,,ii #aahth ,,congress #b;d ,session ,s4 #djbc ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,march #ba1 #bjbd,ms4 ,smith 7for herself and ,mr4 ,wyden7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to further protect patients and improve the accuracy of provider directory information by eliminating ghost networks4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,behavioral ,health ,network and ,directory ,improvement ,act 4 7b7 ,table of contents ,the table of contents for this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4,sec4 #b4 ,protecting patients and improving the accuracy of provider directory information4,sec4 #c4 ,provider requirements to protect patients and improve the accuracy of provider directory information4,sec4 #d4 ,strengthening mental health and substance use disorder parity requirements4,sec4 #e4 ,state and ,tribal ombudsman programs relating to mental health and substance use disorder parity4,sec4 #f4 ,report to ,congress4,sec4 #g4 ,authorization of appropriations4 #b4 ,protecting patients and improving the accuracy of provider directory information 7a7 ,,phsa ,section #bgii;,a-#e of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#aae7 is amended-- 7#a7 in subsection 7a7-- 7,a7 in paragraph 7#a7-- 7i7 by striking ,for plan years beginning on or after ,january #a1 #bjbb1 each and inserting ,each2 7ii7 in subparagraph 7,c71 by striking 2 and and inserting a semicolon2 7iii7 in subparagraph 7,d71 by striking the period and inserting 2 and2 and 7iv7 by adding at the end the following3 7,e7 ensure that any directory1 including the database described in subparagraph 7,c71 containing provider directory information with respect to such plan or such coverage complies with the requirements developed by the appropriate agencies in accordance with paragraph 7#f7 in order to ensure that participants1 beneficiaries1 and enrollees are able to identify actively participating health care providers and health care facilities4 2 7,b7 in paragraph 7#c7-- 7i7 in the matter preceding subparagraph 7,a71 by striking 1 in the case such request is made through a telephone call2 and 7ii7 in subparagraph 7,a71 by striking call is received1 through a written electronic or print 7as requested by such individual7 communication and inserting a request is received1 by telephone1 or through a written electronic or print communication 7as requested by such individual72 7,c7 in paragraph 7#d7-- 7i7 in subparagraph 7,a71 by striking and at the end2 7ii7 in subparagraph 7,b71 by striking the period and inserting 2 and2 and 7iii7 by adding at the end the following3 7,c7 information1 in plain language1 concerning the rights of the participant1 beneficiary1 or enrollee to cost-sharing protections pursuant to subsection 7b7 in the event of reliance on inaccurate provider network information supplied by a group health plan or health insurance issuer1 and contact information for1 as appropriate1 the ,state consumer assistance program or ombudsman or the ,employee ,benefits ,security ,administration for more information4 2 7,d7 in paragraph 7#e71 by adding at the end the following3 ,such information shall include a statement1 in plain language1 concerning the rights of the participant1 beneficiary1 or enrollee to cost-sharing protections pursuant to subsection 7b7 in the event of reliance on inaccurate provider directory information supplied by a group health plan or health insurance issuer1 and contact information for1 as appropriate1 the ,state consumer assistance program or ombudsman or the ,employee ,benefits ,security ,administration for more information42 7,e7 by redesignating paragraphs 7#f7 and 7#g7 as paragraphs 7#h7 and 7#i71 respectively2 7,f7 by inserting after paragraph 7#e7 the following3 7#f7 ,protecting participants1 beneficiaries1 and enrollees from ghost networks ,the ,secretary1 in collaboration with the ,secretary of ,labor and the ,secretary of the ,treasury1 shall-- 7,a7 not later than #d years after the date of enactment of the ,behavioral ,health ,network and ,directory ,improvement ,act1 issue final regulations further defining the term ghost network 7as defined in paragraph 7#h772 and 7,b7 not later than #d years after the date of enactment of the ,behavioral ,health ,network and ,directory ,improvement ,act1 issue final regulations1 subregulatory guidance1 or program instruction on how to assess ghost networks in health plan directories including reasonable assumptions related to statistics and research methods4 7#g7 ,database reporting and auditing to protect against ghost networks 7,a7 ,reporting requirements ,beginning not later than #c years after the date of enactment of the ,behavioral ,health ,network and ,directory ,improvement ,act1 each group health plan and health insurance issuer offering group or individual health insurance coverage shall submit to the ,secretary1 at such time as the ,secretary1 in coordination with the ,secretary of ,labor and the ,secretary of the ,treasury1 shall require1 but not less frequently than annually1 the directory data described in paragraph 7a77#d71 in a machine readable format 7as defined in section #adg4baj7;a77#b77xiv7 of title #de1 ,code of ,federal ,regulations 7or any successor regulations774 ,a health insurance issuer or a third party administrator of a group health plan may submit such information for all health insurance coverage or all group health plans1 collectively1 that such issuer or administrator administers4 ,the ,secretary1 in coordination with the ,secretary of ,labor and the ,secretary of the ,treasury1 shall make data submitted under this subparagraph available on a public website4 7,b7 ,provider directory independent audit requirements 7i7 ,in general ,beginning not later than #c years after the date of enactment of the ,behavioral ,health ,network and ,directory ,improvement ,act1 each group health plan and health insurance issuer offering group or individual health insurance coverage shall conduct an annual directory audit1 through an independent entity not associated with the health plan or issuer1 that considers the factors described in clause 7ii77,i77aa7 and follows the guidelines developed under clause 7ii77,i77bb74 7ii7 ,information to be included 7,i7 ,in general ,for purposes of carrying out the audits under this subparagraph1 the ,secretary shall-- 7aa7 develop a list of information required to be included2 and 7bb7 provide guidelines for carrying out such audits1 for use by group health plans and health insurance issuers1 on-- 7,,aa7 the reasonable assumptions and research methods to select a reasonable sample in order to assess provider directory information accuracy2 and 7,,bb7 determining the criteria of an eligible auditor4 7,,ii7 ,contents ,the information listed under subclause 7,i77aa7 shall include the following3 7aa7 ,the proportion of directory listings of the plan or coverage with inaccurate information1 including incorrect contact information1 as specified by the ,secretary1 during the audit period4 7bb7 ,the number of in-network items or services paid on behalf of participants1 beneficiaries1 and enrollees in the plan or coverage to providers or facilities who have a network provider contract with the health plan or issuer and were not listed in the directory of the health plan or health insurance coverage for the audit period4 7cc7 ,the resources of the plan or issuer to help participants1 beneficiaries1 and enrollees locate an accurately listed in-network provider who is accepting new patients4 7dd7 ,the proportion of participants1 beneficiaries1 and enrollees using out-of-network providers for mental health and substance use disorder services1 and the proportion of participants1 beneficiaries1 and enrollees using out-of-network providers and facilities for medical and surgical services4 7ee7 ,documentation that the plan or issuer verifies the accuracy of the provider directory information every #ij days4 7ff7 ,other factors as determined by the ,secretary4 7iii7 ,standards for reporting ,an audit under this subparagraph is complete if all of the following conditions are met3 7,i7 ,the audit report includes the following3 7aa7 ,a statement by the independent auditor that1 to the best of the auditor's knowledge1 the report is complete and accurate1 and that reasonable assumptions related to statistics and research methods have been complied with4 7bb7 ,a statement explaining the