,,ii #aagth ,,congress #b;d ,session ,s4 #dfaf ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,july #bf1 #bjbb,ms4 ,warren 7for herself1 ,ms4 ,baldwin1 ,mr4 ,blumenthal1 ,mr4 ,booker1 ,mr4 ,brown1 ,mr4 ,kaine1 ,ms4 ,klobuchar1 ,mr4 ,lujn1 ,mr4 ,markey1 ,mr4 ,murphy1 ,mr4 ,sanders1 ,ms4 ,smith1 ,ms4 ,stabenow1 and ,mr4 ,van ,hollen7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to amend title ,,xxvii of the ,public ,health ,service ,act1 the ,employee ,retirement ,income ,security ,act of #aigd1 and the ,internal ,revenue ,code of #aihf to strengthen parity in mental health and substance use disorder benefits4 #a4 ,short title ,this ,act may be cited as the ,behavioral ,health ,coverage ,transparency ,act of #bjbb4 #b4 ,strengthening parity in mental health and substance use disorder benefits 7a7 ,public ,health ,service ,act ,section #bgbf7;a77#h7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#bf7;a77#h77 is amended-- 7#a7 in subparagraph 7,a71 in the matter preceding clause 7i7-- 7,a7 by inserting 7including entities that provide administrative services in connection with a group health plan1 such as third party administrators7 after insurance coverage2 and 7,b7 by striking and1 beginning #de days after and all that follows through upon request1 and inserting and submit to the ,secretary 7or the ,secretary of ,labor or the ,secretary of the ,treasury1 as applicable71 on an annual basis 7and at any other time upon request of the ,secretary71 and to the applicable ,state authority upon request12 7#b7 in subparagraph 7,b7-- 7,a7 in the heading1 by striking request and inserting review2 7,b7 in clause 7i7-- 7i7 in the heading1 by striking ,submission upon request and inserting ,in general2 7ii7 by striking shall request and all that follows through coverage submit and insert shall conduct a review of2 and 7iii7 by striking shall request not fewer than #bj and inserting shall conduct a review of not fewer than #fj2 7,c7 in clause 7ii7-- 7i7 in the first sentence1 by striking as requested under clause 7i7 and inserting as submitted under such subparagraph2 7ii7 in the first sentence1 by striking to be responsive to the request under clause 7i7 for and inserting to enable2 and 7iii7 in the second sentence1 by striking 1 as requested under clause 7i72 7,d7 in clause 7iii7-- 7i7 in subclause 7,i71 by striking 1 as requested under clause 7i712 and 7ii7 by adding at the end of subclause 7,,ii7 the following new sentence3 ,the preceding sentence shall not apply with respect to disclosures made on or after the date of the enactment of this sentence42 and 7,e7 in clause 7iv7-- 7i7 in subclause 7,i7-- 7,i7 by striking requested under clause 7i7 and inserting reviewed under clause 7i72 and 7,,ii7 by striking after the final determination by the ,secretary described in clause 7iii77,i77bb7 and inserting by the ,secretary as described in clause 7iii77,i72 7ii7 in subclause 7,,ii71 by striking the comparative analyses requested under clause 7i7 and inserting such comparative analyses2 7iii7 in subclause 7,,iii71 by striking the comparative analyses requested under clause 7i7 and inserting such comparative analyses2 7iv7 in subclause 7,,iv7-- 7,i7 by striking the comparative analyses requested under clause 7i7 and inserting such comparative analyses2 and 7,,ii7 by striking and at the end2 7v7 in subclause 7,v71 by striking the period and inserting a semicolon2 and 7vi7 by adding at the end the following3 7,,vi7 the name of each group health plan or health insurance issuer found not to have submitted comparative analyses in accordance with subparagraph 7,a72 7,,vii7 the name of each group health plan or health insurance issuer whose comparative analyses were reviewed under clause 7i7 and found not to have submitted sufficient information for the ,secretary to review2 and 7,,viii7 the name of any plan or coverage with respect to which a complaint has been submitted under subparagraph 7,c7 and for which a final review finding has been issued4 ,the requirements of this clause with respect to plans or issuers shall also apply to entities that provide administrative services in connection with a group health plan1 such as third party administrators1 if applicable4 2 7#c7 in subparagraph 7,c77i71 by striking requested2 and 7#d7 by adding at the end the following new subparagraphs3 7,d7 ,audit process ,beginning #a year after the date of enactment of this subparagraph1 the ,secretary1 in cooperation with the ,secretaries of ,labor and the ,treasury1 as applicable1 shall1 in addition to conducting reviews in accordance with subparagraph 7,b71 conduct randomized audits of group health plans1 health insurance issuers offering group or individual health insurance coverage1 and entities that provide administrative services in connection with a group health plan1 such as third party administrators1 to determine compliance with this section4 ,such audits shall be conducted on no fewer than #dj plans or coverages per calendar year 7not including any reviews conducted under such subparagraph74 ,in addition1 the ,secretary may1 in cooperation with the ,secretaries of ,labor and the ,treasury1 as applicable1 and in consultation with the ,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 as applicable1 conduct audits on any such plan or coverage with