income ,security ,act (     
#aigd1 or section #ihab ( ! ,int]nal    
,rev5ue ,code ( #aihf1 z applicable1 &  
enc\rage ! developm5t & use ( int]nal   
controls to monitor adh]5ce to          
applicable /atutes1 regulations1 &      
program requirem5ts4 ,su* int]nal       
controls may include illu/rative        
examples ( nonquantitative treatm5t     
limitations on m5tal heal? & sub/ance   
use disord] b5efits1 :i* may fail to    
comply ) ?is section1 section #gab ( !  
,employee ,retirem5t ,income ,security  
,act ( #aigd1 or section #ihab ( !      
,int]nal ,rev5ue ,code ( #aihf1 z       
applicable1 9 relation to               
nonquantitative treatm5t limitations on 
m$ical & surgical b5efits4  7,d7 ,updat+
 ! compliance program guidance docum5t  
,! ,secret>y1 ! ,secret>y ( ,labor1 & ! 
,secret>y ( ! ,treasury1 9 consultation 

) ! ,inspector ,g5]al ( ! ,dep>tm5t (   
,heal? & ,human ,s]vices1 ! ,inspector  
,g5]al ( ! ,dep>tm5t ( ,labor1 & !      
,inspector ,g5]al ( ! ,dep>tm5t ( !     
,treasury1 %all update ! compliance     
program guidance docum5t e #b ye>s to   
include illu/rative1 de-id5tifi$        
examples 7t d n disclose any protect$   
heal? in=mation or individually         
id5tifiable in=mation7 ( previ\s f9d+s (
 compliance & noncompliance ) ?is       
section1 section #gab ( ! ,employee     
,retirem5t ,income ,security ,act (     
#aigd1 or section #ihab ( ! ,int]nal    
,rev5ue ,code ( #aihf1 z applicable4    
7#g7 ,additional guidance  7,a7 ,9 g5]al
 ,n lat] ?an #ab mon?s aft] ! date (    
enactm5t ( ! ,help+ ,families 9 ,m5tal  
,heal? ,crisis ,re=m ,act ( #bjaf1 !    
,secret>y1 ! ,secret>y ( ,labor1 & !    
,secret>y ( ! ,treasury %all issue      
guidance to gr\p heal? plans & heal?    
insurance issu]s (f]+ gr\p or individual
 heal? insurance cov]age to assi/ su*   
plans & issu]s 9 satisfy+ ! requirem5ts 

( ?is section1 section #gab ( !         
,employee ,retirem5t ,income ,security  
,act ( #aigd1 or section #ihab ( !      
,int]nal ,rev5ue ,code ( #aihf1 z       
applicable4  7,b7 ,disclosure  7i7      
,guidance = plans & issu]s ,! guidance  
issu$ "u ?is p>agraph %all include      
cl>ify+ in=mation & illu/rative examples
 ( me?ods t gr\p heal? plans & heal?    
insurance issu]s (f]+ gr\p or individual
 heal? insurance cov]age may use =      
disclos+ in=mation to ensure compliance 
) ! requirem5ts "u ?is section1 section 
#gab ( ! ,employee ,retirem5t ,income   
,security ,act ( #aigd1 or section #ihab
 ( ! ,int]nal ,rev5ue ,code ( #aihf1 z  
applicable1 7& any regulations          
promulgat$ pursuant to su* sections1 z  
applicable74  7ii7 ,docum5ts =          
p>ticipants1 b5efici>ies1 contract+     
provid]s1 or au?oriz$ repres5tatives ,! 
guidance issu$ "u ?is p>agraph %all     
include cl>ify+ in=mation & illu/rative 
examples ( me?ods t gr\p heal? plans &  
heal? insurance issu]s (f]+ gr\p or     

individual heal? insurance cov]age may  
use to provide any p>ticipant1          
b5efici>y1 contract+ provid]1 or        
au?oriz$ repres5tative1 z applicable1 ) 
docum5ts conta9+ in=mation t ! heal?    
plans or issu]s are requir$ to disclose 
to p>ticipants1 b5efici>ies1 contract+  
provid]s1 or au?oriz$ repres5tatives to 
ensure compliance ) ?is section1 section
 #gab ( ! ,employee ,retirem5t ,income  
,security ,act ( #aigd1 or section #ihab
 ( ! ,int]nal ,rev5ue ,code ( #aihf1 z  
applicable1 compliance ) any regulation 
issu$ pursuant to su* respective        
section1 or compliance ) any o!r        
applicable law or regulation4 ,su*      
guidance %all include in=mation t is    
comp>ative 9 nature ) respect to-- 7,i7 
nonquantitative treatm5t limitations =  
bo? m$ical & surgical b5efits & m5tal   
heal? & sub/ance use disord] b5efits2   
7,,ii7 ! processes1 /rategies1 evid5ti>y
 /&>ds1 & o!r factors us$ to apply !    
limitations describ$ 9 subclause 7,i72 &
  7,,iii7 ! application ( ! limitations 

describ$ 9 subclause 7,i7 to ensure t   
su* limitations are appli$ 9 p>ity )    
respect to bo? m$ical & surgical b5efits
 & m5tal heal? & sub/ance use disord]   
b5efits4  7,c7 ,nonquantitative treatm5t
 limitations ,! guidance issu$ "u ?is   
p>agraph %all include cl>ify+ in=mation 
& illu/rative examples ( me?ods1        
processes1 /rategies1 evid5ti>y /&>ds1 &
 o!r factors t gr\p heal? plans & heal? 
insurance issu]s (f]+ gr\p or individual
 heal? insurance cov]age may use reg>d+ 
! developm5t & application (            
nonquantitative treatm5t limitations to 
ensure compliance ) ?is section1 section
 #gab ( ! ,employee ,retirem5t ,income  
,security ,act ( #aigd1 or section #ihab
 ( ! ,int]nal ,rev5ue ,code ( #aihf1 z  
applicable1 7& any regulations          
promulgat$ pursuant to su* respective   
section71 includ+-- 7i7 examples (      
me?ods ( det]m9+ appropriate types (    
nonquantitative treatm5t limitations )  
respect to bo? m$ical & surgical b5efits
 & m5tal heal? & sub/ance use disord]   

b5efits1 includ+ nonquantitative        
treatm5t limitations p]ta9+ to-- 7,i7   
m$ical managem5t /&>ds bas$ on m$ical   
necessity or appropriat5ess1 or :e!r a  
treatm5t is exp]im5tal or inve/igative2 
7,,ii7 limitations ) respect to         
prescription drug =mul>y design2 &      
7,,iii7 use ( fail-fir/ or /ep !rapy    
protocols2  7ii7 examples ( me?ods (    
det]m9+-- 7,i7 network admission /&>ds  
7su* z cr$5tial+72 &  7,,ii7 factors us$
 9 provid] reimbursem5t me?odologies    
7su* z s]vice type1 geographic m>ket1   
dem& = s]vices1 & provid] supply1       
practice size1 tra9+1 exp]i5ce1 &       
lic5sure7 z su* factors apply to network
 adequacy2  7iii7 examples ( s\rces (   
in=mation t may s]ve z evid5ti>y /&>ds =
 ! purposes ( mak+ det]m9ations reg>d+ !
 developm5t & application (             
nonquantitative treatm5t limitations2   
7iv7 examples ( specific factors1 & !   
evid5ti>y /&>ds us$ to evaluate su*     
factors1 us$ by su* plans or issu]s 9   
p]=m+ a nonquantitative treatm5t        

limitation analysis2  7v7 examples ( h[ 
specific evid5ti>y /&>ds may be us$ to  
det]m9e :e!r treatm5ts are consid]$     
exp]im5tal or inve/igative2  7vi7       
examples ( h[ specific evid5ti>y /&>ds  
may be appli$ to ea* s]vice category or 
classification ( b5efits2  7vii7        
examples ( me?ods ( rea*+ appropriate   
cov]age det]m9ations = new m5tal heal?  
or sub/ance use disord] treatm5ts1 su* z
 evid5ce-bas$ e>ly int]v5tion programs =
 individuals ) a s]i\s m5tal illness &  
types ( m$ical managem5t te*niques2     
7viii7 examples ( me?ods ( rea*+        
appropriate cov]age det]m9ations = :i*  
!re is an indirect relation%ip betwe5 ! 
cov]$ m5tal heal? or sub/ance use       
disord] b5efit & a traditional cov]$    
m$ical & surgical b5efit1 su* z         
resid5tial treatm5t or hospitalizations 
involv+ volunt>y or involunt>y          
commitm5t2 &  7ix7 additional           
illu/rative examples ( me?ods1          
processes1 /rategies1 evid5ti>y /&>ds1 &
 o!r factors = :i* ! ,secret>y det]m9es 

t additional guidance is necess>y to    
improve compliance ) ?is section1       
section #gab ( ! ,employee ,retirem5t   
,income ,security ,act ( #aigd1 or      
section #ihab ( ! ,int]nal ,rev5ue ,code
 ( #aihf1 z applicable4  7,d7 ,public   
comm5t ,prior to issu+ any f9al guidance
 "u ?is p>agraph1 ! ,secret>y %all      
provide a public comm5t p]iod ( n less  
?an #fj days dur+ :i* any memb] ( !     
public may provide comm5ts on a draft ( 
! guidance4  7#h7 ,compliance           
requirem5ts  7,a7 ,nonquantitative      
treatm5t limitation 7,,nqtl7 requirem5ts
 ,9 ! case ( a gr\p heal? plan or a     
heal? insurance issu] (f]+ gr\p or      
individual heal? insurance cov]age t    
provides bo? m$ical & surgical b5efits &
 m5tal heal? or sub/ance use disord]    
b5efits & t imposes nonquantitative     
treatm5t limitations 7ref]r$ to 9 ?is   
section z ,,nqtl7 on m5tal heal? or     
sub/ance use disord] b5efits1 ! plan or 
issu] (f]+ heal? insurance cov]age %all 
p]=m comp>ative analyses ( ! design &   

application ( ,n,q,t,ls 9 accordance )  
subp>agraph 7,b71 &1 beg9n+ #de days    
aft] ! date ( enactm5t ( ?is p>agraph1  
make available to ! applicable ,/ate    
au?ority 7or1 z applicable1 !           
,secret>y71 ^u reque/1 ! comp>ative     
analyses & ! foll[+ in=mation3 7i7 ,!   
specific plan or cov]age t]ms reg>d+ !  
,,nqtl1 t applies to su* plan or        
cov]age1 & a description ( all m5tal    
heal? or sub/ance use disord] & m$ical  
or surgical b5efits to :i* x applies 9  
ea* respective b5efits classification4  
7ii7 ,! factors us$ to det]m9e t !      
,,nqtl w apply to m5tal heal? or        
sub/ance use disord] b5efits & m$ical or
 surgical b5efits4  7iii7 ,! evid5ti>y  
/&>ds us$ = ! factors id5tifi$ 9 clause 
7ii71 :5 applicable1 provid$ t e factor 
%all be def9$ & any o!r s\rce or evid5ce
 reli$ ^u to design & apply ! ,,nqtl to 
m5tal heal? or sub/ance use disord]     
b5efits & m$ical or surgical b5efits4   
7iv7 ,! comp>ative analyses demon/rat+ t
 ! processes1 /rategies1 evid5ti>y      

