[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6983 Introduced in House (IH)]







110th CONGRESS
  2d Session
                                H. R. 6983

To amend section 712 of the Employee Retirement Income Security Act of 
 1974, section 2705 of the Public Health Service Act, and section 9812 
of the Internal Revenue Code of 1986 to require equity in the provision 
 of mental health and substance-related disorder benefits under group 
                 health plans, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 22, 2008

  Mr. Kennedy (for himself, Mr. Ramstad, Mr. Dingell, Mr. Rangel, Mr. 
    Pallone, Mr. Andrews, Mr. Stark, and Mr. Waxman) introduced the 
   following bill; which was referred to the Committee on Energy and 
Commerce, and in addition to the Committees on Education and Labor and 
   Ways and Means, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
To amend section 712 of the Employee Retirement Income Security Act of 
 1974, section 2705 of the Public Health Service Act, and section 9812 
of the Internal Revenue Code of 1986 to require equity in the provision 
 of mental health and substance-related disorder benefits under group 
                 health plans, and for other purposes.

    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 ``Paul Wellstone and Pete Domenici 
Mental Health Parity and Addiction Equity Act of 2008''.

SEC. 2. MENTAL HEALTH PARITY.

    (a) Amendments to ERISA.--Section 712 of the Employee Retirement 
Income Security Act of 1974 (29 U.S.C. 1185a) is amended--
            (1) in subsection (a), by adding at the end the following:
            ``(3) Financial requirements and treatment limitations.--
                    ``(A) In general.--In the case of a group health 
                plan (or health insurance coverage offered in 
                connection with such a plan) that provides both medical 
                and surgical benefits and mental health or substance 
                use disorder benefits, such plan or coverage shall 
                ensure that--
                            ``(i) the financial requirements applicable 
                        to such mental health or substance use disorder 
                        benefits are no more restrictive than the 
                        predominant financial requirements applied to 
                        substantially all medical and surgical benefits 
                        covered by the plan (or coverage), and there 
                        are no separate cost sharing requirements that 
                        are applicable only with respect to mental 
                        health or substance use disorder benefits; and
                            ``(ii) the treatment limitations applicable 
                        to such mental health or substance use disorder 
                        benefits are no more restrictive than the 
                        predominant treatment limitations applied to 
                        substantially all medical and surgical benefits 
                        covered by the plan (or coverage) and there are 
                        no separate treatment limitations that are 
                        applicable only with respect to mental health 
                        or substance use disorder benefits.
                    ``(B) Definitions.--In this paragraph:
                            ``(i) Financial requirement.--The term 
                        `financial requirement' includes deductibles, 
                        copayments, coinsurance, and out-of-pocket 
                        expenses, but excludes an aggregate lifetime 
                        limit and an annual limit subject to paragraphs 
                        (1) and (2).
                            ``(ii) Predominant.--A financial 
                        requirement or treatment limit is considered to 
                        be predominant if it is the most common or 
                        frequent of such type of limit or requirement.
                            ``(iii) Treatment limitation.--The term 
                        `treatment limitation' includes limits on the 
                        frequency of treatment, number of visits, days 
                        of coverage, or other similar limits on the 
                        scope or duration of treatment.
            ``(4) Availability of plan information.--The criteria for 
        medical necessity determinations made under the plan with 
        respect to mental health or substance use disorder benefits (or 
        the health insurance coverage offered in connection with the 
        plan with respect to such benefits) shall be made available by 
        the plan administrator (or the health insurance issuer offering 
        such coverage) in accordance with regulations to any current or 
        potential participant, beneficiary, or contracting provider 
        upon request. The reason for any denial under the plan (or 
        coverage) of reimbursement or payment for services with respect 
        to mental health or substance use disorder benefits in the case 
        of any participant or beneficiary shall, on request or as 
        otherwise required, be made available by the plan administrator 
        (or the health insurance issuer offering such coverage) to the 
        participant or beneficiary in accordance with regulations.
