,,ii  #aafth ,,congress  #ast ,session  
,s4 #agcg  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,june #e1      
#bjai,mr4 ,murphy 7for himself and ,mr4 
,cassidy7 introduced the following bill2
 which was read twice and referred to   
the ,committee on ,health1 ,education1  
,labor1 and ,pensions  ,a ,,bill  ,to   
strengthen parity in mental health and  
substance use disorder benefits4  #a4   
,short title ,this ,act may be cited as 
the ,mental ,health ,parity ,compliance 
,act4  #b4 ,strengthening parity in     
mental health and substance use disorder
 benefits  7a7 ,employee retirement     
income security act of #aigd ,section   
#gab7;a7 of the ,employee ,retirement   
,income ,security ,act of #aigd 7#bi    
,u4,s4,c4 #aahe;a7a77 is amended by     
adding at the end the following3  7#f7  
,compliance requirements  7,a7          
,nonquantitative treatment limitation   
7nqtl7 requirements ,in the case of a   
group health plan 7or health insurance  
coverage offered in connection with such

 a plan7 that provides both medical and 
surgical benefits and mental health or  
substance use disorder benefits1 the    
plan or coverage shall perform          
comparative analyses about the design   
and application of nonquantitative      
treatment limitations 7referred to in   
this paragraph as the ,,nqtl7 in        
accordance with the following process1  
and make available to the ,secretary    
upon request within #fj days beginning  
,january #a1 #bjbj1 and immediately upon
 request beginning ,january #a1 #bjba   
the following information3  7i7 ,the    
specific plan or coverage language      
regarding the ,,nqtl and a description  
of all mental health or substance use   
disorder and medical_/surgical services 
to which it applies in each respective  
benefits classification4  7ii7 ,the     
factors used to determine that an ,,nqtl
 will apply to mental health or         
substance use disorder benefits and     
medical_/surgical benefits1 including   
factors that were considered but        

rejected4  7iii7 ,the evidentiary       
standard 7both identified and           
deidentified7 for each of the factors   
identified in clause 7ii7 and any other 
evidence relied upon to design and apply
 the ,,nqtl to mental health or         
substance use disorder benefits and     
medical_/surgical benefits4  7iv7 ,the  
comparative analyses demonstrating that 
the processes and strategies used to    
design the ,,nqtl1 as written1 and the  
as written processes and strategies used
 to apply the ,,nqtl for mental health  
or substance use disorder benefits are  
comparable to1 and are applied no more  
stringently than1 the processes and     
strategies used to design the ,,nqtl1 as
 written1 and the as written processes  
and strategies used to apply the ,,nqtl 
to medical_/surgical benefits4  7v7 ,the
 comparative analyses demonstrating that
 the processes and strategies used to   
apply the ,,nqtl1 in operation1 for     
mental health and substance use disorder
 benefits are comparable to1 and are    

applied no more stringently than1 the   
processes and strategies used to apply  
each ,,nqtl1 in operation1 for medical  
and surgical benefits4  7vi7 ,a         
disclosure of the specific findings and 
conclusions reached by the plan or      
coverage that the results of the        
analyses described in this subparagraph 
indicate that the plan or coverage is in
 compliance with this section4  7,b7    
,secretary request process  7i7         
,submission upon complaint ,the         
,secretary shall request that a group   
health plan 7or health insurance        
coverage offered in connection with such
 a plan7 submit the comparative analyses
 described in subparagraph 7,a7 if the  
,secretary has received any complaints  
about such a plan or coverage that      
involve mental health or substance use  
disorder benefits4  7ii7 ,random        
submissions ,the ,secretary shall       
request the comparative analyses        
described in subparagraph 7,a7 from no  
fewer than #ej plans or coverages       

selected at random1 annually1 and such  
plans or coverages shall not be the same
 plans or coverages for which the       
comparative analyses are requested under
 clause 7i74  7iii7 ,additional         
information ,in instances in which the  
,secretary has concluded that the plan  
or coverage has not submitted sufficient
 information for the ,secretary to      
review the comparative analyses         
described in subparagraph 7,a71 as      
requested under clauses 7i7 and 7ii71   
the ,secretary shall specify to the plan
 or coverage the additional information 
the plan or coverage must submit for the
 ,secretary to review the comparative   
analyses described in subparagraph 7,a7 
for compliance with this section4  7iv7 
,required action ,in instances in which 
the ,secretary has reviewed the         
comparative analyses described in       
subparagraph 7,a71 as requested under   
clauses 7i7 and 7ii71 and determined    
that the plan or coverage is not in     
compliance with this section1 the       