/&>ds1 & o!r factors us$ to design !    
,,nqtl1 z writt51 & ! op]ation processes
 & /rategies z writt5 & 9 op]ation t are
 us$ to apply ! ,,nqtl = m5tal heal? or 
sub/ance use disord] b5efits are        
comp>able to1 & are appli$ no m /r+5tly 
?an1 ! processes1 /rategies1 evid5ti>y  
/&>ds1 & o!r factors us$ to design !    
,,nqtl1 z writt51 & ! op]ation processes
 & /rategies z writt5 & 9 op]ation t are
 us$ to apply ! ,,nqtl to m$ical or     
surgical b5efits4  7v7 ,a disclosure ( !
 specific f9d+s & conclusions rea*$ by !
 plan or cov]age t ! results ( !        
analyses describ$ 9 ?is subp>agraph     
indicate t ! plan or cov]age is 9       
compliance ) ?is section4  7,b7         
,secret>y reque/ process  7i7           
,submission ^u reque/ ,! ,secret>y %all 
reque/ t a gr\p heal? plan or a heal?   
insurance issu] (f]+ gr\p or individual 
heal? insurance cov]age submit !        
comp>ative analyses describ$ 9          
subp>agraph 7,a7 = plans t involve      
pot5tial violations ( ?is section or    

compla9ts reg>d+ noncompliance ) ?is    
section t conc]n ,n,q,t,ls & any o!r    
in/ances 9 :i* ! ,secret>y det]m9es     
appropriate4 ,! ,secret>y %all reque/ n 
few] ?an #bj su* analyses p] ye>4  7ii7 
,additional in=mation ,9 in/ances 9 :i* 
! ,secret>y has conclud$ t ! plan or    
cov]age has n submitt$ suffici5t        
in=mation = ! ,secret>y to review !     
comp>ative analyses describ$ 9          
subp>agraph 7,a71 z reque/$ "u clause   
7i71 ! ,secret>y %all specify to ! plan 
or cov]age ! in=mation ! plan or cov]age
 mu/ submit to be responsive to ! reque/
 "u clause 7i7 = ! ,secret>y to review !
 comp>ative analyses describ$ 9         
subp>agraph7,a7 = compliance ) ?is      
section4 ,no?+ 9 ?is p>agraph %all      
require ! ,secret>y to conclude t a plan
 is 9 compliance ) ?is section solely   
bas$ ^u ! inspection ( ! comp>ative     
analyses describ$ 9 subp>agraph 7,a71 z 
reque/$ "u clause 7i74  7iii7 ,requir$  
action  7,i7 ,9 g5]al ,9 in/ances 9 :i* 
! ,secret>y has review$ ! comp>ative    

analyses describ$ 9 subp>agraph 7,a71 z 
reque/$ "u clause 7i71 & det]m9$ t !    
plan or cov]age is n 9 compliance ) ?is 
section1 ! plan or cov]age-- 7aa7 %all  
specify to ! ,secret>y ! actions ! plan 
or cov]age w take to be 9 compliance )  
?is section & provide to ! ,secret>y    
comp>ative analyses describ$ 9          
subp>agraph 7,a7 t demon/rate compliance
 ) ?is section n lat] ?an #de days aft] 
! initial det]m9ation by ! ,secret>y t !
 plan or cov]age is n 9 compliance2 &   
7bb7 foll[+ ! #de-;day corrective action
 p]iod "u item 7aa71 if ! ,secret>y     
det]m9es t ! plan or cov]age /ill is n 9
 compliance ) ?is section1 n lat] ?an #g
 days aft] su* det]m9ation1 %all notify 
all individuals enroll$ 9 ! plan or     
cov]age t ! plan or cov]age has be5     
det]m9$ to be n 9 compliance ) ?is      
section4  7,,ii7 ,exemption f disclosure
 ,docum5ts or communications produc$ 9  
connection ) ! ,secret>y's              
recomm5dations to ! plan or cov]age %all
 n be subject to disclosure pursuant to 

section #eeb ( title #e1 ,unit$ ,/ates  
,code4  7iv7 ,report ,n lat] ?an #a ye> 
aft] ! date ( enactm5t ( ?is p>agraph1 &
 n lat] ?an ,octob] #a ( ea* ye>        
!reaft]1 ! ,secret>y %all submit to     
,congress1 & make publicly available1 a 
report t conta9s-- 7,i7 a summ>y ( !    
comp>ative analyses reque/$ "u clause   
7i71 includ+ ! id5tity ( ea* plan or    
cov]age t is det]m9$ to be n 9          
compliance aft] ! f9al det]m9ation by ! 
,secret>y describ$ 9 clause             
7iii77,i77bb72  7,,ii7 ! ,secret>y's    
conclusions z to :e!r ea* plan or       
cov]age submitt$ suffici5t in=mation = !
 ,secret>y to review ! comp>ative       
analyses reque/$ "u clause 7i7 =        
compliance ) ?is section2  7,,iii7 = ea*
 plan or cov]age t did submit suffici5t 
in=mation = ! ,secret>y to review !     
comp>ative analyses reque/$ "u clause   
7i71 ! ,secret>y's conclusions z to :e!r
 & :y ! plan or cov]age is 9 compliance 
) ! requirem5ts "u ?is section2  7,,iv7 
! ,secret>y's specifications describ$ 9 

clause 7ii7 = ea* plan or cov]age t !   
,secret>y det]m9$ did n submit suffici5t
 in=mation = ! ,secret>y to review !    
comp>ative analyses reque/$ "u clause   
7i7 = compliance ) ?is section2 &  7,v7 
! ,secret>y's specifications describ$ 9 
clause 7iii7 ( ! actions ea* plan or    
cov]age t ! ,secret>y det]m9$ is n 9    
compliance ) ?is section mu/ take to be 
9 compliance ) ?is section1 includ+ !   
reason :y ! ,secret>y det]m9$ ! plan or 
cov]age is n 9 compliance4  7,c7        
,compliance program guidance docum5t    
update process  7i7 ,9 g5]al ,!         
,secret>y %all include in/ances (       
noncompliance t ! ,secret>y discov]s ^u 
review+ ! comp>ative analyses reque/$ "u
 subp>agraph 7,b77i7 9 ! compliance     
program guidance docum5t describ$ 9     
p>agraph 7#f71 z x is updat$ e #b ye>s1 
except t su* in/ances %all n disclose   
any protect$ heal? in=mation or         
individually id5tifiable in=mation4     
7ii7 ,guidance & regulations ,n lat] ?an
 #ah mon?s aft] ! date ( enactm5t ( ?is 

p>agraph1 ! ,secret>y %all f9alize any  
draft or int]im guidance & regulations  
relat+ to m5tal heal? p>ity "u ?is      
section4 ,su* draft guidance %all       
include 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 plans to    
file compla9ts ( su* plans or issu]s be+
 9 violation ( ?is section1 includ+     
guidance1 by plan type1 on ! relevant   
,/ate1 regional1 or national (fice ) :i*
 su* compla9ts %\ld be fil$4  7iii7     
,/ate ,! ,secret>y %all %>e in=mation on
 f9d+s ( compliance & noncompliance     
discov]$ ^u review+ ! comp>ative        
analyses reque/$ "u subp>agraph 7,b77i7 
) ! ,/ate :]e ! gr\p heal? plan is      
locat$ or ! ,/ate :]e ! heal? insurance 
issu] is lic5s$ to d bus9ess = cov]age  
(f]$ by a heal? insurance issu] 9 ! gr\p
 m>ket1 9 accordance ) p>agraph         
7#f77;,b77iii77,,ii74  7b7 ,con/ruction 
,no?+ 9 ?is section %all be con/ru$--   

