[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 5093 Introduced in Senate (IS)]

<DOC>






117th CONGRESS
  2d Session
                                S. 5093

   To further protect patients and improve the accuracy of provider 
          directory information by eliminating ghost networks.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           November 15, 2022

 Ms. Smith (for herself and Mr. Wyden) introduced the following bill; 
     which was read twice and referred to the Committee on Health, 
                     Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
   To further protect patients and improve the accuracy of provider 
          directory information by eliminating ghost networks.

    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 Network and 
Directory Improvement Act''.

SEC. 2. PROTECTING PATIENTS AND IMPROVING THE ACCURACY OF PROVIDER 
              DIRECTORY INFORMATION.

    (a) PHSA.--Section 2799A-5 of the Public Health Service Act (42 
U.S.C. 300gg-115) is amended--
            (1) in subsection (a)--
                    (A) in paragraph (1)--
                            (i) by striking ``For plan years beginning 
                        on or after January 1, 2022, each'' and 
                        inserting ``Each'';
                            (ii) in subparagraph (C), by striking ``; 
                        and'' and inserting a semicolon;
                            (iii) in subparagraph (D), by striking the 
                        period and inserting ``; and''; and
                            (iv) by adding at the end the following:
                    ``(E) ensure that any directory, including the 
                database described in subparagraph (C), containing 
                provider directory information with respect to such 
                plan or such coverage complies with the requirements 
                developed by the appropriate agencies in accordance 
                with paragraph (6) in order to ensure that 
                participants, beneficiaries, and enrollees are able to 
                identify actively participating health care providers 
                and health care facilities.'';
                    (B) in paragraph (2)(A), by striking ``90 days'' 
                and inserting ``30 days'';
                    (C) in paragraph (3)--
                            (i) in the matter preceding subparagraph 
                        (A), by striking ``, in the case such request 
                        is made through a telephone call''; and
                            (ii) in subparagraph (A), by striking 
                        ``call is received, through a written 
                        electronic or print (as requested by such 
                        individual) communication'' and inserting ``a 
                        request is received, by telephone, or through a 
                        written electronic or print communication (as 
                        requested by such individual)'';
                    (D) in paragraph (4)--
                            (i) in subparagraph (A), by striking 
                        ``and'' at the end;
                            (ii) in subparagraph (B), by striking the 
                        period and inserting ``; and''; and
                            (iii) by adding at the end the following:
                    ``(C) information, in plain language, concerning 
                the rights of the participant, beneficiary, or enrollee 
                to cost-sharing protections pursuant to subsection (b) 
                in the event of reliance on inaccurate provider network 
                information supplied by a group health plan or health 
                insurance issuer, and contact information for the State 
                consumer assistance program or ombudsman for more 
                information.'';
                    (E) in paragraph (5), by adding at the end the 
                following: ``Such information shall include a 
                statement, in plain language, concerning the rights of 
                the participant, beneficiary, or enrollee to cost-
                sharing protections pursuant to subsection (b) in the 
                event of reliance on inaccurate provider directory 
                information supplied by a group health plan or health 
                insurance issuer, and contact information for the State 
                consumer assistance program or ombudsman for more 
                information.'';
                    (F) by redesignating paragraphs (6) and (7) as 
                paragraphs (8) and (9), respectively;
                    (G) by inserting after paragraph (5) the following:
            ``(6) Protecting participants, beneficiaries, and enrollees 
        from ghost networks.--The Secretary, in collaboration with the 
        Secretary of Labor and the Secretary of the Treasury, shall--
                    ``(A) not later than 180 days after the date of 
                enactment of the Behavioral Health Network and 
                Directory Improvement Act, issue interim final 
                regulations (without prior notice and comment as 
                required under section 553 of title 5, United States 
                Code) further defining the term `ghost network' (as 
                defined in paragraph (8)); and
                    ``(B) not later than 18 months after the date of 
                enactment of the Behavioral Health Network and 
                Directory Improvement Act, issue interim final 
                regulations (without prior notice and comment as 
                required under section 553 of title 5, United States 
                Code), subregulatory guidance, or program instruction 
                on how to assess ghost networks in health plan 
                directories including reasonable assumptions related to 
                statistics and research methods.