,secretary shall specify to the plan or 
coverage the actions the plan or        
coverage must take to be in compliance  
with this section4  7v7 ,report ,not    
later than #a year after the date of    
enactment of this paragraph1 and        
annually thereafter1 the ,secretary     
shall submit to the ,committee on       
,education and ,labor of the ,house of  
,representatives and the ,committee on  
,health1 ,education1 ,labor1 and        
,pensions of the ,senate a report that  
contains--  7,i7 each of the comparative
 analyses requested under clauses 7i7   
and 7ii71 except that the identity of   
each plan or coverage and any contracted
 entity of a plan or coverage shall be  
redacted2  7,,ii7 the ,secretary's      
conclusions as to whether each plan or  
coverage submitted sufficient           
information for the ,secretary to review
 the comparative analyses requested     
under clauses 7i7 and 7ii7 for          
compliance with this section2  7,,iii7  
for each plan or coverage that did      

submit sufficient information for the   
,secretary to review the comparative    
analyses requested under clause 7i71 the
 ,secretary's conclusions as to whether 
the plan or coverage is in compliance   
with this section2  7,,iv7 the          
,secretary's specifications described in
 clause 7iii7 for each plan or coverage 
that the ,secretary determined did not  
submit sufficient information for the   
,secretary to review the comparative    
analyses requested under clauses 7i7 and
 7ii7 for compliance with this section2 
and  7,v7 the ,secretary's              
specifications described in clause 7iv7 
of the actions each plan or coverage    
that the ,secretary determined is not in
 compliance with this section must take 
to be in compliance with this section4  
7,c7 ,compliance program guidance       
document update process  7i7 ,in general
 ,the ,secretary shall include select   
instances of noncompliance that the     
,secretary discovers upon reviewing the 
comparative analyses requested under    

clauses 7i7 and 7ii7 of subparagraph    
7,b7 in the compliance program guidance 
document described in section           
#bgbf7;a77#f7 of the ,public ,health    
,service ,act1 as it is updated every #b
 years1 except that all instances shall 
be deidentified and such instances shall
 not disclose any protected health      
information or individually identifiable
 information4  7ii7 ,inspector general  
,any instances of noncompliance the     
,secretary discovers upon reviewing the 
comparative analyses requested under    
clauses 7i7 and 7ii7 of subparagraph    
7,b7 shall be shared with ,inspector    
,general of the ,department of ,health  
and ,human ,services1 the ,inspector    
,general of the ,department of ,labor1  
and the ,inspector ,general of the      
,department of the ,treasury1 in        
accordance with section                 
#bgbf7;a77#f77;,b77iii77,i7 of the      
,public ,health ,service ,act4  7iii7   
,state ,any instances of noncompliance  
the ,secretary discovers upon reviewing 

the comparative analyses requested under
 clauses 7i7 and 7ii7 of subparagraph   
7,b7 shall be shared with a ,state1 in  
accordance with section                 
#bgbf7;a77#f77;,b77iii77,,ii7 of the    
,public ,health ,service ,act4  4  7b7  
,internal revenue code of #aihf ,section
 #ihab7;a7 of the ,internal ,revenue    
,code of #aihf is amended by adding at  
the end the following3  7#f7 ,compliance
 requirements  7,a7 ,nonquantitative    
treatment limitation 7nqtl7 requirements
 ,in the case of a group health plan    
that provides both medical and surgical 
benefits and mental health or substance 
use disorder benefits1 the plan shall   
perform comparative analyses about the  
design and application of               
nonquantitative treatment limitations   
7referred to in this paragraph as the   
,,nqtl7 in accordance with the following
 process1 and make available to the     
,secretary upon request within #fj days 
beginning ,january #a1 #bjbj1 and       
immediately upon request beginning      