7#a7 z requir+ a gr\p heal? plan or a   
heal? insurance issu] (f]+ gr\p or      
individual heal? insurance cov]age to   
provide any m5tal heal? or sub/ance use 
disord] b5efits2 or  7#b7 9 ! case ( a  
gr\p heal? plan or a heal? insurance    
issu] (f]+ gr\p or individual heal?     
insurance cov]age t provides m5tal heal?
 or sub/ance use disord] b5efits1 z     
affect+ ! t]ms & conditions ( ! plan or 
cov]age relat+ to su* b5efits "u ! plan 
or cov]age1 except z provid$ 9          
subsection 7a74  7c7 ,exemptions  7#a7  
,small employ] exemption ,?is section   
%all n apply to any gr\p heal? plan & a 
heal? insurance issu] (f]+ gr\p or      
individual heal? insurance cov]age = any
 plan ye> ( a small employ] 7z def9$ 9  
section #bgia7;e77#d71 except t =       
purposes ( ?is p>agraph su* t]m %all    
include employ]s ) #a employee 9 ! case 
( an employ] resid+ 9 a ,/ate t p]mits  
small gr\ps to include a s+le           
individual74  7#b7 ,co/ exemption  7,a7 
,9 g5]al ,) respect to a gr\p heal? plan

 or a heal? insurance issu] (f]+ gr\p or
 individual heal? insurance cov]age1 if 
! application ( ?is section to su* plan 
7or cov]age7 results 9 an increase = !  
plan ye> involv$ ( ! actual total co/s (
 cov]age ) respect to m$ical & surgical 
b5efits & m5tal heal? & sub/ance use    
disord] b5efits "u ! plan 7z det]m9$ &  
c]tifi$ "u subp>agraph 7,c77 by an am\nt
 t exce$s ! applicable p]c5tage describ$
 9 subp>agraph 7,b7 ( ! actual total    
plan co/s1 ! provisions ( ?is section   
%all n apply to su* plan 7or cov]age7   
dur+ ! foll[+ plan ye>1 & su* exemption 
%all apply to ! plan 7or cov]age7 = #a  
plan ye>4 ,an employ] may elect to      
cont9ue to apply m5tal heal? & sub/ance 
use disord] p>ity pursuant to ?is       
section ) respect to ! gr\p heal? plan  
7or cov]age7 involv$ reg>dless ( any    
increase 9 total co/s4  7,b7 ,applicable
 p]c5tage ,) respect to a plan 7or      
cov]age71 ! applicable p]c5tage describ$
 9 ?is subp>agraph %all be-- 7i7 #b     
p]c5t 9 ! case ( ! fir/ plan ye> 9 :i*  

?is section is appli$2 &  7ii7 #a p]c5t 
9 ! case ( ea* subsequ5t plan ye>4  7,c7
 ,det]m9ations by actu>ies ,det]m9ations
 z to increases 9 actual co/s "u a plan 
7or cov]age7 = purposes ( ?is section   
%all be made & c]tifi$ by a qualifi$ &  
lic5s$ actu>y :o is a memb] 9 good /&+ (
 ! ,am]ican ,academy ( ,actu>ies4 ,all  
su* det]m9ations %all be 9 a writt5     
report prep>$ by ! actu>y4 ,! report1 & 
all und]ly+ docum5tation reli$ ^u by !  
actu>y1 %all be ma9ta9$ by ! gr\p heal? 
plan or heal? insurance issu] = a p]iod 
( #f ye>s foll[+ ! notification made "u 
subp>agraph 7,e74  7,d7 #f-mon?         
det]m9ations ,if a gr\p heal? plan 7or a
 heal? insurance issu] (f]+ cov]age 9   
connection ) a gr\p heal? plan7 seeks an
 exemption "u ?is p>agraph1 det]m9ations
 "u subp>agraph 7,a7 %all be made aft]  
su* plan 7or cov]age7 has compli$ ) ?is 
section = ! fir/ #f mon?s ( ! plan ye>  
involv$4  7,e7 ,notification  7i7 ,9    
g5]al ,a gr\p heal? plan 7or a heal?    
insurance issu] (f]+ cov]age 9          

connection ) a gr\p heal? plan7 t1 bas$ 
^u a c]tification describ$ "u           
subp>agraph 7,c71 qualifies = an        
exemption "u ?is p>agraph1 & elects to  
implem5t ! exemption1 %all promptly     
notify ! ,secret>y1 ! appropriate ,/ate 
ag5cies1 & p>ticipants & b5efici>ies 9 !
 plan ( su* election4  7ii7 ,requirem5t 
,a notification to ! ,secret>y "u clause
 7i7 %all include-- 7,i7 a description (
 ! numb] ( cov]$ lives "u ! plan 7or    
cov]age7 involv$ at ! "t ( !            
notification1 & z applicable1 at ! "t ( 
any prior election ( ! co/-exemption "u 
?is p>agraph by su* plan 7or cov]age72  
7,,ii7 = bo? ! plan ye> ^u :i* a co/    
exemption is s\ght & ! ye> prior1 a     
description ( ! actual total co/s (     
cov]age ) respect to m$ical & surgical  
b5efits & m5tal heal? & sub/ance use    
disord] b5efits "u ! plan2 &  7,,iii7 = 
bo? ! plan ye> ^u :i* a co/ exemption is
 s\ght & ! ye> prior1 ! actual total    
co/s ( cov]age ) respect to m5tal heal? 
& sub/ance use disord] b5efits "u !     

plan4  7iii7 ,confid5tiality ,a         
notification to ! ,secret>y "u clause   
7i7 %all be confid5tial4 ,! ,secret>y   
%all make available1 ^u reque/ & on n m 
?an an annual basis1 an anonym\s        
itemization ( su* notifications1 t      
includes-- 7,i7 a breakd[n ( ,/ates by !
 size & type ( employ]s submitt+ su*    
notification2 &  7,,ii7 a summ>y ( !    
data receiv$ "u clause 7ii74  7,f7      
,audits by appropriate ag5cies ,to      
det]m9e compliance ) ?is p>agraph1 !    
,secret>y may audit ! books & records ( 
a gr\p heal? plan or heal? insurance    
issu] relat+ to an exemption1 includ+   
any actu>ial reports prep>$ pursuant to 
subp>agraph 7,c71 dur+ ! #f ye> p]iod   
foll[+ ! notification ( su* exemption "u
 subp>agraph 7,e74 ,a ,/ate ag5cy       
receiv+ a notification "u subp>agraph   
7,e7 may also conduct su* an audit )    
respect to an exemption cov]$ by su*    
notification4  7d7 ,sep>ate ,application
 to ,ea* ,option ,(f]$ ,9 ! case ( a    
gr\p heal? plan t (f]s a p>ticipant or  

b5efici>y two or m b5efit package       
options "u ! plan1 ! requirem5ts ( ?is  
section %all be appli$ sep>ately )      
respect to ea* su* option4  7e7         
,def9itions ,= purposes ( ?is section-- 
7#a7 ,aggregate lifetime limit ,! t]m   
aggregate lifetime limit means1 )       
respect to b5efits "u a gr\p heal? plan 
or heal? insurance cov]age1 a doll>     
limitation on ! total am\nt t may be    
paid ) respect to su* b5efits "u ! plan 
or heal? insurance cov]age ) respect to 
an individual or o!r cov]age unit4  7#b7
 ,annual limit ,! t]m annual limit      
means1 ) respect to b5efits "u a gr\p   
heal? plan or heal? insurance cov]age1 a
 doll> limitation on ! total am\nt (    
b5efits t may be paid ) respect to su*  
b5efits 9 a #ab-mon? p]iod "u ! plan or 
heal? insurance cov]age ) respect to an 
individual or o!r cov]age unit4  7#c7   
,m$ical or surgical b5efits ,! t]m      
m$ical or surgical b5efits means b5efits
 ) respect to m$ical or surgical        
s]vices1 z def9$ "u ! t]ms ( ! plan or  

cov]age 7z ! case may be71 b does n     
include m5tal heal? or sub/ance use     
disord] b5efits4  7#d7 ,m5tal heal?     
b5efits ,! t]m m5tal heal? b5efits means
 b5efits ) respect to s]vices = m5tal   
heal? conditions1 z def9$ "u ! t]ms ( ! 
plan & 9 accordance ) applicable ,f$]al 
& ,/ate law4  7#e7 ,sub/ance use disord]
 b5efits ,! t]m sub/ance use disord]    
b5efits means b5efits ) respect to      
s]vices = sub/ance use disord]s1 z def9$
 "u ! t]ms ( ! plan & 9 accordance )    
applicable ,f$]al & ,/ate law4  4  7#b7 
,sunset ,section #bgbf ( ! ,public      
,heal? ,s]vice ,act 7#db ,u4,s4,c4      
#cjj;gg-#bf7 is am5d$ by add+ at ! end !
 foll[+ new subsection  7f7 ,sunset ,!  
provisions ( ?is section %all h no =ce  
or effect aft] ! date ( ! enactm5t ( !  
,/r5g!n+ ,behavioral ,heal? ,p>ity ,act4
  4  7#c7 ,adm9i/ration2 con=m+ am5dm5ts
  7,a7 ,application ( implem5tation     
regulations ,! provisions ( sections    
#adf4acf & #adg4afj ( title #de1 ,code (
 ,f$]al ,regulations %all apply to      

section #bgii;,a-#a ( ! ,public ,heal?  
,s]vice ,act1 z add$ by p>agraph 7#a71 9
 ! same mann] z su* provisions appli$ to
 section #bgbf ( ! ,public ,heal?       
,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#bf7
 be=e ! date ( ! enactm5t ( ?is ,act4   
7,b7 ,con=m+ am5dm5ts  7i7 ,section     
#bgbb ( ! ,public ,heal? ,s]vice ,act   
7#db ,u4,s4,c4 #cjj;gg-#ba7 is am5d$--  
7,i7 9 subsection 7a77#a71 by ins]t+ &  
"p ,d aft] subp>ts #a & #b2  7,,ii7 9   
subsection 7b71 by ins]t+ & "p ,d aft]  
subp>ts #a & #b2  7,,iii7 9 subsection  
7c77#a71 by ins]t+ & "p ,d aft] subp>ts 
#a & #b2  7,,iv7 9 subsection 7c77#b71  
by ins]t+ & "p ,d aft] subp>ts #a & #b2 
7,v7 9 subsection 7c77#c71 by ins]t+ &  
"p ,d aft] ?is "p2 &  7,,vi7 9          
subsection 7d71 9 ! matt] prec$+        
p>agraph 7#a71 by ins]t+ & "p ,d aft]   
?is "p4  7ii7 ,section #bgbc ( ! ,public
 ,heal? ,s]vice ,act 7#db ,u4,s4,c4     
#cjj;gg-#bb7 is am5d$-- 7,i7 9          
subsection 7a77#a71 by ins]t+ & "p ,d   
aft] ?is "p2  7,,ii7 9 subsection       

