,,ii  #aag? ,,congress  #b;d ,session   
,s4 #dfaf  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,july #bf1 #bjbb,ms4   
,w>r5 7= h]self1 ,ms4 ,baldw91 ,mr4     
,blum5?al1 ,mr4 ,book]1 ,mr4 ,br[n1 ,mr4
 ,ka9e1 ,ms4 ,klobu*>1 ,mr4 ,lujn1 ,mr4 
,m>key1 ,mr4 ,murphy1 ,mr4 ,s&]s1 ,ms4  
,smi?1 ,ms4 ,/ab5[1 & ,mr4 ,van ,holl57 
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,heal?1 ,education1 ,labor1 & ,p5sions  
,a ,,bill  ,to am5d title ,,xxvii ( !   
,public ,heal? ,s]vice ,act1 ! ,employee
 ,retirem5t ,income ,security ,act (    
#aigd1 & ! ,int]nal ,rev5ue ,code (     
#aihf to /r5g!n p>ity 9 m5tal heal? &   
sub/ance use disord] b5efits4  #a4 ,%ort
 title ,?is ,act may be cit$ z !        
,behavioral ,heal? ,cov]age ,transp>5cy 
,act ( #bjbb4  #b4 ,/r5g!n+ p>ity 9     
m5tal heal? & sub/ance use disord]      
b5efits  7a7 ,public ,heal? ,s]vice ,act
 ,section #bgbf7;a77#h7 ( ! ,public     
,heal? ,s]vice ,act 7#db ,u4,s4,c4      
#cjj;gg-#bf7;a77#h77 is am5d$-- 7#a7 9  

subp>agraph 7,a71 9 ! matt] prec$+      
clause 7i7-- 7,a7 by ins]t+ 7includ+    
entities t provide adm9i/rative s]vices 
9 connection ) a gr\p heal? plan1 su* z 
?ird p>ty adm9i/rators7 aft] insurance  
cov]age2 &  7,b7 by /rik+ &1 beg9n+ #de 
days aft] & all t foll[s ?r\gh ^u       
reque/1 & ins]t+ & submit to ! ,secret>y
 7or ! ,secret>y ( ,labor or ! ,secret>y
 ( ! ,treasury1 z applicable71 on an    
annual basis 7& at any o!r "t ^u reque/ 
( ! ,secret>y71 & to ! applicable ,/ate 
au?ority ^u reque/12  7#b7 9 subp>agraph
 7,b7-- 7,a7 9 ! head+1 by /rik+ reque/ 
& ins]t+ review2  7,b7 9 clause 7i7--   
7i7 9 ! head+1 by /rik+ ,submission ^u  
reque/ & ins]t+ ,9 g5]al2  7ii7 by /rik+
 %all reque/ & all t foll[s ?r\gh       
cov]age submit & ins]t %all conduct a   
review (2 &  7iii7 by /rik+ %all reque/ 
n few] ?an #bj & ins]t+ %all conduct a  
review ( n few] ?an #fj2  7,c7 9 clause 
7ii7-- 7i7 9 ! fir/ s5t5ce1 by /rik+ z  
reque/$ "u clause 7i7 & ins]t+ z        
submitt$ "u su* subp>agraph2  7ii7 9 !  

fir/ s5t5ce1 by /rik+ to be responsive  
to ! reque/ "u clause 7i7 = & ins]t+ to 
enable2 &  7iii7 9 ! second s5t5ce1 by  
/rik+ 1 z reque/$ "u clause 7i72  7,d7 9
 clause 7iii7-- 7i7 9 subclause 7,i71 by
 /rik+ 1 z reque/$ "u clause 7i712 &    
7ii7 by add+ at ! end ( subclause 7,,ii7
 ! foll[+ new s5t5ce3 ,! prec$+ s5t5ce  
%all n apply ) respect to disclosures   
made on or aft] ! date ( ! enactm5t (   
?is s5t5ce42 &  7,e7 9 clause 7iv7-- 7i7
 9 subclause 7,i7-- 7,i7 by /rik+       
reque/$ "u clause 7i7 & ins]t+ review$  
"u clause 7i72 &  7,,ii7 by /rik+ aft] !
 f9al det]m9ation by ! ,secret>y        
describ$ 9 clause 7iii77,i77bb7 & ins]t+
 by ! ,secret>y z describ$ 9 clause     
7iii77,i72  7ii7 9 subclause 7,,ii71 by 
/rik+ ! comp>ative analyses reque/$ "u  
clause 7i7 & ins]t+ su* comp>ative      
analyses2  7iii7 9 subclause 7,,iii71 by
 /rik+ ! comp>ative analyses reque/$ "u 
clause 7i7 & ins]t+ su* comp>ative      
analyses2  7iv7 9 subclause 7,,iv7--    
7,i7 by /rik+ ! comp>ative analyses     

reque/$ "u clause 7i7 & ins]t+ su*      
comp>ative analyses2 &  7,,ii7 by /rik+ 
& at ! end2  7v7 9 subclause 7,v71 by   
/rik+ ! p]iod & ins]t+ a semicolon2 &   
7vi7 by add+ at ! end ! foll[+3  7,,vi7 
! "n ( ea* gr\p heal? plan or heal?     
insurance issu] f\nd n to h submitt$    
comp>ative analyses 9 accordance )      
subp>agraph 7,a72  7,,vii7 ! "n ( ea*   
gr\p heal? plan or heal? insurance issu]
 ^: comp>ative analyses 7 review$ "u    
clause 7i7 & f\nd n to h submitt$       
suffici5t in=mation = ! ,secret>y to    
review2 &  7,,viii7 ! "n ( any plan or  
cov]age ) respect to :i* a compla9t has 
be5 submitt$ "u subp>agraph 7,c7 & = :i*
 a f9al review f9d+ has be5 issu$4 ,!   
requirem5ts ( ?is clause ) respect to   
plans or issu]s %all also apply to      
entities t provide adm9i/rative s]vices 
9 connection ) a gr\p heal? plan1 su* z 
?ird p>ty adm9i/rators1 if applicable4 2
  7#c7 9 subp>agraph 7,c77i71 by /rik+  
reque/$2 &  7#d7 by add+ at ! end !     
foll[+ new subp>agraphs3  7,d7 ,audit   

process ,beg9n+ #a ye> aft] ! date (    
enactm5t ( ?is subp>agraph1 ! ,secret>y1
 9 coop]ation ) ! ,secret>ies ( ,labor &
 ! ,treasury1 z applicable1 %all1 9     
addition to conduct+ reviews 9          
accordance ) subp>agraph 7,b71 conduct  
r&omiz$ audits ( gr\p heal? plans1 heal?
 insurance issu]s (f]+ gr\p or          
individual heal? insurance cov]age1 &   
entities t provide adm9i/rative s]vices 
9 connection ) a gr\p heal? plan1 su* z 
?ird p>ty adm9i/rators1 to det]m9e      
compliance ) ?is section4 ,su* audits   
%all be conduct$ on no few] ?an #dj     
plans or cov]ages p] cal5d> ye> 7n      
includ+ any reviews conduct$ "u su*     
subp>agraph74 ,9 addition1 ! ,secret>y  
may1 9 coop]ation ) ! ,secret>ies (     
,labor & ! ,treasury1 z applicable1 & 9 
consultation ) ! ,inspector ,g5]al ( !  
,dep>tm5t ( ,heal? & ,human ,s]vices1 ! 
,inspector ,g5]al ( ! ,dep>tm5t (       
,labor1 & ! ,inspector ,g5]al ( !       
,dep>tm5t ( ! ,treasury1 z applicable1  
conduct audits on any su* plan or       