respect to which a complaint has been submitted under subparagraph 7,e7 to determine compliance with this section4 7,e7 ,complaint process ,not later than #f months after the date of enactment of this subparagraph1 the ,secretary1 in cooperation with the ,secretary of ,labor and the ,secretary of the ,treasury1 shall1 with respect to group health plans and health insurance issuers offering group or individual health insurance coverage 7including entities that provide administrative services in connection with a group health plan1 such as third party administrators71 issue guidance to clarify the process and timeline for current and potential participants and beneficiaries 7and authorized representatives and health care providers of such participants and beneficiaries7 with respect to such plans and coverage to file formal complaints of such plans or issuers being in violation of this section1 including guidance1 by plan type1 on the relevant ,state1 regional1 and national offices with which such complaints should be filed4 7,f7 ,coverage disparity information ,for the first calendar year that begins on or after the date that is #b years after the date of the enactment of this subparagraph1 and for each subsequent calendar year1 the ,secretary1 in cooperation with the ,secretaries of ,labor and the ,treasury1 shall submit to the ,committee on ,energy and ,commerce of the ,house of ,representatives and the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate the following information with respect to the preceding calendar year3 7i7 ,denial rates ,data comparing the rates of and reasons for denial by group health plans and health insurance issuers offering group or individual health insurance coverage 7including entities that provide administrative services in connection with a group health plan1 such as third party administrators7 of claims for mental health benefits1 substance use disorder benefits1 and medical and surgical benefits1 disaggregated by the following categories3 7,i7 ,inpatient1 in-network claims4 7,,ii7 ,inpatient1 out-of-network claims4 7,,iii7 ,outpatient1 in-network claims4 7,,iv7 ,outpatient1 out-of-network claims4 7,v7 ,emergency services4 7,,vi7 ,prescription drug claims4 7ii7 ,network adequacy data ,data comparing the network adequacy of group health plans and health insurance issuers offering group or individual health insurance coverage 7including entities that provide administrative services in connection with a group health plan1 such as third party administrators7 based on claims for outpatient and inpatient mental health benefits1 substance use disorder benefits1 and medical and surgical benefits1 including out-of-network utilization rates1 the number and percentage of in-network providers accepting new patients1 and average wait times between receiving initial treatment and diagnosis and follow-up treatment4 7iii7 ,reimbursement rates ,data comparing the reimbursement rates of group health plans and health insurance issuers offering group or individual health insurance coverage 7including entities that provide administrative services in connection with a group health plan1 such as third party administrators7 for the #aj most commonly billed mental health services1 substance use services1 and medical and surgical services1 each as a percentage of rates payable for such services under title ,,xviii of the ,social ,security ,act1 disaggregated by the following categories3 7,i7 ,inpatient1 in-network claims4 7,,ii7 ,inpatient1 out-of-network claims4 7,,iii7 ,outpatient1 in-network claims4 7,,iv7 ,outpatient1 out-of-network claims4 7,v7 ,emergency services4 7,,vi7 ,prescription drug claims4 4 7b7 ,employee ,retirement ,income ,security ,act of #aigd ,section #gab7;a77#h7 of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aahe;a7a77#h77 is amended-- 7#a7 in subparagraph 7,a71 in the matter preceding clause 7i7-- 7,a7 by inserting 7including entities that provide administrative services in connection with a group health plan1 such as third party administrators7 after insurance coverage2 and 7,b7 by striking and1 beginning #de days after and all that follows through upon request1 and inserting and submit to the ,secretary 7or the ,secretary of ,health and ,human ,services or the ,secretary of the ,treasury1 as applicable71 on an annual basis 7and at any other time upon request of the ,secretary712 7#b7 in subparagraph 7,b7-- 7,a7 in the heading1 by striking request and inserting review2 7,b7 in clause 7i7-- 7i7 in the heading1 by striking ,submission upon request and inserting ,in general2 7ii7 by striking shall request and all that follows through coverage submit and insert shall conduct a review of2 and 7iii7 by striking shall request not fewer than #bj and inserting shall conduct a review of not fewer than #fj2 7,c7 in clause 7ii7-- 7i7 in the first sentence1 by striking as requested under clause 7i7 and inserting as submitted under such subparagraph2 7ii7 in the first sentence1 by striking to be responsive to the request under clause 7i7 for and inserting to enable2 and 7iii7 in the second sentence1 by striking 1 as requested under clause 7i72 7,d7 in clause 7iii7-- 7i7 in subclause 7,i71 by striking 1 as requested under clause 7i712 and 7ii7 by adding at the end of subclause 7,,ii7 the following new