7a77#b71 by ins]t+ or "p ,d aft] ?is "p2
  7,,iii7 9 subsection 7b77#a71 by      
ins]t+ or "p ,d aft] ?is "p2  7,,iv7 9  
subsection 7b77#b77;,a71 by ins]t+ or "p
 ,d aft] ?is "p2 &  7,v7 9 subsection   
7b77#b77;,c77ii71 by ins]t+ & "p ,d aft]
 ?is "p4  7iii7 ,section #bgbd ( !      
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #cjj;gg-#bc7 is am5d$-- 7,i7 9
 subsection 7a77#a7-- 7aa7 by /rik+ ?is 
"p & "p ,c ins(> z x relates to ?is "p &
 ins]t+ ?is "p1 "p ,d1 & "p ,c ins(> z x
 relates to ?is "p or "p ,d2 &  7bb7 by 
ins]t+ or "p ,d aft] requirem5t ( ?is   
"p2  7,,ii7 9 subsection 7a77#b71 by    
ins]t+ or "p ,d aft] ?is "p2 &  7,,iii7 
9 subsection 7c71 by ins]t+ or "p ,d    
aft] ?is "p 7o!r ?an section #bgjd74    
7b7 ,,erisa ,section #gab7;a7 ( !       
,employee ,retirem5t ,income ,security  
,act ( #aigd 7#aahe;a7a77 is am5d$ by   
add+ at ! end ! foll[+ new p>agraphs3   
7#f7 ,compliance program guidance       
docum5t  7,a7 ,9 g5]al ,n lat] ?an #ab  
mon?s aft] ! date ( enactm5t ( ! ,help+ 

,families 9 ,m5tal ,heal? ,crisis ,re=m 
,act ( #bjaf1 ! ,secret>y1 ! ,secret>y (
 ,heal? & ,human ,s]vices1 & ! ,secret>y
 ( ! ,treasury1 9 consultation ) !      
,inspector ,g5]al ( ! ,dep>tm5t ( ,heal?
 & ,human ,s]vices1 ! ,inspector ,g5]al 
( ! ,dep>tm5t ( ,labor1 & ! ,inspector  
,g5]al ( ! ,dep>tm5t ( ! ,treasury1 %all
 issue a compliance program guidance    
docum5t to help improve compliance ) ?is
 section1 section #bgii;,a-#a ( !       
,public ,heal? ,s]vice ,act1 & section  
#ihab ( ! ,int]nal ,rev5ue ,code (      
#aihf1 z applicable4 ,9 c>ry+ out ?is   
p>agraph1 ! ,secret>ies may take into   
consid]ation ! #bjaf publication ( !    
,dep>tm5t ( ,heal? & ,human ,s]vices & !
 ,dep>tm5t ( ,labor1 entitl$ ,w>n+      
,signs - ,plan or ,policy               
,non-,quantitative ,treatm5t            
,limitations 7,n,q,t,ls7 t ,require     
,additional ,analysis to ,det]m9e ,m5tal
 ,heal? ,p>ity ,compliance4  7,b7       
,examples illu/rat+ compliance &        
noncompliance  7i7 ,9 g5]al ,!          

compliance program guidance docum5t     
requir$ "u ?is p>agraph %all provide    
illu/rative1 de-id5tifi$ examples 7t d n
 disclose any protect$ heal? in=mation  
or individually id5tifiable in=mation7 (
 previ\s f9d+s ( compliance &           
noncompliance ) ?is section1 section    
#bgii;,a-#a ( ! ,public ,heal? ,s]vice  
,act1 or section #ihab ( ! ,int]nal     
,rev5ue ,code ( #aihf1 z applicable1    
bas$ on inve/igations ( violations ( su*
 sections1 includ+-- 7,i7 examples      
illu/rat+ requirem5ts = in=mation       
disclosures & nonquantitative treatm5t  
limitations2 &  7,,ii7 descriptions ( ! 
violations uncov]$ dur+ ! c\rse ( su*   
inve/igations4  7ii7 ,nonquantitative   
treatm5t limitations ,to ! ext5t t any  
example describ$ 9 clause 7i7 involves a
 f9d+ ( compliance or noncompliance )   
reg>d to any requirem5t =               
nonquantitative treatm5t limitations1 ! 
example %all provide suffici5t detail to
 fully expla9 su* f9d+1 includ+ a full  
description ( ! crit]ia involv$ =       

approv+ m$ical & surgical b5efits & !   
crit]ia involv$ = approv+ m5tal heal? & 
sub/ance use disord] b5efits4  7iii7    
,access to additional in=mation reg>d+  
compliance ,9 develop+ & issu+ !        
compliance program guidance docum5t     
requir$ "u ?is p>agraph1 ! ,secret>ies  
specifi$ 9 subp>agraph 7,a7-- 7,i7 %all 
ent] into int]ag5cy agreem5ts ) !       
,inspector ,g5]al ( ! ,dep>tm5t ( ,heal?
 & ,human ,s]vices1 ! ,inspector ,g5]al 
( ! ,dep>tm5t ( ,labor1 & ! ,inspector  
,g5]al ( ! ,dep>tm5t ( ! ,treasury to   
%>e f9d+s ( compliance & noncompliance )
 ?is section1 section #bgii;,a-#a ( !   
,public ,heal? ,s]vice ,act1 or section 
#ihab ( ! ,int]nal ,rev5ue ,code (      
#aihf1 z applicable2 &  7,,ii7 %all seek
 to ent] into an agreem5t ) a ,/ate to  
%>e in=mation on f9d+s ( compliance &   
noncompliance ) ?is section1 section    
#bgii;,a-#a ( ! ,public ,heal? ,s]vice  
,act1 or section #ihab ( ! ,int]nal     
,rev5ue ,code ( #aihf1 z applicable4    
7,c7 ,recomm5dations ,! compliance      

program guidance docum5t %all include   
recomm5dations to advance compliance )  
?is section1 section #bgii;,a-#a ( !    
,public ,heal? ,s]vice ,act1 or section 
#ihab ( ! ,int]nal ,rev5ue ,code (      
#aihf1 z applicable1 & enc\rage !       
developm5t & use ( int]nal controls to  
monitor adh]5ce to applicable /atutes1  
regulations1 & program requirem5ts4 ,su*
 int]nal controls may include           
illu/rative examples ( nonquantitative  
treatm5t limitations on m5tal heal? &   
sub/ance use disord] b5efits1 :i* may   
fail to comply ) ?is section1 section   
#bgii;,a-#a ( ! ,public ,heal? ,s]vice  
,act1 or section #ihab ( ! ,int]nal     
,rev5ue ,code ( #aihf1 z applicable1 9  
relation to nonquantitative treatm5t    
limitations on m$ical & surgical        
b5efits4  7,d7 ,updat+ ! compliance     
program guidance docum5t ,! ,secret>y1 !
 ,secret>y ( ,heal? & ,human ,s]vices1 &
 ! ,secret>y ( ! ,treasury1 9           
consultation ) ! ,inspector ,g5]al ( !  
,dep>tm5t ( ,heal? & ,human ,s]vices1 ! 

,inspector ,g5]al ( ! ,dep>tm5t (       
,labor1 & ! ,inspector ,g5]al ( !       
,dep>tm5t ( ! ,treasury1 %all update !  
compliance program guidance docum5t e #b
 ye>s to include illu/rative1           
de-id5tifi$ examples 7t d n disclose any
 protect$ heal? in=mation or            
individually id5tifiable in=mation7 (   
previ\s f9d+s ( compliance &            
noncompliance ) ?is section1 section    
#bgii;,a-#a ( ! ,public ,heal? ,s]vice  
,act1 or section #ihab ( ! ,int]nal     
,rev5ue ,code ( #aihf1 z applicable4    
7#g7 ,additional guidance  7,a7 ,9 g5]al
 ,n lat] ?an #ab mon?s aft] ! date (    
enactm5t ( ! ,help+ ,families 9 ,m5tal  
,heal? ,crisis ,re=m ,act ( #bjaf1 !    
,secret>y1 ! ,secret>y ( ,heal? & ,human
 ,s]vices1 & ! ,secret>y ( ! ,treasury  
%all issue guidance to gr\p heal? plans 
& heal? insurance issu]s (f]+ gr\p or   
individual heal? insurance cov]age to   
assi/ su* plans & issu]s 9 satisfy+ !   
requirem5ts ( ?is section1 section      
#bgii;,a-#a ( ! ,public ,heal? ,s]vice  