            ``(7) Database reporting and auditing to protect against 
        ghost networks.--
                    ``(A) Reporting requirements.--Beginning not later 
                than 3 years after the date of enactment of the 
                Behavioral Health Network and Directory Improvement 
                Act, each group health plan and health insurance issuer 
                offering group or individual health insurance coverage 
                shall submit to the Secretary, at such time as the 
                Secretary, in coordination with the Secretary of Labor 
                and the Secretary of the Treasury, shall require, but 
                not less frequently than annually, the directory data 
                described in paragraph (a)(4), in a machine readable 
                format (as defined in section 147.210(a)(2)(xiv) of 
                title 45, Code of Federal Regulations (or any successor 
                regulations)). The Secretary, in coordination with the 
                Secretary of Labor and the Secretary of the Treasury, 
                shall make data submitted under this subparagraph 
                available on a public website.
                    ``(B) Provider directory independent audit 
                requirements.--
                            ``(i) In general.--Beginning not later than 
                        3 years after the date of enactment of the 
                        Behavioral Health Network and Directory 
                        Improvement Act, each group health plan and 
                        health insurance issuer offering group or 
                        individual health insurance coverage shall 
                        conduct an annual directory audit, through an 
                        independent entity not associated with the 
                        health plan or issuer, that considers the 
                        factors described in clause (ii)(I)(aa) and 
                        follows the guidelines developed under clause 
                        (ii)(I)(bb).
                            ``(ii) Factors.--
                                    ``(I) In general.--For purposes of 
                                carrying out the audits under this 
                                subparagraph, the Secretary shall--
                                            ``(aa) develop a list of 
                                        factors to be considered; and
                                            ``(bb) provide guidelines 
                                        for carrying out such audits, 
                                        for use by group health plans 
                                        and health insurance issuers, 
                                        on--

                                                    ``(AA) the 
                                                reasonable assumptions 
                                                and research methods to 
                                                select a reasonable 
                                                sample in order to 
                                                assess provider 
                                                directory information 
                                                accuracy; and

                                                    ``(BB) determining 
                                                the criteria of an 
                                                eligible auditor.

                                    ``(II) Contents.--The factors under 
                                subclause (I)(aa) shall include the 
                                following:
                                            ``(aa) A list of every 
                                        health care provider and health 
                                        care facility that was part of 
                                        the network of the applicable 
                                        plan or coverage, the months 
                                        during the plan year during 
                                        which each such provider or 
                                        facility was part of the 
                                        network, and the number of 
                                        participants, beneficiaries, 
                                        and enrollees in the plan or 
                                        coverage (including 
                                        participants, beneficiaries, 
                                        and enrollees who are new 
                                        patients of the provider) each 
                                        such provider or facility 
                                        treated during such period.
                                            ``(bb) The proportion of 
                                        directory listings of the plan 
                                        or coverage with inaccurate 
                                        information, including 
                                        incorrect contact information, 
                                        including incorrect contact 
                                        information, as specified by 
                                        the Secretary, during the audit 
                                        period.
                                            ``(cc) The number of in-
                                        network items or services paid 
                                        on behalf of participants, 
                                        beneficiaries, and enrollees in 
                                        the plan or coverage to 
                                        providers or facilities who 
                                        have a network provider 
                                        contract with the health plan 
                                        or issuer and were not listed 
                                        in the directory of the health 
                                        plan or health insurance 
                                        coverage for the audit period.
                                            ``(dd) The resources of the 
                                        plan or issuer to help 
                                        participants, beneficiaries, 
                                        and enrollees locate an 
                                        accurately listed in-network 
                                        provider who is accepting new 
                                        patients.