            ``(5) Out-of-network providers.--In the case of a plan or 
        coverage that provides both medical and surgical benefits and 
        mental health or substance use disorder benefits, if the plan 
        or coverage provides coverage for medical or surgical benefits 
        provided by out-of-network providers, the plan or coverage 
        shall provide coverage for mental health or substance use 
        disorder benefits provided by out-of-network providers in a 
        manner that is consistent with the requirements of this 
        section.'';
            (2) in subsection (b), by amending paragraph (2) to read as 
        follows:
            ``(2) in the case of a group health plan (or health 
        insurance coverage offered in connection with such a plan) that 
        provides mental health or substance use disorder benefits, as 
        affecting the terms and conditions of the plan or coverage 
        relating to such benefits under the plan or coverage, except as 
        provided in subsection (a).'';
            (3) in subsection (c)--
                    (A) in paragraph (1)(B)--
                            (i) by inserting ``(or 1 in the case of an 
                        employer residing in a State that permits small 
                        groups to include a single individual)'' after 
                        ``at least 2'' the first place that such 
                        appears; and
                            (ii) by striking ``and who employs at least 
                        2 employees on the first day of the plan 
                        year''; and
                    (B) by striking paragraph (2) and inserting the 
                following:
            ``(2) Cost exemption.--
                    ``(A) In general.--With respect to a group health 
                plan (or health insurance coverage offered in 
                connection with such a plan), if the application of 
                this section to such plan (or coverage) results in an 
                increase for the plan year involved of the actual total 
                costs of coverage with respect to medical and surgical 
                benefits and mental health and substance use disorder 
                benefits under the plan (as determined and certified 
                under subparagraph (C)) by an amount that exceeds the 
                applicable percentage described in subparagraph (B) of 
                the actual total plan costs, the provisions of this 
                section shall not apply to such plan (or coverage) 
                during the following plan year, and such exemption 
                shall apply to the plan (or coverage) for 1 plan year. 
                An employer may elect to continue to apply mental 
                health and substance use disorder parity pursuant to 
                this section with respect to the group health plan (or 
                coverage) involved regardless of any increase in total 
                costs.
                    ``(B) Applicable percentage.--With respect to a 
                plan (or coverage), the applicable percentage described 
                in this subparagraph shall be--
                            ``(i) 2 percent in the case of the first 
                        plan year in which this section is applied; and
                            ``(ii) 1 percent in the case of each 
                        subsequent plan year.
                    ``(C) Determinations by actuaries.--Determinations 
                as to increases in actual costs under a plan (or 
                coverage) for purposes of this section shall be made 
                and certified by a qualified and licensed actuary who 
                is a member in good standing of the American Academy of 
                Actuaries. All such determinations shall be in a 
                written report prepared by the actuary. The report, and 
                all underlying documentation relied upon by the 
                actuary, shall be maintained by the group health plan 
                or health insurance issuer for a period of 6 years 
                following the notification made under subparagraph (E).
                    ``(D) 6-month determinations.--If a group health 
                plan (or a health insurance issuer offering coverage in 
                connection with a group health plan) seeks an exemption 
                under this paragraph, determinations under subparagraph 
                (A) shall be made after such plan (or coverage) has 
                complied with this section for the first 6 months of 
                the plan year involved.
                    ``(E) Notification.--
                            ``(i) In general.--A group health plan (or 
                        a health insurance issuer offering coverage in 
                        connection with a group health plan) that, 
                        based upon a certification described under 
                        subparagraph (C), qualifies for an exemption 
                        under this paragraph, and elects to implement 
                        the exemption, shall promptly notify the 
                        Secretary, the appropriate State agencies, and 
                        participants and beneficiaries in the plan of 
                        such election.
                            ``(ii) Requirement.--A notification to the 
                        Secretary under clause (i) shall include--
                                    ``(I) a description of the number 
                                of covered lives under the plan (or 
                                coverage) involved at the time of the 
                                notification, and as applicable, at the 
                                time of any prior election of the cost-
                                exemption under this paragraph by such 
                                plan (or coverage);
                                    ``(II) for both the plan year upon 
                                which a cost exemption is sought and 
                                the year prior, a description of the 
                                actual total costs of coverage with 
                                respect to medical and surgical 
                                benefits and mental health and 
                                substance use disorder benefits under 
                                the plan; and
                                    ``(III) for both the plan year upon 
                                which a cost exemption is sought and 
                                the year prior, the actual total costs 
                                of coverage with respect to mental 
                                health and substance use disorder 
                                benefits under the plan.
