Behavioral Health Coverage Transparency Act of 2022
This bill increases oversight of the insurance coverage parity requirements for mental health and substance use disorder, including providing a process for auditing insurance providers and filing formal complaints for violations of the requirements.
To amend title XXVII of the Public Health Service Act, the Employee 
 Retirement Income Security Act of 1974, and the Internal Revenue Code 
    of 1986 to strengthen parity in mental health and substance use 
                           disorder benefits.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Behavioral Health Coverage 
Transparency Act of 2022''.

SEC. 2. STRENGTHENING PARITY IN MENTAL HEALTH AND SUBSTANCE USE 
              DISORDER BENEFITS.

    (a) Public Health Service Act.--Section 2726(a)(8) of the Public 
Health Service Act (42 U.S.C. 300gg-26(a)(8)) is amended--
            (1) in subparagraph (A), in the matter preceding clause 
        (i)--
                    (A) by inserting ``(including entities that provide 
                administrative services in connection with a group 
                health plan, such as third party administrators)'' 
                after ``insurance coverage''; and
                    (B) by striking ``and, beginning 45 days after'' 
                and all that follows through ``upon request,'' and 
                inserting ``and submit to the Secretary (or the 
                Secretary of Labor or the Secretary of the Treasury, as 
                applicable), on an annual basis (and at any other time 
                upon request of the Secretary), and to the applicable 
                State authority upon request,'';
            (2) in subparagraph (B)--
                    (A) in the heading, by striking ``request'' and 
                inserting ``review'';
                    (B) in clause (i)--
                            (i) in the heading, by striking 
                        ``Submission upon request'' and inserting ``In 
                        general'';
                            (ii) by striking ``shall request'' and all 
                        that follows through ``coverage submit'' and 
                        insert ``shall conduct a review of''; and
                            (iii) by striking ``shall request not fewer 
                        than 20'' and inserting ``shall conduct a 
                        review of not fewer than 60'';
                    (C) in clause (ii)--
                            (i) in the first sentence, by striking ``as 
                        requested under clause (i)'' and inserting ``as 
                        submitted under such subparagraph'';
                            (ii) in the first sentence, by striking 
                        ``to be responsive to the request under clause 
                        (i) for'' and inserting ``to enable''; and
                            (iii) in the second sentence, by striking 
                        ``, as requested under clause (i)'';
                    (D) in clause (iii)--
                            (i) in subclause (I), by striking ``, as 
                        requested under clause (i),''; and
                            (ii) by adding at the end of subclause (II) 
                        the following new sentence: ``The preceding 
                        sentence shall not apply with respect to 
                        disclosures made on or after the date of the 
                        enactment of this sentence.''; and
                    (E) in clause (iv)--
                            (i) in subclause (I)--
                                    (I) by striking ``requested under 
                                clause (i)'' and inserting ``reviewed 
                                under clause (i)''; and
                                    (II) by striking ``after the final 
                                determination by the Secretary 
                                described in clause (iii)(I)(bb)'' and 
                                inserting ``by the Secretary as 
                                described in clause (iii)(I)'';
                            (ii) in subclause (II), by striking ``the 
                        comparative analyses requested under clause 
                        (i)'' and inserting ``such comparative 
                        analyses'';
                            (iii) in subclause (III), by striking ``the 
                        comparative analyses requested under clause 
                        (i)'' and inserting ``such comparative 
                        analyses'';
                            (iv) in subclause (IV)--
                                    (I) by striking ``the comparative 
                                analyses requested under clause (i)'' 
                                and inserting ``such comparative 
                                analyses''; and
                                    (II) by striking ``and'' at the 
                                end;
                            (v) in subclause (V), by striking the 
                        period and inserting a semicolon; and
                            (vi) by adding at the end the following:
                                    ``(VI) the name of each group 
                                health plan or health insurance issuer 
                                found not to have submitted comparative 
                                analyses in accordance with 
                                subparagraph (A);
                                    ``(VII) the name of each group 
                                health plan or health insurance issuer 
                                whose comparative analyses were 
                                reviewed under clause (i) and found not 
                                to have submitted sufficient 
                                information for the Secretary to 
                                review; and
                                    ``(VIII) the name of any plan or 
                                coverage with respect to which a 
                                complaint has been submitted under 
                                subparagraph (C) and for which a final 
                                review finding has been issued.
                        The requirements of this clause with respect to 
                        plans or issuers shall also apply to entities 
                        that provide administrative services in 
                        connection with a group health plan, such as 
                        third party administrators, if applicable.'';
            (3) in subparagraph (C)(i), by striking ``requested''; and
            (4) by adding at the end the following new subparagraphs:
                    ``(D) Audit process.--Beginning 1 year after the 
                date of enactment of this subparagraph, the Secretary, 
                in cooperation with the Secretaries of Labor and the 
                Treasury, as applicable, shall, in addition to 
                conducting reviews in accordance with subparagraph (B), 
                conduct randomized audits of group health plans, health 
                insurance issuers offering group or individual health 
                insurance coverage, and entities that provide 
                administrative services in connection with a group 
                health plan, such as third party administrators, to 
                determine compliance with this section. Such audits 
                shall be conducted on no fewer than 40 plans or 
                coverages per calendar year (not including any reviews 
                conducted under such subparagraph). In addition, the 
                Secretary may, in cooperation with the Secretaries of 
                Labor and the Treasury, as applicable, and in 
                consultation with the Inspector General of the 
                Department of Health and Human Services, the Inspector 
                General of the Department of Labor, and the Inspector 
                General of the Department of the Treasury, as 
                applicable, conduct audits on any such plan or coverage 
                with respect to which a complaint has been submitted 
                under subparagraph (E) to determine compliance with 
                this section.