,january #a1 #bjba the following        
information3  7i7 ,the specific plan    
language regarding the ,,nqtl and a     
description of all mental health or     
substance use disorder and              
medical_/surgical services to which it  
applies in each respective benefits     
classification4  7ii7 ,the factors used 
to determine that an ,,nqtl will apply  
to mental health or substance use       
disorder benefits and medical_/surgical 
benefits1 including factors that were   
considered but rejected4  7iii7 ,the    
evidentiary standard 7both identified   
and deidentified7 for each of the       
factors identified in clause 7ii7 and   
any other evidence relied upon to design
 and apply the ,,nqtl to mental health  
or substance use disorder benefits and  
medical_/surgical benefits4  7iv7 ,the  
comparative analyses demonstrating that 
the processes and strategies used to    
design the ,,nqtl1 as written1 and the  
as written processes and strategies used
 to apply the ,,nqtl for mental health  

or substance use disorder benefits are  
comparable to1 and are applied no more  
stringently than1 the processes and     
strategies used to design the ,,nqtl1 as
 written1 and the as written processes  
and strategies used to apply the ,,nqtl 
to medical_/surgical benefits4  7v7 ,the
 comparative analyses demonstrating that
 the processes and strategies used to   
apply the ,,nqtl1 in operation1 for     
mental health and substance use disorder
 benefits are comparable to1 and are    
applied no more stringently than1 the   
processes and strategies used to apply  
each ,,nqtl1 in operation1 for medical  
and surgical benefits4  7vi7 ,a         
disclosure of the specific findings and 
conclusions reached by the plan that the
 results of the analyses described in   
this subparagraph indicate that the plan
 or coverage is in compliance with this 
section4  7,b7 ,secretary request       
process  7i7 ,submission upon complaint 
,the ,secretary shall request that a    
group health plan submit the comparative

 analyses described in subparagraph 7,a7
 if the ,secretary has received any     
complaints about such a plan that       
involve mental health or substance use  
disorder benefits4  7ii7 ,random        
submissions ,the ,secretary shall       
request the comparative analyses        
described in subparagraph 7,a7 from no  
fewer than #ej plans selected at random1
 annually1 and such plans shall not be  
the same plans for which the comparative
 analyses are requested under clause    
7i74  7iii7 ,additional information ,in 
instances in which the ,secretary has   
concluded that the plan has not         
submitted sufficient information for the
 ,secretary to review the comparative   
analyses described in subparagraph 7,a71
 as requested under clauses 7i7 and     
7ii71 the ,secretary shall specify to   
the plan the additional information the 
plan must submit for the ,secretary to  
review the comparative analyses         
described in subparagraph 7,a7 for      
compliance with this section4  7iv7     

,required action ,in instances in which 
the ,secretary has reviewed the         
comparative analyses described in       
subparagraph 7,a71 as requested under   
clauses 7i7 and 7ii71 and determined    
that the plan is not in compliance with 
this section1 the ,secretary shall      
specify to the plan the actions the plan
 must take to be in compliance with this
 section4  7v7 ,report ,not later than  
#a year after the date of enactment of  
this paragraph1 and annually thereafter1
 the ,secretary shall submit to the     
,committee on ,ways and ,means of the   
,house of ,representatives and the      
,committee on ,finance of the ,senate a 
report that contains--  7,i7 each of the
 comparative analyses requested under   
clauses 7i7 and 7ii71 except that the   
identity of each plan and any contracted
 entity of a plan shall be redacted2    
7,,ii7 the ,secretary's conclusions as  
to whether each plan submitted          
sufficient information for the          
,secretary to review the comparative    

analyses requested under clauses 7i7 and
 7ii7 for compliance with this section2 
7,,iii7 for each plan that did submit   
sufficient information for the          
,secretary to review the comparative    
analyses requested under clause 7i71 the
 ,secretary's conclusions as to whether 
the plan is in compliance with this     
section2  7,,iv7 the ,secretary's       
specifications described in clause 7iii7
 for each plan that the ,secretary      
determined did not submit sufficient    
information for the ,secretary to review
 the comparative analyses requested     
under clauses 7i7 and 7ii7 for          
compliance with this section2 and  7,v7 
the ,secretary's specifications         
described in clause 7iv7 of the actions 
each plan that the ,secretary determined
 is not in compliance with this section 
must take to be in compliance with this 
section4  7,c7 ,compliance program      
guidance document update process  7i7   
,in general ,the ,secretary shall       
include select instances of             