                            ``(iii) Confidentiality.--A notification to 
                        the Secretary under clause (i) shall be 
                        confidential. The Secretary shall make 
                        available, upon request and on not more than an 
                        annual basis, an anonymous itemization of such 
                        notifications, that includes--
                                    ``(I) a breakdown of States by the 
                                size and type of employers submitting 
                                such notification; and
                                    ``(II) a summary of the data 
                                received under clause (ii).
                    ``(F) Audits by appropriate agencies.--To determine 
                compliance with this paragraph, the Secretary may audit 
                the books and records of a group health plan or health 
                insurance issuer relating to an exemption, including 
                any actuarial reports prepared pursuant to subparagraph 
                (C), during the 6-year period following the 
                notification of such exemption under subparagraph (E). 
                A State agency receiving a notification under 
                subparagraph (E) may also conduct such an audit with 
                respect to an exemption covered by such 
                notification.'';
            (4) in subsection (e), by striking paragraph (4) and 
        inserting the following:
            ``(4) Mental health benefits.--The term `mental health 
        benefits' means benefits with respect to services for mental 
        health conditions, as defined under the terms of the plan and 
        in accordance with applicable Federal and State law.
            ``(5) Substance use disorder benefits.--The term `substance 
        use disorder benefits' means benefits with respect to services 
        for substance use disorders, as defined under the terms of the 
        plan and in accordance with applicable Federal and State 
        law.'';
            (5) by striking subsection (f);
            (6) by inserting after subsection (e) the following:
    ``(f) Secretary Report.--The Secretary shall, by January 1, 2012, 
and every two years thereafter, submit to the appropriate committees of 
Congress a report on compliance of group health plans (and health 
insurance coverage offered in connection with such plans) with the 
requirements of this section. Such report shall include the results of 
any surveys or audits on compliance of group health plans (and health 
insurance coverage offered in connection with such plans) with such 
requirements and an analysis of the reasons for any failures to comply.
    ``(g) Notice and Assistance.--The Secretary, in cooperation with 
the Secretaries of Health and Human Services and Treasury, as 
appropriate, shall publish and widely disseminate guidance and 
information for group health plans, participants and beneficiaries, 
applicable State and local regulatory bodies, and the National 
Association of Insurance Commissioners concerning the requirements of 
this section and shall provide assistance concerning such requirements 
and the continued operation of applicable State law. Such guidance and 
information shall inform participants and beneficiaries of how they may 
obtain assistance under this section, including, where appropriate, 
assistance from State consumer and insurance agencies.'';
            (7) by striking ``mental health benefits'' and inserting 
        ``mental health and substance use disorder benefits'' each 
        place it appears in subsections (a)(1)(B)(i), (a)(1)(C), 
        (a)(2)(B)(i), and (a)(2)(C); and
            (8) by striking ``mental health benefits'' and inserting 
        ``mental health or substance use disorder benefits'' each place 
        it appears (other than in any provision amended by the previous 
        paragraph).
    (b) Amendments to Public Health Service Act.--Section 2705 of the 
Public Health Service Act (42 U.S.C. 300gg-5) is amended--
            (1) in subsection (a), by adding at the end the following:
            ``(3) Financial requirements and treatment limitations.--
                    ``(A) In general.--In the case of a group health 
                plan (or health insurance coverage offered in 
                connection with such a plan) that provides both medical 
                and surgical benefits and mental health or substance 
                use disorder benefits, such plan or coverage shall 
                ensure that--
                            ``(i) the financial requirements applicable 
                        to such mental health or substance use disorder 
                        benefits are no more restrictive than the 
                        predominant financial requirements applied to 
                        substantially all medical and surgical benefits 
                        covered by the plan (or coverage), and there 
                        are no separate cost sharing requirements that 
                        are applicable only with respect to mental 
                        health or substance use disorder benefits; and
                            ``(ii) the treatment limitations applicable 
                        to such mental health or substance use disorder 
                        benefits are no more restrictive than the 
                        predominant treatment limitations applied to 
                        substantially all medical and surgical benefits 
                        covered by the plan (or coverage) and there are 
                        no separate treatment limitations that are 
                        applicable only with respect to mental health 
                        or substance use disorder benefits.