                    ``(E) Complaint process.--Not later than 6 months 
                after the date of enactment of this subparagraph, the 
                Secretary, in cooperation with the Secretary of Labor 
                and the Secretary of the Treasury, shall, with respect 
                to group health plans and health insurance issuers 
                offering group or individual health insurance coverage 
                (including entities that provide administrative 
                services in connection with a group health plan, such 
                as third party administrators), issue guidance to 
                clarify the process and timeline for current and 
                potential participants and beneficiaries (and 
                authorized representatives and health care providers of 
                such participants and beneficiaries) with respect to 
                such plans and coverage to file formal complaints of 
                such plans or issuers being in violation of this 
                section, including guidance, by plan type, on the 
                relevant State, regional, and national offices with 
                which such complaints should be filed.
                    ``(F) Coverage disparity information.--For the 
                first calendar year that begins on or after the date 
                that is 2 years after the date of the enactment of this 
                subparagraph, and for each subsequent calendar year, 
                the Secretary, in cooperation with the Secretaries of 
                Labor and the Treasury, shall submit to the Committee 
                on Energy and Commerce of the House of Representatives 
                and the Committee on Health, Education, Labor, and 
                Pensions of the Senate the following information with 
                respect to the preceding calendar year:
                            ``(i) Denial rates.--Data comparing the 
                        rates of and reasons for denial by group health 
                        plans and health insurance issuers offering 
                        group or individual health insurance coverage 
                        (including entities that provide administrative 
                        services in connection with a group health 
                        plan, such as third party administrators) of 
                        claims for mental health benefits, substance 
                        use disorder benefits, and medical and surgical 
                        benefits, disaggregated by the following 
                        categories:
                                    ``(I) Inpatient, in-network claims.
                                    ``(II) Inpatient, out-of-network 
                                claims.
                                    ``(III) Outpatient, in-network 
                                claims.
                                    ``(IV) Outpatient, out-of-network 
                                claims.
                                    ``(V) Emergency services.
                                    ``(VI) Prescription drug claims.
                            ``(ii) Network adequacy data.--Data 
                        comparing the network adequacy of group health 
                        plans and health insurance issuers offering 
                        group or individual health insurance coverage 
                        (including entities that provide administrative 
                        services in connection with a group health 
                        plan, such as third party administrators) based 
                        on claims for outpatient and inpatient mental 
                        health benefits, substance use disorder 
                        benefits, and medical and surgical benefits, 
                        including out-of-network utilization rates, the 
                        number and percentage of in-network providers 
                        accepting new patients, and average wait times 
                        between receiving initial treatment and 
                        diagnosis and follow-up treatment.
                            ``(iii) Reimbursement rates.--Data 
                        comparing the reimbursement rates of group 
                        health plans and health insurance issuers 
                        offering group or individual health insurance 
                        coverage (including entities that provide 
                        administrative services in connection with a 
                        group health plan, such as third party 
                        administrators) for the 10 most commonly billed 
                        mental health services, substance use services, 
                        and medical and surgical services, each as a 
                        percentage of rates payable for such services 
                        under title XVIII of the Social Security Act, 
                        disaggregated by the following categories:
                                    ``(I) Inpatient, in-network claims.
                                    ``(II) Inpatient, out-of-network 
                                claims.
                                    ``(III) Outpatient, in-network 
                                claims.
                                    ``(IV) Outpatient, out-of-network 
                                claims.
                                    ``(V) Emergency services.
                                    ``(VI) Prescription drug claims.''.