sentence3 ,the preceding sentence shall not apply with respect to disclosures made on or after the date of the enactment of this sentence42 and 7,e7 in clause 7iv7-- 7i7 in subclause 7,i7-- 7,i7 by striking requested under clause 7i7 and inserting reviewed under clause 7i72 and 7,,ii7 by striking after the final determination by the ,secretary described in clause 7iii77,i77bb7 and inserting by the ,secretary as described in clause 7iii77,i72 7ii7 in subclause 7,,ii71 by striking the comparative analyses requested under clause 7i7 and inserting such comparative analyses2 7iii7 in subclause 7,,iii71 by striking the comparative analyses requested under clause 7i7 and inserting such comparative analyses2 7iv7 in subclause 7,,iv7-- 7,i7 by striking the comparative analyses requested under clause 7i7 and inserting such comparative analyses2 and 7,,ii7 by striking and at the end2 7v7 in subclause 7,v71 by striking the period and inserting a semicolon2 and 7vi7 by adding at the end the following3 7,,vi7 the name of each group health plan or health insurance issuer found not to have submitted comparative analyses in accordance with subparagraph 7,a72 7,,vii7 the name of each group health plan or health insurance issuer whose comparative analyses were reviewed under clause 7i7 and found not to have submitted sufficient information for the ,secretary to review2 and 7,,viii7 the name of any plan or coverage with respect to which a complaint has been submitted under subparagraph 7,c7 and for which a final review finding has been issued4 ,the requirements of this clause with respect to plans or issuers shall also apply to entities that provide administrative services in connection with a group health plan1 such as third party administrators1 if applicable4 2 7#c7 in subparagraph 7,c77i71 by striking requested2 and 7#d7 by adding at the end the following new subparagraphs3 7,d7 ,audit process ,beginning #a year after the date of enactment of this subparagraph1 the ,secretary1 in cooperation with the ,secretaries of ,health and ,human ,services and the ,treasury1 as applicable1 shall1 in addition to conducting reviews in accordance with subparagraph 7,b71 conduct randomized audits of group health plans1 health insurance issuers offering group health insurance coverage1 and entities that provide administrative services in connection with a group health plan1 such as third party administrators1 to determine compliance with this section4 ,such audits shall be conducted on no fewer than #dj plans or coverages per calendar year 7not including any reviews conducted under such subparagraph74 ,in addition1 the ,secretary may1 in cooperation with the ,secretaries of ,health and ,human ,services and the ,treasury1 as applicable1 and in consultation with the ,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 as applicable1 conduct audits on any such plan or coverage with respect to which a complaint has been submitted under subparagraph 7,e7 to determine compliance with this section4 7,e7 ,complaint process ,not later than #f months after the date of enactment of this subparagraph1 the ,secretary1 in cooperation with the ,secretary of ,health and ,human ,services and the ,secretary of the ,treasury1 shall1 with respect to group health plans and health insurance issuers offering group health insurance coverage 7including entities that provide administrative services in connection with a group health plan1 such as third party administrators71 issue guidance to clarify the process and timeline for current and potential participants and beneficiaries 7and authorized representatives and health care providers of such participants and beneficiaries7 with respect to such plans and coverage to file formal complaints of such plans or issuers being in violation of this section1 including guidance1 by plan type1 on the relevant ,state1 regional1 and national offices with which such complaints should be filed4 7,f7 ,coverage disparity information ,for the first calendar year that begins on or after the date that is #b years after the date of the enactment of this subparagraph1 and for each subsequent calendar year1 the ,secretary1 in cooperation with the ,secretaries of ,health and ,human ,services and the ,treasury1 shall submit to the ,committee on ,energy and ,commerce of the ,house of ,representatives and the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate the following information with respect to the preceding calendar year3 7i7 ,denial rates ,data comparing the rates of and reasons for denial by group health plans and health insurance issuers offering group health insurance coverage 7including entities that provide administrative services in connection with a group health plan1 such as third party administrators7 of claims for mental health benefits1 substance use disorder benefits1 and medical and surgical benefits1 disaggregated by the following categories3 7,i7 ,inpatient1 in-network claims4 7,,ii7 ,inpatient1 out-of-network claims4 7,,iii7 ,outpatient1 in-network claims4 7,,iv7 ,outpatient1 out-of-network claims4 7,v7 ,emergency services4 7,,vi7 ,prescription drug claims4 7ii7 ,network adequacy data ,data comparing the network adequacy of group health plans and health insurance issuers offering group health insurance coverage 7including entities that provide