                                            ``(ee) The proportion of 
                                        participants, beneficiaries, 
                                        and enrollees using out-of-
                                        network providers for mental 
                                        health and substance use 
                                        disorder services, and the 
                                        proportion of participants, 
                                        beneficiaries, and enrollees 
                                        using out-of-network providers 
                                        and facilities for medical and 
                                        surgical services.
                                            ``(ff) Documentation that 
                                        the plan or issuer verifies the 
                                        accuracy of the provider 
                                        directory information every 30 
                                        days.
                                            ``(gg) Other factors as 
                                        determined by the Secretary.
                            ``(iii) Requirements of the independent 
                        audit.--An audit under this subparagraph is 
                        complete if all of the following conditions are 
                        met:
                                    ``(I) The audit report includes the 
                                following:
                                            ``(aa) A statement by the 
                                        independent auditor that, to 
                                        the best of the auditor's 
                                        knowledge, the report is 
                                        complete and accurate, and that 
                                        reasonable assumptions related 
                                        to statistics and research 
                                        methods have been complied 
                                        with.
                                            ``(bb) A statement 
                                        explaining the assumptions, 
                                        statistics, and methods used to 
                                        select the sample and assess 
                                        provider directory information 
                                        accuracy.
                                            ``(cc) Such other 
                                        information as the Secretary 
                                        determines necessary.
                                    ``(II) The group health plan or 
                                health insurer issuer makes the 
                                independent audit available on a public 
                                website.
                            ``(iv) Rulemaking.--The Secretary, the 
                        Secretary of Labor, and the Secretary of the 
                        Treasury shall issue interim final regulations 
                        (without prior notice and comment as required 
                        under section 553 of title 5, United States 
                        Code) concerning the national standards for 
                        conducting audits under this subparagraph, not 
                        later than 2 years after the date of enactment 
                        of the Behavioral Health Network and Directory 
                        Improvement Act.
                    ``(C) Audits by the secretary.--
                            ``(i) In general.--Beginning not later than 
                        the third plan year after the date of enactment 
                        of the Behavioral Health Network and Directory 
                        Improvement Act, the Secretary shall conduct 
                        annual audits to ensure compliance with the 
                        provider directory requirements of this 
                        subsection.
                            ``(ii) Requirements.--Audits conducted by 
                        the Secretary under this subparagraph shall--
                                    ``(I) assess the accuracy of the 
                                information provided in health plan 
                                directories required under this 
                                subsection, including the proportion of 
                                listings with incorrect information, 
                                the last date on which the behavioral 
                                health network of the group health plan 
                                or health insurance coverage was 
                                updated, and other information 
                                determined appropriate by the 
                                Secretary; and
                                    ``(II) use reasonable assumptions 
                                related to statistics and research 
                                methods to identify a representative 
                                sample of listings for analysis and 
                                such methods as the Secretary 
                                determines appropriate, which may 
                                include retrospective analysis of 
                                billing data.
                            ``(iii) Selection of plans and issuers.--
                        The Secretary shall conduct annual audits of a 
                        total of not fewer than 10 group health plans 
                        or health insurance issuers offering group or 
                        individual health insurance coverage, as 
                        determined by the Secretary, that are the 
                        subjects of complaints about ghost networks or 
                        other complaints, or that are randomly selected 
                        by the Secretary.''; and
                    (H) in paragraph (8), as so redesignated--
                            (i) in the paragraph heading, by striking 
                        ``Definition'' and inserting ``Definitions'';
                            (ii) by striking ``For purposes of this 
                        subsection, the term'' and inserting the 
                        following: ``For purposes of this subsection:
                    ``(A) Provider directory information.--The term'';
                            (iii) by striking ``health insurance 
                        coverage, the name'' and inserting ``health 
                        insurance coverage--
                            ``(i) the name'';
                            (iv) by striking the period and inserting 
                        ``; and''; and
                            (v) by adding at the end the following:
                            ``(ii) with respect to each such provider 
                        or facility--
                                    ``(I) whether such provider or 
                                facility is accepting new patients;
                                    ``(II) the languages spoken and the 
                                availability of language translators 
                                for specified languages at each health 
                                care facility listed in the directory;
                                    ``(III) whether the provider or 
                                facility offers medication-assisted 
                                treatment for opioid use disorder;
                                    ``(IV) the State license number;
                                    ``(V) the national provider 
                                identifier;
                                    ``(VI) the age groups served by the 
                                provider or facility, such as 
                                pediatric, adolescent, adult, or 
                                geriatric populations;
                                    ``(VII) whether such provider or 
                                facility offers in-person services, 
                                telehealth services, or both; and
                                    ``(VIII) the cost-sharing tier, if 
                                applicable.