noncompliance that the ,secretary       
discovers upon reviewing the comparative
 analyses requested under clauses 7i7   
and 7ii7 of subparagraph 7,b7 in the    
compliance program guidance document    
described in section #bgbf7;a77#f7 of   
the ,public ,health ,service ,act1 as it
 is updated every #b years1 except that 
all instances shall be deidentified and 
such instances shall not disclose any   
protected health information or         
individually identifiable information4  
7ii7 ,inspector general ,any instances  
of noncompliance the ,secretary         
discovers upon reviewing the comparative
 analyses requested under clauses 7i7   
and 7ii7 of subparagraph 7,b7 shall be  
shared with ,inspector ,general of the  
,department of ,health and ,human       
,services1 the ,inspector ,general of   
the ,department of ,labor1 and the      
,inspector ,general of the ,department  
of the ,treasury1 in accordance with    
section #bgbf7;a77#f77;,b77iii77,i7 of  
the ,public ,health ,service ,act4      

7iii7 ,state ,any instances of          
noncompliance the ,secretary discovers  
upon reviewing the comparative analyses 
requested under clauses 7i7 and 7ii7 of 
subparagraph 7,b7 shall be shared with a
 ,state1 in accordance with section     
#bgbf7;a77#f77;,b77iii77,,ii7 of the    
,public ,health ,service ,act4  4  7c7  
,public health service act ,section     
#bgbf of the ,public ,health ,service   
,act 7#db ,u4,s4,c4 #cjj;gg-#bf7 is     
amended-- 7#a7 in subsection 7a71 by    
adding at the end the following3  7#h7  
,compliance requirements  7,a7          
,nonquantitative treatment limitation   
7nqtl7 requirements ,in the case of a   
group health plan or a health insurance 
issuer offering group or individual     
health insurance coverage that provides 
both medical and surgical benefits and  
mental health or substance use disorder 
benefits1 the plan or issuer offering   
group or individual health insurance    
coverage shall perform comparative      
analyses about the design and           

application of nonquantitative treatment
 limitations 7referred to in this       
paragraph as the ,,nqtl7 in accordance  
with the following process1 and make    
available to ,state1 or to the          
,secretary as permitted under           
subsections 7a77#b7 and 7b77#a7 of      
section #bgbc1 upon request within #fj  
days beginning ,january #a1 #bjbj1 and  
immediately upon request beginning      
,january #a1 #bjba1 the following       
information3  7i7 ,the specific plan or 
coverage language regarding the ,,nqtl  
and a description of all mental health  
or substance use disorder and           
medical_/surgical services to which it  
applies in each respective benefits     
classification4  7ii7 ,the factors used 
to determine that an ,,nqtl will apply  
to mental health or substance use       
disorder benefits and medical_/surgical 
benefits1 including factors that were   
considered but rejected4  7iii7 ,the    
evidentiary standard 7both identified   
and deidentified7 for each of the       

factors identified in clause 7ii7 and   
any other evidence relied upon to design
 and apply the ,,nqtl to mental health  
or substance use disorder benefits and  
medical_/surgical benefits4  7iv7 ,the  
comparative analyses demonstrating that 
the processes and strategies used to    
design the ,,nqtl1 as written1 and the  
as written processes and strategies used
 to apply the ,,nqtl for mental health  
or substance use disorder benefits are  
comparable to1 and are applied no more  
stringently than1 the processes and     
strategies used to design the ,,nqtl1 as
 written1 and the as written processes  
and strategies used to apply the ,,nqtl 
to medical_/surgical benefits4  7v7 ,the
 comparative analyses demonstrating that
 the processes and strategies used to   
apply the ,,nqtl1 in operation1 for     
mental health and substance use disorder
 benefits are comparable to1 and are    
applied no more stringently than1 the   
processes and strategies used to apply  
each ,,nqtl1 in operation1 for medical  