administrative services in connection with a group health plan1 such as third party administrators7 based on claims for outpatient and inpatient mental health benefits1 substance use disorder benefits1 and medical and surgical benefits1 including out-of-network utilization rates1 the number and percentage of in-network providers accepting new patients1 and average wait times between receiving initial treatment and diagnosis and follow-up treatment4 7iii7 ,reimbursement rates ,data comparing the reimbursement rates of group health plans and health insurance issuers offering group health insurance coverage 7including entities that provide administrative services in connection with a group health plan1 such as third party administrators7 for the #aj most commonly billed mental health services1 substance use services1 and medical and surgical services1 each as a percentage of rates payable for such services under title ,,xviii of the ,social ,security ,act1 disaggregated by the following categories3 7,i7 ,inpatient1 in-network claims4 7,,ii7 ,inpatient1 out-of-network claims4 7,,iii7 ,outpatient1 in-network claims4 7,,iv7 ,outpatient1 out-of-network claims4 7,v7 ,emergency services4 7,,vi7 ,prescription drug claims4 4 7c7 ,internal ,revenue ,code of #aihf ,section #ihab7;a77#h7 of the ,internal ,revenue ,code of #aihf is amended-- 7#a7 in subparagraph 7,a71 in the matter preceding clause 7i7-- 7,a7 by inserting 7including entities that provide administrative services in connection with a group health plan1 such as third party administrators7 after ,in the case of a group health plan2 and 7,b7 by striking and1 beginning #de days after and all that follows through upon request1 and inserting and submit to the ,secretary 7or the ,secretary of ,health and ,human ,services or the ,secretary of ,labor1 as applicable71 on an annual basis 7and at any other time upon request of the ,secretary712 7#b7 in subparagraph 7,b7-- 7,a7 in the heading1 by striking request and inserting review2 7,b7 in clause 7i7-- 7i7 in the heading1 by striking ,submission upon request and inserting ,in general2 7ii7 by striking shall request and all that follows through plan submit and insert shall conduct a review of2 and 7iii7 by striking shall request not fewer than #bj and inserting shall conduct a review of not fewer than #fj2 7,c7 in clause 7ii7-- 7i7 in the first sentence1 by striking as requested under clause 7i7 and inserting as submitted under such subparagraph2 7ii7 in the first sentence1 by striking to be responsive to the request under clause 7i7 for and inserting to enable2 and 7iii7 in the second sentence1 by striking 1 as requested under clause 7i72 7,d7 in clause 7iii7-- 7i7 in subclause 7,i71 by striking 1 as requested under clause 7i712 and 7ii7 by adding at the end of subclause 7,,ii7 the following new sentence3 ,the preceding sentence shall not apply with respect to disclosures made on or after the date of the enactment of this sentence42 and 7,e7 in clause 7iv7-- 7i7 in subclause 7,i7-- 7,i7 by striking requested under clause 7i7 and inserting reviewed under clause 7i72 and 7,,ii7 by striking after the final determination by the ,secretary described in clause 7iii77,i77bb7 and inserting by the ,secretary as described in clause 7iii77,i72 7ii7 in subclause 7,,ii71 by striking the comparative analyses requested under clause 7i7 and inserting such comparative analyses2 7iii7 in subclause 7,,iii71 by striking the comparative analyses requested under clause 7i7 and inserting such comparative analyses2 7iv7 in subclause 7,,iv7-- 7,i7 by striking the comparative analyses requested under clause 7i7 and inserting such comparative analyses2 and 7,,ii7 by striking and at the end2 7v7 in subclause 7,v71 by striking the period and inserting a semicolon2 and 7vi7 by adding at the end the following3 7,,vi7 the name of each group health plan found not to have submitted comparative analyses in accordance with subparagraph 7,a72 7,,vii7 the name of each group health plan whose comparative analyses were reviewed under clause 7i7 and found not to have submitted sufficient information for the ,secretary to review2 and 7,,viii7 the name of any plan with respect to which a complaint has been submitted under subparagraph 7,c7 and for which a final review finding has been issued4 ,the requirements of this clause with respect to plans shall also apply to entities that provide administrative services in connection with a group health plan1 such as third party administrators1 if applicable4 2 7#c7 in subparagraph 7,c77i71 by striking requested2 and 7#d7 by adding at the end the following new subparagraphs3 7,d7 ,audit process ,beginning #a year after the date of enactment of this subparagraph1 the ,secretary1 in cooperation with the ,secretaries of ,health and ,human ,services and ,labor1 as applicable1 shall1 in addition to conducting reviews in accordance with subparagraph 7,b71 conduct randomized audits of group health plans and entities that provide administrative services in connection with a group health plan1 such as third party administrators1 to determine compliance with this section4 ,such audits shall be conducted on no fewer than #dj plans per calendar year 7not including any reviews conducted under such subparagraph74 ,in addition1 the ,secretary may1 in cooperation