cov]age ) respect to :i* a compla9t has 
be5 submitt$ "u subp>agraph 7,e7 to     
det]m9e compliance ) ?is section4  7,e7 
,compla9t process ,n lat] ?an #f mon?s  
aft] ! date ( enactm5t ( ?is            
subp>agraph1 ! ,secret>y1 9 coop]ation )
 ! ,secret>y ( ,labor & ! ,secret>y ( ! 
,treasury1 %all1 ) respect to gr\p heal?
 plans & heal? insurance issu]s (f]+    
gr\p or individual heal? insurance      
cov]age 7includ+ entities t provide     
adm9i/rative s]vices 9 connection ) a   
gr\p heal? plan1 su* z ?ird p>ty        
adm9i/rators71 issue guidance to cl>ify 
! process & timel9e = curr5t & pot5tial 
p>ticipants & b5efici>ies 7& au?oriz$   
repres5tatives & heal? c>e provid]s (   
su* p>ticipants & b5efici>ies7 ) respect
 to su* plans & cov]age to file =mal    
compla9ts ( su* plans or issu]s be+ 9   
violation ( ?is section1 includ+        
guidance1 by plan type1 on ! relevant   
,/ate1 regional1 & national (fices ) :i*
 su* compla9ts %\ld be fil$4  7,f7      
,cov]age disp>ity in=mation ,= ! fir/   

cal5d> ye> t beg9s on or aft] ! date t  
is #b ye>s aft] ! date ( ! enactm5t (   
?is subp>agraph1 & = ea* subsequ5t      
cal5d> ye>1 ! ,secret>y1 9 coop]ation ) 
! ,secret>ies ( ,labor & ! ,treasury1   
%all submit to ! ,committee on ,en]gy & 
,comm]ce ( ! ,h\se ( ,repres5tatives & !
 ,committee on ,heal?1 ,education1      
,labor1 & ,p5sions ( ! ,s5ate ! foll[+  
in=mation ) respect to ! prec$+ cal5d>  
ye>3 7i7 ,d5ial rates ,data comp>+ !    
rates ( & reasons = d5ial by gr\p heal? 
plans & heal? insurance issu]s (f]+ gr\p
 or individual heal? insurance cov]age  
7includ+ entities t provide adm9i/rative
 s]vices 9 connection ) a gr\p heal?    
plan1 su* z ?ird p>ty adm9i/rators7 (   
claims = m5tal heal? b5efits1 sub/ance  
use disord] b5efits1 & m$ical & surgical
 b5efits1 disaggregat$ by ! foll[+      
categories3 7,i7 ,inpati5t1 9-network   
claims4  7,,ii7 ,inpati5t1 out-(-network
 claims4  7,,iii7 ,outpati5t1 9-network 
claims4  7,,iv7 ,outpati5t1             
out-(-network claims4  7,v7 ,em]g5cy    

s]vices4  7,,vi7 ,prescription drug     
claims4  7ii7 ,network adequacy data    
,data comp>+ ! network adequacy ( gr\p  
heal? plans & heal? insurance issu]s    
(f]+ gr\p or individual heal? insurance 
cov]age 7includ+ entities t provide     
adm9i/rative s]vices 9 connection ) a   
gr\p heal? plan1 su* z ?ird p>ty        
adm9i/rators7 bas$ on claims = outpati5t
 & inpati5t m5tal heal? b5efits1        
sub/ance use disord] b5efits1 & m$ical &
 surgical b5efits1 includ+ out-(-network
 utilization rates1 ! numb] & p]c5tage (
 9-network provid]s accept+ new pati5ts1
 & av]age wait times betwe5 receiv+     
initial treatm5t & diagnosis & foll[-up 
treatm5t4  7iii7 ,reimbursem5t rates    
,data comp>+ ! reimbursem5t rates ( gr\p
 heal? plans & heal? insurance issu]s   
(f]+ gr\p or individual heal? insurance 
cov]age 7includ+ entities t provide     
adm9i/rative s]vices 9 connection ) a   
gr\p heal? plan1 su* z ?ird p>ty        
adm9i/rators7 = ! #aj mo/ commonly bill$
 m5tal heal? s]vices1 sub/ance use      

s]vices1 & m$ical & surgical s]vices1   
ea* z a p]c5tage ( rates payable = su*  
s]vices "u title ,,xviii ( ! ,social    
,security ,act1 disaggregat$ by ! foll[+
 categories3 7,i7 ,inpati5t1 9-network  
claims4  7,,ii7 ,inpati5t1 out-(-network
 claims4  7,,iii7 ,outpati5t1 9-network 
claims4  7,,iv7 ,outpati5t1             
out-(-network claims4  7,v7 ,em]g5cy    
s]vices4  7,,vi7 ,prescription drug     
claims4  4  7b7 ,employee ,retirem5t    
,income ,security ,act ( #aigd ,section 
#gab7;a77#h7 ( ! ,employee ,retirem5t   
,income ,security ,act ( #aigd 7#bi     
,u4,s4,c4 #aahe;a7a77#h77 is am5d$--    
7#a7 9 subp>agraph 7,a71 9 ! matt]      
prec$+ clause 7i7-- 7,a7 by ins]t+      
7includ+ entities t provide adm9i/rative
 s]vices 9 connection ) a gr\p heal?    
plan1 su* z ?ird p>ty adm9i/rators7 aft]
 insurance cov]age2 &  7,b7 by /rik+ &1 
beg9n+ #de days aft] & all t foll[s     
?r\gh ^u reque/1 & ins]t+ & submit to ! 
,secret>y 7or ! ,secret>y ( ,heal? &    
,human ,s]vices or ! ,secret>y ( !      