    (b) Employee Retirement Income Security Act of 1974.--Section 
712(a)(8) of the Employee Retirement Income Security Act of 1974 (29 
U.S.C. 1185a(a)(8)) is amended--
            (1) in subparagraph (A), in the matter preceding clause 
        (i)--
                    (A) by inserting ``(including entities that provide 
                administrative services in connection with a group 
                health plan, such as third party administrators)'' 
                after ``insurance coverage''; and
                    (B) by striking ``and, beginning 45 days after'' 
                and all that follows through ``upon request,'' and 
                inserting ``and submit to the Secretary (or the 
                Secretary of Health and Human Services or the Secretary 
                of the Treasury, as applicable), on an annual basis 
                (and at any other time upon request of the 
                Secretary),'';
            (2) in subparagraph (B)--
                    (A) in the heading, by striking ``request'' and 
                inserting ``review'';
                    (B) in clause (i)--
                            (i) in the heading, by striking 
                        ``Submission upon request'' and inserting ``In 
                        general'';
                            (ii) by striking ``shall request'' and all 
                        that follows through ``coverage submit'' and 
                        insert ``shall conduct a review of''; and
                            (iii) by striking ``shall request not fewer 
                        than 20'' and inserting ``shall conduct a 
                        review of not fewer than 60'';
                    (C) in clause (ii)--
                            (i) in the first sentence, by striking ``as 
                        requested under clause (i)'' and inserting ``as 
                        submitted under such subparagraph'';
                            (ii) in the first sentence, by striking 
                        ``to be responsive to the request under clause 
                        (i) for'' and inserting ``to enable''; and
                            (iii) in the second sentence, by striking 
                        ``, as requested under clause (i)'';
                    (D) in clause (iii)--
                            (i) in subclause (I), by striking ``, as 
                        requested under clause (i),''; and
                            (ii) by adding at the end of subclause (II) 
                        the following new sentence: ``The preceding 
                        sentence shall not apply with respect to 
                        disclosures made on or after the date of the 
                        enactment of this sentence.''; and
                    (E) in clause (iv)--
                            (i) in subclause (I)--
                                    (I) by striking ``requested under 
                                clause (i)'' and inserting ``reviewed 
                                under clause (i)''; and
                                    (II) by striking ``after the final 
                                determination by the Secretary 
                                described in clause (iii)(I)(bb)'' and 
                                inserting ``by the Secretary as 
                                described in clause (iii)(I)'';
                            (ii) in subclause (II), by striking ``the 
                        comparative analyses requested under clause 
                        (i)'' and inserting ``such comparative 
                        analyses'';
                            (iii) in subclause (III), by striking ``the 
                        comparative analyses requested under clause 
                        (i)'' and inserting ``such comparative 
                        analyses'';
                            (iv) in subclause (IV)--
                                    (I) by striking ``the comparative 
                                analyses requested under clause (i)'' 
                                and inserting ``such comparative 
                                analyses''; and
                                    (II) by striking ``and'' at the 
                                end;
                            (v) in subclause (V), by striking the 
                        period and inserting a semicolon; and
                            (vi) by adding at the end the following:
                                    ``(VI) the name of each group 
                                health plan or health insurance issuer 
                                found not to have submitted comparative 
                                analyses in accordance with 
                                subparagraph (A);
                                    ``(VII) the name of each group 
                                health plan or health insurance issuer 
                                whose comparative analyses were 
                                reviewed under clause (i) and found not 
                                to have submitted sufficient 
                                information for the Secretary to 
                                review; and
                                    ``(VIII) the name of any plan or 
                                coverage with respect to which a 
                                complaint has been submitted under 
                                subparagraph (C) and for which a final 
                                review finding has been issued.
                        The requirements of this clause with respect to 
                        plans or issuers shall also apply to entities 
                        that provide administrative services in 
                        connection with a group health plan, such as 
                        third party administrators, if applicable.'';
            (3) in subparagraph (C)(i), by striking ``requested''; and
            (4) by adding at the end the following new subparagraphs:
                    ``(D) Audit process.--Beginning 1 year after the 
                date of enactment of this subparagraph, the Secretary, 
                in cooperation with the Secretaries of Health and Human 
                Services and the Treasury, as applicable, shall, in 
                addition to conducting reviews in accordance with 
                subparagraph (B), conduct randomized audits of group 
                health plans, health insurance issuers offering group 
                health insurance coverage, and entities that provide 
                administrative services in connection with a group 
                health plan, such as third party administrators, to 
                determine compliance with this section. Such audits 
                shall be conducted on no fewer than 40 plans or 
                coverages per calendar year (not including any reviews 
                conducted under such subparagraph). In addition, the 
                Secretary may, in cooperation with the Secretaries of 
                Health and Human Services and the Treasury, as 
                applicable, and in consultation with the Inspector 
                General of the Department of Health and Human Services, 
                the Inspector General of the Department of Labor, and 
                the Inspector General of the Department of the 
                Treasury, as applicable, conduct audits on any such 
                plan or coverage with respect to which a complaint has 
                been submitted under subparagraph (E) to determine 
                compliance with this section.
                    ``(E) Complaint process.--Not later than 6 months 
                after the date of enactment of this subparagraph, the 
                Secretary, in cooperation with the Secretary of Health 
                and Human Services and the Secretary of the Treasury, 
                shall, with respect to group health plans and health 
                insurance issuers offering group health insurance 
                coverage (including entities that provide 
                administrative services in connection with a group 
                health plan, such as third party administrators), issue 
                guidance to clarify the process and timeline for 
                current and potential participants and beneficiaries 
                (and authorized representatives and health care 
                providers of such participants and beneficiaries) with 
                respect to such plans and coverage to file formal 
                complaints of such plans or issuers being in violation 
                of this section, including guidance, by plan type, on 
                the relevant State, regional, and national offices with 
                which such complaints should be filed.
                    ``(F) Coverage disparity information.--For the 
                first calendar year that begins on or after the date 
                that is 2 years after the date of the enactment of this 
                subparagraph, and for each subsequent calendar year, 
                the Secretary, in cooperation with the Secretaries of 
                Health and Human Services and the Treasury, shall 
                submit to the Committee on Energy and Commerce of the 
                House of Representatives and the Committee on Health, 
                Education, Labor, and Pensions of the Senate the 
                following information with respect to the preceding 
                calendar year:
                            ``(i) Denial rates.--Data comparing the 
                        rates of and reasons for denial by group health 
                        plans and health insurance issuers offering 
                        group health insurance coverage (including 
                        entities that provide administrative services 
                        in connection with a group health plan, such as 
                        third party administrators) of claims for 
                        mental health benefits, substance use disorder 
                        benefits, and medical and surgical benefits, 
                        disaggregated by the following categories:
                                    ``(I) Inpatient, in-network claims.