with the ,secretaries of ,health and ,human ,services and ,labor1 as applicable1 and in consultation with the ,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 as applicable1 conduct audits on any such plan with respect to which a complaint has been submitted under subparagraph 7,e7 to determine compliance with this section4 7,e7 ,complaint process ,not later than #f months after the date of enactment of this subparagraph1 the ,secretary1 in cooperation with the ,secretary of ,health and ,human ,services and the ,secretary of ,labor1 shall1 with respect to group health plans 7including entities that provide administrative services in connection with a group health plan1 such as third party administrators71 issue guidance to clarify the process and timeline for current and potential participants and beneficiaries 7and authorized representatives and health care providers of such participants and beneficiaries7 with respect to such plans to file formal complaints of such plans being in violation of this section1 including guidance1 by plan type1 on the relevant ,state1 regional1 and national offices with which such complaints should be filed4 7,f7 ,coverage disparity information ,for the first calendar year that begins on or after the date that is #b years after the date of the enactment of this subparagraph1 and for each subsequent calendar year1 the ,secretary1 in cooperation with the ,secretaries of ,health and ,human ,services and ,labor1 shall submit to the ,committee on ,energy and ,commerce of the ,house of ,representatives and the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate the following information with respect to the preceding calendar year3 7i7 ,denial rates ,data comparing the rates of and reasons for denial by group health plans 7including entities that provide administrative services in connection with a group health plan1 such as third party administrators7 of claims for mental health benefits1 substance use disorder benefits1 and medical and surgical benefits1 disaggregated by the following categories3 7,i7 ,inpatient1 in-network claims4 7,,ii7 ,inpatient1 out-of-network claims4 7,,iii7 ,outpatient1 in-network claims4 7,,iv7 ,outpatient1 out-of-network claims4 7,v7 ,emergency services4 7,,vi7 ,prescription drug claims4 7ii7 ,network adequacy data ,data comparing the network adequacy of group health plans 7including entities that provide administrative services in connection with a group health plan1 such as third party administrators7 based on claims for outpatient and inpatient mental health benefits1 substance use disorder benefits1 and medical and surgical benefits1 including out-of-network utilization rates1 the number and percentage of in-network providers accepting new patients1 and average wait times between receiving initial treatment and diagnosis and follow-up treatment4 7iii7 ,reimbursement rates ,data comparing the reimbursement rates of group health plans 7including entities that provide administrative services in connection with a group health plan1 such as third party administrators7 for the #aj most commonly billed mental health services1 substance use services1 and medical and surgical services1 each as a percentage of rates payable for such services under title ,,xviii of the ,social ,security ,act1 disaggregated by the following categories3 7,i7 ,inpatient1 in-network claims4 7,,ii7 ,inpatient1 out-of-network claims4 7,,iii7 ,outpatient1 in-network claims4 7,,iv7 ,outpatient1 out-of-network claims4 7,v7 ,emergency services4 7,,vi7 ,prescription drug claims4 4 #c4 ,consumer parity unit for mental health and substance use disorder parity violations 7a7 ,definitions ,in this section3 7#a7 ,applicable state authority ,the term applicable ,state authority has the meaning given the term in section #bgia of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ia74 7#b7 ,covered plan ,the term covered plan means any creditable coverage that is subject to any of the mental health parity laws described in paragraph 7#d74 7#c7 ,creditable coverage ,the term creditable coverage has the meaning given the term in section #bgjd7;c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#c7;c774 7#d7 ,mental health parity law ,the term mental health parity law means-- 7,a7 section #bgbf of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#bf72 7,b7 section #gab of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aahe;a72 7,c7 section #ihab of the ,internal ,revenue ,code of #aihf2 or 7,d7 any other ,federal law that applies the requirements under any of the sections described in subparagraph 7,a71 7,b71 or 7,c71 or requirements that are substantially similar to the requirements under any such section1 as determined by the ,secretary1 to creditable coverage4 7#e7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7#f7 ,specified covered plan ,the term specified covered plan means a covered plan that is any of the following3 7,a7 ,a group health plan or group or individual health insurance coverage 7as such terms are defined in section #bgia of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ia774 7,b7 ,a ,medicare ,advantage plan offered under part ,c of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ba et seq474 7,c7 ,a ,state plan 7or waiver of such plan7 