,treasury1 z applicable71 on an annual  
basis 7& at any o!r "t ^u reque/ ( !    
,secret>y712  7#b7 9 subp>agraph 7,b7-- 
7,a7 9 ! head+1 by /rik+ reque/ & ins]t+
 review2  7,b7 9 clause 7i7-- 7i7 9 !   
head+1 by /rik+ ,submission ^u reque/ & 
ins]t+ ,9 g5]al2  7ii7 by /rik+ %all    
reque/ & all t foll[s ?r\gh cov]age     
submit & ins]t %all conduct a review (2 
&  7iii7 by /rik+ %all reque/ n few] ?an
 #bj & ins]t+ %all conduct a review ( n 
few] ?an #fj2  7,c7 9 clause 7ii7-- 7i7 
9 ! fir/ s5t5ce1 by /rik+ z reque/$ "u  
clause 7i7 & ins]t+ z submitt$ "u su*   
subp>agraph2  7ii7 9 ! fir/ s5t5ce1 by  
/rik+ to be responsive to ! reque/ "u   
clause 7i7 = & ins]t+ to enable2 &      
7iii7 9 ! second s5t5ce1 by /rik+ 1 z   
reque/$ "u clause 7i72  7,d7 9 clause   
7iii7-- 7i7 9 subclause 7,i71 by /rik+ 1
 z reque/$ "u clause 7i712 &  7ii7 by   
add+ at ! end ( subclause 7,,ii7 !      
foll[+ new s5t5ce3 ,! prec$+ s5t5ce %all
 n apply ) respect to disclosures made  
on or aft] ! date ( ! enactm5t ( ?is    

s5t5ce42 &  7,e7 9 clause 7iv7-- 7i7 9  
subclause 7,i7-- 7,i7 by /rik+ reque/$  
"u clause 7i7 & ins]t+ review$ "u clause
 7i72 &  7,,ii7 by /rik+ aft] ! f9al    
det]m9ation by ! ,secret>y describ$ 9   
clause 7iii77,i77bb7 & ins]t+ by !      
,secret>y z describ$ 9 clause 7iii77,i72
  7ii7 9 subclause 7,,ii71 by /rik+ !   
comp>ative analyses reque/$ "u clause   
7i7 & ins]t+ su* comp>ative analyses2   
7iii7 9 subclause 7,,iii71 by /rik+ !   
comp>ative analyses reque/$ "u clause   
7i7 & ins]t+ su* comp>ative analyses2   
7iv7 9 subclause 7,,iv7-- 7,i7 by /rik+ 
! comp>ative analyses reque/$ "u clause 
7i7 & ins]t+ su* comp>ative analyses2 & 
7,,ii7 by /rik+ & at ! end2  7v7 9      
subclause 7,v71 by /rik+ ! p]iod &      
ins]t+ a semicolon2 &  7vi7 by add+ at !
 end ! foll[+3  7,,vi7 ! "n ( ea* gr\p  
heal? plan or heal? insurance issu] f\nd
 n to h submitt$ comp>ative analyses 9  
accordance ) subp>agraph 7,a72  7,,vii7 
! "n ( ea* gr\p heal? plan or heal?     
insurance issu] ^: comp>ative analyses 7

 review$ "u clause 7i7 & f\nd n to h    
submitt$ suffici5t in=mation = !        
,secret>y to review2 &  7,,viii7 ! "n ( 
any plan or cov]age ) respect to :i* a  
compla9t has be5 submitt$ "u subp>agraph
 7,c7 & = :i* a f9al review f9d+ has be5
 issu$4 ,! requirem5ts ( ?is clause )   
respect to plans or issu]s %all also    
apply to entities t provide adm9i/rative
 s]vices 9 connection ) a gr\p heal?    
plan1 su* z ?ird p>ty adm9i/rators1 if  
applicable4 2  7#c7 9 subp>agraph       
7,c77i71 by /rik+ reque/$2 &  7#d7 by   
add+ at ! end ! foll[+ new subp>agraphs3
  7,d7 ,audit process ,beg9n+ #a ye>    
aft] ! date ( enactm5t ( ?is            
subp>agraph1 ! ,secret>y1 9 coop]ation )
 ! ,secret>ies ( ,heal? & ,human        
,s]vices & ! ,treasury1 z applicable1   
%all1 9 addition to conduct+ reviews 9  
accordance ) subp>agraph 7,b71 conduct  
r&omiz$ audits ( gr\p heal? plans1 heal?
 insurance issu]s (f]+ gr\p heal?       
insurance cov]age1 & entities t provide 
adm9i/rative s]vices 9 connection ) a   

gr\p heal? plan1 su* z ?ird p>ty        
adm9i/rators1 to det]m9e compliance )   
?is section4 ,su* audits %all be        
conduct$ on no few] ?an #dj plans or    
cov]ages p] cal5d> ye> 7n includ+ any   
reviews conduct$ "u su* subp>agraph74 ,9
 addition1 ! ,secret>y may1 9 coop]ation
 ) ! ,secret>ies ( ,heal? & ,human      
,s]vices & ! ,treasury1 z applicable1 & 
9 consultation ) ! ,inspector ,g5]al ( !
 ,dep>tm5t ( ,heal? & ,human ,s]vices1 !
 ,inspector ,g5]al ( ! ,dep>tm5t (      
,labor1 & ! ,inspector ,g5]al ( !       
,dep>tm5t ( ! ,treasury1 z applicable1  
conduct audits on any su* plan or       
cov]age ) respect to :i* a compla9t has 
be5 submitt$ "u subp>agraph 7,e7 to     
det]m9e compliance ) ?is section4  7,e7 
,compla9t process ,n lat] ?an #f mon?s  
aft] ! date ( enactm5t ( ?is            
subp>agraph1 ! ,secret>y1 9 coop]ation )
 ! ,secret>y ( ,heal? & ,human ,s]vices 
& ! ,secret>y ( ! ,treasury1 %all1 )    
respect to gr\p heal? plans & heal?     
insurance issu]s (f]+ gr\p heal?        

insurance cov]age 7includ+ entities t   
provide adm9i/rative s]vices 9          
connection ) a gr\p heal? plan1 su* z   
?ird p>ty adm9i/rators71 issue guidance 
to cl>ify ! process & timel9e = curr5t &
 pot5tial p>ticipants & b5efici>ies 7&  
au?oriz$ repres5tatives & heal? c>e     
provid]s ( su* p>ticipants &            
b5efici>ies7 ) respect to su* plans &   
cov]age to file =mal compla9ts ( su*    
plans or issu]s be+ 9 violation ( ?is   
section1 includ+ guidance1 by plan type1
 on ! relevant ,/ate1 regional1 &       
national (fices ) :i* su* compla9ts %\ld
 be fil$4  7,f7 ,cov]age disp>ity       
in=mation ,= ! fir/ cal5d> ye> t beg9s  
on or aft] ! date t is #b ye>s aft] !   
date ( ! enactm5t ( ?is subp>agraph1 & =
 ea* subsequ5t cal5d> ye>1 ! ,secret>y1 
9 coop]ation ) ! ,secret>ies ( ,heal? & 
,human ,s]vices & ! ,treasury1 %all     
submit to ! ,committee on ,en]gy &      
,comm]ce ( ! ,h\se ( ,repres5tatives & !
 ,committee on ,heal?1 ,education1      
,labor1 & ,p5sions ( ! ,s5ate ! foll[+  

in=mation ) respect to ! prec$+ cal5d>  
ye>3 7i7 ,d5ial rates ,data comp>+ !    
rates ( & reasons = d5ial by gr\p heal? 
plans & heal? insurance issu]s (f]+ gr\p
 heal? insurance cov]age 7includ+       
entities t provide adm9i/rative s]vices 
9 connection ) a gr\p heal? plan1 su* z 
?ird p>ty adm9i/rators7 ( claims = m5tal
 heal? b5efits1 sub/ance use disord]    
b5efits1 & m$ical & surgical b5efits1   
disaggregat$ by ! foll[+ categories3    
7,i7 ,inpati5t1 9-network claims4       
7,,ii7 ,inpati5t1 out-(-network claims4 
7,,iii7 ,outpati5t1 9-network claims4   
7,,iv7 ,outpati5t1 out-(-network claims4
  7,v7 ,em]g5cy s]vices4  7,,vi7        
,prescription drug claims4  7ii7        
,network adequacy data ,data comp>+ !   
network adequacy ( gr\p heal? plans &   
heal? insurance issu]s (f]+ gr\p heal?  
insurance cov]age 7includ+ entities t   
provide adm9i/rative s]vices 9          
connection ) a gr\p heal? plan1 su* z   
?ird p>ty adm9i/rators7 bas$ on claims =
 outpati5t & inpati5t m5tal heal?       