                    ``(B) Definitions.--In this paragraph:
                            ``(i) Financial requirement.--The term 
                        `financial requirement' includes deductibles, 
                        copayments, coinsurance, and out-of-pocket 
                        expenses, but excludes an aggregate lifetime 
                        limit and an annual limit subject to paragraphs 
                        (1) and (2),
                            ``(ii) Predominant.--A financial 
                        requirement or treatment limit is considered to 
                        be predominant if it is the most common or 
                        frequent of such type of limit or requirement.
                            ``(iii) Treatment limitation.--The term 
                        `treatment limitation' includes limits on the 
                        frequency of treatment, number of visits, days 
                        of coverage, or other similar limits on the 
                        scope or duration of treatment.
            ``(4) Availability of plan information.--The criteria for 
        medical necessity determinations made under the plan with 
        respect to mental health or substance use disorder benefits (or 
        the health insurance coverage offered in connection with the 
        plan with respect to such benefits) shall be made available by 
        the plan administrator (or the health insurance issuer offering 
        such coverage) in accordance with regulations to any current or 
        potential participant, beneficiary, or contracting provider 
        upon request. The reason for any denial under the plan (or 
        coverage) of reimbursement or payment for services with respect 
        to mental health or substance use disorder benefits in the case 
        of any participant or beneficiary shall, on request or as 
        otherwise required, be made available by the plan administrator 
        (or the health insurance issuer offering such coverage) to the 
        participant or beneficiary in accordance with regulations.
            ``(5) Out-of-network providers.--In the case of a plan or 
        coverage that provides both medical and surgical benefits and 
        mental health or substance use disorder benefits, if the plan 
        or coverage provides coverage for medical or surgical benefits 
        provided by out-of-network providers, the plan or coverage 
        shall provide coverage for mental health or substance use 
        disorder benefits provided by out-of-network providers in a 
        manner that is consistent with the requirements of this 
        section.'';
            (2) in subsection (b), by amending paragraph (2) to read as 
        follows:
            ``(2) in the case of a group health plan (or health 
        insurance coverage offered in connection with such a plan) that 
        provides mental health or substance use disorder benefits, as 
        affecting the terms and conditions of the plan or coverage 
        relating to such benefits under the plan or coverage, except as 
        provided in subsection (a).'';
            (3) in subsection (c)--
                    (A) in paragraph (1), by inserting before the 
                period the following: ``(as defined in section 
                2791(e)(4), except that for purposes of this paragraph 
                such term shall include employers with 1 employee in 
                the case of an employer residing in a State that 
                permits small groups to include a single individual)''; 
                and
                    (B) by striking paragraph (2) and inserting the 
                following:
            ``(2) Cost exemption.--
                    ``(A) In general.--With respect to a group health 
                plan (or health insurance coverage offered in 
                connection with such a plan), if the application of 
                this section to such plan (or coverage) results in an 
                increase for the plan year involved of the actual total 
                costs of coverage with respect to medical and surgical 
                benefits and mental health and substance use disorder 
                benefits under the plan (as determined and certified 
                under subparagraph (C)) by an amount that exceeds the 
                applicable percentage described in subparagraph (B) of 
                the actual total plan costs, the provisions of this 
                section shall not apply to such plan (or coverage) 
                during the following plan year, and such exemption 
                shall apply to the plan (or coverage) for 1 plan year. 
                An employer may elect to continue to apply mental 
                health and substance use disorder parity pursuant to 
                this section with respect to the group health plan (or 
                coverage) involved regardless of any increase in total 
                costs.
                    ``(B) Applicable percentage.--With respect to a 
                plan (or coverage), the applicable percentage described 
                in this subparagraph shall be--
                            ``(i) 2 percent in the case of the first 
                        plan year in which this section is applied; and
                            ``(ii) 1 percent in the case of each 
                        subsequent plan year.
                    ``(C) Determinations by actuaries.--Determinations 
                as to increases in actual costs under a plan (or 
                coverage) for purposes of this section shall be made 
                and certified by a qualified and licensed actuary who 
                is a member in good standing of the American Academy of 
                Actuaries. All such determinations shall be in a 
                written report prepared by the actuary. The report, and 
                all underlying documentation relied upon by the 
                actuary, shall be maintained by the group health plan 
                or health insurance issuer for a period of 6 years 
                following the notification made under subparagraph (E).