under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq474 7,d7 ,a plan offered under the program established under chapter #hi of title #e1 ,united ,states ,code4 7b7 ,establishment ,not later than #f months after the date of enactment of this ,act1 the ,secretary1 in consultation with the ,secretary of ,labor1 the ,secretary of the ,treasury1 and the heads of any other applicable agencies1 shall establish a consumer parity unit with functions that include-- 7#a7 facilitating the centralized collection of1 monitoring of1 and response to consumer complaints 7including provider complaints7 regarding violations of mental health parity laws through developing and administering1 in accordance with subsection 7d7-- 7,a7 a single1 toll-free telephone number2 and 7,b7 a public website portal1 which may include enhancing a website portal in existence on the date of enactment of this ,act2 and 7#b7 providing information to health care consumers regarding the disclosure requirements and enforcement under section #bgbf7;a77#h7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#bf7;a77#h771 section #gab7;a77#h7 of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aahe;a7a77#h771 and section #ihab7;a77#h7 of the ,internal ,revenue ,code of #aihf4 7c7 ,website portal ,the ,secretary1 in consultation with the ,secretary of ,labor1 the ,secretary of the ,treasury1 and the heads of any other applicable agencies1 shall make available on the website portal established under subsection 7b77#a77;,b7-- 7#a7 any guidance and any reports issued by the ,secretary1 the ,secretary of ,labor1 or the ,secretary of the ,treasury1 under section #bgbf of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#bf71 section #gab of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aahe;a71 or section #ihab of the ,internal ,revenue ,code of #aihf1 respectively2 7#b7 any information obtained under subsection 7b77#a7 that it is in the public interest to disclose1 through aggregated reported or other appropriate formats designed to protect confidential information in accordance with subsection 7g72 and 7#c7 information on the results of1 or progress on1 any concluded or ongoing audits or investigations of the ,secretary1 the ,secretary of ,labor1 or the ,secretary of the ,treasury1 as applicable1 under such section #bgbf1 #gab1 or #ihab1 respectively1 including the identity of each group health plan or health insurance issuer 7including entities that provide administrative services in connection with a group health plan1 such as third party administrators7 that-- 7,a7 was the subject of a concluded audit or investigation2 or 7,b7 that is the subject of an ongoing audit or investigation and which was found1 pursuant to such audit or investigation1 not to have submitted ,,nqtl analyses in accordance with such sections 7or to have submitted incomplete ,,nqtl analyses74 7d7 ,response to consumer complaints and inquiries 7#a7 ,timely response to consumers ,the ,secretary1 in consultation with the ,secretary of ,labor1 the ,secretary of the ,treasury1 and the heads of any other applicable agencies1 shall establish reasonable procedures for the consumer parity unit established under this section to provide a response 7in writing if appropriate7 within #ij days to consumers regarding complaints received by the unit against1 or inquiries concerning1 a covered plan1 at the discretion of the applicable agency1 which shall at minimum include-- 7,a7 steps that have been taken by the appropriate ,state or ,federal enforcement agency in response to the complaint or inquiry of the consumer2 7,b7 in the case such complaint relates to a specified covered plan1 any responses received by the appropriate ,state or ,federal enforcement agency from the covered plan2 7,c7 any follow-up actions or planned follow-up actions by the appropriate ,state or ,federal enforcement agency in response to the complaint or inquiry of the consumer2 and 7,d7 contact information of the appropriate enforcement agency for the consumer to obtain additional information on the complaint or inquiry4 7#b7 ,timely response to regulators ,a specified covered plan shall provide a response 7in writing if appropriate7 within #g days to the appropriate ,state or ,federal enforcement agency having jurisdiction over such plan 7or1 in the case such plan is a ,state plan 7or wavier of such plan7 under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq471 to the ,secretary of ,health and ,human ,services7 concerning a consumer complaint or inquiry submitted to the consumer parity unit established under this section including-- 7,a7 steps that have been taken by the plan to respond to the complaint or inquiry of the consumer2 7,b7 any responses received by the plan from the consumer2 and 7,c7 follow-up actions or planned follow-up actions by the plan in response to the complaint or inquiry of the consumer4 7#c7 ,provision of information to consumers 7,a7 ,in general ,a covered plan shall comply with a consumer request for information in the control or possession of such covered plan concerning the coverage the consumer obtained from such covered plan within #g days of receipt of such request4 7,b7 ,exceptions ,notwithstanding subparagraph 7,a71 a covered plan1 and any agency or entity having jurisdiction over a covered plan1 may not be required by this