b5efits1 sub/ance use disord] b5efits1 &
 m$ical & surgical b5efits1 includ+     
out-(-network utilization rates1 ! numb]
 & p]c5tage ( 9-network provid]s accept+
 new pati5ts1 & av]age wait times betwe5
 receiv+ initial treatm5t & diagnosis & 
foll[-up treatm5t4  7iii7 ,reimbursem5t 
rates ,data comp>+ ! reimbursem5t rates 
( gr\p heal? plans & heal? insurance    
issu]s (f]+ gr\p heal? insurance cov]age
 7includ+ entities t provide            
adm9i/rative s]vices 9 connection ) a   
gr\p heal? plan1 su* z ?ird p>ty        
adm9i/rators7 = ! #aj mo/ commonly bill$
 m5tal heal? s]vices1 sub/ance use      
s]vices1 & m$ical & surgical s]vices1   
ea* z a p]c5tage ( rates payable = su*  
s]vices "u title ,,xviii ( ! ,social    
,security ,act1 disaggregat$ by ! foll[+
 categories3 7,i7 ,inpati5t1 9-network  
claims4  7,,ii7 ,inpati5t1 out-(-network
 claims4  7,,iii7 ,outpati5t1 9-network 
claims4  7,,iv7 ,outpati5t1             
out-(-network claims4  7,v7 ,em]g5cy    
s]vices4  7,,vi7 ,prescription drug     

claims4  4  7c7 ,int]nal ,rev5ue ,code (
 #aihf ,section #ihab7;a77#h7 ( !       
,int]nal ,rev5ue ,code ( #aihf is       
am5d$-- 7#a7 9 subp>agraph 7,a71 9 !    
matt] prec$+ clause 7i7-- 7,a7 by ins]t+
 7includ+ entities t provide            
adm9i/rative s]vices 9 connection ) a   
gr\p heal? plan1 su* z ?ird p>ty        
adm9i/rators7 aft] ,9 ! case ( a gr\p   
heal? plan2 &  7,b7 by /rik+ &1 beg9n+  
#de days aft] & all t foll[s ?r\gh ^u   
reque/1 & ins]t+ & submit to ! ,secret>y
 7or ! ,secret>y ( ,heal? & ,human      
,s]vices or ! ,secret>y ( ,labor1 z     
applicable71 on an annual basis 7& at   
any o!r "t ^u reque/ ( ! ,secret>y712   
7#b7 9 subp>agraph 7,b7-- 7,a7 9 !      
head+1 by /rik+ reque/ & ins]t+ review2 
7,b7 9 clause 7i7-- 7i7 9 ! head+1 by   
/rik+ ,submission ^u reque/ & ins]t+ ,9 
g5]al2  7ii7 by /rik+ %all reque/ & all 
t foll[s ?r\gh plan submit & ins]t %all 
conduct a review (2 &  7iii7 by /rik+   
%all reque/ n few] ?an #bj & ins]t+ %all
 conduct a review ( n few] ?an #fj2     

7,c7 9 clause 7ii7-- 7i7 9 ! fir/       
s5t5ce1 by /rik+ z reque/$ "u clause 7i7
 & ins]t+ z submitt$ "u su* subp>agraph2
  7ii7 9 ! fir/ s5t5ce1 by /rik+ to be  
responsive to ! reque/ "u clause 7i7 = &
 ins]t+ to enable2 &  7iii7 9 ! second  
s5t5ce1 by /rik+ 1 z reque/$ "u clause  
7i72  7,d7 9 clause 7iii7-- 7i7 9       
subclause 7,i71 by /rik+ 1 z reque/$ "u 
clause 7i712 &  7ii7 by add+ at ! end ( 
subclause 7,,ii7 ! foll[+ new s5t5ce3 ,!
 prec$+ s5t5ce %all n apply ) respect to
 disclosures made on or aft] ! date ( ! 
enactm5t ( ?is s5t5ce42 &  7,e7 9 clause
 7iv7-- 7i7 9 subclause 7,i7-- 7,i7 by  
/rik+ reque/$ "u clause 7i7 & ins]t+    
review$ "u clause 7i72 &  7,,ii7 by     
/rik+ aft] ! f9al det]m9ation by !      
,secret>y describ$ 9 clause             
7iii77,i77bb7 & ins]t+ by ! ,secret>y z 
describ$ 9 clause 7iii77,i72  7ii7 9    
subclause 7,,ii71 by /rik+ ! comp>ative 
analyses reque/$ "u clause 7i7 & ins]t+ 
su* comp>ative analyses2  7iii7 9       
subclause 7,,iii71 by /rik+ ! comp>ative

 analyses reque/$ "u clause 7i7 & ins]t+
 su* comp>ative analyses2  7iv7 9       
subclause 7,,iv7-- 7,i7 by /rik+ !      
comp>ative analyses reque/$ "u clause   
7i7 & ins]t+ su* comp>ative analyses2 & 
7,,ii7 by /rik+ & at ! end2  7v7 9      
subclause 7,v71 by /rik+ ! p]iod &      
ins]t+ a semicolon2 &  7vi7 by add+ at !
 end ! foll[+3  7,,vi7 ! "n ( ea* gr\p  
heal? plan f\nd n to h submitt$         
comp>ative analyses 9 accordance )      
subp>agraph 7,a72  7,,vii7 ! "n ( ea*   
gr\p heal? plan ^: comp>ative analyses 7
 review$ "u clause 7i7 & f\nd n to h    
submitt$ suffici5t in=mation = !        
,secret>y to review2 &  7,,viii7 ! "n ( 
any plan ) respect to :i* a compla9t has
 be5 submitt$ "u subp>agraph 7,c7 & =   
:i* a f9al review f9d+ has be5 issu$4 ,!
 requirem5ts ( ?is clause ) respect to  
plans %all also apply to entities t     
provide adm9i/rative s]vices 9          
connection ) a gr\p heal? plan1 su* z   
?ird p>ty adm9i/rators1 if applicable4 2
  7#c7 9 subp>agraph 7,c77i71 by /rik+  