,act1 or section #ihab ( ! ,int]nal     
,rev5ue ,code ( #aihf1 z applicable4    
7,b7 ,disclosure  7i7 ,guidance = plans 
& issu]s ,! guidance issu$ "u ?is       
p>agraph %all include cl>ify+ in=mation 
& illu/rative examples ( me?ods t gr\p  
heal? plans & heal? insurance issu]s    
(f]+ gr\p or individual heal? insurance 
cov]age may use = disclos+ in=mation to 
ensure compliance ) ! requirem5ts "u ?is
 section1 section #bgii;,a-#a ( !       
,public ,heal? ,s]vice ,act1 or section 
#ihab ( ! ,int]nal ,rev5ue ,code (      
#aihf1 z applicable1 7& any regulations 
promulgat$ pursuant to su* sections1 z  
applicable74  7ii7 ,docum5ts =          
p>ticipants1 b5efici>ies1 contract+     
provid]s1 or au?oriz$ repres5tatives ,! 
guidance issu$ "u ?is p>agraph %all     
include cl>ify+ in=mation & illu/rative 
examples ( me?ods t gr\p heal? plans &  
heal? insurance issu]s (f]+ gr\p or     
individual heal? insurance cov]age may  
use to provide any p>ticipant1          
b5efici>y1 contract+ provid]1 or        

au?oriz$ repres5tative1 z applicable1 ) 
docum5ts conta9+ in=mation t ! heal?    
plans or issu]s are requir$ to disclose 
to p>ticipants1 b5efici>ies1 contract+  
provid]s1 or au?oriz$ repres5tatives to 
ensure compliance ) ?is section1 section
 #bgii;,a-#a ( ! ,public ,heal? ,s]vice 
,act1 or section #ihab ( ! ,int]nal     
,rev5ue ,code ( #aihf1 z applicable1    
compliance ) any regulation issu$       
pursuant to su* respective section1 or  
compliance ) any o!r applicable law or  
regulation4 ,su* guidance %all include  
in=mation t is comp>ative 9 nature )    
respect to-- 7,i7 nonquantitative       
treatm5t limitations = bo? m$ical &     
surgical b5efits & m5tal heal? &        
sub/ance use disord] b5efits2  7,,ii7 ! 
processes1 /rategies1 evid5ti>y /&>ds1 &
 o!r factors us$ to apply ! limitations 
describ$ 9 subclause 7,i72 &  7,,iii7 ! 
application ( ! limitations describ$ 9  
subclause 7,i7 to ensure t su*          
limitations are appli$ 9 p>ity ) respect
 to bo? m$ical & surgical b5efits &     

m5tal heal? & sub/ance use disord]      
b5efits4  7,c7 ,nonquantitative treatm5t
 limitations ,! guidance issu$ "u ?is   
p>agraph %all include cl>ify+ in=mation 
& illu/rative examples ( me?ods1        
processes1 /rategies1 evid5ti>y /&>ds1 &
 o!r factors t gr\p heal? plans & heal? 
insurance issu]s (f]+ gr\p or individual
 heal? insurance cov]age may use reg>d+ 
! developm5t & application (            
nonquantitative treatm5t limitations to 
ensure compliance ) ?is section1 section
 #bgii;,a-#a ( ! ,public ,heal? ,s]vice 
,act1 or section #ihab ( ! ,int]nal     
,rev5ue ,code ( #aihf1 z applicable1 7& 
any regulations promulgat$ pursuant to  
su* respective section71 includ+-- 7i7  
examples ( me?ods ( det]m9+ appropriate 
types ( nonquantitative treatm5t        
limitations ) respect to bo? m$ical &   
surgical b5efits & m5tal heal? &        
sub/ance use disord] b5efits1 includ+   
nonquantitative treatm5t limitations    
p]ta9+ to-- 7,i7 m$ical managem5t /&>ds 
bas$ on m$ical necessity or             

appropriat5ess1 or :e!r a treatm5t is   
exp]im5tal or inve/igative2  7,,ii7     
limitations ) respect to prescription   
drug =mul>y design2 &  7,,iii7 use (    
fail-fir/ or /ep !rapy protocols2  7ii7 
examples ( me?ods ( det]m9+-- 7,i7      
network admission /&>ds 7su* z          
cr$5tial+72 &  7,,ii7 factors us$ 9     
provid] reimbursem5t me?odologies 7su* z
 s]vice type1 geographic m>ket1 dem& =  
s]vices1 & provid] supply1 practice     
size1 tra9+1 exp]i5ce1 & lic5sure7 z su*
 factors apply to network adequacy2     
7iii7 examples ( s\rces ( in=mation t   
may s]ve z evid5ti>y /&>ds = ! purposes 
( mak+ det]m9ations reg>d+ ! developm5t 
& application ( nonquantitative treatm5t
 limitations2  7iv7 examples ( specific 
factors1 & ! evid5ti>y /&>ds us$ to     
evaluate su* factors1 us$ by su* plans  
or issu]s 9 p]=m+ a nonquantitative     
treatm5t limitation analysis2  7v7      
examples ( h[ specific evid5ti>y /&>ds  
may be us$ to det]m9e :e!r treatm5ts are
 consid]$ exp]im5tal or inve/igative2   

7vi7 examples ( h[ specific evid5ti>y   
/&>ds may be appli$ to ea* s]vice       
category or classification ( b5efits2   
7vii7 examples ( me?ods ( rea*+         
appropriate cov]age det]m9ations = new  
m5tal heal? or sub/ance use disord]     
treatm5ts1 su* z evid5ce-bas$ e>ly      
int]v5tion programs = individuals ) a   
s]i\s m5tal illness & types ( m$ical    
managem5t te*niques2  7viii7 examples ( 
me?ods ( rea*+ appropriate cov]age      
det]m9ations = :i* !re is an indirect   
relation%ip betwe5 ! cov]$ m5tal heal?  
or sub/ance use disord] b5efit & a      
traditional cov]$ m$ical & surgical     
b5efit1 su* z resid5tial treatm5t or    
hospitalizations involv+ volunt>y or    
involunt>y commitm5t2 &  7ix7 additional
 illu/rative examples ( me?ods1         
processes1 /rategies1 evid5ti>y /&>ds1 &
 o!r factors = :i* ! ,secret>y det]m9es 
t additional guidance is necess>y to    
improve compliance ) ?is section1       
section #bgii;,a-#a ( ! ,public ,heal?  
,s]vice ,act1 or section #ihab ( !      

,int]nal ,rev5ue ,code ( #aihf1 z       
applicable4  7,d7 ,public comm5t ,prior 
to issu+ any f9al guidance "u ?is       
p>agraph1 ! ,secret>y %all provide a    
public comm5t p]iod ( n less ?an #fj    
days dur+ :i* any memb] ( ! public may  
provide comm5ts on a draft ( ! guidance4
  7#h7 ,compliance requirem5ts  7,a7    
,nonquantitative treatm5t limitation    
7,,nqtl7 requirem5ts ,beg9n+ #de days   
aft] ! date ( enactm5t ( ?is p>agraph1 9
 ! case ( a gr\p heal? plan or a heal?  
insurance issu] (f]+ gr\p heal?         
insurance cov]age t provides bo? m$ical 
& surgical b5efits & m5tal heal? or     
sub/ance use disord] b5efits & t imposes
 nonquantitative treatm5t limitations   
7ref]r$ to 9 ?is section z ,,nqtl7 on   
m5tal heal? or sub/ance use disord]     
b5efits1 ! plan or issu] (f]+ heal?     
insurance cov]age %all p]=m comp>ative  
analyses ( ! design & application (     
,n,q,t,ls 9 accordance ) subp>agraph    
7,b71 & make available to ! applicable  
,/ate au?ority 7or1 z applicable1 !     

,secret>y71 ^u reque/1 ! foll[+         
in=mation3 7i7 ,! specific plan or      
cov]age t]ms reg>d+ ! ,,nqtl1 t applies 
to su* plan or cov]age1 & a description 
( all m5tal heal? or sub/ance use       
disord] & m$ical or surgical b5efits to 
:i* x applies 9 ea* respective b5efits  
classification4  7ii7 ,! factors us$ to 
det]m9e t ! ,,nqtl w apply to m5tal     
heal? or sub/ance use disord] b5efits & 
m$ical or surgical b5efits4  7iii7 ,!   
evid5ti>y /&>ds us$ = ! factors id5tifi$
 9 clause 7ii71 :5 applicable1 provid$ t
 e factor %all be def9$ & any o!r s\rce 
or evid5ce reli$ ^u to design & apply ! 
,,nqtl to m5tal heal? or sub/ance use   
disord] b5efits & m$ical or surgical    
b5efits4  7iv7 ,! comp>ative analyses   
demon/rat+ t ! processes1 /rategies1    
evid5ti>y /&>ds1 & o!r factors us$ to   
design ! ,,nqtl1 z writt51 & ! op]ation 
processes & /rategies z writt5 & 9      
op]ation t are us$ to apply ! ,,nqtl =  
m5tal heal? or sub/ance use disord]     
b5efits are comp>able to1 & are appli$  

no m /r+5tly ?an1 ! processes1          
/rategies1 evid5ti>y /&>ds1 & o!r       
factors us$ to design ! ,,nqtl1 z       
writt51 & ! op]ation processes &        
/rategies z writt5 & 9 op]ation t are   
us$ to apply ! ,,nqtl to m$ical or      
surgical b5efits4  7v7 ,a disclosure ( !
 specific f9d+s & conclusions rea*$ by !
 plan or cov]age t ! results ( !        
analyses describ$ 9 ?is subp>agraph     
indicate t ! plan or cov]age is 9       
compliance ) ?is section4  7,b7         
,secret>y reque/ process  7i7           
,submission ^u reque/ ,! ,secret>y %all 
reque/ t a gr\p heal? plan or a heal?   
insurance issu] (f]+ gr\p heal?         
insurance cov]age submit ! comp>ative   
analyses describ$ 9 subp>agraph 7,a7 =  
plans t involve pot5tial violations (   
?is section or compla9ts reg>d+         
noncompliance ) ?is section t conc]n    
,n,q,t,ls & any o!r in/ances 9 :i* !    
,secret>y det]m9es appropriate4 ,!      
,secret>y %all reque/ n few] ?an #bj su*
 analyses p] ye>4  7ii7 ,additional     