paragraph to make available to the consumer any information required to be kept confidential by any other provision of law4 7#d7 ,enforcement 7,a7 ,private insurance ,the provisions of paragraphs 7#b7 and 7#c7 shall apply to group health plans and group and individual health insurance coverage 7as such terms are defined in section #bgia of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ia77 as if such provisions were included in part ,d of title ,,xxvii of such ,act 7#db ,u4,s4,c4 #cjj;g-#aaa et seq471 part #g of title ,i of the ,employee ,retirement ,act of #aigd 7#bi ,u4,s4,c4 #aaha et seq471 and chapter #ajj of the ,internal ,revenue ,code of #aihf4 7,b7 ,other specified covered plans 7i7 ,medicare ,advantage plans ,section #aheb of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bb7 is amended by adding at the end the following new section3 7o7 ,application of certain mental health parity complaint requirements ,an ,,ma plan shall comply with the requirements of paragraphs 7#b7 and 7#c7 of section #c7;d7 of the ,behavioral ,health ,coverage ,transparency ,act of #bjbb4 4 7ii7 ,medicaid ,section #aijb7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77 is amended-- 7,i7 in paragraph 7#hf71 by striking 2 and at the end2 7,,ii7 in paragraph 7#hg77;,d71 by striking the period and inserting 2 and2 and 7,,iii7 by inserting after paragraph 7#hg7 the following new paragraph3 7#hh7 provide for compliance with the provisions of paragraphs 7#b7 and 7#c7 of section #c7;d7 of the ,behavioral ,health ,coverage ,transparency ,act of #bjbb4 4 7,c7 ,other covered plans ,in the case of a covered plan that is not a specified covered plan1 the ,federal agency charged with the administration or supervision of such plan shall ensure that such plan complies with the provisions of paragraph 7#c74 7e7 ,reports 7#a7 ,in general ,not later than ,december #ca of each year1 the ,secretary1 in consultation with the ,secretary of ,labor1 the ,secretary of the ,treasury1 and the heads of any other applicable agencies1 shall submit a report to ,congress on the complaints received by the consumer parity unit established under this section in the prior year regarding covered plans4 7#b7 ,contents ,each such report shall include information and analysis about complaint numbers1 complaint types1 and1 where applicable1 information about the resolution of complaints1 including the identity of the group health plan or health insurance issuer that is the subject of such a complaint4 7#c7 ,consumer parity unit posting ,the ,secretary shall submit such reports to the consumer parity unit established under this section1 and such unit shall post the reports on the website portal established under subsection 7b77#a77;,b74 7f7 ,data sharing ,subject to any applicable standards for ,federal or ,state agencies with respect to protecting personally identifiable information and data security and integrity1 including the regulations under part #b of title #db1 ,code of ,federal ,regulations-- 7#a7 the consumer parity unit established under this section shall share consumer complaint information with the ,secretary1 and the head of any other applicable ,federal or ,state agency2 and 7#b7 the ,secretary1 and the head of any other applicable ,federal or ,state agency1 shall share data relating to consumer complaints regarding covered plans with such unit4 7g7 ,privacy considerations 7#a7 ,in general ,in carrying out this section1 the consumer parity unit established under this section and the ,secretary1 in consultation with the ,secretary of ,labor1 the ,secretary of the ,treasury1 and the head of any other applicable agency1 shall take measures to ensure that proprietary1 personal1 or confidential consumer information that is protected from public disclosure under section #eeb7;b7 or #eeb;a of title #e1 ,united ,states ,code1 or any other provision of law1 is not made public under this section4 7#b7 ,exceptions ,the consumer parity unit established under this section may not obtain from a covered plan any personally identifiable information about a consumer from the records of the covered plan1 except-- 7,a7 if the records are reasonably described in a request by the consumer parity unit established under this section1 and the consumer provides appropriate consent for the disclosure and use of such information by the covered plan to such unit2 or 7,b7 as may be specifically permitted or required under other applicable provisions of law1 including the regulations under part #b of title #db1 ,code of ,federal ,regulations4 7h7 ,collaboration 7#a7 ,agreements with other agencies ,the ,secretary1 the ,secretary of ,labor1 the ,secretary of the ,treasury1 and the heads of any other applicable agencies1 shall enter into a memorandum of understanding with any affected ,federal regulatory agency regarding procedures by which any covered plan1 and any other agency having jurisdiction over a covered plan1 shall comply with this section4 7#b7 ,agreements with states ,to the extent practicable1 an applicable ,state authority may receive appropriate complaints from the consumer parity unit established under this section1 if-- 7,a7 the applicable ,state authority has the functional capacity to receive calls or electronic reports routed by the unit2 7,b7 the applicable ,state authority