reque/$2 &  7#d7 by add+ at ! end !     
foll[+ new subp>agraphs3  7,d7 ,audit   
process ,beg9n+ #a ye> aft] ! date (    
enactm5t ( ?is subp>agraph1 ! ,secret>y1
 9 coop]ation ) ! ,secret>ies ( ,heal? &
 ,human ,s]vices & ,labor1 z applicable1
 %all1 9 addition to conduct+ reviews 9 
accordance ) subp>agraph 7,b71 conduct  
r&omiz$ audits ( gr\p heal? plans &     
entities t provide adm9i/rative s]vices 
9 connection ) a gr\p heal? plan1 su* z 
?ird p>ty adm9i/rators1 to det]m9e      
compliance ) ?is section4 ,su* audits   
%all be conduct$ on no few] ?an #dj     
plans p] cal5d> ye> 7n includ+ any      
reviews conduct$ "u su* subp>agraph74 ,9
 addition1 ! ,secret>y may1 9 coop]ation
 ) ! ,secret>ies ( ,heal? & ,human      
,s]vices & ,labor1 z applicable1 & 9    
consultation ) ! ,inspector ,g5]al ( !  
,dep>tm5t ( ,heal? & ,human ,s]vices1 ! 
,inspector ,g5]al ( ! ,dep>tm5t (       
,labor1 & ! ,inspector ,g5]al ( !       
,dep>tm5t ( ! ,treasury1 z applicable1  
conduct audits on any su* plan ) respect

 to :i* a compla9t has be5 submitt$ "u  
subp>agraph 7,e7 to det]m9e compliance )
 ?is section4  7,e7 ,compla9t process ,n
 lat] ?an #f mon?s aft] ! date (        
enactm5t ( ?is subp>agraph1 ! ,secret>y1
 9 coop]ation ) ! ,secret>y ( ,heal? &  
,human ,s]vices & ! ,secret>y ( ,labor1 
%all1 ) respect to gr\p heal? plans     
7includ+ entities t provide adm9i/rative
 s]vices 9 connection ) a gr\p heal?    
plan1 su* z ?ird p>ty adm9i/rators71    
issue guidance to cl>ify ! process &    
timel9e = curr5t & pot5tial p>ticipants 
& b5efici>ies 7& au?oriz$ repres5tatives
 & heal? c>e provid]s ( su* p>ticipants 
& b5efici>ies7 ) respect to su* plans to
 file =mal compla9ts ( su* plans be+ 9  
violation ( ?is section1 includ+        
guidance1 by plan type1 on ! relevant   
,/ate1 regional1 & national (fices ) :i*
 su* compla9ts %\ld be fil$4  7,f7      
,cov]age disp>ity in=mation ,= ! fir/   
cal5d> ye> t beg9s on or aft] ! date t  
is #b ye>s aft] ! date ( ! enactm5t (   
?is subp>agraph1 & = ea* subsequ5t      

cal5d> ye>1 ! ,secret>y1 9 coop]ation ) 
! ,secret>ies ( ,heal? & ,human ,s]vices
 & ,labor1 %all submit to ! ,committee  
on ,en]gy & ,comm]ce ( ! ,h\se (        
,repres5tatives & ! ,committee on       
,heal?1 ,education1 ,labor1 & ,p5sions (
 ! ,s5ate ! foll[+ in=mation ) respect  
to ! prec$+ cal5d> ye>3 7i7 ,d5ial rates
 ,data comp>+ ! rates ( & reasons =     
d5ial by gr\p heal? plans 7includ+      
entities t provide adm9i/rative s]vices 
9 connection ) a gr\p heal? plan1 su* z 
?ird p>ty adm9i/rators7 ( claims = m5tal
 heal? b5efits1 sub/ance use disord]    
b5efits1 & m$ical & surgical b5efits1   
disaggregat$ by ! foll[+ categories3    
7,i7 ,inpati5t1 9-network claims4       
7,,ii7 ,inpati5t1 out-(-network claims4 
7,,iii7 ,outpati5t1 9-network claims4   
7,,iv7 ,outpati5t1 out-(-network claims4
  7,v7 ,em]g5cy s]vices4  7,,vi7        
,prescription drug claims4  7ii7        
,network adequacy data ,data comp>+ !   
network adequacy ( gr\p heal? plans     
7includ+ entities t provide adm9i/rative

 s]vices 9 connection ) a gr\p heal?    
plan1 su* z ?ird p>ty adm9i/rators7 bas$
 on claims = outpati5t & inpati5t m5tal 
heal? b5efits1 sub/ance use disord]     
b5efits1 & m$ical & surgical b5efits1   
includ+ out-(-network utilization rates1
 ! numb] & p]c5tage ( 9-network provid]s
 accept+ new pati5ts1 & av]age wait     
times betwe5 receiv+ initial treatm5t & 
diagnosis & foll[-up treatm5t4  7iii7   
,reimbursem5t rates ,data comp>+ !      
reimbursem5t rates ( gr\p heal? plans   
7includ+ entities t provide adm9i/rative
 s]vices 9 connection ) a gr\p heal?    
plan1 su* z ?ird p>ty adm9i/rators7 = ! 
#aj mo/ commonly bill$ m5tal heal?      
s]vices1 sub/ance use s]vices1 & m$ical 
& surgical s]vices1 ea* z a p]c5tage (  
rates payable = su* s]vices "u title    
,,xviii ( ! ,social ,security ,act1     
disaggregat$ by ! foll[+ categories3    
7,i7 ,inpati5t1 9-network claims4       
7,,ii7 ,inpati5t1 out-(-network claims4 
7,,iii7 ,outpati5t1 9-network claims4   
7,,iv7 ,outpati5t1 out-(-network claims4

  7,v7 ,em]g5cy s]vices4  7,,vi7        
,prescription drug claims4  4  #c4      
,consum] p>ity unit = m5tal heal? &     
sub/ance use disord] p>ity violations   
7a7 ,def9itions ,9 ?is section3 7#a7    
,applicable /ate au?ority ,! t]m        
applicable ,/ate au?ority has ! mean+   
giv5 ! t]m 9 section #bgia ( ! ,public  
,heal? ,s]vice ,act 7#db ,u4,s4,c4      
#cjj;gg-#ia74  7#b7 ,cov]$ plan ,! t]m  
cov]$ plan means any cr$itable cov]age t
 is subject to any ( ! m5tal heal? p>ity
 laws describ$ 9 p>agraph 7#d74  7#c7   
,cr$itable cov]age ,! t]m cr$itable     
cov]age has ! mean+ giv5 ! t]m 9 section
 #bgjd7;c7 ( ! ,public ,heal? ,s]vice   
,act 7#db ,u4,s4,c4 #cjj;gg-#c7;c774    
7#d7 ,m5tal heal? p>ity law ,! t]m m5tal
 heal? p>ity law means-- 7,a7 section   
#bgbf ( ! ,public ,heal? ,s]vice ,act   
7#db ,u4,s4,c4 #cjj;gg-#bf72  7,b7      
section #gab ( ! ,employee ,retirem5t   
,income ,security ,act ( #aigd 7#bi     
,u4,s4,c4 #aahe;a72  7,c7 section #ihab 
( ! ,int]nal ,rev5ue ,code ( #aihf2 or  