assumptions1 statistics1 and methods used to select the sample and assess provider directory information accuracy4 7cc7 ,such other requirements as the ,secretary determines necessary4 7,,ii7 ,the group health plan or health insurer issuer makes the independent audit available on a public website4 7iv7 ,rulemaking ,the ,secretary1 the ,secretary of ,labor1 and the ,secretary of the ,treasury shall issue interim final regulations 7without prior notice and comment as generally required under section #eec of title #e1 ,united ,states ,code7 concerning the national standards for conducting audits under this subparagraph1 not later than #b years after the date of enactment of the ,behavioral ,health ,network and ,directory ,improvement ,act4 7,c7 ,audits by the ,secretary 7i7 ,in general ,beginning not later than the fourth plan year after the date of enactment of the ,behavioral ,health ,network and ,directory ,improvement ,act1 the ,secretary shall conduct annual audits to ensure compliance with the auditing requirements under subparagraph 7,b74 7ii7 ,selection of plans and issuers ,the ,secretary1 the ,secretary of ,labor1 and the ,secretary of the ,treasury 7referred to in this clause as the ,secretaries71 jointly1 shall conduct annual audits of the submissions under subparagraph 7,b7 of a total of not fewer than #aj group health plans or health insurance issuers offering group or individual health insurance coverage1 as determined by the ,secretaries1 that are the subjects of complaints about ghost networks or other complaints1 or that are randomly selected by the ,secretaries4 2 and 7,g7 in paragraph 7#h71 as so redesignated-- 7i7 in the paragraph heading1 by striking ,definition and inserting ,definitions2 7ii7 by striking ,for purposes of this subsection1 the term and inserting the following3 8,for purposes of this subsection3 7,a7 ,provider directory information ,the term 2 7iii7 by striking health insurance coverage1 the name1 address and inserting 8health insurance coverage-- 7i7 the name1 address where the provider regularly sees patients 2 7iv7 by striking the period and inserting 2 and2 and 7v7 by adding at the end the following3 7ii7 with respect to each such provider or facility-- 7,i7 whether such provider or facility is accepting new patients2 7,,ii7 the languages spoken and the availability of language translators for specified languages at each health care facility listed in the directory2 7,,iii7 whether the provider or facility offers medication-assisted treatment for opioid use disorder2 7,,iv7 the ,state license number2 7,v7 the national provider identifier2 7,,vi7 the age groups served by the provider or facility1 such as pediatric1 adolescent1 adult1 or geriatric populations2 7,,vii7 whether such provider or facility offers in-person services1 telehealth services1 or both2 7,,viii7 the cost-sharing tier1 if applicable2 and 7,,ix7 health insurance plans accepted 7including the plan identifier and type of plan74 7,b7 ,ghost network ,the term ghost network means a group health plan or group or individual health insurance coverage for which the provider directory information describing the network of such plan or coverage-- 7i7 includes inaccurate contact information with respect to a substantial share of included listings and providers who are part of the network2 7ii7 includes a substantial number of providers and facilities 7as specified by the ,secretary1 in coordination with the ,secretary of ,labor and the ,secretary of the ,treasury7 in a specialty who are not accepting new patients within a time period specified by such secretaries2 7iii7 includes a substantial number of providers and facilities that are not part of the network2 or 7iv7 omits a substantial number of providers and facilities that are part of the network4 2 and 7#b7 in subsection 7b7-- 7,a7 in paragraph 7#a71 by striking and if either of the criteria described in paragraph 7#b7 applies with respect to such participant1 beneficiary1 or enrollee and item or service2 and 7,b7 by striking paragraph 7#b7 and inserting the following3 7#b7 ,reconciliation requirement ,if a nonparticipating provider was listed as a participating provider in the posted provider directory database1 the group health plan or health insurance issuer shall1 not later than #cj days after receiving the request for payment1 notify the participant1 beneficiary1 or enrollee1 in plain language1 that the participant1 beneficiary1 or enrollee may be eligible for a refund from the group health plan or health insurance issuer if such participant1 beneficiary1 or enrollee paid the out of network cost-sharing and did not receive a refund under section #bgii;,b-#i7;b74 4 7b7 ,,erisa 7#a7 ,in general ,section #gbj of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aahe;i7 is amended-- 7,a7 in subsection 7a7-- 7i7 in paragraph 7#a7-- 7,i7 by striking ,for plan years beginning on or after ,january #a1 #bjbb1 each and inserting ,each2 7,,ii7 in subparagraph 7,c71 by striking 2 and and inserting a semicolon2 7,,iii7 in subparagraph 7,d71 by striking the period and inserting 2 and2 and 7,,iv7 by adding at the end the following3 7,e7 ensure that any directory1 including the database described in subparagraph 7,c71 containing provider directory information with respect to such plan or such coverage complies with the requirements developed by the appropriate agencies in accordance with paragraph 7#f7 in order to ensure that participants1 beneficiaries1 and enrollees are able to identify actively participating health care providers and health care facilities4 2 7ii7 in paragraph 7#c7-- 7,i7 in the matter preceding subparagraph 7,a71 by striking 1 in the case such request is made through a telephone call2 and 7,,ii7 in subparagraph 7,a71 by striking call is received1 through a written electronic or print 7as requested by such individual7 communication and inserting a request is received1 by telephone1 or through a written electronic or print communication 7as requested by such individual72 7iii7 in paragraph 7#d7-- 7,i7 in subparagraph 7,a71 by striking and at the end2 7,,ii7 in subparagraph 7,b71 by striking the period and inserting 2 and2 and 7,,iii7 by adding at the end the following3 7,c7 information1 in plain language1 concerning the rights of the participant1 beneficiary1 or enrollee to cost-sharing protections pursuant to subsection 7b7 in the event of reliance on inaccurate provider network information supplied by a group health plan or health insurance issuer1 and contact information for1 as appropriate1 the ,state consumer assistance program or ombudsman or the ,employee ,benefits ,security ,administration for more information4 2 7iv7 in paragraph 7#e71 by adding at the end the following3 ,such information shall include a statement1 in plain language1 concerning the rights of the participant1 beneficiary1 or enrollee to cost-sharing protections pursuant to subsection 7b7 in the event of reliance on inaccurate provider directory information supplied by a group health plan or health insurance issuer1 and contact information for1 as appropriate1 the ,state consumer assistance program or ombudsman or the ,employee ,benefits ,security ,administration for more information42 7v7 by redesignating paragraphs 7#f7 and 7#g7 as paragraphs 7#h7 and 7#i71 respectively2 7vi7 by inserting after paragraph 7#e7 the following3 7#f7 ,protecting participants1 beneficiaries1 and enrollees from ghost networks ,the ,secretary1 in collaboration with the ,secretary of ,labor and the ,secretary of the ,treasury1 shall-- 7,a7 not later than #d years after the date of enactment of the ,behavioral ,health ,network and ,directory ,improvement ,act1 issue final regulations further defining the term ghost network 7as defined in paragraph 7#h772 and 7,b7 not later than #d years after the date of enactment of the ,behavioral ,health ,network and ,directory ,improvement ,act1 issue final regulations1 subregulatory guidance1 or program instruction on how to assess ghost networks in health plan directories including reasonable assumptions related to statistics and research methods4 7#g7 ,database reporting and auditing to protect against ghost networks 7,a7 ,reporting requirements ,beginning not later than #c years after the date of enactment of the ,behavioral ,health ,network and ,directory ,improvement ,act1 each group health plan and health insurance issuer offering group health insurance coverage