                                    ``(II) Inpatient, out-of-network 
                                claims.
                                    ``(III) Outpatient, in-network 
                                claims.
                                    ``(IV) Outpatient, out-of-network 
                                claims.
                                    ``(V) Emergency services.
                                    ``(VI) Prescription drug claims.
                            ``(ii) Network adequacy data.--Data 
                        comparing the network adequacy of group health 
                        plans and health insurance issuers offering 
                        group health insurance coverage (including 
                        entities that provide administrative services 
                        in connection with a group health plan, such as 
                        third party administrators) based on claims for 
                        outpatient and inpatient mental health 
                        benefits, substance use disorder benefits, and 
                        medical and surgical benefits, including out-
                        of-network utilization rates, the number and 
                        percentage of in-network providers accepting 
                        new patients, and average wait times between 
                        receiving initial treatment and diagnosis and 
                        follow-up treatment.
                            ``(iii) Reimbursement rates.--Data 
                        comparing the reimbursement rates of group 
                        health plans and health insurance issuers 
                        offering group health insurance coverage 
                        (including entities that provide administrative 
                        services in connection with a group health 
                        plan, such as third party administrators) for 
                        the 10 most commonly billed mental health 
                        services, substance use services, and medical 
                        and surgical services, each as a percentage of 
                        rates payable for such services under title 
                        XVIII of the Social Security Act, disaggregated 
                        by the following categories:
                                    ``(I) Inpatient, in-network claims.
                                    ``(II) Inpatient, out-of-network 
                                claims.
                                    ``(III) Outpatient, in-network 
                                claims.
                                    ``(IV) Outpatient, out-of-network 
                                claims.
                                    ``(V) Emergency services.
                                    ``(VI) Prescription drug claims.''.
    (c) Internal Revenue Code of 1986.--Section 9812(a)(8) of the 
Internal Revenue Code of 1986 is amended--
            (1) in subparagraph (A), in the matter preceding clause 
        (i)--
                    (A) by inserting ``(including entities that provide 
                administrative services in connection with a group 
                health plan, such as third party administrators)'' 
                after ``In the case of a group health plan''; and
                    (B) by striking ``and, beginning 45 days after'' 
                and all that follows through ``upon request,'' and 
                inserting ``and submit to the Secretary (or the 
                Secretary of Health and Human Services or the Secretary 
                of Labor, as applicable), on an annual basis (and at 
                any other time upon request of the Secretary),'';
            (2) in subparagraph (B)--
                    (A) in the heading, by striking ``request'' and 
                inserting ``review'';
                    (B) in clause (i)--
                            (i) in the heading, by striking 
                        ``Submission upon request'' and inserting ``In 
                        general'';
                            (ii) by striking ``shall request'' and all 
                        that follows through ``plan submit'' and insert 
                        ``shall conduct a review of''; and
                            (iii) by striking ``shall request not fewer 
                        than 20'' and inserting ``shall conduct a 
                        review of not fewer than 60'';
                    (C) in clause (ii)--
                            (i) in the first sentence, by striking ``as 
                        requested under clause (i)'' and inserting ``as 
                        submitted under such subparagraph'';
                            (ii) in the first sentence, by striking 
                        ``to be responsive to the request under clause 
                        (i) for'' and inserting ``to enable''; and
                            (iii) in the second sentence, by striking 
                        ``, as requested under clause (i)'';
                    (D) in clause (iii)--
                            (i) in subclause (I), by striking ``, as 
                        requested under clause (i),''; and
                            (ii) by adding at the end of subclause (II) 
                        the following new sentence: ``The preceding 
                        sentence shall not apply with respect to 
                        disclosures made on or after the date of the 
                        enactment of this sentence.''; and
                    (E) in clause (iv)--
                            (i) in subclause (I)--
                                    (I) by striking ``requested under 
                                clause (i)'' and inserting ``reviewed 
                                under clause (i)''; and
                                    (II) by striking ``after the final 
                                determination by the Secretary 
                                described in clause (iii)(I)(bb)'' and 
                                inserting ``by the Secretary as 
                                described in clause (iii)(I)'';
                            (ii) in subclause (II), by striking ``the 
                        comparative analyses requested under clause 
                        (i)'' and inserting ``such comparative 
                        analyses'';
                            (iii) in subclause (III), by striking ``the 
                        comparative analyses requested under clause 
                        (i)'' and inserting ``such comparative 
                        analyses'';
                            (iv) in subclause (IV)--
                                    (I) by striking ``the comparative 
                                analyses requested under clause (i)'' 
                                and inserting ``such comparative 
                                analyses''; and
                                    (II) by striking ``and'' at the 
                                end;
                            (v) in subclause (V), by striking the 
                        period and inserting a semicolon; and
                            (vi) by adding at the end the following:
                                    ``(VI) the name of each group 
                                health plan found not to have submitted 
                                comparative analyses in accordance with 
                                subparagraph (A);
                                    ``(VII) the name of each group 
                                health plan whose comparative analyses 
                                were reviewed under clause (i) and 
                                found not to have submitted sufficient 
                                information for the Secretary to 
                                review; and
                                    ``(VIII) the name of any plan with 
                                respect to which a complaint has been 
                                submitted under subparagraph (C) and 
                                for which a final review finding has 
                                been issued.