and surgical benefits4  7vi7 ,a         
disclosure of the specific findings and 
conclusions reached by the plan or      
health insurance issuer offering group  
or individual health insurance coverage 
that the results of the analyses        
described in this subparagraph indicate 
that the plan or coverage is in         
compliance with this section4  7,b7     
,secretary request process  7i7         
,submission upon complaint ,as permitted
 under subsections 7a77#b7 and 7b77#a7  
of section #bgbc1 the ,secretary shall  
request that a group health plan or a   
health insurance issuer offering group  
or individual health insurance coverage 
submit the comparative analyses         
described in subparagraph 7,a7 if the   
,secretary has received any complaints  
about such a plan or issuer that involve
 mental health or substance use disorder
 benefits4  7ii7 ,random submissions ,as
 permitted under subsections 7a77#b7 and
 7b77#a7 of section #bgbc1 the          
,secretary shall request the comparative

 analyses described in subparagraph 7,a7
 from no fewer than #ej plans or issuers
 selected at random1 annually1 and such 
plans or issuers shall not be the same  
plans or issuers for which the          
comparative analyses are requested under
 clause 7i74  7iii7 ,additional         
information ,in instances in which the  
,secretary has concluded that the plan  
or issuer has not submitted sufficient  
information for the ,secretary to review
 the comparative analyses described in  
subparagraph 7,a71 as requested under   
clauses 7i7 and 7ii71 the ,secretary    
shall specify to the plan or issuer the 
additional information the plan or      
issuer must submit for the ,secretary to
 review the comparative analyses        
described in subparagraph 7,a7 for      
compliance with this section4  7iv7     
,required action ,in instances in which 
the ,secretary has reviewed the         
comparative analyses described in       
subparagraph 7,a71 as requested under   
clauses 7i7 and 7ii71 and determined    

that the plan or issuer is not in       
compliance with this section1 the       
,secretary shall specify to the plan or 
issuer the actions the plan or issuer   
must take to be in compliance with this 
section4  7v7 ,report ,not later than #a
 year after the date of enactment of    
this paragraph1 and annually thereafter1
 the ,secretary shall submit to the     
,committee on ,education and ,labor of  
the ,house of ,representatives and the  
,committee on ,health1 ,education1      
,labor1 and ,pensions of the ,senate a  
report that contains--  7,i7 each of the
 comparative analyses requested under   
clauses 7i7 and 7ii71 except that the   
identity of each plan or issuer and any 
contracted entity of a plan or issuer   
shall be redacted2  7,,ii7 the          
,secretary's conclusions as to whether  
each plan or issuer submitted sufficient
 information for the ,secretary to      
review the comparative analyses         
requested under clauses 7i7 and 7ii7 for
 compliance with this section2  7,,iii7 

for each plan or issuer that did submit 
sufficient information for the          
,secretary to review the comparative    
analyses requested under clause 7i71 the
 ,secretary's conclusions as to whether 
the plan or issuer is in compliance with
 this section2  7,,iv7 the ,secretary's 
specifications described in clause 7iii7
 for each plan or issuer that the       
,secretary determined did not submit    
sufficient information for the          
,secretary to review the comparative    
analyses requested under clauses 7i7 and
 7ii7 for compliance with this section2 
and  7,v7 the ,secretary's              
specifications described in clause 7iv7 
of the actions each plan or issuer that 
the ,secretary determined is not in     
compliance with this section must take  
to be in compliance with this section4  
7,c7 ,compliance program guidance       
document update process  7i7 ,in general
 ,the ,secretary shall include select   
instances of noncompliance that the     
,secretary discovers upon reviewing the 

comparative analyses requested under    
clauses 7i7 and 7ii7 of subparagraph    
7,b7 in the compliance program guidance 
document described in subsection        
7a77#f71 as it is updated every #b      
years1 except that all instances shall  
be deidentified and such instances shall
 not disclose any protected health      
information or individually identifiable
 information4  7ii7 ,inspector general  
,any instances of noncompliance the     
,secretary discovers upon reviewing the 
comparative analyses requested under    
clauses 7i7 and 7ii7 of subparagraph    
7,b7 shall be shared with ,inspector    
,general of the ,department of ,health  
and ,human ,services1 the ,inspector    
,general of the ,department of ,labor1  
and the ,inspector ,general of the      
,department of the ,treasury1 in        
accordance with subsection              
7a77#f77;,b77iii77,i74  7iii7 ,state    
,any instances of noncompliance the     
,secretary discovers upon reviewing the 
comparative analyses requested under    

clauses 7i7 and 7ii7 of subparagraph    
7,b7 shall be shared with a ,state1 in  
accordance with subsection              
7a77#f77;,b77iii77,,ii74  4