                    ``(B) Ghost network.--The term `ghost network' 
                means a group health plan or group or individual health 
                insurance coverage for which the provider directory 
                information describing the network of such plan or 
                coverage--
                            ``(i) does not include accurate required 
                        information for purposes of making an 
                        appointment for in-network care within a 
                        reasonable time period;
                            ``(ii) includes a meaningful number of 
                        providers and facilities (as specified by the 
                        Secretary, in coordination with the Secretary 
                        of Labor and the Secretary of the Treasury) in 
                        a specialty who are not accepting new patients 
                        within a time period specified by such 
                        secretaries;
                            ``(iii) includes providers that are not 
                        part of the network; or
                            ``(iv) omits providers that are part of the 
                        network.''; and
            (2) in subsection (b)--
                    (A) in paragraph (1), by striking ``and if either 
                of the criteria described in paragraph (2) applies with 
                respect to such participant, beneficiary, or enrollee 
                and item or service''; and
                    (B) by striking paragraph (2) and inserting the 
                following:
            ``(2) Reconciliation requirement.--For purposes of 
        paragraph (1), a group health plan or group or individual 
        health insurance coverage offered by a health insurance issuer, 
        on a regular basis, shall reconcile payment requests for items 
        or services furnished by a nonparticipating provider or a 
        nonparticipating facility and the posted provider directory 
        database for the day the delivered item or service was 
        provided. If a nonparticipating provider was listed as a 
        participating provider in the directory, the group health plan 
        or health insurance issuer shall notify the participant, 
        beneficiary, or enrollee, in plain language, that the 
        participant, beneficiary, or enrollee may be eligible for a 
        refund from the group health plan or health insurance issuer if 
        such participant, beneficiary, or enrollee paid the out of 
        network cost-sharing and did not receive a refund under section 
        2799B-9(b).''.
    (b) ERISA.--
            (1) In general.--Section 720 of the Employee Retirement 
        Income Security Act of 1974 (29 U.S.C. 1185i) is amended--
                    (A) in subsection (a)--
                            (i) in paragraph (1)--
                                    (I) by striking ``For plan years 
                                beginning on or after January 1, 2022, 
                                each'' and inserting ``Each'';
                                    (II) in subparagraph (C), by 
                                striking ``; and'' and inserting a 
                                semicolon;
                                    (III) in subparagraph (D), by 
                                striking the period and inserting ``; 
                                and''; and
                                    (IV) by adding at the end the 
                                following:
                    ``(E) ensure that any directory, including the 
                database described in subparagraph (C), containing 
                provider directory information with respect to such 
                plan or such coverage complies with the requirements 
                developed by the appropriate agencies in accordance 
                with paragraph (6) in order to ensure that 
                participants, beneficiaries, and enrollees are able to 
                identify actively participating health care providers 
                and health care facilities.'';
                            (ii) in paragraph (2)(A), by striking ``90 
                        days'' and inserting ``30 days'';
                            (iii) in paragraph (3)--
                                    (I) in the matter preceding 
                                subparagraph (A), by striking ``, in 
                                the case such request is made through a 
                                telephone call''; and
                                    (II) in subparagraph (A), by 
                                striking ``call is received, through a 
                                written electronic or print (as 
                                requested by such individual) 
                                communication'' and inserting ``a 
                                request is received, by telephone, or 
                                through a written electronic or print 
                                communication (as requested by such 
                                individual)'';
                            (iv) in paragraph (4)--