shall submit to the ,secretary1 at such time as the ,secretary1 in coordination with the ,secretary of ,health and ,human ,services and the ,secretary of the ,treasury1 shall require1 but not less frequently than annually1 the directory data described in paragraph 7a77#d71 in a machine readable format 7as defined in section #adg4baj7;a77#b77xiv7 of title #de1 ,code of ,federal ,regulations 7or any successor regulations774 ,a health insurance issuer or a third party administrator of a group health plan may submit such information for all health insurance coverage or all group health plans1 collectively1 that such issuer or administrator administers4 ,the ,secretary1 in coordination with the ,secretary of ,health and ,human ,services and the ,secretary of the ,treasury1 shall make data submitted under this subparagraph available on a public website4 7,b7 ,provider directory independent audit requirements 7i7 ,in general ,beginning not later than #c years after the date of enactment of the ,behavioral ,health ,network and ,directory ,improvement ,act1 each group health plan and health insurance issuer offering group health insurance coverage shall conduct an annual directory audit1 through an independent entity not associated with the health plan or issuer1 that considers the factors described in clause 7ii77,i77aa7 and follows the guidelines developed under clause 7ii77,i77bb74 7ii7 ,information to be included 7,i7 ,in general ,for purposes of carrying out the audits under this subparagraph1 the ,secretary shall-- 7aa7 develop a list of information required to be included2 and 7bb7 provide guidelines for carrying out such audits1 for use by group health plans and health insurance issuers1 on-- 7,,aa7 the reasonable assumptions and research methods to select a reasonable sample in order to assess provider directory information accuracy2 and 7,,bb7 determining the criteria of an eligible auditor4 7,,ii7 ,contents ,the information listed under subclause 7,i77aa7 shall include the following3 7aa7 ,the proportion of directory listings of the plan or coverage with inaccurate information1 including incorrect contact information1 as specified by the ,secretary1 during the audit period4 7bb7 ,the number of in-network items or services paid on behalf of participants1 beneficiaries1 and enrollees in the plan or coverage to providers or facilities who have a network provider contract with the health plan or issuer and were not listed in the directory of the health plan or health insurance coverage for the audit period4 7cc7 ,the resources of the plan or issuer to help participants1 beneficiaries1 and enrollees locate an accurately listed in-network provider who is accepting new patients4 7dd7 ,the proportion of participants1 beneficiaries1 and enrollees using out-of-network providers for mental health and substance use disorder services1 and the proportion of participants1 beneficiaries1 and enrollees using out-of-network providers and facilities for medical and surgical services4 7ee7 ,documentation that the plan or issuer verifies the accuracy of the provider directory information every #ij days4 7ff7 ,other factors as determined by the ,secretary4 7iii7 ,standards for reporting ,an audit under this subparagraph is complete if all of the following conditions are met3 7,i7 ,the audit report includes the following3 7aa7 ,a statement by the independent auditor that1 to the best of the auditor's knowledge1 the report is complete and accurate1 and that reasonable assumptions related to statistics and research methods have been complied with4 7bb7 ,a statement explaining the assumptions1 statistics1 and methods used to select the sample and assess provider directory information accuracy4 7cc7 ,such other requirements as the ,secretary determines necessary4 7,,ii7 ,the group health plan or health insurer issuer makes the independent audit available on a public website4 7iv7 ,rulemaking ,the ,secretary1 the ,secretary of ,health and ,human ,services1 and the ,secretary of the ,treasury shall issue interim final regulations 7without prior notice and comment as generally required under section #eec of title #e1 ,united ,states ,code7 concerning the national standards for conducting audits under this subparagraph1 not later than #b years after the date of enactment of the ,behavioral ,health ,network and ,directory ,improvement ,act4 7,c7 ,audits by the ,secretary 7i7 ,in general ,beginning not later than the fourth plan year after the date of enactment of the ,behavioral ,health ,network and ,directory ,improvement ,act1 the ,secretary shall conduct annual audits to ensure compliance with the auditing requirements under subparagraph 7,b74 7ii7 ,selection of plans and issuers ,the ,secretary1 the ,secretary of ,health and ,human ,services1 and the ,secretary of the ,treasury 7referred to in this clause as the ,secretaries71 jointly1 shall conduct annual audits of the submissions under subparagraph 7,b7 of a total of not fewer than #aj group health plans or health insurance issuers offering group health insurance coverage1 as determined by the ,secretaries1 that are the subjects of complaints about ghost networks or other complaints1 or that are randomly selected by the ,secretaries4 2 and 7vii7 in paragraph 7#h71 as so redesignated-- 7,i7 in the paragraph heading1 by striking ,definition and inserting ,definitions2 7,,ii7 by striking ,for purposes of this subsection1 the term and inserting the following3 8,for purposes of this subsection3 7,a7 ,provider directory information ,the term 2 7,,iii7 by striking health insurance coverage1 the name1 address and inserting 8health insurance coverage-- 7i7 the name1 address where the provider regularly sees patients 2 7,,iv7 by striking the period and inserting 2 and2 and 7,v7 by adding at the end the following3 7ii7 with respect to each such provider or facility-- 7,i7 whether such provider or facility is accepting new patients2 7,,ii7 the languages spoken and the availability of language translators for specified languages at each health care facility listed in the directory2 7,,iii7 whether the provider or facility offers medication-assisted treatment for opioid use disorder2 7,,iv7 the ,state license number2 7,v7 the national provider identifier2 7,,vi7 the age groups served by the provider or facility1 such as pediatric1 adolescent1 adult1 or geriatric populations2 7,,vii7 whether such provider or facility offers in-person services1 telehealth services1 or both2 7,,viii7 the cost-sharing tier1 if applicable2 and 7,,ix7 health insurance plans accepted 7including the plan identifier and type of plan74 7,b7 ,ghost network ,the term ghost network means a group health plan or group health insurance coverage for which the provider directory information describing the network of such plan or coverage-- 7i7 includes inaccurate contact information with respect to a substantial share of included listings and providers who are part of the network2 7ii7 includes a substantial number of providers and facilities 7as specified by the ,secretary1 in coordination with the ,secretary of ,health and ,human ,services and the ,secretary of the ,treasury7 in a specialty who are not accepting new patients within a time period specified by such secretaries2 7iii7 includes a substantial number of providers and facilities that are not part of the network2 or 7iv7 omits a substantial number of providers and facilities that are part of the network4 2 and 7,b7 in subsection 7b7-- 7i7 in paragraph 7#a71 by striking and if either of the criteria described in paragraph 7#b7 applies with respect to such participant1 beneficiary1 or enrollee and item or service2 and 7ii7 by striking paragraph 7#b7 and inserting the following3 7#b7 ,reconciliation requirement ,if a nonparticipating provider was listed as a participating provider in the posted provider directory database1 the group health plan or health insurance issuer shall1 not later than #cj days after receiving the request for payment1 notify the participant1 beneficiary1 or enrollee1 in plain language1 that the participant1 beneficiary1 or enrollee may be eligible for a refund from the group health plan or health insurance issuer if such participant1 beneficiary1 or enrollee paid the out of network cost-sharing and did not receive a refund under section #bgii;,b-#i7;b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#aci74 4 7#b7 ,civil monetary penalties