                        The requirements of this clause with respect to 
                        plans shall also apply to entities that provide 
                        administrative services in connection with a 
                        group health plan, such as third party 
                        administrators, if applicable.'';
            (3) in subparagraph (C)(i), by striking ``requested''; and
            (4) by adding at the end the following new subparagraphs:
                    ``(D) Audit process.--Beginning 1 year after the 
                date of enactment of this subparagraph, the Secretary, 
                in cooperation with the Secretaries of Health and Human 
                Services and Labor, as applicable, shall, in addition 
                to conducting reviews in accordance with subparagraph 
                (B), conduct randomized audits of group health plans 
                and entities that provide administrative services in 
                connection with a group health plan, such as third 
                party administrators, to determine compliance with this 
                section. Such audits shall be conducted on no fewer 
                than 40 plans per calendar year (not including any 
                reviews conducted under such subparagraph). In 
                addition, the Secretary may, in cooperation with the 
                Secretaries of Health and Human Services and Labor, as 
                applicable, and in consultation with the Inspector 
                General of the Department of Health and Human Services, 
                the Inspector General of the Department of Labor, and 
                the Inspector General of the Department of the 
                Treasury, as applicable, conduct audits on any such 
                plan with respect to which a complaint has been 
                submitted under subparagraph (E) to determine 
                compliance with this section.
                    ``(E) Complaint process.--Not later than 6 months 
                after the date of enactment of this subparagraph, the 
                Secretary, in cooperation with the Secretary of Health 
                and Human Services and the Secretary of Labor, shall, 
                with respect to group health plans (including entities 
                that provide administrative services in connection with 
                a group health plan, such as third party 
                administrators), issue guidance to clarify the process 
                and timeline for current and potential participants and 
                beneficiaries (and authorized representatives and 
                health care providers of such participants and 
                beneficiaries) with respect to such plans to file 
                formal complaints of such plans being in violation of 
                this section, including guidance, by plan type, on the 
                relevant State, regional, and national offices with 
                which such complaints should be filed.
                    ``(F) Coverage disparity information.--For the 
                first calendar year that begins on or after the date 
                that is 2 years after the date of the enactment of this 
                subparagraph, and for each subsequent calendar year, 
                the Secretary, in cooperation with the Secretaries of 
                Health and Human Services and Labor, shall submit to 
                the Committee on Energy and Commerce of the House of 
                Representatives and the Committee on Health, Education, 
                Labor, and Pensions of the Senate the following 
                information with respect to the preceding calendar 
                year:
                            ``(i) Denial rates.--Data comparing the 
                        rates of and reasons for denial by group health 
                        plans (including entities that provide 
                        administrative services in connection with a 
                        group health plan, such as third party 
                        administrators) of claims for mental health 
                        benefits, substance use disorder benefits, and 
                        medical and surgical benefits, disaggregated by 
                        the following categories:
                                    ``(I) Inpatient, in-network claims.
                                    ``(II) Inpatient, out-of-network 
                                claims.
                                    ``(III) Outpatient, in-network 
                                claims.
                                    ``(IV) Outpatient, out-of-network 
                                claims.
                                    ``(V) Emergency services.
                                    ``(VI) Prescription drug claims.
                            ``(ii) Network adequacy data.--Data 
                        comparing the network adequacy of group health 
                        plans (including entities that provide 
                        administrative services in connection with a 
                        group health plan, such as third party 
                        administrators) based on claims for outpatient 
                        and inpatient mental health benefits, substance 
                        use disorder benefits, and medical and surgical 
                        benefits, including out-of-network utilization 
                        rates, the number and percentage of in-network 
                        providers accepting new patients, and average 
                        wait times between receiving initial treatment 
                        and diagnosis and follow-up treatment.
                            ``(iii) Reimbursement rates.--Data 
                        comparing the reimbursement rates of group 
                        health plans (including entities that provide 
                        administrative services in connection with a 
                        group health plan, such as third party 
                        administrators) for the 10 most commonly billed 
                        mental health services, substance use services, 
                        and medical and surgical services, each as a 
                        percentage of rates payable for such services 
                        under title XVIII of the Social Security Act, 
                        disaggregated by the following categories:
                                    ``(I) Inpatient, in-network claims.
                                    ``(II) Inpatient, out-of-network 
                                claims.
                                    ``(III) Outpatient, in-network 
                                claims.
                                    ``(IV) Outpatient, out-of-network 
                                claims.
                                    ``(V) Emergency services.
                                    ``(VI) Prescription drug claims.''.

SEC. 3. CONSUMER PARITY UNIT FOR MENTAL HEALTH AND SUBSTANCE USE 
              DISORDER PARITY VIOLATIONS.

    (a) Definitions.--In this section:
            (1) Applicable state authority.--The term ``applicable 
        State authority'' has the meaning given the term in section 
        2791 of the Public Health Service Act (42 U.S.C. 300gg-91).
            (2) Covered plan.--The term ``covered plan'' means any 
        creditable coverage that is subject to any of the mental health 
        parity laws described in paragraph (4).
            (3) Creditable coverage.--The term ``creditable coverage'' 
        has the meaning given the term in section 2704(c) of the Public 
        Health Service Act (42 U.S.C. 300gg-3(c)).