7,d7 any o!r ,f$]al law t applies !     
requirem5ts "u any ( ! sections describ$
 9 subp>agraph 7,a71 7,b71 or 7,c71 or  
requirem5ts t are sub/antially simil> to
 ! requirem5ts "u any su* section1 z    
det]m9$ by ! ,secret>y1 to cr$itable    
cov]age4  7#e7 ,secret>y ,! t]m         
,secret>y means ! ,secret>y ( ,heal? &  
,human ,s]vices4  7#f7 ,specifi$ cov]$  
plan ,! t]m specifi$ cov]$ plan means a 
cov]$ plan t is any ( ! foll[+3 7,a7 ,a 
gr\p heal? plan or gr\p or individual   
heal? insurance cov]age 7z su* t]ms are 
def9$ 9 section #bgia ( ! ,public ,heal?
 ,s]vice ,act 7#db ,u4,s4,c4            
#cjj;gg-#ia774  7,b7 ,a ,m$ic>e         
,advantage plan (f]$ "u "p ,c ( title   
,,xviii ( ! ,social ,security ,act 7#db 
,u4,s4,c4 #aciew-#ba et seq474  7,c7 ,a 
,/ate plan 7or waiv] ( su* plan7 "u     
title ,,xix ( ! ,social ,security ,act  
7#db ,u4,s4,c4 #acif et seq474  7,d7 ,a 
plan (f]$ "u ! program e/abli%$ "u *apt]
 #hi ( title #e1 ,unit$ ,/ates ,code4   
7b7 ,e/abli%m5t ,n lat] ?an #f mon?s    

aft] ! date ( enactm5t ( ?is ,act1 !    
,secret>y1 9 consultation ) ! ,secret>y 
( ,labor1 ! ,secret>y ( ! ,treasury1 & !
 heads ( any o!r applicable ag5cies1    
%all e/abli% a consum] p>ity unit )     
functions t include-- 7#a7 facilitat+ ! 
c5traliz$ collection (1 monitor+ (1 &   
response to consum] compla9ts 7includ+  
provid] compla9ts7 reg>d+ violations (  
m5tal heal? p>ity laws ?r\gh develop+ & 
adm9i/]+1 9 accordance ) subsection     
7d7-- 7,a7 a s+le1 toll-free telephone  
numb]2 &  7,b7 a public website portal1 
:i* may include enhanc+ a website portal
 9 exi/5ce on ! date ( enactm5t ( ?is   
,act2 &  7#b7 provid+ in=mation to heal?
 c>e consum]s reg>d+ ! disclosure       
requirem5ts & en=cem5t "u section       
#bgbf7;a77#h7 ( ! ,public ,heal? ,s]vice
 ,act 7#db ,u4,s4,c4                    
#cjj;gg-#bf7;a77#h771 section           
#gab7;a77#h7 ( ! ,employee ,retirem5t   
,income ,security ,act ( #aigd 7#bi     
,u4,s4,c4 #aahe;a7a77#h771 & section    
#ihab7;a77#h7 ( ! ,int]nal ,rev5ue ,code

 ( #aihf4  7c7 ,website portal ,!       
,secret>y1 9 consultation ) ! ,secret>y 
( ,labor1 ! ,secret>y ( ! ,treasury1 & !
 heads ( any o!r applicable ag5cies1    
%all make available on ! website portal 
e/abli%$ "u subsection 7b77#a77;,b7--   
7#a7 any guidance & any reports issu$ by
 ! ,secret>y1 ! ,secret>y ( ,labor1 or !
 ,secret>y ( ! ,treasury1 "u section    
#bgbf ( ! ,public ,heal? ,s]vice ,act   
7#db ,u4,s4,c4 #cjj;gg-#bf71 section    
#gab ( ! ,employee ,retirem5t ,income   
,security ,act ( #aigd 7#bi ,u4,s4,c4   
#aahe;a71 or section #ihab ( ! ,int]nal 
,rev5ue ,code ( #aihf1 respectively2    
7#b7 any in=mation obta9$ "u subsection 
7b77#a7 t x is 9 ! public int]e/ to     
disclose1 ?r\gh aggregat$ report$ or o!r
 appropriate =mats design$ to protect   
confid5tial in=mation 9 accordance )    
subsection 7g72 &  7#c7 in=mation on !  
results (1 or progress on1 any conclud$ 
or ongo+ audits or inve/igations ( !    
,secret>y1 ! ,secret>y ( ,labor1 or !   
,secret>y ( ! ,treasury1 z applicable1  

"u su* section #bgbf1 #gab1 or #ihab1   
respectively1 includ+ ! id5tity ( ea*   
gr\p heal? plan or heal? insurance issu]
 7includ+ entities t provide            
adm9i/rative s]vices 9 connection ) a   
gr\p heal? plan1 su* z ?ird p>ty        
adm9i/rators7 t-- 7,a7 0 ! subject ( a  
conclud$ audit or inve/igation2 or  7,b7
 t is ! subject ( an ongo+ audit or     
inve/igation & :i* 0 f\nd1 pursuant to  
su* audit or inve/igation1 n to h       
submitt$ ,,nqtl analyses 9 accordance ) 
su* sections 7or to h submitt$          
incomplete ,,nqtl analyses74  7d7       
,response to consum] compla9ts &        
inquiries  7#a7 ,timely response to     
consum]s ,! ,secret>y1 9 consultation ) 
! ,secret>y ( ,labor1 ! ,secret>y ( !   
,treasury1 & ! heads ( any o!r          
applicable ag5cies1 %all e/abli%        
reasonable proc$ures = ! consum] p>ity  
unit e/abli%$ "u ?is section to provide 
a response 79 writ+ if appropriate7 )9  
#ij days to consum]s reg>d+ compla9ts   
receiv$ by ! unit aga9/1 or inquiries   

conc]n+1 a cov]$ plan1 at ! discretion (
 ! applicable ag5cy1 :i* %all at m9imum 
include-- 7,a7 /eps t h be5 tak5 by !   
appropriate ,/ate or ,f$]al en=cem5t    
ag5cy 9 response to ! compla9t or       
inquiry ( ! consum]2  7,b7 9 ! case su* 
compla9t relates to a specifi$ cov]$    
plan1 any responses receiv$ by !        
appropriate ,/ate or ,f$]al en=cem5t    
ag5cy f ! cov]$ plan2  7,c7 any foll[-up
 actions or plann$ foll[-up actions by !
 appropriate ,/ate or ,f$]al en=cem5t   
ag5cy 9 response to ! compla9t or       
inquiry ( ! consum]2 &  7,d7 contact    
in=mation ( ! appropriate en=cem5t ag5cy
 = ! consum] to obta9 additional        
in=mation on ! compla9t or inquiry4     
7#b7 ,timely response to regulators ,a  
specifi$ cov]$ plan %all provide a      
response 79 writ+ if appropriate7 )9 #g 
days to ! appropriate ,/ate or ,f$]al   
en=cem5t ag5cy hav+ jurisdiction ov] su*
 plan 7or1 9 ! case su* plan is a ,/ate 
plan 7or wavi] ( su* plan7 "u title     
,,xix ( ! ,social ,security ,act 7#db   