for violations 7,a7 ,civil monetary penalties relating to provider directory requirements ,section #ejb7;c77#aj7 of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aacb7;c77#aj77;,a77 is amended-- 7i7 in the heading1 by striking use of genetic information and inserting use of genetic information and provider directory requirements2 and 7ii7 in subparagraph 7,a7-- 7,i7 by inserting plan administrator of a group health plan 7including a third party administrator71 after plan sponsor of a group health plan12 7,,ii7 by inserting 1 administrator1 after such sponsor2 and 7,,iii7 by striking for any failure and all that follows through in connection with the plan4 and inserting for any failure by such plan sponsor1 plan administrator1 or health insurance issuer1 in connection with the plan-- 7i7 to meet the requirements of subsection 7a77#a77;,f71 7b77#c71 7c71 or 7d7 of section #gjb or section #gja or #gjb7;b77#a7 with respect to genetic information2 or 7ii7 to meet the requirements of section #gbj with respect to provider directory information4 4 7,b7 ,exception to the general prohibition on enforcement ,section #ejb of such ,act 7#bi ,u4,s4,c4 #aacb7 is amended-- 7i7 in subsection 7a77#f71 by striking or 7#i7 and inserting 7#i71 or 7#aj72 and 7ii7 in subsection 7b77#c7-- 7,i7 by striking subsections 7c77#i7 and 7a77#f7 and inserting subsections 7c77#i71 7c77#aj71 and 7a77#f72 7,,ii7 by striking under subsection 7c77#i77 and inserting under subsections 7c77#i7 and 7c77#aj771 and except with respect to enforcement by the ,secretary of section #gbj2 and 7,,iii7 by striking #gjf7;a77#a7 and inserting #gcc7;a77#a74 7c7 ,,irc ,section #ihbj of the ,internal ,revenue ,code of #aihf is amended-- 7#a7 in subsection 7a7-- 7,a7 in paragraph 7#a7-- 7i7 by striking ,for plan years beginning on or after ,january #a1 #bjbb1 each and inserting ,each2 7ii7 in subparagraph 7,c71 by striking 2 and and inserting a semicolon2 7iii7 in subparagraph 7,d71 by striking the period and inserting 2 and2 and 7iv7 by adding at the end the following3 7,e7 ensure that any directory1 including the database described in subparagraph 7,c71 containing provider directory information with respect to such plan complies with the requirements developed by the appropriate agencies in accordance with paragraph 7#f7 in order to ensure that participants1 beneficiaries1 and enrollees are able to identify actively participating health care providers and health care facilities4 2 7,b7 in paragraph 7#c7-- 7i7 in the matter preceding subparagraph 7,a71 by striking 1 in the case such request is made through a telephone call2 and 7ii7 in subparagraph 7,a71 by striking call is received1 through a written electronic or print 7as requested by such individual7 communication and inserting a request is received1 by telephone1 or through a written electronic or print communication 7as requested by such individual72 7,c7 in paragraph 7#d7-- 7i7 in subparagraph 7,a71 by striking and at the end2 7ii7 in subparagraph 7,b71 by striking the period and inserting 2 and2 and 7iii7 by adding at the end the following3 7,c7 information1 in plain language1 concerning the rights of the participant1 beneficiary1 or enrollee to cost-sharing protections pursuant to subsection 7b7 in the event of reliance on inaccurate provider network information supplied by a group health plan1 and contact information for1 as appropriate1 the ,state consumer assistance program or ombudsman or the ,employee ,benefits ,security ,administration for more information4 2 7,d7 in paragraph 7#e71 by adding at the end the following3 ,such information shall include a statement1 in plain language1 concerning the rights of the participant1 beneficiary1 or enrollee to cost-sharing protections pursuant to subsection 7b7 in the event of reliance on inaccurate provider directory information supplied by a group health plan1 and contact information for1 as appropriate1 the ,state consumer assistance program or ombudsman or the ,employee ,benefits ,security ,administration for more information42 7,e7 by redesignating paragraphs 7#f7 and 7#g7 as paragraphs 7#h7 and 7#i71 respectively2 7,f7 by inserting after paragraph 7#e7 the following3 7#f7 ,protecting participants1 beneficiaries1 and enrollees from ghost networks ,the ,secretary1 in collaboration with the ,secretary of ,labor and the ,secretary of ,health and ,human ,services1 shall-- 7,a7 not later than #d years after the date of enactment of the ,behavioral ,health ,network and ,directory ,improvement ,act1 issue final regulations further defining the term ghost network 7as defined in paragraph 7#h772 and 7,b7 not later than #d years after the date of enactment of the ,behavioral ,health ,network and ,directory ,improvement ,act1 issue final regulations1 subregulatory guidance1 or program instruction on how to assess ghost networks in health plan directories including reasonable assumptions related to statistics and research methods4 7#g7 ,database reporting and auditing to protect against ghost networks 7,a7 ,reporting requirements ,beginning not later than #c years after the date of enactment of the ,behavioral ,health ,network and ,directory ,improvement ,act1 each group health plan shall submit to the ,secretary1 at such time as the ,secretary1 in coordination with the ,secretary of ,labor and the ,secretary of ,health and ,human ,services1 shall require1 but not less frequently than annually1 the directory data described in paragraph 7a77#d71 in a machine readable format 7as defined in section #adg4baj7;a77#b77xiv7 of title #de1 ,code of ,federal ,regulations 7or any successor regulations774 ,a third party administrator of a group health plan may submit such information for all group health plans1 collectively1 that such administrator administers4 ,the ,secretary1 in coordination with the ,secretary of ,labor and the ,secretary of ,health and ,human ,services1 shall make data submitted under this subparagraph available on a public website4 7,b7 ,provider directory independent audit requirements 7i7 ,in general ,beginning not later than #c years after the date of enactment of the ,behavioral ,health ,network and ,directory ,improvement ,act1 each group health plan shall conduct an annual directory audit1 through an independent entity not associated with the health plan1 that considers the factors described in clause 7ii77,i77aa7 and follows the guidelines developed under clause 7ii77,i77bb74 7ii7 ,information to be included 7,i7 ,in general ,for purposes of carrying out the audits under this subparagraph1 the ,secretary shall-- 7aa7 develop a list of information required to be included2 and 7bb7 provide guidelines for carrying out such audits1 for use by group health plans1 on-- 7,,aa7 the reasonable assumptions and research methods to select a reasonable sample in order to assess provider directory information accuracy2 and 7,,bb7 determining the criteria of an eligible auditor4 7,,ii7 ,contents ,the information listed under subclause 7,i77aa7 shall include the following3 7aa7 ,the proportion of directory listings of the plan with inaccurate information1 including incorrect contact information1 as specified by the ,secretary1 during the audit period4 7bb7 ,the number of in-network items or services paid on behalf of participants1 beneficiaries1 and enrollees in the plan to providers or facilities who have a network provider contract with the health plan and were not listed in the directory of the health plan for the audit period4 7cc7 ,the resources of the plan to help participants1 beneficiaries1 and enrollees locate an accurately listed in-network provider who is accepting new patients4 7dd7 ,the proportion of participants1 beneficiaries1 and enrollees using out-of-network providers for mental health and substance use disorder services1 and the proportion of participants1 beneficiaries1 and enrollees using out-of-network providers and facilities for medical and surgical services4 7ee7 ,documentation that the plan verifies the accuracy of the provider directory information every #ij days4 7ff7 ,other factors as determined by the ,secretary4 7iii7 ,standards for reporting ,an audit under this subparagraph is complete if all of the following conditions are met3 7,i7 ,the audit report includes the following3 7aa7 ,a statement by the independent auditor that1 to the best of the auditor's knowledge1 the report is complete and accurate1 and that reasonable