            (4) Mental health parity law.--The term ``mental health 
        parity law'' means--
                    (A) section 2726 of the Public Health Service Act 
                (42 U.S.C. 300gg-26);
                    (B) section 712 of the Employee Retirement Income 
                Security Act of 1974 (29 U.S.C. 1185a);
                    (C) section 9812 of the Internal Revenue Code of 
                1986; or
                    (D) any other Federal law that applies the 
                requirements under any of the sections described in 
                subparagraph (A), (B), or (C), or requirements that are 
                substantially similar to the requirements under any 
                such section, as determined by the Secretary, to 
                creditable coverage.
            (5) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (6) Specified covered plan.--The term ``specified covered 
        plan'' means a covered plan that is any of the following:
                    (A) A group health plan or group or individual 
                health insurance coverage (as such terms are defined in 
                section 2791 of the Public Health Service Act (42 
                U.S.C. 300gg-91)).
                    (B) A Medicare Advantage plan offered under part C 
                of title XVIII of the Social Security Act (42 U.S.C. 
                1395w-21 et seq.).
                    (C) A State plan (or waiver of such plan) under 
                title XIX of the Social Security Act (42 U.S.C. 1396 et 
                seq.).
                    (D) A plan offered under the program established 
                under chapter 89 of title 5, United States Code.
    (b) Establishment.--Not later than 6 months after the date of 
enactment of this Act, the Secretary, in consultation with the 
Secretary of Labor, the Secretary of the Treasury, and the heads of any 
other applicable agencies, shall establish a consumer parity unit with 
functions that include--
            (1) facilitating the centralized collection of, monitoring 
        of, and response to consumer complaints (including provider 
        complaints) regarding violations of mental health parity laws 
        through developing and administering, in accordance with 
        subsection (d)--
                    (A) a single, toll-free telephone number; and
                    (B) a public website portal, which may include 
                enhancing a website portal in existence on the date of 
                enactment of this Act; and
            (2) providing information to health care consumers 
        regarding the disclosure requirements and enforcement under 
        section 2726(a)(8) of the Public Health Service Act (42 U.S.C. 
        300gg-26(a)(8)), section 712(a)(8) of the Employee Retirement 
        Income Security Act of 1974 (29 U.S.C. 1185a(a)(8)), and 
        section 9812(a)(8) of the Internal Revenue Code of 1986.
    (c) Website Portal.--The Secretary, in consultation with the 
Secretary of Labor, the Secretary of the Treasury, and the heads of any 
other applicable agencies, shall make available on the website portal 
established under subsection (b)(1)(B)--
            (1) any guidance and any reports issued by the Secretary, 
        the Secretary of Labor, or the Secretary of the Treasury, under 
        section 2726 of the Public Health Service Act (42 U.S.C. 300gg-
        26), section 712 of the Employee Retirement Income Security Act 
        of 1974 (29 U.S.C. 1185a), or section 9812 of the Internal 
        Revenue Code of 1986, respectively;
            (2) any information obtained under subsection (b)(1) that 
        it is in the public interest to disclose, through aggregated 
        reported or other appropriate formats designed to protect 
        confidential information in accordance with subsection (g); and
            (3) information on the results of, or progress on, any 
        concluded or ongoing audits or investigations of the Secretary, 
        the Secretary of Labor, or the Secretary of the Treasury, as 
        applicable, under such section 2726, 712, or 9812, 
        respectively, including the identity of each group health plan 
        or health insurance issuer (including entities that provide 
        administrative services in connection with a group health plan, 
        such as third party administrators) that--
                    (A) was the subject of a concluded audit or 
                investigation; or
                    (B) that is the subject of an ongoing audit or 
                investigation and which was found, pursuant to such 
                audit or investigation, not to have submitted NQTL 
                analyses in accordance with such sections (or to have 
                submitted incomplete NQTL analyses).
    (d) Response to Consumer Complaints and Inquiries.--
            (1) Timely response to consumers.--The Secretary, in 
        consultation with the Secretary of Labor, the Secretary of the 
        Treasury, and the heads of any other applicable agencies, shall 
        establish reasonable procedures for the consumer parity unit 
        established under this section to provide a response (in 
        writing if appropriate) within 90 days to consumers regarding 
        complaints received by the unit against, or inquiries 
        concerning, a covered plan, at the discretion of the applicable 
        agency, which shall at minimum include--
                    (A) steps that have been taken by the appropriate 
                State or Federal enforcement agency in response to the 
                complaint or inquiry of the consumer;
                    (B) in the case such complaint relates to a 
                specified covered plan, any responses received by the 
                appropriate State or Federal enforcement agency from 
                the covered plan;
                    (C) any follow-up actions or planned follow-up 
                actions by the appropriate State or Federal enforcement 
                agency in response to the complaint or inquiry of the 
                consumer; and
                    (D) contact information of the appropriate 
                enforcement agency for the consumer to obtain 
                additional information on the complaint or inquiry.