                    ``(D) 6-month determinations.--If a group health 
                plan (or a health insurance issuer offering coverage in 
                connection with a group health plan) seeks an exemption 
                under this paragraph, determinations under subparagraph 
                (A) shall be made after such plan (or coverage) has 
                complied with this section for the first 6 months of 
                the plan year involved.
                    ``(E) Notification.--
                            ``(i) In general.--A group health plan (or 
                        a health insurance issuer offering coverage in 
                        connection with a group health plan) that, 
                        based upon a certification described under 
                        subparagraph (C), qualifies for an exemption 
                        under this paragraph, and elects to implement 
                        the exemption, shall promptly notify the 
                        Secretary, the appropriate State agencies, and 
                        participants and beneficiaries in the plan of 
                        such election.
                            ``(ii) Requirement.--A notification to the 
                        Secretary under clause (i) shall include--
                                    ``(I) a description of the number 
                                of covered lives under the plan (or 
                                coverage) involved at the time of the 
                                notification, and as applicable, at the 
                                time of any prior election of the cost-
                                exemption under this paragraph by such 
                                plan (or coverage);
                                    ``(II) for both the plan year upon 
                                which a cost exemption is sought and 
                                the year prior, a description of the 
                                actual total costs of coverage with 
                                respect to medical and surgical 
                                benefits and mental health and 
                                substance use disorder benefits under 
                                the plan; and
                                    ``(III) for both the plan year upon 
                                which a cost exemption is sought and 
                                the year prior, the actual total costs 
                                of coverage with respect to mental 
                                health and substance use disorder 
                                benefits under the plan.
                            ``(iii) Confidentiality.--A notification to 
                        the Secretary under clause (i) shall be 
                        confidential. The Secretary shall make 
                        available, upon request and on not more than an 
                        annual basis, an anonymous itemization of such 
                        notifications, that includes--
                                    ``(I) a breakdown of States by the 
                                size and type of employers submitting 
                                such notification; and
                                    ``(II) a summary of the data 
                                received under clause (ii).
                    ``(F) Audits by appropriate agencies.--To determine 
                compliance with this paragraph, the Secretary may audit 
                the books and records of a group health plan or health 
                insurance issuer relating to an exemption, including 
                any actuarial reports prepared pursuant to subparagraph 
                (C), during the 6-year period following the 
                notification of such exemption under subparagraph (E). 
                A State agency receiving a notification under 
                subparagraph (E) may also conduct such an audit with 
                respect to an exemption covered by such 
                notification.'';
            (4) in subsection (e), by striking paragraph (4) and 
        inserting the following:
            ``(4) Mental health benefits.--The term `mental health 
        benefits' means benefits with respect to services for mental 
        health conditions, as defined under the terms of the plan and 
        in accordance with applicable Federal and State law.
            ``(5) Substance use disorder benefits.--The term `substance 
        use disorder benefits' means benefits with respect to services 
        for substance use disorders, as defined under the terms of the 
        plan and in accordance with applicable Federal and State 
        law.'';
            (5) by striking subsection (f);
            (6) by striking ``mental health benefits'' and inserting 
        ``mental health and substance use disorder benefits'' each 
        place it appears in subsections (a)(1)(B)(i), (a)(1)(C), 
        (a)(2)(B)(i), and (a)(2)(C); and
            (7) by striking ``mental health benefits'' and inserting 
        ``mental health or substance use disorder benefits'' each place 
        it appears (other than in any provision amended by the previous 
        paragraph).
    (c) Amendments to Internal Revenue Code.--Section 9812 of the 
Internal Revenue Code of 1986 is amended--
            (1) in subsection (a), by adding at the end the following:
            ``(3) Financial requirements and treatment limitations.--
                    ``(A) In general.--In the case of a group health 
                plan that provides both medical and surgical benefits 
                and mental health or substance use disorder benefits, 
                such plan shall ensure that--
                            ``(i) the financial requirements applicable 
                        to such mental health or substance use disorder 
                        benefits are no more restrictive than the 
                        predominant financial requirements applied to 
                        substantially all medical and surgical benefits 
                        covered by the plan, and there are no separate 
                        cost sharing requirements that are applicable 
                        only with respect to mental health or substance 
                        use disorder benefits; and
                            ``(ii) the treatment limitations applicable 
                        to such mental health or substance use disorder 
                        benefits are no more restrictive than the 
                        predominant treatment limitations applied to 
                        substantially all medical and surgical benefits 
                        covered by the plan and there are no separate 
                        treatment limitations that are applicable only 
                        with respect to mental health or substance use 
                        disorder benefits.