assumptions related to statistics and research methods have been complied with4 7bb7 ,a statement explaining the assumptions1 statistics1 and methods used to select the sample and assess provider directory information accuracy4 7cc7 ,such other requirements as the ,secretary determines necessary4 7,,ii7 ,the group health plan makes the independent audit available on a public website4 7iv7 ,rulemaking ,the ,secretary1 the ,secretary of ,labor1 and the ,secretary of ,health and ,human ,services shall issue interim final regulations 7without prior notice and comment as generally required under section #eec of title #e1 ,united ,states ,code7 concerning the national standards for conducting audits under this subparagraph1 not later than #b years after the date of enactment of the ,behavioral ,health ,network and ,directory ,improvement ,act4 7,c7 ,audits by the ,secretary 7i7 ,in general ,beginning not later than the fourth plan year after the date of enactment of the ,behavioral ,health ,network and ,directory ,improvement ,act1 the ,secretary shall conduct annual audits to ensure compliance with the auditing requirements under subparagraph 7,b74 7ii7 ,selection of plans ,the ,secretary1 the ,secretary of ,labor1 and the ,secretary of ,health and ,human ,services 7referred to in this clause as the ,secretaries71 jointly1 shall conduct annual audits of the submissions under subparagraph 7,b7 of a total of not fewer than #aj group health plans1 as determined by the ,secretaries1 that are the subjects of complaints about ghost networks or other complaints1 or that are randomly selected by the ,secretaries4 2 and 7,g7 in paragraph 7#h71 as so redesignated-- 7i7 in the paragraph heading1 by striking ,definition and inserting ,definitions2 7ii7 by striking ,for purposes of this subsection1 the term and inserting the following3 8,for purposes of this subsection3 7,a7 ,provider directory information ,the term 2 7iii7 by striking group health plan1 the name1 address and inserting 8group health plan-- 7i7 the name1 address where the provider regularly sees patients 2 7iv7 by striking the period and inserting 2 and2 and 7v7 by adding at the end the following3 7ii7 with respect to each such provider or facility-- 7,i7 whether such provider or facility is accepting new patients2 7,,ii7 the languages spoken and the availability of language translators for specified languages at each health care facility listed in the directory2 7,,iii7 whether the provider or facility offers medication-assisted treatment for opioid use disorder2 7,,iv7 the ,state license number2 7,v7 the national provider identifier2 7,,vi7 the age groups served by the provider or facility1 such as pediatric1 adolescent1 adult1 or geriatric populations2 7,,vii7 whether such provider or facility offers in-person services1 telehealth services1 or both2 7,,viii7 the cost-sharing tier1 if applicable2 and 7,,ix7 health insurance plans accepted 7including the plan identifier and type of plan74 7,b7 ,ghost network ,the term ghost network means a group health plan for which the provider directory information describing the network of such plan-- 7i7 includes inaccurate contact information with respect to a substantial share of included listings and providers who are part of the network2 7ii7 includes a substantial number of providers and facilities 7as specified by the ,secretary1 in coordination with the ,secretary of ,labor and the ,secretary of ,health and ,human ,services7 in a specialty who are not accepting new patients within a time period specified by such secretaries2 7iii7 includes a substantial number of providers and facilities that are not part of the network2 or 7iv7 omits a substantial number of providers and facilities that are part of the network4 2 and 7#b7 in subsection 7b7-- 7,a7 in paragraph 7#a71 by striking and if either of the criteria described in paragraph 7#b7 applies with respect to such participant1 beneficiary1 or enrollee and item or service2 and 7,b7 by striking paragraph 7#b7 and inserting the following3 7#b7 ,reconciliation requirement ,if a nonparticipating provider was listed as a participating provider in the posted provider directory database1 the group health plan shall1 not later than #cj days after receiving the request for payment1 notify the participant1 beneficiary1 or enrollee1 in plain language1 that the participant1 beneficiary1 or enrollee may be eligible for a refund from the group health plan if such participant1 beneficiary1 or enrollee paid the out of network cost-sharing and did not receive a refund under section #bgii;,b-#i7;b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#aci74 4 7d7 ,effective date ,the amendments made by subsections 7a71 7b71 and 7c7 shall apply with respect to group health plans1 or any health insurance issuer offering health insurance coverage in connection with such plan1 for plan years beginning after the date that is #a year after the date of enactment of this ,act4 #c4 ,provider requirements to protect patients and improve the accuracy of provider directory information ,section #bgii;,b-#i of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#aci7 is amended-- 7#a7 in subsection 7a7-- 7,a7 in paragraph 7#c71 by striking 2 and and inserting a semicolon2 7,b7 by redesignating paragraph 7#d7 as paragraph 7#f72 and 7,c7 by inserting after paragraph 7#c7 the following3 7#d7 subject to paragraph 7#e71 when a provider or facility that is not accepting new patients determines that it has the ability to accept new patients1 within #e business days of such determination2 7#e7 when a solo practitioner or small provider1 as determined by the ,secretary1 determines that it has the ability to accept new patients1 within #aj business days of such determination2 and 2 and 7#b7 by amending subsection 7d7 to read as follows3 7d7 ,definition ,for purposes of this section1 the term provider directory information includes-- 7#a7 the name1 address1 specialty1 telephone number1 and digital contact information of each individual health care provider contracted to participate in any of the networks of the group health plan or health insurance coverage involved2 7#b7 the name1 address1 specialty1 telephone number1 and digital contact information of each medical group1 clinic1 or facility contracted to participate in any of the networks of the group health plan or health insurance coverage involved2 and 7#c7 with respect to each such provider1 medical group1 clinic1 or facility-- 7,a7 whether such provider1 medical group1 clinic1 or facility is accepting new patients2 7,b7 the languages spoken and the availability of language translators for specified languages at each provider1 medical group1 clinic1 or facility listed in the directory2 7,c7 whether the provider1 medical group1 clinic1 or facility offers medication-assisted treatment for opioid use disorder2 7,d7 the ,state license number2 7,e7 the national provider identifier2 7,f7 the age groups served by such provider1 group1 clinic1 or facility1 such as pediatric1 adolescent1 adult1 or geriatric populations2 7,g7 whether such provider1 group1 clinic1 or facility offers in-person services1 telehealth services1 or both2 and 7,h7 the cost-sharing tier1 if applicable4 4 #d4 ,strengthening mental health and substance use disorder parity requirements 7a7 ,,phsa 7#a7 ,network adequacy requirements ,section #bgbf7;a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#bf7;a77 is amended by adding at the end the following3 7#i7 ,network adequacy requirements 7,a7 ,in general ,the ,secretary1 the ,secretary of ,labor1 and the ,secretary of the ,treasury shall issue regulations establishing national quantitative standards for mental health and substance use disorder network adequacy4 ,such standards shall consider-- 7i7 the ratio of in-network mental health providers who submitted claims under the plan or coverage in the previous plan year1 separated by professional type of mental health provider1 to participants1 beneficiaries1 and enrollees in a group health plan or health insurance coverage2 7ii7 the ratio of in-network substance use disorder providers who submitted claims under the plan or coverage in the previous plan year1 separated by professional type of substance use disorder provider1 to participants1 beneficiaries1 and enrollees in a group health plan or health insurance coverage2 7iii7 separately1 for mental health services and substance use disorder