            (2) Timely response to regulators.--A specified covered 
        plan shall provide a response (in writing if appropriate) 
        within 7 days to the appropriate State or Federal enforcement 
        agency having jurisdiction over such plan (or, in the case such 
        plan is a State plan (or wavier of such plan) under title XIX 
        of the Social Security Act (42 U.S.C. 1396 et seq.), to the 
        Secretary of Health and Human Services) concerning a consumer 
        complaint or inquiry submitted to the consumer parity unit 
        established under this section including--
                    (A) steps that have been taken by the plan to 
                respond to the complaint or inquiry of the consumer;
                    (B) any responses received by the plan from the 
                consumer; and
                    (C) follow-up actions or planned follow-up actions 
                by the plan in response to the complaint or inquiry of 
                the consumer.
            (3) Provision of information to consumers.--
                    (A) In general.--A covered plan shall comply with a 
                consumer request for information in the control or 
                possession of such covered plan concerning the coverage 
                the consumer obtained from such covered plan within 7 
                days of receipt of such request.
                    (B) Exceptions.--Notwithstanding subparagraph (A), 
                a covered plan, and any agency or entity having 
                jurisdiction over a covered plan, may not be required 
                by this paragraph to make available to the consumer any 
                information required to be kept confidential by any 
                other provision of law.
            (4) Enforcement.--
                    (A) Private insurance.--The provisions of 
                paragraphs (2) and (3) shall apply to group health 
                plans and group and individual health insurance 
                coverage (as such terms are defined in section 2791 of 
                the Public Health Service Act (42 U.S.C. 300gg-91)) as 
                if such provisions were included in part D of title 
                XXVII of such Act (42 U.S.C. 300g-111 et seq.), part 7 
                of title I of the Employee Retirement Act of 1974 (29 
                U.S.C. 1181 et seq.), and chapter 100 of the Internal 
                Revenue Code of 1986.
                    (B) Other specified covered plans.--
                            (i) Medicare advantage plans.--Section 1852 
                        of the Social Security Act (42 U.S.C. 1395w-22) 
                        is amended by adding at the end the following 
                        new section:
    ``(o) Application of Certain Mental Health Parity Complaint 
Requirements.--An MA plan shall comply with the requirements of 
paragraphs (2) and (3) of section 3(d) of the Behavioral Health 
Coverage Transparency Act of 2022.''.
                            (ii) Medicaid.--Section 1902(a) of the 
                        Social Security Act (42 U.S.C. 1396a(a)) is 
                        amended--
                                    (I) in paragraph (86), by striking 
                                ``; and'' at the end;
                                    (II) in paragraph (87)(D), by 
                                striking the period and inserting ``; 
                                and''; and
                                    (III) by inserting after paragraph 
                                (87) the following new paragraph:
            ``(88) provide for compliance with the provisions of 
        paragraphs (2) and (3) of section 3(d) of the Behavioral Health 
        Coverage Transparency Act of 2022.''.
                    (C) Other covered plans.--In the case of a covered 
                plan that is not a specified covered plan, the Federal 
                agency charged with the administration or supervision 
                of such plan shall ensure that such plan complies with 
                the provisions of paragraph (3).
    (e) Reports.--
            (1) In general.--Not later than December 31 of each year, 
        the Secretary, in consultation with the Secretary of Labor, the 
        Secretary of the Treasury, and the heads of any other 
        applicable agencies, shall submit a report to Congress on the 
        complaints received by the consumer parity unit established 
        under this section in the prior year regarding covered plans.
            (2) Contents.--Each such report shall include information 
        and analysis about complaint numbers, complaint types, and, 
        where applicable, information about the resolution of 
        complaints, including the identity of the group health plan or 
        health insurance issuer that is the subject of such a 
        complaint.
            (3) Consumer parity unit posting.--The Secretary shall 
        submit such reports to the consumer parity unit established 
        under this section, and such unit shall post the reports on the 
        website portal established under subsection (b)(1)(B).
    (f) Data Sharing.--Subject to any applicable standards for Federal 
or State agencies with respect to protecting personally identifiable 
information and data security and integrity, including the regulations 
under part 2 of title 42, Code of Federal Regulations--
            (1) the consumer parity unit established under this section 
        shall share consumer complaint information with the Secretary, 
        and the head of any other applicable Federal or State agency; 
        and
            (2) the Secretary, and the head of any other applicable 
        Federal or State agency, shall share data relating to consumer 
        complaints regarding covered plans with such unit.
    (g) Privacy Considerations.--
            (1) In general.--In carrying out this section, the consumer 
        parity unit established under this section and the Secretary, 
        in consultation with the Secretary of Labor, the Secretary of 
        the Treasury, and the head of any other applicable agency, 
        shall take measures to ensure that proprietary, personal, or 
        confidential consumer information that is protected from public 
        disclosure under section 552(b) or 552a of title 5, United 
        States Code, or any other provision of law, is not made public 
        under this section.
            (2) Exceptions.--The consumer parity unit established under 
        this section may not obtain from a covered plan any personally 
        identifiable information about a consumer from the records of 
        the covered plan, except--
                    (A) if the records are reasonably described in a 
                request by the consumer parity unit established under 
                this section, and the consumer provides appropriate 
                consent for the disclosure and use of such information 
                by the covered plan to such unit; or
                    (B) as may be specifically permitted or required 
                under other applicable provisions of law, including the 
                regulations under part 2 of title 42, Code of Federal 
                Regulations.