in=mation ,9 in/ances 9 :i* ! ,secret>y 
has conclud$ t ! plan or cov]age has n  
submitt$ suffici5t in=mation = !        
,secret>y to review ! comp>ative        
analyses describ$ 9 subp>agraph 7,a71 z 
reque/$ "u clause 7i71 ! ,secret>y %all 
specify to ! plan or cov]age ! in=mation
 ! plan or cov]age mu/ submit to be     
responsive to ! reque/ "u clause 7i7 = !
 ,secret>y to review ! comp>ative       
analyses describ$ 9 subp>agraph7,a7 =   
compliance ) ?is section4 ,no?+ 9 ?is   
p>agraph %all require ! ,secret>y to    
conclude t a plan is 9 compliance ) ?is 
section solely bas$ ^u ! inspection ( ! 
comp>ative analyses describ$ 9          
subp>agraph 7,a71 z reque/$ "u clause   
7i74  7iii7 ,requir$ action  7,i7 ,9    
g5]al ,9 in/ances 9 :i* ! ,secret>y has 
review$ ! comp>ative analyses describ$ 9
 subp>agraph 7,a71 z reque/$ "u clause  
7i71 & det]m9$ t ! plan or cov]age is n 
9 compliance ) ?is section1 ! plan or   
cov]age-- 7aa7 %all specify to !        
,secret>y ! actions ! plan or cov]age w 

take to be 9 compliance ) ?is section & 
provide to ! ,secret>y comp>ative       
analyses describ$ 9 subp>agraph 7,a7 t  
demon/rate compliance ) ?is section n   
lat] ?an #de days aft] ! initial        
det]m9ation by ! ,secret>y t ! plan or  
cov]age is n 9 compliance2 &  7bb7      
foll[+ ! #de-;day corrective action     
p]iod "u item 7aa71 if ! ,secret>y      
det]m9es t ! plan or cov]age /ill is n 9
 compliance ) ?is section1 n lat] ?an #g
 days aft] su* det]m9ation1 %all notify 
all individuals enroll$ 9 ! plan or     
cov]age t ! plan or cov]age has be5     
det]m9$ to be n 9 compliance ) ?is      
section4  7,,ii7 ,exemption f disclosure
 ,docum5ts or communications produc$ 9  
connection ) ! ,secret>y's              
recomm5dations to ! plan or cov]age %all
 n be subject to disclosure pursuant to 
section #eeb ( title #e1 ,unit$ ,/ates  
,code4  7iv7 ,report ,n lat] ?an #a ye> 
aft] ! date ( enactm5t ( ?is p>agraph1 &
 n lat] ?an ,octob] #a ( ea* ye>        
!reaft]1 ! ,secret>y %all submit to     

,congress1 & make publicly available1 a 
report t conta9s-- 7,i7 a summ>y ( !    
comp>ative analyses reque/$ "u clause   
7i71 includ+ ! id5tity ( ea* plan or    
cov]age t is det]m9$ to be n 9          
compliance aft] ! f9al det]m9ation by ! 
,secret>y describ$ 9 clause             
7iii77,i77bb72  7,,ii7 ! ,secret>y's    
conclusions z to :e!r ea* plan or       
cov]age submitt$ suffici5t in=mation = !
 ,secret>y to review ! comp>ative       
analyses reque/$ "u clause 7i7 =        
compliance ) ?is section2  7,,iii7 = ea*
 plan or cov]age t did submit suffici5t 
in=mation = ! ,secret>y to review !     
comp>ative analyses reque/$ "u clause   
7i71 ! ,secret>y's conclusions z to :e!r
 & :y ! plan or cov]age is 9 compliance 
) ! requirem5ts "u ?is section2  7,,iv7 
! ,secret>y's specifications describ$ 9 
clause 7ii7 = ea* plan or cov]age t !   
,secret>y det]m9$ did n submit suffici5t
 in=mation = ! ,secret>y to review !    
comp>ative analyses reque/$ "u clause   
7i7 = compliance ) ?is section2 &  7,v7 

! ,secret>y's specifications describ$ 9 
clause 7iii7 ( ! actions ea* plan or    
cov]age t ! ,secret>y det]m9$ is n 9    
compliance ) ?is section mu/ take to be 
9 compliance ) ?is section1 includ+ !   
reason :y ! ,secret>y det]m9$ ! plan or 
cov]age is n 9 compliance4  7,c7        
,compliance program guidance docum5t    
update process  7i7 ,9 g5]al ,!         
,secret>y %all include in/ances (       
noncompliance t ! ,secret>y discov]s ^u 
review+ ! comp>ative analyses reque/$ "u
 subp>agraph 7,b77i7 9 ! compliance     
program guidance docum5t describ$ 9     
p>agraph 7#f71 z x is updat$ e #b ye>s1 
except t su* in/ances %all n disclose   
any protect$ heal? in=mation or         
individually id5tifiable in=mation4     
7ii7 ,guidance & regulations ,n lat] ?an
 #ah mon?s aft] ! date ( enactm5t ( ?is 
p>agraph1 ! ,secret>y %all f9alize any  
draft or int]im guidance & regulations  
relat+ to m5tal heal? p>ity "u ?is      
section4 ,su* draft guidance %all       
include 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 plans to    
file compla9ts ( su* plans or issu]s be+
 9 violation ( ?is section1 includ+     
guidance1 by plan type1 on ! relevant   
,/ate1 regional1 or national (fice ) :i*
 su* compla9ts %\ld be fil$4  7iii7     
,/ate ,! ,secret>y %all %>e in=mation on
 f9d+s ( compliance & noncompliance     
discov]$ ^u review+ ! comp>ative        
analyses reque/$ "u subp>agraph 7,b77i7 
) ! ,/ate :]e ! gr\p heal? plan is      
locat$ or ! ,/ate :]e ! heal? insurance 
issu] is lic5s$ to d bus9ess = cov]age  
(f]$ by a heal? insurance issu] 9 ! gr\p
 m>ket1 9 accordance ) p>agraph         
7#f77;,b77iii77,,ii74  4  7c7 ,,irc     
,section #ihab ( ! ,int]nal ,rev5ue     
,code ( #aihf is am5d$ by add+ at ! end 
! foll[+ new p>agraphs3  7#f7           
,compliance program guidance docum5t    
7,a7 ,9 g5]al ,n lat] ?an #ab mon?s aft]
 ! date ( enactm5t ( ! ,help+ ,families 

9 ,m5tal ,heal? ,crisis ,re=m ,act (    
#bjaf1 ! ,secret>y1 ! ,secret>y (       
,labor1 & ! ,secret>y ( ,heal? & ,human 
,s]vices1 9 consultation ) ! ,inspector 
,g5]al ( ! ,dep>tm5t ( ,heal? & ,human  
,s]vices1 ! ,inspector ,g5]al ( !       
,dep>tm5t ( ,labor1 & ! ,inspector      
,g5]al ( ! ,dep>tm5t ( ! ,treasury1 %all
 issue a compliance program guidance    
docum5t to help improve compliance ) ?is
 section1 section #gab ( ! ,employee    
,retirem5t ,income ,security ,act (     
#aigd1 & section #bgii;,a-#a ( ! ,public
 ,heal? ,s]vice ,act1 z applicable4 ,9  
c>ry+ out ?is p>agraph1 ! ,secret>ies   
may take into consid]ation ! #bjaf      
publication ( ! ,dep>tm5t ( ,heal? &    
,human ,s]vices & ! ,dep>tm5t ( ,labor1 
entitl$ ,w>n+ ,signs - ,plan or ,policy 
,non-,quantitative ,treatm5t            
,limitations 7,n,q,t,ls7 t ,require     
,additional ,analysis to ,det]m9e ,m5tal
 ,heal? ,p>ity ,compliance4  7,b7       
,examples illu/rat+ compliance &        
noncompliance  7i7 ,9 g5]al ,!          

compliance program guidance docum5t     
requir$ "u ?is p>agraph %all provide    
illu/rative1 de-id5tifi$ examples 7t d n
 disclose any protect$ heal? in=mation  
or individually id5tifiable in=mation7 (
 previ\s f9d+s ( compliance &           
noncompliance ) ?is section1 section    
#gab ( ! ,employee ,retirem5t ,income   
,security ,act ( #aigd1 or section      
#bgii;,a-#a ( ! ,public ,heal? ,s]vice  
,act1 z applicable1 bas$ on             
inve/igations ( violations ( su*        
sections1 includ+-- 7,i7 examples       
illu/rat+ requirem5ts = in=mation       
disclosures & nonquantitative treatm5t  
limitations2 &  7,,ii7 descriptions ( ! 
violations uncov]$ dur+ ! c\rse ( su*   
inve/igations4  7ii7 ,nonquantitative   
treatm5t limitations ,to ! ext5t t any  
example describ$ 9 clause 7i7 involves a
 f9d+ ( compliance or noncompliance )   
reg>d to any requirem5t =               
nonquantitative treatm5t limitations1 ! 
example %all provide suffici5t detail to
 fully expla9 su* f9d+1 includ+ a full  

description ( ! crit]ia involv$ =       
approv+ m$ical & surgical b5efits & !   
crit]ia involv$ = approv+ m5tal heal? & 
sub/ance use disord] b5efits4  7iii7    
,access to additional in=mation reg>d+  
compliance ,9 develop+ & issu+ !        
compliance program guidance docum5t     
requir$ "u ?is p>agraph1 ! ,secret>ies  
specifi$ 9 subp>agraph 7,a7-- 7,i7 %all 
ent] into int]ag5cy agreem5ts ) !       
,inspector ,g5]al ( ! ,dep>tm5t ( ,heal?
 & ,human ,s]vices1 ! ,inspector ,g5]al 
( ! ,dep>tm5t ( ,labor1 & ! ,inspector  
,g5]al ( ! ,dep>tm5t ( ! ,treasury to   
%>e f9d+s ( compliance & noncompliance )
 ?is section1 section #gab ( ! ,employee
 ,retirem5t ,income ,security ,act (    
#aigd1 or section #bgii;,a-#a ( !       
,public ,heal? ,s]vice ,act1 z          
applicable2 &  7,,ii7 %all seek to ent] 
into an agreem5t ) a ,/ate to %>e       
in=mation on f9d+s ( compliance &       
noncompliance ) ?is section1 section    
#gab ( ! ,employee ,retirem5t ,income   
,security ,act ( #aigd1 or section      