services-- 7,i7 geographic accessibility of providers2 7,,ii7 geographic variation and population dispersion2 7,,iii7 waiting times for appointments with participating providers2 7,,iv7 hours of operation for participating providers2 7,v7 the ability of the network to meet the needs of participants1 beneficiaries1 and enrollees1 including low-income individuals1 individuals who are members of a racial or ethnic minority1 individuals who live in a health professional shortage area1 children and adults with serious1 chronic1 and complex health conditions1 individuals with physical or mental disabilities or substance use disorders1 pediatric populations1 and individuals with limited ,english proficiency2 7,,vi7 the availability of in-person services1 telehealth services1 and hybrid services to serve the needs of participants1 beneficiaries1 and enrollees2 and 7,,vii7 the percentage of in-network providers who have submitted a claim for payment during a previous #f-month period1 as determined by the ,secretary1 the ,secretary of ,labor1 and the ,secretary of the ,treasury2 and 7iv7 other standards as determined by the ,secretary1 the ,secretary of ,labor1 and the ,secretary of the ,treasury4 7,b7 ,timing 7i7 ,issuance ,the ,secretary1 the ,secretary of ,labor1 and the ,secretary of the ,treasury shall-- 7,i7 issue proposed regulations required under subparagraph 7,a7 not later than #b years after the date of enactment of the ,behavioral ,health ,network and ,directory ,improvement ,act2 and 7,,ii7 issue final regulations under subparagraph 7,a7 not later than #a year thereafter4 7ii7 ,effective date ,the regulations promulgated under this paragraph shall take effect in the first plan year that begins after the date on which such final regulations are issued4 7,c7 ,audits ,the ,secretary1 the ,secretary of ,labor1 and the ,secretary of the ,treasury 7referred to in this subparagraph as the ,secretaries71 jointly1 shall conduct annual1 targeted audits of not fewer than #aj group health plans and health insurance issuers offering group or individual health insurance coverage that the ,secretaries select based upon the number of complaints about mental health and substance use disorder network adequacy to ensure compliance with the requirements of this paragraph4 ,such audits shall begin not earlier than one year after the final regulations implementing this paragraph begin to apply to group health plans and health insurance issuers4 4 7#b7 ,definitions ,paragraphs 7#d7 and 7#e7 of section #bgbf7;e7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#bf7;e77 are amended to read as follows3 7#d7 ,mental health benefits ,the term mental health benefits means benefits with respect to services related to a mental health condition1 defined consistently with generally recognized independent standards of current medical practice1 such as the ,diagnostic and ,statistical ,manual of ,mental ,disorders of the ,american ,psychiatric ,association4 7#e7 ,substance use disorder benefits ,the term substance use disorder benefits means benefits with respect to services related to a substance use disorder1 defined consistently with generally recognized independent standards of current medical practice1 such as the ,diagnostic and ,statistical ,manual of ,mental ,disorders of the ,american ,psychiatric ,association4 4 7#c7 ,standards for parity in reimbursement rates ,section #bgbf7;a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#bf7;a771 as amended by paragraph 7#a71 is further amended by adding at the end the following3 7#aj7 ,standards for parity in reimbursement rates 7,a7 ,in general ,not later than #b years after the date of enactment of the ,behavioral ,health ,network and ,directory ,improvement ,act1 the ,secretary1 the ,secretary of ,labor1 and the ,secretary of the ,treasury shall issue regulations on a standard for parity in reimbursement rates for mental health or substance use disorder benefits and medical and surgical benefits1 based on a comparative analysis conducted by such ,secretaries using data submitted by group health plans and health insurance issuers1 provider associations1 and other experts related to the cost of care delivery for mental health and substance use disorder benefits4 7,b7 ,requests for data ,group health plans and health insurance issuers shall comply with any request for data issued by the ,secretary1 the ,secretary of ,labor1 and the ,secretary of the ,treasury for purposes of developing the standards under subparagraph 7,a71 in a manner that avoids unnecessary duplication4 7,c7 ,effective date ,the regulations promulgated under subparagraph 7,a7 shall apply to group health plans and health insurance issuers offering group or individual health insurance coverage beginning in the first plan year that begins after issuance of the final regulations4 4 7b7 ,,erisa 7#a7 ,network adequacy requirements ,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#i7 ,network adequacy requirements 7,a7 ,in general ,the ,secretary1 the ,secretary of ,health and ,human ,services1 and the ,secretary of the ,treasury shall issue regulations establishing national quantitative standards for mental health and substance use disorder network adequacy4 ,such standards shall consider-- 7i7 the ratio of in-network mental health providers who submitted claims under the plan or coverage in the previous plan year1 separated by professional type of mental health provider1 to participants1 beneficiaries1 and enrollees in a group health plan or health insurance coverage2 7ii7 the ratio of in-network substance use disorder providers who submitted claims under the plan or coverage in the previous plan year1 separated by professional type of substance use disorder provider1 to participants1 beneficiaries1 and enrollees in a group health plan or health insurance coverage2 7iii7 separately1 for mental health services and substance use disorder services-- 7,i7 geographic accessibility of providers2 7,,ii7 geographic variation and population dispersion2 7,,iii7 waiting times for appointments with participating providers2 7,,iv7 hours of operation for participating providers2 7,v7 the ability of the network to meet the needs of participants1 beneficiaries1 and enrollees1 including low-income individuals1 individuals who are members of a racial or ethnic minority1 individuals who live in a health professional shortage area1 children and adults with serious1 chronic1 and complex health conditions1 individuals with physical or mental disabilities or substance use disorders1 pediatric populations1 and individuals with limited ,english proficiency2 7,,vi7 the availability of in-person services1 telehealth services1 and hybrid services to serve the needs of participants1 beneficiaries1 and enrollees2 and 7,,vii7 the percentage of in-network providers who have submitted a claim for payment during a previous #f-month period1 as determined by the ,secretary1 the ,secretary of ,health and ,human ,services1 and the ,secretary of the ,treasury2 and 7iv7 other standards as determined by the ,secretary1 the ,secretary of ,health and ,human ,services1 and the ,secretary of the ,treasury4 7,b7 ,timing 7i7 ,issuance ,the ,secretary1 the ,secretary of ,health and ,human ,services1 and the ,secretary of the ,treasury shall-- 7,i7 issue proposed regulations required under subparagraph 7,a7 not later than #b years after the date of enactment of the ,behavioral ,health ,network and ,directory ,improvement ,act2 and 7,,ii7 issue final regulations under subparagraph 7,a7 not later than #a year thereafter4 7ii7 ,effective date ,the regulations promulgated under this paragraph shall take effect in the first plan year that begins after the date on which such final regulations are issued4 7,c7 ,audits ,the ,secretary1 the ,secretary of ,health and ,human ,services1 and the ,secretary of the ,treasury 7referred to in this subparagraph as the ,secretaries71 jointly1 shall conduct annual1 targeted audits of not fewer than #aj group health plans and health insurance issuers offering group health insurance coverage that the ,secretaries select based upon the number of complaints about mental health and substance use disorder network adequacy to ensure compliance with the requirements of this paragraph4 ,such audits shall begin not earlier than one year after the final regulations implementing this paragraph begin to apply to group health plans and health