                    ``(B) Definitions.--In this paragraph:
                            ``(i) Financial requirement.--The term 
                        `financial requirement' includes deductibles, 
                        copayments, coinsurance, and out-of-pocket 
                        expenses, but excludes an aggregate lifetime 
                        limit and an annual limit subject to paragraphs 
                        (1) and (2),
                            ``(ii) Predominant.--A financial 
                        requirement or treatment limit is considered to 
                        be predominant if it is the most common or 
                        frequent of such type of limit or requirement.
                            ``(iii) Treatment limitation.--The term 
                        `treatment limitation' includes limits on the 
                        frequency of treatment, number of visits, days 
                        of coverage, or other similar limits on the 
                        scope or duration of treatment.
            ``(4) Availability of plan information.--The criteria for 
        medical necessity determinations made under the plan with 
        respect to mental health or substance use disorder benefits 
        shall be made available by the plan administrator in accordance 
        with regulations to any current or potential participant, 
        beneficiary, or contracting provider upon request. The reason 
        for any denial under the plan of reimbursement or payment for 
        services with respect to mental health or substance use 
        disorder benefits in the case of any participant or beneficiary 
        shall, on request or as otherwise required, be made available 
        by the plan administrator to the participant or beneficiary in 
        accordance with regulations.
            ``(5) Out-of-network providers.--In the case of a plan that 
        provides both medical and surgical benefits and mental health 
        or substance use disorder benefits, if the plan provides 
        coverage for medical or surgical benefits provided by out-of-
        network providers, the plan shall provide coverage for mental 
        health or substance use disorder benefits provided by out-of-
        network providers in a manner that is consistent with the 
        requirements of this section.'';
            (2) in subsection (b), by amending paragraph (2) to read as 
        follows:
            ``(2) in the case of a group health plan that provides 
        mental health or substance use disorder benefits, as affecting 
        the terms and conditions of the plan relating to such benefits 
        under the plan, except as provided in subsection (a).'';
            (3) in subsection (c)--
                    (A) by amending paragraph (1) to read as follows:
            ``(1) Small employer exemption.--
                    ``(A) In general.--This section shall not apply to 
                any group health plan for any plan year of a small 
                employer.
                    ``(B) Small employer.--For purposes of subparagraph 
                (A), the term `small employer' means, with respect to a 
                calendar year and a plan year, an employer who employed 
                an average of at least 2 (or 1 in the case of an 
                employer residing in a State that permits small groups 
                to include a single individual) but not more than 50 
                employees on business days during the preceding 
                calendar year. For purposes of the preceding sentence, 
                all persons treated as a single employer under 
                subsection (b), (c), (m), or (o) of section 414 shall 
                be treated as 1 employer and rules similar to rules of 
                subparagraphs (B) and (C) of section 4980D(d)(2) shall 
                apply.''; and
                    (B) by striking paragraph (2) and inserting the 
                following:
            ``(2) Cost exemption.--
                    ``(A) In general.--With respect to a group health 
                plan, if the application of this section to such plan 
                results in an increase for the plan year involved of 
                the actual total costs of coverage with respect to 
                medical and surgical benefits and mental health and 
                substance use disorder benefits under the plan (as 
                determined and certified under subparagraph (C)) by an 
                amount that exceeds the applicable percentage described 
                in subparagraph (B) of the actual total plan costs, the 
                provisions of this section shall not apply to such plan 
                during the following plan year, and such exemption 
                shall apply to the plan for 1 plan year. An employer 
                may elect to continue to apply mental health and 
                substance use disorder parity pursuant to this section 
                with respect to the group health plan involved 
                regardless of any increase in total costs.