#bgii;,a-#a ( ! ,public ,heal? ,s]vice  
,act1 z applicable4  7,c7               
,recomm5dations ,! compliance program   
guidance docum5t %all include           
recomm5dations to advance compliance )  
?is section1 section #gab ( ! ,employee 
,retirem5t ,income ,security ,act (     
#aigd1 or section #bgii;,a-#a ( !       
,public ,heal? ,s]vice ,act1 z          
applicable1 & enc\rage ! developm5t &   
use ( int]nal controls to monitor       
adh]5ce to applicable /atutes1          
regulations1 & program requirem5ts4 ,su*
 int]nal controls may include           
illu/rative examples ( nonquantitative  
treatm5t limitations on m5tal heal? &   
sub/ance use disord] b5efits1 :i* may   
fail to comply ) ?is section1 section   
#gab ( ! ,employee ,retirem5t ,income   
,security ,act ( #aigd1 or section      
#bgii;,a-#a ( ! ,public ,heal? ,s]vice  
,act1 z applicable1 9 relation to       
nonquantitative treatm5t limitations on 
m$ical & surgical b5efits4  7,d7 ,updat+
 ! compliance program guidance docum5t  

,! ,secret>y1 ! ,secret>y ( ,labor1 & ! 
,secret>y ( ,heal? & ,human ,s]vices1 9 
consultation ) ! ,inspector ,g5]al ( !  
,dep>tm5t ( ,heal? & ,human ,s]vices1 ! 
,inspector ,g5]al ( ! ,dep>tm5t (       
,labor1 & ! ,inspector ,g5]al ( !       
,dep>tm5t ( ! ,treasury1 %all update !  
compliance program guidance docum5t e #b
 ye>s to include illu/rative1           
de-id5tifi$ examples 7t d n disclose any
 protect$ heal? in=mation or            
individually id5tifiable in=mation7 (   
previ\s f9d+s ( compliance &            
noncompliance ) ?is section1 section    
#gab ( ! ,employee ,retirem5t ,income   
,security ,act ( #aigd1 or section      
#bgii;,a-#a ( ! ,public ,heal? ,s]vice  
,act1 z applicable4  7#g7 ,additional   
guidance  7,a7 ,9 g5]al ,n lat] ?an #ab 
mon?s aft] ! date ( enactm5t ( ! ,help+ 
,families 9 ,m5tal ,heal? ,crisis ,re=m 
,act ( #bjaf1 ! ,secret>y1 ! ,secret>y (
 ,labor1 & ! ,secret>y ( ,heal? & ,human
 ,s]vices %all issue guidance to gr\p   
heal? plans & heal? insurance issu]s    

(f]+ gr\p or individual heal? insurance 
cov]age to assi/ su* plans & issu]s 9   
satisfy+ ! requirem5ts ( ?is section1   
section #gab ( ! ,employee ,retirem5t   
,income ,security ,act ( #aigd1 or      
section #bgii;,a-#a ( ! ,public ,heal?  
,s]vice ,act1 z applicable4  7,b7       
,disclosure  7i7 ,guidance = plans &    
issu]s ,! guidance issu$ "u ?is p>agraph
 %all include cl>ify+ in=mation &       
illu/rative examples ( me?ods t gr\p    
heal? plans & heal? insurance issu]s    
(f]+ gr\p or individual heal? insurance 
cov]age may use = disclos+ in=mation to 
ensure compliance ) ! requirem5ts "u ?is
 section1 section #gab ( ! ,employee    
,retirem5t ,income ,security ,act (     
#aigd1 or section #bgii;,a-#a ( !       
,public ,heal? ,s]vice ,act1 7& any     
regulations promulgat$ pursuant to su*  
sections1 z applicable74  7ii7 ,docum5ts
 = p>ticipants1 b5efici>ies1 contract+  
provid]s1 or au?oriz$ repres5tatives ,! 
guidance issu$ "u ?is p>agraph %all     
include cl>ify+ in=mation & illu/rative 

examples ( me?ods t gr\p heal? plans &  
heal? insurance issu]s (f]+ gr\p or     
individual heal? insurance cov]age may  
use to provide any p>ticipant1          
b5efici>y1 contract+ provid]1 or        
au?oriz$ repres5tative1 z applicable1 ) 
docum5ts conta9+ in=mation t ! heal?    
plans or issu]s are requir$ to disclose 
to p>ticipants1 b5efici>ies1 contract+  
provid]s1 or au?oriz$ repres5tatives to 
ensure compliance ) ?is section1 section
 #gab ( ! ,employee ,retirem5t ,income  
,security ,act ( #aigd1 or section      
#bgii;,a-#a ( ! ,public ,heal? ,s]vice  
,act1 z applicable1 compliance ) any    
regulation issu$ pursuant to su*        
respective section1 or compliance ) any 
o!r applicable law or regulation4 ,su*  
guidance %all include in=mation t is    
comp>ative 9 nature ) respect to-- 7,i7 
nonquantitative treatm5t limitations =  
bo? m$ical & surgical b5efits & m5tal   
heal? & sub/ance use disord] b5efits2   
7,,ii7 ! processes1 /rategies1 evid5ti>y
 /&>ds1 & o!r factors us$ to apply !    

limitations describ$ 9 subclause 7,i72 &
  7,,iii7 ! application ( ! limitations 
describ$ 9 subclause 7,i7 to ensure t   
su* limitations are appli$ 9 p>ity )    
respect to bo? m$ical & surgical b5efits
 & m5tal heal? & sub/ance use disord]   
b5efits4  7,c7 ,nonquantitative treatm5t
 limitations ,! guidance issu$ "u ?is   
p>agraph %all include cl>ify+ in=mation 
& illu/rative examples ( me?ods1        
processes1 /rategies1 evid5ti>y /&>ds1 &
 o!r factors t gr\p heal? plans & heal? 
insurance issu]s (f]+ gr\p or individual
 heal? insurance cov]age may use reg>d+ 
! developm5t & application (            
nonquantitative treatm5t limitations to 
ensure compliance ) ?is section1 section
 #gab ( ! ,employee ,retirem5t ,income  
,security ,act ( #aigd1 or section      
#bgii;,a-#a ( ! ,public ,heal? ,s]vice  
,act1 z applicable1 7& any regulations  
promulgat$ pursuant to su* respective   
section71 includ+-- 7i7 examples (      
me?ods ( det]m9+ appropriate types (    
nonquantitative treatm5t limitations )  

respect to bo? m$ical & surgical b5efits
 & m5tal heal? & sub/ance use disord]   
b5efits1 includ+ nonquantitative        
treatm5t limitations p]ta9+ to-- 7,i7   
m$ical managem5t /&>ds bas$ on m$ical   
necessity or appropriat5ess1 or :e!r a  
treatm5t is exp]im5tal or inve/igative2 
7,,ii7 limitations ) respect to         
prescription drug =mul>y design2 &      
7,,iii7 use ( fail-fir/ or /ep !rapy    
protocols2  7ii7 examples ( me?ods (    
det]m9+-- 7,i7 network admission /&>ds  
7su* z cr$5tial+72 &  7,,ii7 factors us$
 9 provid] reimbursem5t me?odologies    
7su* z s]vice type1 geographic m>ket1   
dem& = s]vices1 & provid] supply1       
practice size1 tra9+1 exp]i5ce1 &       
lic5sure7 z su* factors apply to network
 adequacy2  7iii7 examples ( s\rces (   
in=mation t may s]ve z evid5ti>y /&>ds =
 ! purposes ( mak+ det]m9ations reg>d+ !
 developm5t & application (             
nonquantitative treatm5t limitations2   
7iv7 examples ( specific factors1 & !   
evid5ti>y /&>ds us$ to evaluate su*     

factors1 us$ by su* plans or issu]s 9   
p]=m+ a nonquantitative treatm5t        
limitation analysis2  7v7 examples ( h[ 
specific evid5ti>y /&>ds may be us$ to  
det]m9e :e!r treatm5ts are consid]$     
exp]im5tal or inve/igative2  7vi7       
examples ( h[ specific evid5ti>y /&>ds  
may be appli$ to ea* s]vice category or 
classification ( b5efits2  7vii7        
examples ( me?ods ( rea*+ appropriate   
cov]age det]m9ations = new m5tal heal?  
or sub/ance use disord] treatm5ts1 su* z
 evid5ce-bas$ e>ly int]v5tion programs =
 individuals ) a s]i\s m5tal illness &  
types ( m$ical managem5t te*niques2     
7viii7 examples ( me?ods ( rea*+        
appropriate cov]age det]m9ations = :i*  
!re is an indirect relation%ip betwe5 ! 
cov]$ m5tal heal? or sub/ance use       
disord] b5efit & a traditional cov]$    
m$ical & surgical b5efit1 su* z         
resid5tial treatm5t or hospitalizations 
involv+ volunt>y or involunt>y          
commitm5t2 &  7ix7 additional           
illu/rative examples ( me?ods1          

processes1 /rategies1 evid5ti>y /&>ds1 &
 o!r factors = :i* ! ,secret>y det]m9es 
t additional guidance is necess>y to    
improve compliance ) ?is section1       
section #gab ( ! ,employee ,retirem5t   
,income ,security ,act ( #aigd1 or      
section #bgii;,a-#a ( ! ,public ,heal?  
,s]vice ,act1 z applicable4  7,d7       
,public comm5t ,prior to issu+ any f9al 
guidance "u ?is p>agraph1 ! ,secret>y   
%all provide a public comm5t p]iod ( n  
less ?an #fj days dur+ :i* any memb] ( !
 public may provide comm5ts on a draft (
 ! guidance4  7#h7 ,compliance          
requirem5ts  7,a7 ,nonquantitative      
treatm5t limitation 7,,nqtl7 requirem5ts
 ,beg9n+ #de days aft] ! date ( enactm5t
 ( ?is p>agraph1 9 ! case ( a gr\p heal?
 plan t provides bo? m$ical & surgical  
b5efits & m5tal heal? or sub/ance use   
disord] b5efits & t imposes             
nonquantitative treatm5t limitations    
7ref]r$ to 9 ?is section z ,,nqtl7 on   
m5tal heal? or sub/ance use disord]     
b5efits1 ! plan %all p]=m comp>ative    