                                    (I) in subparagraph (A), by 
                                striking ``and'' at the end;
                                    (II) in subparagraph (B), by 
                                striking the period and inserting ``; 
                                and''; and
                                    (III) by adding at the end the 
                                following:
                    ``(C) information, in plain language, concerning 
                the rights of the participant, beneficiary, or enrollee 
                to cost-sharing protections pursuant to subsection (b) 
                in the event of reliance on inaccurate provider network 
                information supplied by a group health plan or health 
                insurance issuer, and contact information for the State 
                consumer assistance program or ombudsman for more 
                information.'';
                            (v) in paragraph (5), by adding at the end 
                        the following: ``Such information shall include 
                        a statement, in plain language, concerning the 
                        rights of the participant, beneficiary, or 
                        enrollee to cost-sharing protections pursuant 
                        to subsection (b) in the event of reliance on 
                        inaccurate provider directory information 
                        supplied by a group health plan or health 
                        insurance issuer, and contact information for 
                        the State consumer assistance program or 
                        ombudsman for more information.'';
                            (vi) by redesignating paragraphs (6) and 
                        (7) as paragraphs (8) and (9), respectively;
                            (vii) by inserting after paragraph (5) the 
                        following:
            ``(6) Protecting participants, beneficiaries, and enrollees 
        from ghost networks.--The Secretary, in collaboration with the 
        Secretary of Labor and the Secretary of the Treasury, shall--
                    ``(A) not later than 180 days after the date of 
                enactment of the Behavioral Health Network and 
                Directory Improvement Act, issue interim final 
                regulations (without prior notice and comment as 
                required under section 553 of title 5, United States 
                Code) further defining the term `ghost network' (as 
                defined in paragraph (8)); and
                    ``(B) not later than 18 months after the date of 
                enactment of the Behavioral Health Network and 
                Directory Improvement Act, issue interim final 
                regulations (without prior notice and comment as 
                required under section 553 of title 5, United States 
                Code), subregulatory guidance, or program instruction 
                on how to assess ghost networks in health plan 
                directories including reasonable assumptions related to 
                statistics and research methods.
            ``(7) Database reporting and auditing to protect against 
        ghost networks.--
                    ``(A) Reporting requirements.--Beginning not later 
                than 3 years after the date of enactment of the 
                Behavioral Health Network and Directory Improvement 
                Act, each group health plan and health insurance issuer 
                offering group health insurance coverage shall submit 
                to the Secretary, at such time as the Secretary, in 
                coordination with the Secretary of Health and Human 
                Services and the Secretary of the Treasury, shall 
                require, but not less frequently than annually, the 
                directory data described in paragraph (a)(4), in a 
                machine readable format (as defined in section 
                147.210(a)(2)(xiv) of title 45, Code of Federal 
                Regulations (or any successor regulations)). The 
                Secretary, in coordination with the Secretary of Health 
                and Human Services and the Secretary of the Treasury, 
                shall make data submitted under this subparagraph 
                available on a public website.
                    ``(B) Provider directory independent audit 
                requirements.--
                            ``(i) In general.--Beginning not later than 
                        3 years after the date of enactment of the 
                        Behavioral Health Network and Directory 
                        Improvement Act, each group health plan and 
                        health insurance issuer offering group health 
                        insurance coverage shall conduct an annual 
                        directory audit, through an independent entity 
                        not associated with the health plan or issuer, 
                        that considers the factors described in clause 
                        (ii)(I)(aa) and follows the guidelines 
                        developed under clause (ii)(I)(bb).