,u4,s4,c4 #acif et seq471 to ! ,secret>y
 ( ,heal? & ,human ,s]vices7 conc]n+ a  
consum] compla9t or inquiry submitt$ to 
! consum] p>ity unit e/abli%$ "u ?is    
section includ+-- 7,a7 /eps t h be5 tak5
 by ! plan to respond to ! compla9t or  
inquiry ( ! consum]2  7,b7 any responses
 receiv$ by ! plan f ! consum]2 &  7,c7 
foll[-up actions or plann$ foll[-up     
actions by ! plan 9 response to !       
compla9t or inquiry ( ! consum]4  7#c7  
,provision ( in=mation to consum]s  7,a7
 ,9 g5]al ,a cov]$ plan %all comply ) a 
consum] reque/ = in=mation 9 ! control  
or possession ( su* cov]$ plan conc]n+ !
 cov]age ! consum] obta9$ f su* cov]$   
plan )9 #g days ( receipt ( su* reque/4 
7,b7 ,exceptions ,not)/&+ subp>agraph   
7,a71 a cov]$ plan1 & any ag5cy or      
entity hav+ jurisdiction ov] a cov]$    
plan1 may n be requir$ by ?is p>agraph  
to make available to ! consum] any      
in=mation requir$ to be kept confid5tial
 by any o!r provision ( law4  7#d7      
,en=cem5t  7,a7 ,private insurance ,!   

provisions ( p>agraphs 7#b7 & 7#c7 %all 
apply to gr\p heal? plans & gr\p &      
individual heal? insurance cov]age 7z   
su* t]ms are def9$ 9 section #bgia ( !  
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #cjj;gg-#ia77 z if su*        
provisions 7 includ$ 9 "p ,d ( title    
,,xxvii ( su* ,act 7#db ,u4,s4,c4       
#cjj;g-#aaa et seq471 "p #g ( title ,i (
 ! ,employee ,retirem5t ,act ( #aigd    
7#bi ,u4,s4,c4 #aaha et seq471 & *apt]  
#ajj ( ! ,int]nal ,rev5ue ,code ( #aihf4
  7,b7 ,o!r specifi$ cov]$ plans  7i7   
,m$ic>e ,advantage plans ,section #aheb 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #aciew-#bb7 is am5d$ by add+  
at ! end ! foll[+ new section3  7o7     
,application ( c]ta9 m5tal heal? p>ity  
compla9t requirem5ts ,an ,,ma plan %all 
comply ) ! requirem5ts ( p>agraphs 7#b7 
& 7#c7 ( section #c7;d7 ( ! ,behavioral 
,heal? ,cov]age ,transp>5cy ,act (      
#bjbb4  4  7ii7 ,m$icaid ,section       
#aijb7;a7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acif;a7a77 is am5d$--   

7,i7 9 p>agraph 7#hf71 by /rik+ 2 & at !
 end2  7,,ii7 9 p>agraph 7#hg77;,d71 by 
/rik+ ! p]iod & ins]t+ 2 &2 &  7,,iii7  
by ins]t+ aft] p>agraph 7#hg7 ! foll[+  
new p>agraph3  7#hh7 provide =          
compliance ) ! provisions ( p>agraphs   
7#b7 & 7#c7 ( section #c7;d7 ( !        
,behavioral ,heal? ,cov]age ,transp>5cy 
,act ( #bjbb4  4  7,c7 ,o!r cov]$ plans 
,9 ! case ( a cov]$ plan t is n a       
specifi$ cov]$ plan1 ! ,f$]al ag5cy *>g$
 ) ! adm9i/ration or sup]vision ( su*   
plan %all ensure t su* plan complies ) !
 provisions ( p>agraph 7#c74  7e7       
,reports  7#a7 ,9 g5]al ,n lat] ?an     
,decemb] #ca ( ea* ye>1 ! ,secret>y1 9  
consultation ) ! ,secret>y ( ,labor1 !  
,secret>y ( ! ,treasury1 & ! heads ( any
 o!r applicable ag5cies1 %all submit a  
report to ,congress on ! compla9ts      
receiv$ by ! consum] p>ity unit e/abli%$
 "u ?is section 9 ! prior ye> reg>d+    
cov]$ plans4  7#b7 ,cont5ts ,ea* su*    
report %all include in=mation & analysis
 ab\t compla9t numb]s1 compla9t types1  

&1 :]e applicable1 in=mation ab\t !     
resolution ( compla9ts1 includ+ !       
id5tity ( ! gr\p heal? plan or heal?    
insurance issu] t is ! subject ( su* a  
compla9t4  7#c7 ,consum] p>ity unit po/+
 ,! ,secret>y %all submit su* reports to
 ! consum] p>ity unit e/abli%$ "u ?is   
section1 & su* unit %all po/ ! reports  
on ! website portal e/abli%$ "u         
subsection 7b77#a77;,b74  7f7 ,data %>+ 
,subject to any applicable /&>ds =      
,f$]al or ,/ate ag5cies ) respect to    
protect+ p]sonally id5tifiable in=mation
 & data security & integrity1 includ+ ! 
regulations "u "p #b ( title #db1 ,code 
( ,f$]al ,regulations-- 7#a7 ! consum]  
p>ity unit e/abli%$ "u ?is section %all 
%>e consum] compla9t in=mation ) !      
,secret>y1 & ! head ( any o!r applicable
 ,f$]al or ,/ate ag5cy2 &  7#b7 !       
,secret>y1 & ! head ( any o!r applicable
 ,f$]al or ,/ate ag5cy1 %all %>e data   
relat+ to consum] compla9ts reg>d+ cov]$
 plans ) su* unit4  7g7 ,privacy        
consid]ations  7#a7 ,9 g5]al ,9 c>ry+   

out ?is section1 ! consum] p>ity unit   
e/abli%$ "u ?is section & ! ,secret>y1 9
 consultation ) ! ,secret>y ( ,labor1 ! 
,secret>y ( ! ,treasury1 & ! head ( any 
o!r applicable ag5cy1 %all take measures
 to ensure t propriet>y1 p]sonal1 or    
confid5tial consum] in=mation t is      
protect$ f public disclosure "u section 
#eeb7;b7 or #eeb;a ( title #e1 ,unit$   
,/ates ,code1 or any o!r provision (    
law1 is n made public "u ?is section4   
7#b7 ,exceptions ,! consum] p>ity unit  
e/abli%$ "u ?is section may n obta9 f a 
cov]$ plan any p]sonally id5tifiable    
in=mation ab\t a consum] f ! records ( !
 cov]$ plan1 except-- 7,a7 if ! records 
are reasonably describ$ 9 a reque/ by ! 
consum] p>ity unit e/abli%$ "u ?is      
section1 & ! consum] provides           
appropriate cons5t = ! disclosure & use 
( su* in=mation by ! cov]$ plan to su*  
unit2 or  7,b7 z may be specifically    
p]mitt$ or requir$ "u o!r applicable    
provisions ( law1 includ+ ! regulations 
"u "p #b ( title #db1 ,code ( ,f$]al    