insurance issuers4 4 7#b7 ,definitions ,paragraphs 7#d7 and 7#e7 of section #gab7;e7 of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aahe;a7e77 are amended to read as follows3 7#d7 ,mental health benefits ,the term mental health benefits means benefits with respect to services related to a mental health condition1 defined consistently with generally recognized independent standards of current medical practice1 such as the ,diagnostic and ,statistical ,manual of ,mental ,disorders of the ,american ,psychiatric ,association4 7#e7 ,substance use disorder benefits ,the term substance use disorder benefits means benefits with respect to services related to a substance use disorder1 defined consistently with generally recognized independent standards of current medical practice1 such as the ,diagnostic and ,statistical ,manual of ,mental ,disorders of the ,american ,psychiatric ,association4 4 7#c7 ,standards for parity in reimbursement rates ,section #gab7;a7 of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aahe;a7a771 as amended by paragraph 7#a71 is further amended by adding at the end the following3 7#aj7 ,standards for parity in reimbursement rates 7,a7 ,in general ,not later than #b years after the date of enactment of the ,behavioral ,health ,network and ,directory ,improvement ,act1 the ,secretary1 the ,secretary of ,health and ,human ,services1 and the ,secretary of the ,treasury shall issue regulations on a standard for parity in reimbursement rates for mental health or substance use disorder benefits and medical and surgical benefits1 based on a comparative analysis conducted by such ,secretaries using data submitted by group health plans and health insurance issuers1 provider associations1 and other experts related to the cost of care delivery for mental health and substance use disorder benefits4 7,b7 ,requests for data ,group health plans and health insurance issuers shall comply with any request for data issued by the ,secretary1 the ,secretary of ,health and ,human ,services1 and the ,secretary of the ,treasury for purposes of developing the standards under subparagraph 7,a71 in a manner that avoids unnecessary duplication4 7,c7 ,effective date ,the regulations promulgated under subparagraph 7,a7 shall apply to group health plans and health insurance issuers offering group health insurance coverage beginning in the first plan year that begins after issuance of the final regulations4 4 7c7 ,,irc 7#a7 ,network adequacy requirements ,section #ihab7;a7 of the ,internal ,revenue ,code of #aihf is amended by adding at the end the following3 7#i7 ,network adequacy requirements 7,a7 ,in general ,the ,secretary1 the ,secretary of ,health and ,human ,services1 and the ,secretary of ,labor shall issue regulations establishing national quantitative standards for mental health and substance use disorder network adequacy4 ,such standards shall consider-- 7i7 the ratio of in-network mental health providers who submitted claims under the plan in the previous plan year1 separated by professional type of mental health provider1 to participants1 beneficiaries1 and enrollees in a group health plan2 7ii7 the ratio of in-network substance use disorder providers who submitted claims under the plan in the previous plan year1 separated by professional type of substance use disorder provider1 to participants1 beneficiaries1 and enrollees in a group health plan2 7iii7 separately1 for mental health services and substance use disorder services-- 7,i7 geographic accessibility of providers2 7,,ii7 geographic variation and population dispersion2 7,,iii7 waiting times for appointments with participating providers2 7,,iv7 hours of operation for participating providers2 7,v7 the ability of the network to meet the needs of participants1 beneficiaries1 and enrollees1 including low-income individuals1 individuals who are members of a racial or ethnic minority1 individuals who live in a health professional shortage area1 children and adults with serious1 chronic1 and complex health conditions1 individuals with physical or mental disabilities or substance use disorders1 pediatric populations1 and individuals with limited ,english proficiency2 7,,vi7 the availability of in-person services1 telehealth services1 and hybrid services to serve the needs of participants1 beneficiaries1 and enrollees2 and 7,,vii7 the percentage of in-network providers who have submitted a claim for payment during a previous #f-month period1 as determined by the ,secretary1 the ,secretary of ,health and ,human ,services1 and the ,secretary of ,labor2 and 7iv7 other standards as determined by the ,secretary1 the ,secretary of ,health and ,human ,services1 and the ,secretary of ,labor4 7,b7 ,timing 7i7 ,issuance ,the ,secretary1 the ,secretary of ,health and ,human ,services1 and the ,secretary of ,labor shall-- 7,i7 issue proposed regulations required under subparagraph 7,a7 not later than #b years after the date of enactment of the ,behavioral ,health ,network and ,directory ,improvement ,act2 and 7,,ii7 issue final regulations under subparagraph 7,a7 not later than #a year thereafter4 7ii7 ,effective date ,the regulations promulgated under this paragraph shall take effect in the first plan year that begins after the date on which such final regulations are issued4 7,c7 ,audits ,the ,secretary1 the ,secretary of ,health and ,human ,services1 and the ,secretary of ,labor 7referred to in this subparagraph as the ,secretaries71 jointly1 shall conduct annual1 targeted audits of not fewer than #aj group health plans that the ,secretaries select based upon the number of complaints about mental health and substance use disorder network adequacy to ensure compliance with the requirements of this paragraph4 ,such audits shall begin not earlier than one year after the final regulations implementing this paragraph begin to apply to group health plans4 4 7#b7 ,definitions ,paragraphs 7#d7 and 7#e7 of section #ihab7;e7 of the ,internal ,revenue ,code of #aihf are amended to read as follows3 7#d7 ,mental health benefits ,the term mental health benefits means benefits with respect to services related to a mental health condition1 defined consistently with generally recognized independent standards of current medical practice1 such as the ,diagnostic and ,statistical ,manual of ,mental ,disorders of the ,american ,psychiatric ,association4 7#e7 ,substance use disorder benefits ,the term substance use disorder benefits means benefits with respect to services related to a substance use disorder1 defined consistently with generally recognized independent standards of current medical practice1 such as the ,diagnostic and ,statistical ,manual of ,mental ,disorders of the ,american ,psychiatric ,association4 4 7#c7 ,standards for parity in reimbursement rates ,section #ihab7;a7 of the ,internal ,revenue ,code of #aihf1 as amended by paragraph 7#a71 is further amended by adding at the end the following3 7#aj7 ,standards for parity in reimbursement rates 7,a7 ,in general ,not later than #b years after the date of enactment of the ,behavioral ,health ,network and ,directory ,improvement ,act1 the ,secretary1 the ,secretary of ,health and ,human ,services1 and the ,secretary of ,labor shall issue regulations on a standard for parity in reimbursement rates for mental health or substance use disorder benefits and medical and surgical benefits1 based on a comparative analysis conducted by such ,secretaries using data submitted by group health plans1 provider associations1 and other experts related to the cost of care delivery for mental health and substance use disorder benefits4 7,b7 ,requests for data ,group health plans shall comply with any request for data issued by the ,secretary1 the ,secretary of ,health and ,human ,services1 and the ,secretary of ,labor for purposes of developing the standards under subparagraph 7,a71 in a manner that avoids unnecessary duplication4 7,c7 ,effective date ,the regulations promulgated under subparagraph 7,a7 shall apply to group health plans beginning in the first plan year that begins after issuance of the final regulations4 4 #e4 ,state and ,tribal ombudsman programs relating to mental health and substance use disorder parity ,part ,c of title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ia et seq47 is amended-- 7#a7 by redesignating section #bgid 7#db ,u4,s4,c4 #cjj;gg-#ie7 7regarding uniform fraud and abuse referral format71 as