                    ``(B) Applicable percentage.--With respect to a 
                plan, the applicable percentage described in this 
                subparagraph shall be--
                            ``(i) 2 percent in the case of the first 
                        plan year in which this section is applied; and
                            ``(ii) 1 percent in the case of each 
                        subsequent plan year.
                    ``(C) Determinations by actuaries.--Determinations 
                as to increases in actual costs under a plan for 
                purposes of this section shall be made and certified by 
                a qualified and licensed actuary who is a member in 
                good standing of the American Academy of Actuaries. All 
                such determinations shall be in a written report 
                prepared by the actuary. The report, and all underlying 
                documentation relied upon by the actuary, shall be 
                maintained by the group health plan for a period of 6 
                years following the notification made under 
                subparagraph (E).
                    ``(D) 6-month determinations.--If a group health 
                plan seeks an exemption under this paragraph, 
                determinations under subparagraph (A) shall be made 
                after such plan has complied with this section for the 
                first 6 months of the plan year involved.
                    ``(E) Notification.--
                            ``(i) In general.--A group health plan 
                        that, based upon a certification described 
                        under subparagraph (C), qualifies for an 
                        exemption under this paragraph, and elects to 
                        implement the exemption, shall promptly notify 
                        the Secretary, the appropriate State agencies, 
                        and participants and beneficiaries in the plan 
                        of such election.
                            ``(ii) Requirement.--A notification to the 
                        Secretary under clause (i) shall include--
                                    ``(I) a description of the number 
                                of covered lives under the plan 
                                involved at the time of the 
                                notification, and as applicable, at the 
                                time of any prior election of the cost-
                                exemption under this paragraph by such 
                                plan;
                                    ``(II) for both the plan year upon 
                                which a cost exemption is sought and 
                                the year prior, a description of the 
                                actual total costs of coverage with 
                                respect to medical and surgical 
                                benefits and mental health and 
                                substance use disorder benefits under 
                                the plan; and
                                    ``(III) for both the plan year upon 
                                which a cost exemption is sought and 
                                the year prior, the actual total costs 
                                of coverage with respect to mental 
                                health and substance use disorder 
                                benefits under the plan.
                            ``(iii) Confidentiality.--A notification to 
                        the Secretary under clause (i) shall be 
                        confidential. The Secretary shall make 
                        available, upon request and on not more than an 
                        annual basis, an anonymous itemization of such 
                        notifications, that includes--
                                    ``(I) a breakdown of States by the 
                                size and type of employers submitting 
                                such notification; and
                                    ``(II) a summary of the data 
                                received under clause (ii).
                    ``(F) Audits by appropriate agencies.--To determine 
                compliance with this paragraph, the Secretary may audit 
                the books and records of a group health plan relating 
                to an exemption, including any actuarial reports 
                prepared pursuant to subparagraph (C), during the 6-
                year period following the notification of such 
                exemption under subparagraph (E). A State agency 
                receiving a notification under subparagraph (E) may 
                also conduct such an audit with respect to an exemption 
                covered by such notification.'';
            (4) in subsection (e), by striking paragraph (4) and 
        inserting the following:
            ``(4) Mental health benefits.--The term `mental health 
        benefits' means benefits with respect to services for mental 
        health conditions, as defined under the terms of the plan and 
        in accordance with applicable Federal and State law.
            ``(5) Substance use disorder benefits.--The term `substance 
        use disorder benefits' means benefits with respect to services 
        for substance use disorders, as defined under the terms of the 
        plan and in accordance with applicable Federal and State 
        law.'';
            (5) by striking subsection (f);
            (6) by striking ``mental health benefits'' and inserting 
        ``mental health and substance use disorder benefits'' each 
        place it appears in subsections (a)(1)(B)(i), (a)(1)(C), 
        (a)(2)(B)(i), and (a)(2)(C); and
            (7) by striking ``mental health benefits'' and inserting 
        ``mental health or substance use disorder benefits'' each place 
        it appears (other than in any provision amended by the previous 
        paragraph).
    (d) Regulations.--Not later than 1 year after the date of enactment 
of this Act, the Secretaries of Labor, Health and Human Services, and 
the Treasury shall issue regulations to carry out the amendments made 
by subsections (a), (b), and (c), respectively.