                            ``(ii) Factors.--
                                    ``(I) In general.--For purposes of 
                                carrying out the audits under this 
                                subparagraph, the Secretary shall--
                                            ``(aa) develop a list of 
                                        factors to be considered; and
                                            ``(bb) provide guidelines 
                                        for carrying out such audits, 
                                        for use by group health plans 
                                        and health insurance issuers, 
                                        on--

                                                    ``(AA) the 
                                                reasonable assumptions 
                                                and research methods to 
                                                select a reasonable 
                                                sample in order to 
                                                assess provider 
                                                directory information 
                                                accuracy; and

                                                    ``(BB) determining 
                                                the criteria of an 
                                                eligible auditor.

                                    ``(II) Contents.--The factors under 
                                subclause (I)(aa) shall include the 
                                following:
                                            ``(aa) A list of every 
                                        health care provider and health 
                                        care facility that was part of 
                                        the network of the applicable 
                                        plan or coverage, the months 
                                        during the plan year during 
                                        which each such provider or 
                                        facility was part of the 
                                        network, and the number of 
                                        participants, beneficiaries, 
                                        and enrollees in the plan or 
                                        coverage (including 
                                        participants, beneficiaries, 
                                        and enrollees who are new 
                                        patients of the provider) each 
                                        such provider or facility 
                                        treated during such period.
                                            ``(bb) The proportion of 
                                        directory listings of the plan 
                                        or coverage with inaccurate 
                                        information, including 
                                        incorrect contact information, 
                                        including incorrect contact 
                                        information, as specified by 
                                        the Secretary, during the audit 
                                        period.
                                            ``(cc) The number of in-
                                        network items or services paid 
                                        on behalf of participants, 
                                        beneficiaries, and enrollees in 
                                        the plan or coverage to 
                                        providers or facilities who 
                                        have a network provider 
                                        contract with the health plan 
                                        or issuer and were not listed 
                                        in the directory of the health 
                                        plan or health insurance 
                                        coverage for the audit period.
                                            ``(dd) The resources of the 
                                        plan or issuer to help 
                                        participants, beneficiaries, 
                                        and enrollees locate an 
                                        accurately listed in-network 
                                        provider who is accepting new 
                                        patients.
                                            ``(ee) The proportion of 
                                        participants, beneficiaries, 
                                        and enrollees using out-of-
                                        network providers for mental 
                                        health and substance use 
                                        disorder services, and the 
                                        proportion of participants, 
                                        beneficiaries, and enrollees 
                                        using out-of-network providers 
                                        and facilities for medical and 
                                        surgical services.
                                            ``(ff) Documentation that 
                                        the plan or issuer verifies the 
                                        accuracy of the provider 
                                        directory information every 30 
                                        days.
                                            ``(gg) Other factors as 
                                        determined by the Secretary.
                            ``(iii) Requirements of the independent 
                        audit.--An audit under this subparagraph is 
                        complete if all of the following conditions are 
                        met:
                                    ``(I) The audit report includes the 
                                following:
                                            ``(aa) A statement by the 
                                        independent auditor that, to 
                                        the best of the auditor's 
                                        knowledge, the report is 
                                        complete and accurate, and that 
                                        reasonable assumptions related 
                                        to statistics and research 
                                        methods have been complied 
                                        with.
                                            ``(bb) A statement 
                                        explaining the assumptions, 
                                        statistics, and methods used to 
                                        select the sample and assess 
                                        provider directory information 
                                        accuracy.
                                            ``(cc) Such other 
                                        information as the Secretary 
                                        determines necessary.
                                    ``(II) The group health plan or 
                                health insurer issuer makes the 
                                independent audit available on a public 
                                website.
                            ``(iv) Rulemaking.--The Secretary, the 
                        Secretary of Health and Human Services, and the 
                        Secretary of the Treasury shall issue interim 
                        final regulations (without prior notice and 
                        comment as required under section 553 of title 
                        5, United States Code) concerning the national 
                        standards for conducting audits under this 
                        subparagraph, not later than 2 years after the 
                        date of enactment of the Behavioral Health 
                        Network and Directory Improvement Act.