added by section #ffjc of the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh71 as section #bgie2 and 7#b7 by adding at the end the following3 #bgif4 ,state and ,tribal ombudsman programs relating to mental health and substance use disorder parity 7a7 ,in general ,the ,secretary shall make grants to eligible entities1 designated by a ,state1 ,indian ,tribe1 or ,tribal organization1 as described in subsection 7b71 for the purpose of-- 7#a7 establishing or supporting ,state and ,tribal mental health and substance use disorder parity ombudsman programs to-- 7,a7 educate consumers about the mental health and substance use disorder coverage in individual plans1 group health plans1 self-insured plans1 and ,state ,medicaid managed care plans2 7,b7 assist consumers in understanding their rights as health benefits plan members1 including appeal processes and how to use such benefits1 and how to access appropriate medical information2 7,c7 assist consumers in exercising their rights under the provisions of part ,d1 including resolving problems related to a group health plan or health insurance issuer erroneously charging a consumer out-of-network rates for services listed in-network on the group health plan or health insurance issuer's provider directory2 7,d7 identify1 investigate1 and help resolve complaints related to mental health and substance use disorder coverage 7including potential violations of the mental health and substance use disorder parity laws7 on behalf of consumers2 7,e7 maintain a toll-free hotline and website for consumers2 7,f7 collect1 track1 and quantify problems and inquiries encountered by consumers2 and 7,g7 other activities as defined by the ,secretary2 and 7#b7 provide support and training for such ,state and ,tribal mental health parity ombudsman programs 7such as through the establishment of a mental health parity ombudsman program resource center74 7b7 ,eligibility ,to be eligible to receive a grant under this section1 a ,state1 ,indian ,tribe1 or ,tribal organization shall designate an ombudsman or consumer assistance program or other independent entity that-- 7#a7 has specialized knowledge of mental health conditions and substance use disorders and experience resolving inquiries and complaints2 and 7#b7 directly1 or in coordination with departments of insurance1 and consumer assistance organizations1 receives and responds to inquiries and complaints concerning access to mental health and substance use disorder services4 7c7 ,criteria ,a ,state1 ,indian ,tribe1 or ,tribal organization that receives a grant under this section shall comply with criteria established by the ,secretary for carrying out activities under such grant4 7d7 ,data collection ,as a condition of receiving a grant1 an eligible entity shall agree to-- 7#a7 collect and report data to the ,secretary1 ,state legislature1 and relevant ,state agencies1 including the departments of insurance and the ,state attorney general1 on the numbers and types of problems and inquiries encountered by individuals with respect to access to behavioral health services2 and 7#b7 report to the ,secretary on how identified problems were addressed1 including through promising practices related to responding to mental health and substance use disorder coverage issues1 including appeals and education4 7e7 ,report to congress ,not later than #d years after the date of the enactment of the ,behavioral ,health ,network and ,directory ,improvement ,act1 the ,secretary shall submit to ,congress a report on the data collected under subsection4 7f7 ,definitions ,in this section1 the terms ,indian ,tribe and ,tribal organization have the meanings given such terms in section #d of the ,indian ,self-,determination and ,education ,assistance ,act4 7g7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated #bj1jjj1jjj for fiscal year #bjbe and #aj1jjj1jjj for fiscal year #bjbf and each fiscal year thereafter4 4 #f4 ,report to ,congress 7a7 ,in general ,not later than #f years after the date of enactment of this ,act and every #b years for the next #aj years1 the ,secretary of ,health and ,human ,services1 the ,secretary of ,labor1 and the ,secretary of the ,treasury 7collectively referred to in this section as the ,secretaries7 shall jointly submit to ,congress and make publicly available a report to assess the prevalence of ghost networks and the adequacy of mental health and substance use disorder networks1 in accordance with section #bgbf7;a77#i7 of the ,public ,health ,service ,act1 section #gab7;a77#i7 of the ,employee ,retirement ,income ,security ,act of #aigd1 and section #ihab7;a77#i7 of the ,internal ,revenue ,code of #aihf1 as amended by section #d4 ,such report shall include the following3 7#a7 ,aggregate information about group health plans and health insurance issuers determined by the ,secretaries to be out of compliance with the provider directory requirements under section #bgii;,a-#e of the ,public ,health ,service ,act1 section #gbj of the ,employee ,retirement ,income ,security ,act of #aigd1 and section #ihbj of the ,internal ,revenue ,code of #aihf1 as amended by section #b4 7#b7 ,aggregate information about group health plans and health insurance issuers determined by the ,secretaries to be out of compliance with the requirements for parity in mental health and substance use disorder benefits 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 and section #ihab of the ,internal ,revenue ,code of #aihf1 as amended by section #d4 7#c7 ,a summary of findings through audits1 in the aggregate1 under section #bgii;,a-#e7;a77#g77;,c7 of the ,public ,health ,service ,act1 section #gbj7;a77#g77;,c7 of the ,employee ,retirement ,income ,security ,act of #aigd1 and section #ihbj7;a77#g77;,c7 of the ,internal ,revenue ,code of #aihf1 as amended by section #b1 including-- 7,a7 the accuracy of provider directory information1 sectioned out by accuracy of the provider's name1 address1 specialty1 telephone number1 digital contact information1 whether the providers are accepting new patients1 in-network status1 linguistic- and cultural-competency1 and availability of medications for opioid use disorder2 7,b7 the number of plans and individuals enrolled in a group health plan or group or individual health insurance coverage that offers a mental health and substance use disorder network that meets the network adequacy standards under1 as applicable1 section #bgii;,a-#e of the ,public ,health ,service ,act1 section #gbj of the ,employee ,retirement ,income ,security ,act of #aigd1 or section #ihbj of the ,internal ,revenue ,code of #aihf1 as amended by section #b2 and 7,c7 the number of individuals enrolled in a group health plan or group or individual health insurance coverage with a ghost network4 7#d7 ,a comparative analysis of in-network and out-of-network reimbursement rates for mental health and substance use disorder services compared to medical and surgical services by group health plans and health insurance issuers4 7b7 ,definition ,in this section1 the term ghost network has the meaning given such term in section #bgii;,a-#e7;a77#h7 of the ,public ,health ,service ,act1 section #gbj7;a77#h7 of the ,employee ,retirement ,income ,security ,act of #aigd1 and section #ihbj7;a77#h7 of the ,internal ,revenue ,code of #aihf1 as amended by section #b4 #g4 ,authorization of appropriations 7a7 ,administrative functions ,to carry out sections #d1 #e1 and #f1 including the amendments made by such sections1 there are authorized to be appropriated to the ,secretary of ,health and ,human ,services1 the ,secretary of ,labor1 and the ,secretary of the ,treasury such sums as may be necessary4 7b7 ,protecting patients and improving the accuracy of provider directory information ,to carry out section #b1 including the amendments made by such section1 in addition to amounts otherwise made available for such purposes1 there are authorized to be appropriated-- 7#a7 to the ,secretary of ,health and ,human ,services1 for purposes of carrying out the amendments made by subsection 7a7 of such section-- 7,a7 #ae1bjj1jjj for each of fiscal years #bjbe and #bjbf2 7,b7 #ag1jjj1jjj for fiscal year #bjbg2 and 7,c7 #aj1jjj1jjj for fiscal year #bjbh and each fiscal year thereafter2 and 7#b7 to the ,secretary of ,labor1 for purposes of carrying out the amendments made by subsection 7b7 of such section1 #bb1jjj1jjj for fiscal year #bjbe and each fiscal year thereafter4