has satisfied any conditions of participation that the unit may establish1 including treatment of personally identifiable information and sharing of information on complaint resolution or related compliance procedures and resources2 and 7,c7 participation by the applicable ,state authority includes measures necessary to protect personally identifiable information in accordance with standards that apply to ,federal agencies with respect to protecting personally identifiable information and data security and integrity4 7#c7 ,assistance to ,states ,the ,secretary1 the ,secretary of ,labor1 the ,secretary of the ,treasury1 and the heads of any other applicable agencies1 shall provide assistance to ,states to increase the capacity of ,state governments to work with the ,federal parity unit under this section1 including through the provision of training and technical assistance1 and identification of violations of mental health and substance use disorder parity protections4 7i7 ,funding 7#a7 ,initial funding ,there is hereby appropriated to the ,secretary1 out of any funds in the ,treasury not otherwise appropriated1 #cj1jjj1jjj for the first fiscal year for which this section applies to carry out this section4 ,such amount shall remain available until expended4 7#b7 ,authorization for subsequent years ,there is authorized to be appropriated to the ,secretary for each fiscal year following the fiscal year described in paragraph 7#a71 such sums as may be necessary to carry out this section4 #d4 ,grants for health insurance information concerning mental health and substance use disorder benefits 7a7 ,in general ,the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary7 shall award grants to ,states to enable such ,states 7or the ,exchanges established under the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh7 operating in such ,states7 to establish1 expand1 or provide support for-- 7#a7 offices of health insurance consumer assistance2 or 7#b7 health insurance ombudsman programs1 in order to enable such offices and programs to carry out the activities described in subsection 7c74 7b7 ,eligibility 7#a7 ,in general ,to be eligible to receive a grant1 a ,state shall designate an independent office of health insurance consumer assistance1 or an ombudsman1 that1 directly or in coordination with ,state private and public health insurance regulators and consumer assistance organizations1 receives and responds to inquiries and complaints concerning health insurance coverage with respect to ,federal health insurance requirements and under ,state law relating to mental health or substance use disorder benefits4 7#b7 ,criteria ,a ,state that receives a grant under this section shall comply with criteria established by the ,secretary for carrying out activities under such grant4 7c7 ,use of funds ,funds received from a grant awarded under this section shall be used by an office of health insurance consumer assistance or health insurance ombudsman described in subsection 7a7 to-- 7#a7 assist with the filing of complaints and appeals1 including filing appeals with the internal appeal or grievance process of the group health plan or health insurance issuer1 ,medicaid program1 and ,children's ,health ,insurance ,program involved1 relating to mental health or substance use disorder benefits1 and providing information about the external appeal process2 7#b7 collect1 track1 and quantify problems and inquiries encountered by consumers2 7#c7 educate consumers on their rights and responsibilities with respect to group health plans and health insurance coverage1 ,medicaid1 and ,children's ,health ,insurance ,program relating to mental health or substance use disorder benefits2 7#d7 assist consumers with enrollment in a group health plan or health insurance coverage1 ,medicaid1 and the ,children's ,health ,insurance ,program by providing information1 referral1 and assistance2 and 7#e7 assist consumers in resolving problems with obtaining premium tax credits under section #cf;,b of the ,internal ,revenue ,code of #aihf by providing information1 referral1 and assistance4 7d7 ,data collection ,as a condition of receiving a grant under subsection 7a71 an office of health insurance consumer assistance or ombudsman program shall be required to collect and report data to the ,secretary and ,state public and private health insurance regulators on the types of problems and inquiries encountered by consumers relating to mental health or substance use disorder benefits4 ,the ,secretary shall utilize such data to identify areas where more enforcement action is necessary and shall share such information with ,state insurance regulators1 the ,secretary of ,labor1 and the ,secretary of the ,treasury for use in the enforcement activities of such agencies4 7e7 ,funding 7#a7 ,initial funding ,there is hereby appropriated to the ,secretary1 out of any funds in the ,treasury not otherwise appropriated1 #be1jjj1jjj for the first fiscal year for which this section applies to carry out this section4 ,such amount shall remain available until expended4 7#b7 ,authorization for subsequent years ,there is authorized to be appropriated to the ,secretary for each fiscal year following the fiscal year described in paragraph 7#a71 such sums as may be necessary to carry out this section4