,regulations4  7h7 ,collaboration  7#a7 
,agreem5ts ) o!r ag5cies ,! ,secret>y1 !
 ,secret>y ( ,labor1 ! ,secret>y ( !    
,treasury1 & ! heads ( any o!r          
applicable ag5cies1 %all ent] into a    
memor&um ( und]/&+ ) any affect$ ,f$]al 
regulatory ag5cy reg>d+ proc$ures by :i*
 any cov]$ plan1 & any o!r ag5cy hav+   
jurisdiction ov] a cov]$ plan1 %all     
comply ) ?is section4  7#b7 ,agreem5ts )
 /ates ,to ! ext5t practicable1 an      
applicable ,/ate au?ority may receive   
appropriate compla9ts f ! consum] p>ity 
unit e/abli%$ "u ?is section1 if-- 7,a7 
! applicable ,/ate au?ority has !       
functional capacity to receive calls or 
electronic reports r\t$ by ! unit2  7,b7
 ! applicable ,/ate au?ority has        
satisfi$ any conditions ( p>ticipation t
 ! unit may e/abli%1 includ+ treatm5t ( 
p]sonally id5tifiable in=mation & %>+ ( 
in=mation on compla9t resolution or     
relat$ compliance proc$ures & res\rces2 
&  7,c7 p>ticipation by ! applicable    
,/ate au?ority includes measures        

necess>y to protect p]sonally           
id5tifiable in=mation 9 accordance )    
/&>ds t apply to ,f$]al ag5cies )       
respect to protect+ p]sonally           
id5tifiable in=mation & data security & 
integrity4  7#c7 ,assi/ance to ,/ates ,!
 ,secret>y1 ! ,secret>y ( ,labor1 !     
,secret>y ( ! ,treasury1 & ! heads ( any
 o!r applicable ag5cies1 %all provide   
assi/ance to ,/ates to increase !       
capacity ( ,/ate gov]nm5ts to "w ) !    
,f$]al p>ity unit "u ?is section1       
includ+ ?r\gh ! provision ( tra9+ &     
te*nical assi/ance1 & id5tification (   
violations ( m5tal heal? & sub/ance use 
disord] p>ity protections4  7i7 ,fund+  
7#a7 ,initial fund+ ,!re is h]eby       
appropriat$ to ! ,secret>y1 out ( any   
funds 9 ! ,treasury n o!rwise           
appropriat$1 #cj1jjj1jjj = ! fir/ fiscal
 ye> = :i* ?is section applies to c>ry  
out ?is section4 ,su* am\nt %all rema9  
available until exp5d$4  7#b7           
,au?orization = subsequ5t ye>s ,!re is  
au?oriz$ to be appropriat$ to !         

,secret>y = ea* fiscal ye> foll[+ !     
fiscal ye> describ$ 9 p>agraph 7#a71 su*
 sums z may be necess>y to c>ry out ?is 
section4  #d4 ,grants = heal? insurance 
in=mation conc]n+ m5tal heal? & sub/ance
 use disord] b5efits  7a7 ,9 g5]al ,!   
,secret>y ( ,heal? & ,human ,s]vices    
7ref]r$ to 9 ?is section z ! ,secret>y7 
%all aw>d grants to ,/ates to enable su*
 ,/ates 7or ! ,ex*anges e/abli%$ "u !   
,pati5t ,protection & ,af=dable ,c>e    
,act 7,public ,law #aaa-adh7 op]at+ 9   
su* ,/ates7 to e/abli%1 exp&1 or provide
 support =-- 7#a7 (fices ( heal?        
insurance consum] assi/ance2 or  7#b7   
heal? insurance ombudsman programs1  9  
ord] to enable su* (fices & programs to 
c>ry out ! activities describ$ 9        
subsection 7c74  7b7 ,eligibility  7#a7 
,9 g5]al ,to be eligible to receive a   
grant1 a ,/ate %all designate an        
indep5d5t (fice ( heal? insurance       
consum] assi/ance1 or an ombudsman1 t1  
directly or 9 coord9ation ) ,/ate       
private & public heal? insurance        

regulators & consum] assi/ance          
organizations1 receives & responds to   
inquiries & compla9ts conc]n+ heal?     
insurance cov]age ) respect to ,f$]al   
heal? insurance requirem5ts & "u ,/ate  
law relat+ to m5tal heal? or sub/ance   
use disord] b5efits4  7#b7 ,crit]ia ,a  
,/ate t receives a grant "u ?is section 
%all comply ) crit]ia e/abli%$ by !     
,secret>y = c>ry+ out activities "u su* 
grant4  7c7 ,use ( funds ,funds receiv$ 
f a grant aw>d$ "u ?is section %all be  
us$ by an (fice ( heal? insurance       
consum] assi/ance or heal? insurance    
ombudsman describ$ 9 subsection 7a7 to--
 7#a7 assi/ ) ! fil+ ( compla9ts &      
appeals1 includ+ fil+ appeals ) !       
int]nal appeal or grievance process ( ! 
gr\p heal? plan or heal? insurance      
issu]1 ,m$icaid program1 & ,*ildr5's    
,heal? ,insurance ,program involv$1     
relat+ to m5tal heal? or sub/ance use   
disord] b5efits1 & provid+ in=mation    
ab\t ! ext]nal appeal process2  7#b7    
collect1 track1 & quantify problems &   

inquiries enc\nt]$ by consum]s2  7#c7   
educate consum]s on _! rights &         
responsibilities ) respect to gr\p heal?
 plans & heal? insurance cov]age1       
,m$icaid1 & ,*ildr5's ,heal? ,insurance 
,program relat+ to m5tal heal? or       
sub/ance use disord] b5efits2  7#d7     
assi/ consum]s ) enrollm5t 9 a gr\p     
heal? plan or heal? insurance cov]age1  
,m$icaid1 & ! ,*ildr5's ,heal?          
,insurance ,program by provid+          
in=mation1 ref]ral1 & assi/ance2 &  7#e7
 assi/ consum]s 9 resolv+ problems )    
obta9+ premium tax cr$its "u section    
#cf;,b ( ! ,int]nal ,rev5ue ,code (     
#aihf by provid+ in=mation1 ref]ral1 &  
assi/ance4  7d7 ,data collection ,z a   
condition ( receiv+ a grant "u          
subsection 7a71 an (fice ( heal?        
insurance consum] assi/ance or ombudsman
 program %all be requir$ to collect &   
report data to ! ,secret>y & ,/ate      
public & private heal? insurance        
regulators on ! types ( problems &      
inquiries enc\nt]$ by consum]s relat+ to

 m5tal heal? or sub/ance use disord]    
b5efits4 ,! ,secret>y %all utilize su*  
data to id5tify areas :]e m en=cem5t    
action is necess>y & %all %>e su*       
in=mation ) ,/ate insurance regulators1 
! ,secret>y ( ,labor1 & ! ,secret>y ( ! 
,treasury = use 9 ! en=cem5t activities 
( su* ag5cies4  7e7 ,fund+  7#a7        
,initial fund+ ,!re is h]eby appropriat$
 to ! ,secret>y1 out ( any funds 9 !    
,treasury n o!rwise appropriat$1        
#be1jjj1jjj = ! fir/ fiscal ye> = :i*   
?is section applies to c>ry out ?is     
section4 ,su* am\nt %all rema9 available
 until exp5d$4  7#b7 ,au?orization =    
subsequ5t ye>s ,!re is au?oriz$ to be   
appropriat$ to ! ,secret>y = ea* fiscal 
ye> foll[+ ! fiscal ye> describ$ 9      
p>agraph 7#a71 su* sums z may be        
necess>y to c>ry out ?is section4