    (h) Collaboration.--
            (1) Agreements with other agencies.--The Secretary, the 
        Secretary of Labor, the Secretary of the Treasury, and the 
        heads of any other applicable agencies, shall enter into a 
        memorandum of understanding with any affected Federal 
        regulatory agency regarding procedures by which any covered 
        plan, and any other agency having jurisdiction over a covered 
        plan, shall comply with this section.
            (2) Agreements with states.--To the extent practicable, an 
        applicable State authority may receive appropriate complaints 
        from the consumer parity unit established under this section, 
        if--
                    (A) the applicable State authority has the 
                functional capacity to receive calls or electronic 
                reports routed by the unit;
                    (B) the applicable State authority has satisfied 
                any conditions of participation that the unit may 
                establish, including treatment of personally 
                identifiable information and sharing of information on 
                complaint resolution or related compliance procedures 
                and resources; and
                    (C) participation by the applicable State authority 
                includes measures necessary to protect personally 
                identifiable information in accordance with standards 
                that apply to Federal agencies with respect to 
                protecting personally identifiable information and data 
                security and integrity.
            (3) Assistance to states.--The Secretary, the Secretary of 
        Labor, the Secretary of the Treasury, and the heads of any 
        other applicable agencies, shall provide assistance to States 
        to increase the capacity of State governments to work with the 
        Federal parity unit under this section, including through the 
        provision of training and technical assistance, and 
        identification of violations of mental health and substance use 
        disorder parity protections.
    (i) Funding.--
            (1) Initial funding.--There is hereby appropriated to the 
        Secretary, out of any funds in the Treasury not otherwise 
        appropriated, $30,000,000 for the first fiscal year for which 
        this section applies to carry out this section. Such amount 
        shall remain available until expended.
            (2) Authorization for subsequent years.--There is 
        authorized to be appropriated to the Secretary for each fiscal 
        year following the fiscal year described in paragraph (1), such 
        sums as may be necessary to carry out this section.

SEC. 4. GRANTS FOR HEALTH INSURANCE INFORMATION CONCERNING MENTAL 
              HEALTH AND SUBSTANCE USE DISORDER BENEFITS.

    (a) In General.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary'') shall award grants 
to States to enable such States (or the Exchanges established under the 
Patient Protection and Affordable Care Act (Public Law 111-148) 
operating in such States) to establish, expand, or provide support 
for--
            (1) offices of health insurance consumer assistance; or
            (2) health insurance ombudsman programs,
in order to enable such offices and programs to carry out the 
activities described in subsection (c).
    (b) Eligibility.--
            (1) In general.--To be eligible to receive a grant, a State 
        shall designate an independent office of health insurance 
        consumer assistance, or an ombudsman, that, directly or in 
        coordination with State private and public health insurance 
        regulators and consumer assistance organizations, receives and 
        responds to inquiries and complaints concerning health 
        insurance coverage with respect to Federal health insurance 
        requirements and under State law relating to mental health or 
        substance use disorder benefits.
            (2) Criteria.--A State that receives a grant under this 
        section shall comply with criteria established by the Secretary 
        for carrying out activities under such grant.
    (c) Use of Funds.--Funds received from a grant awarded under this 
section shall be used by an office of health insurance consumer 
assistance or health insurance ombudsman described in subsection (a) 
to--
            (1) assist with the filing of complaints and appeals, 
        including filing appeals with the internal appeal or grievance 
        process of the group health plan or health insurance issuer, 
        Medicaid program, and Children's Health Insurance Program 
        involved, relating to mental health or substance use disorder 
        benefits, and providing information about the external appeal 
        process;
            (2) collect, track, and quantify problems and inquiries 
        encountered by consumers;
            (3) educate consumers on their rights and responsibilities 
        with respect to group health plans and health insurance 
        coverage, Medicaid, and Children's Health Insurance Program 
        relating to mental health or substance use disorder benefits;
            (4) assist consumers with enrollment in a group health plan 
        or health insurance coverage, Medicaid, and the Children's 
        Health Insurance Program by providing information, referral, 
        and assistance; and
            (5) assist consumers in resolving problems with obtaining 
        premium tax credits under section 36B of the Internal Revenue 
        Code of 1986 by providing information, referral, and 
        assistance.
    (d) Data Collection.--As a condition of receiving a grant under 
subsection (a), an office of health insurance consumer assistance or 
ombudsman program shall be required to collect and report data to the 
Secretary and State public and private health insurance regulators on 
the types of problems and inquiries encountered by consumers relating 
to mental health or substance use disorder benefits. The Secretary 
shall utilize such data to identify areas where more enforcement action 
is necessary and shall share such information with State insurance 
regulators, the Secretary of Labor, and the Secretary of the Treasury 
for use in the enforcement activities of such agencies.
    (e) Funding.--
            (1) Initial funding.--There is hereby appropriated to the 
        Secretary, out of any funds in the Treasury not otherwise 
        appropriated, $25,000,000 for the first fiscal year for which 
        this section applies to carry out this section. Such amount 
        shall remain available until expended.
            (2) Authorization for subsequent years.--There is 
        authorized to be appropriated to the Secretary for each fiscal 
        year following the fiscal year described in paragraph (1), such 
        sums as may be necessary to carry out this section.
                                 <all>
Behavioral Health Coverage Transparency Act of 2022
To amend title XXVII of the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to strengthen parity in mental health and substance use disorder benefits.
Behavioral Health Coverage Transparency Act of 2022
Rep. Porter, Katie