    (e) Effective Date.--
            (1) In general.--The amendments made by this section shall 
        apply with respect to group health plans for plan years 
        beginning after the date that is 1 year after the date of 
        enactment of this Act, regardless of whether regulations have 
        been issued to carry out such amendments by such effective 
        date, except that the amendments made by subsections (a)(5), 
        (b)(5), and (c)(5), relating to striking of certain sunset 
        provisions, shall take effect on January 1, 2009.
            (2) Special rule for collective bargaining agreements.--In 
        the case of a group health plan maintained pursuant to one or 
        more collective bargaining agreements between employee 
        representatives and one or more employers ratified before the 
        date of the enactment of this Act, the amendments made by this 
        section shall not apply to plan years beginning before the 
        later of--
                    (A) the date on which the last of the collective 
                bargaining agreements relating to the plan terminates 
                (determined without regard to any extension thereof 
                agreed to after the date of the enactment of this Act), 
                or
                    (B) January 1, 2009.
        For purposes of subparagraph (A), any plan amendment made 
        pursuant to a collective bargaining agreement relating to the 
        plan which amends the plan solely to conform to any requirement 
        added by this section shall not be treated as a termination of 
        such collective bargaining agreement.
    (f) Assuring Coordination.--The Secretary of Health and Human 
Services, the Secretary of Labor, and the Secretary of the Treasury may 
ensure, through the execution or revision of an interagency memorandum 
of understanding among such Secretaries, that--
            (1) regulations, rulings, and interpretations issued by 
        such Secretaries relating to the same matter over which two or 
        more such Secretaries have responsibility under this section 
        (and the amendments made by this section) are administered so 
        as to have the same effect at all times; and
            (2) coordination of policies relating to enforcing the same 
        requirements through such Secretaries in order to have a 
        coordinated enforcement strategy that avoids duplication of 
        enforcement efforts and assigns priorities in enforcement.
    (g) Conforming Clerical Amendments.--
            (1) ERISA heading.--
                    (A) In general.--The heading of section 712 of the 
                Employee Retirement Income Security Act of 1974 is 
                amended to read as follows:

``SEC. 712. PARITY IN MENTAL HEALTH AND SUBSTANCE USE DISORDER 
              BENEFITS.''.

                    (B) Clerical amendment.--The table of contents in 
                section 1 of such Act is amended by striking the item 
                relating to section 712 and inserting the following new 
                item:

``Sec. 712. Parity in mental health and substance use disorder 
                            benefits.''.
            (2) PHSA heading.--The heading of section 2705 of the 
        Public Health Service Act is amended to read as follows:

``SEC. 2705. PARITY IN MENTAL HEALTH AND SUBSTANCE USE DISORDER 
              BENEFITS.''.

            (3) IRC heading.--
                    (A) In general.--The heading of section 9812 of the 
                Internal Revenue Code of 1986 is amended to read as 
                follows:

``SEC. 9812. PARITY IN MENTAL HEALTH AND SUBSTANCE USE DISORDER 
              BENEFITS.''.

                    (B) Clerical amendment.--The table of sections for 
                subchapter B of chapter 100 of such Code is amended by 
                striking the item relating to section 9812 and 
                inserting the following new item:

``Sec. 9812. Parity in mental health and substance use disorder 
                            benefits.''.
    (h) GAO Study on Coverage and Exclusion of Mental Health and 
Substance Use Disorder Diagnoses.--
            (1) In general.--The Comptroller General of the United 
        States shall conduct a study that analyzes the specific rates, 
        patterns, and trends in coverage and exclusion of specific 
        mental health and substance use disorder diagnoses by health 
        plans and health insurance. The study shall include an analysis 
        of--
                    (A) specific coverage rates for all mental health 
                conditions and substance use disorders;
                    (B) which diagnoses are most commonly covered or 
                excluded;
                    (C) whether implementation of this Act has affected 
                trends in coverage or exclusion of such diagnoses; and
                    (D) the impact of covering or excluding specific 
                diagnoses on participants' and enrollees' health, their 
                health care coverage, and the costs of delivering 
                health care.
            (2) Reports.--Not later than 3 years after the date of the 
        enactment of this Act, and 2 years after the date of submission 
        the first report under this paragraph, the Comptroller General 
        shall submit to Congress a report on the results of the study 
        conducted under paragraph (1).
                                 <all>