analyses ( ! design & application (     
,n,q,t,ls 9 accordance ) subp>agraph    
7,b71 & make available to ! applicable  
,/ate au?ority 7or1 z applicable1 !     
,secret>y71 ^u reque/1 ! foll[+         
in=mation3 7i7 ,! specific plan t]ms    
reg>d+ ! ,,nqtl1 t applies to su* plan  
or cov]age1 & a description ( all m5tal 
heal? or sub/ance use disord] & m$ical  
or surgical b5efits to :i* x applies 9  
ea* respective b5efits classification4  
7ii7 ,! factors us$ to det]m9e t !      
,,nqtl w apply to m5tal heal? or        
sub/ance use disord] b5efits & m$ical or
 surgical b5efits4  7iii7 ,! evid5ti>y  
/&>ds us$ = ! factors id5tifi$ 9 clause 
7ii71 :5 applicable1 provid$ t e factor 
%all be def9$ & any o!r s\rce or evid5ce
 reli$ ^u to design & apply ! ,,nqtl to 
m5tal heal? or sub/ance use disord]     
b5efits & m$ical or surgical b5efits4   
7iv7 ,! comp>ative analyses demon/rat+ t
 ! processes1 /rategies1 evid5ti>y      
/&>ds1 & o!r factors us$ to design !    
,,nqtl1 z writt51 & ! op]ation processes

 & /rategies z writt5 & 9 op]ation t are
 us$ to apply ! ,,nqtl = m5tal heal? or 
sub/ance use disord] b5efits are        
comp>able to1 & are appli$ no m /r+5tly 
?an1 ! processes1 /rategies1 evid5ti>y  
/&>ds1 & o!r factors us$ to design !    
,,nqtl1 z writt51 & ! op]ation processes
 & /rategies z writt5 & 9 op]ation t are
 us$ to apply ! ,,nqtl to m$ical or     
surgical b5efits4  7v7 ,a disclosure ( !
 specific f9d+s & conclusions rea*$ by !
 plan t ! results ( ! analyses describ$ 
9 ?is subp>agraph indicate t ! plan is 9
 compliance ) ?is section4  7,b7        
,secret>y reque/ process  7i7           
,submission ^u reque/ ,! ,secret>y %all 
reque/ t a gr\p heal? plan submit !     
comp>ative analyses describ$ 9          
subp>agraph 7,a7 = plans t involve      
pot5tial violations ( ?is section or    
compla9ts reg>d+ noncompliance ) ?is    
section t conc]n ,n,q,t,ls & any o!r    
in/ances 9 :i* ! ,secret>y det]m9es     
appropriate4 ,! ,secret>y %all reque/ n 
few] ?an #bj su* analyses p] ye>4  7ii7 

,additional in=mation ,9 in/ances 9 :i* 
! ,secret>y has conclud$ t ! plan has n 
submitt$ suffici5t in=mation = !        
,secret>y to review ! comp>ative        
analyses describ$ 9 subp>agraph 7,a71 z 
reque/$ "u clause 7i71 ! ,secret>y %all 
specify to ! plan ! in=mation ! plan or 
cov]age mu/ submit to be responsive to !
 reque/ "u clause 7i7 = ! ,secret>y to  
review ! comp>ative analyses describ$ 9 
subp>agraph7,a7 = compliance ) ?is      
section4 ,no?+ 9 ?is p>agraph %all      
require ! ,secret>y to conclude t a plan
 is 9 compliance ) ?is section solely   
bas$ ^u ! inspection ( ! comp>ative     
analyses describ$ 9 subp>agraph 7,a71 z 
reque/$ "u clause 7i74  7iii7 ,requir$  
action  7,i7 ,9 g5]al ,9 in/ances 9 :i* 
! ,secret>y has review$ ! comp>ative    
analyses describ$ 9 subp>agraph 7,a71 z 
reque/$ "u clause 7i71 & det]m9$ t !    
plan is n 9 compliance ) ?is section1 ! 
plan-- 7aa7 %all specify to ! ,secret>y 
! actions ! plan w take to be 9         
compliance ) ?is section & provide to ! 

,secret>y comp>ative analyses describ$ 9
 subp>agraph 7,a7 t demon/rate          
compliance ) ?is section n lat] ?an #de 
days aft] ! initial det]m9ation by !    
,secret>y t ! plan is n 9 compliance2 & 
7bb7 foll[+ ! #de-;day corrective action
 p]iod "u item 7aa71 if ! ,secret>y     
det]m9es t ! plan /ill is n 9 compliance
 ) ?is section1 n lat] ?an #g days aft] 
su* det]m9ation1 %all notify all        
individuals enroll$ 9 ! plan or cov]age 
t ! plan has be5 det]m9$ to be n 9      
compliance ) ?is section4  7,,ii7       
,exemption f disclosure ,docum5ts or    
communications produc$ 9 connection ) ! 
,secret>y's recomm5dations to ! plan or 
cov]age %all n be subject to disclosure 
pursuant to section #eeb ( title #e1    
,unit$ ,/ates ,code4  7iv7 ,report ,n   
lat] ?an #a ye> aft] ! date ( enactm5t (
 ?is p>agraph1 & n lat] ?an ,octob] #a (
 ea* ye> !reaft]1 ! ,secret>y %all      
submit to ,congress1 & make publicly    
available1 a report t conta9s-- 7,i7 a  
summ>y ( ! comp>ative analyses reque/$  

"u clause 7i71 includ+ ! id5tity ( ea*  
plan t is det]m9$ to be n 9 compliance  
aft] ! f9al det]m9ation by ! ,secret>y  
describ$ 9 clause 7iii77,i77bb72  7,,ii7
 ! ,secret>y's conclusions z to :e!r ea*
 plan submitt$ suffici5t in=mation = !  
,secret>y to review ! comp>ative        
analyses reque/$ "u clause 7i7 =        
compliance ) ?is section2  7,,iii7 = ea*
 plan t did submit suffici5t in=mation =
 ! ,secret>y to review ! comp>ative     
analyses reque/$ "u clause 7i71 !       
,secret>y's conclusions z to :e!r & :y !
 plan or cov]age is 9 compliance ) !    
requirem5ts "u ?is section2  7,,iv7 !   
,secret>y's specifications describ$ 9   
clause 7ii7 = ea* plan t ! ,secret>y    
det]m9$ did n submit suffici5t in=mation
 = ! ,secret>y to review ! comp>ative   
analyses reque/$ "u clause 7i7 =        
compliance ) ?is section2 &  7,v7 !     
,secret>y's specifications describ$ 9   
clause 7iii7 ( ! actions ea* plan hat ! 
,secret>y det]m9$ is n 9 compliance )   
?is section mu/ take to be 9 compliance 

) ?is section1 includ+ ! reason :y !    
,secret>y det]m9$ ! plan or cov]age is n
 9 compliance4  7,c7 ,compliance program
 guidance docum5t update process  7i7 ,9
 g5]al ,! ,secret>y %all include        
in/ances ( noncompliance t ! ,secret>y  
discov]s ^u review+ ! comp>ative        
analyses reque/$ "u subp>agraph 7,b77i7 
9 ! compliance program guidance docum5t 
describ$ 9 p>agraph 7#f71 z x is updat$ 
e #b ye>s1 except t su* in/ances %all n 
disclose any protect$ heal? in=mation or
 individually id5tifiable in=mation4    
7ii7 ,guidance & regulations ,n lat] ?an
 #ah mon?s aft] ! date ( enactm5t ( ?is 
p>agraph1 ! ,secret>y %all f9alize any  
draft or int]im guidance & regulations  
relat+ to m5tal heal? p>ity "u ?is      
section4 ,su* draft guidance %all       
include 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 plans to    
file compla9ts ( su* plans or issu]s be+

 9 violation ( ?is section1 includ+     
guidance1 by plan type1 on ! relevant   
,/ate1 regional1 or national (fice ) :i*
 su* compla9ts %\ld be fil$4  7iii7     
,/ate ,! ,secret>y %all %>e in=mation on
 f9d+s ( compliance & noncompliance     
discov]$ ^u review+ ! comp>ative        
analyses reque/$ "u subp>agraph 7,b77i7 
) ! ,/ate :]e ! gr\p heal? plan is      
locat$ or ! ,/ate :]e ! heal? insurance 
issu] is lic5s$ to d bus9ess = cov]age  
(f]$ by a heal? insurance issu] 9 ! gr\p
 m>ket1 9 accordance ) p>agraph         
7#f77;,b77iii77,,ii74  4  7d7           
,implem5tation ,! ,secret>y ( ,heal? &  
,human ,s]vices1 ! ,secret>y ( ,labor1 &
 ! ,secret>y ( ! ,treasury may implem5t 
! p>agraph 7#h7 ( section               
#bgii;,a-#a7;a7 ( ! ,public ,heal?      
,s]vice ,act1 add$ by subsection 7a71 ! 
p>agraph 7#h7 ( section #gab7;a7 ( !    
,employee ,retirem5t ,income ,security  
,act ( #aigd1 z add$by subsection 7b71 &
 ! p>agraph 7#h7 ( section #ihab7;a7 ( !
 ,int]nal ,rev5ue ,code ( #aihf1 z add$ 

by subsection 7c71 by program           
in/ruction1 guidance1 or o!rwise4       
,decemb] #bd1 #bjbj,report$ f !         
,committee on ,en]gy & ,comm]ce ) an    
amendment,december #bd1                 
#bjbj;,committees on ,ways & ,means &   
,education & ,labor dis*>g$2 committ$ to
 ! ,committee ( ! ,:ole ,h\se on ! ,/ate
 ( ! ,union & ord]$ to be pr9t$