                    ``(C) Audits by the secretary.--
                            ``(i) In general.--Beginning not later than 
                        the third plan year after the date of enactment 
                        of the Behavioral Health Network and Directory 
                        Improvement Act, the Secretary shall conduct 
                        annual audits to ensure compliance with the 
                        provider directory requirements of this 
                        subsection.
                            ``(ii) Requirements.--Audits conducted by 
                        the Secretary under this subparagraph shall--
                                    ``(I) assess the accuracy of the 
                                information provided in health plan 
                                directories required under this 
                                subsection, including the proportion of 
                                listings with incorrect information, 
                                the last date on which the behavioral 
                                health network of the group health plan 
                                or health insurance coverage was 
                                updated, and other information 
                                determined appropriate by the 
                                Secretary; and
                                    ``(II) use reasonable assumptions 
                                related to statistics and research 
                                methods to identify a representative 
                                sample of listings for analysis and 
                                such methods as the Secretary 
                                determines appropriate, which may 
                                include retrospective analysis of 
                                billing data.
                            ``(iii) Selection of plans and issuers.--
                        The Secretary shall conduct annual audits of a 
                        total of not fewer than 10 group health plans 
                        or health insurance issuers offering group 
                        health insurance coverage, as determined by the 
                        Secretary, that are the subjects of complaints 
                        about ghost networks or other complaints, or 
                        that are randomly selected by the Secretary.''; 
                        and
                            (viii) in paragraph (8), as so 
                        redesignated--
                                    (I) in the paragraph heading, by 
                                striking ``Definition'' and inserting 
                                ``Definitions'';
                                    (II) by striking ``For purposes of 
                                this subsection, the term'' and 
                                inserting the following: ``For purposes 
                                of this subsection:
                    ``(A) Provider directory information.--The term'';
                                    (III) by striking ``health 
                                insurance coverage, the name'' and 
                                inserting ``health insurance coverage--
                            ``(i) the name'';
                                    (IV) by striking the period and 
                                inserting ``; and''; and
                                    (V) by adding at the end the 
                                following:
                            ``(ii) with respect to each such provider 
                        or facility--
                                    ``(I) whether such provider or 
                                facility is accepting new patients;
                                    ``(II) the languages spoken and the 
                                availability of language translators 
                                for specified languages at each health 
                                care facility listed in the directory;
                                    ``(III) whether the provider or 
                                facility offers medication-assisted 
                                treatment for opioid use disorder;
                                    ``(IV) the State license number;
                                    ``(V) the national provider 
                                identifier;
                                    ``(VI) the age groups served by the 
                                provider or facility, such as 
                                pediatric, adolescent, adult, or 
                                geriatric populations;
                                    ``(VII) whether such provider or 
                                facility offers in-person services, 
                                telehealth services, or both; and
                                    ``(VIII) the cost-sharing tier, if 
                                applicable.
                    ``(B) Ghost network.--The term `ghost network' 
                means a group health plan or group health insurance 
                coverage for which the provider directory information 
                describing the network of such plan or coverage--
                            ``(i) does not include accurate required 
                        information for purposes of making an 
                        appointment for in-network care within a 
                        reasonable time period;
                            ``(ii) includes a meaningful number of 
                        providers and facilities (as specified by the 
                        Secretary, in coordination with the Secretary 
                        of Health and Human Services and the Secretary 
                        of the Treasury) in a specialty who are not 
                        accepting new patients within a time period 
                        specified by such secretaries;
                            ``(iii) includes providers that are not 
                        part of the network; or
                            ``(iv) omits providers that are part of the 
                        network.''; and
                    (B) in subsection (b)--
                            (i) in paragraph (1), by striking ``and if 
                        either of the criteria described in paragraph 
                        (2) applies with respect to such participant, 
                        beneficiary, or enrollee and item or service''; 
                        and
                            (ii) by striking paragraph (2) and 
                        inserting the following:
            ``(2) Reconciliation requirement.--For purposes of 
        paragraph (1), a group health plan or group health insurance 
        coverage offered by a health insurance issuer, on a regular 
        basis, shall reconcile payment requests for items or services 
        furnished by a nonparticipating provider or a nonparticipating 
        facility and the posted provider directory database for the day 
        the delivered item or service was provided. If a 
        nonparticipating provider was listed as a participating 
        provider in the directory, the group health plan or health 
        insurance issuer shall notify the participant, beneficiary, or 
        enrollee, in plain language, that the participant, beneficiary, 
        or enrollee may be eligible for a refund from the group health 
        plan or health insurance issuer if such participant, 
        beneficiary, or enrollee paid the out of network cost-sharing 
        and did not receive a refund under section 2799B-9(b) of the 
        Public Health Service Act (42 U.S.C. 300gg-139).''.
            (2) Civil monetary penalties for violations.--
                    (A) Civil monetary penalties relating to provider 
                directory requirements.--Section 502(c)(10) of the 
                Employee Retirement Income Security Act of 1974 (29 
                U.S.C. 1132(c)(10)(A)) is amended--
                            (i) in the heading, by striking ``use of 
                        genetic information'' and inserting ``use of 
                        genetic information and provider directory 
                        requirements''; and
                            (ii) in subparagraph (A)--
                                    (I) by striking ``any plan sponsor 
                                of a group health plan'' and inserting 
                                ``any plan sponsor or plan 
                                administrator of a group health plan''; 
                                and
                                    (II) by striking ``for any 
                                failure'' and all that follows through 
                                ``in connection with the plan.'' and 
                                inserting ``for any failure by such 
                                plan sponsor, plan administrator, or 
                                health insurance issuer, in connection 
                                with the plan--
                            ``(i) to meet the requirements of 
                        subsection (a)(1)(F), (b)(3), (c), or (d) of 
                        section 702 or section 701 or 702(b)(1) with 
                        respect to genetic information; or
                            ``(ii) to meet the requirements of section 
                        720 with respect to provider directory 
                        information.''.
                    (B) Exception to the general prohibition on 
                enforcement.--Section 502 of such Act (29 U.S.C. 1132) 
                is amended--
                            (i) in subsection (a)(6), by striking ``or 
                        (9)'' and inserting ``(9), or (10)''; and
                            (ii) in subsection (b)(3)--
                                    (I) by striking ``subsections 
                                (c)(9) and (a)(6)'' and inserting 
                                ``subsections (c)(9), (c)(10), and 
                                (a)(6)'';
                                    (II) by striking ``under subsection 
                                (c)(9))'' and inserting ``under 
                                subsections (c)(9) and (c)(10)), and 
                                except with respect to enforcement by 
                                the Secretary of section 720''; and
                                    (III) by striking ``706(a)(1)'' and 
                                inserting ``733(a)(1)''.
                    (C) Effective date.--The amendments made by 
                subparagraph (A) shall apply with respect to group 
                health plans, or any health insurance issuer offering 
                health insurance coverage in connection with such plan, 
                for plan years beginning after the date that is 1 year 
                after the date of enactment of this Act.
    (c) IRC.--Section 9820 of the Internal Revenue Code of 1986 is 
amended--
            (1) in subsection (a)--
                    (A) in paragraph (1)--
                            (i) by striking ``For plan years beginning 
                        on or after January 1, 2022, each'' and 
                        inserting ``Each'';
                            (ii) in subparagraph (C), by striking ``; 
                        and'' and inserting a semicolon;
                            (iii) in subparagraph (D), by striking the 
                        period and inserting ``; and''; and
                            (iv) by adding at the end the following:
                    ``(E) ensure that any directory, including the 
                database described in subparagraph (C), containing 
                provider directory information with respect to such 
                plan complies with the requirements developed by the 
                appropriate agencies in accordance with paragraph (6) 
                in order to ensure that participants, beneficiaries, 
                and enrollees are able to identify actively 
                participating health care providers and health care 
                facilities.'';
                    (B) in paragraph (2)(A), by striking ``90 days'' 
                and inserting ``30 days'';
                    (C) in paragraph (3)--
                            (i) in the matter preceding subparagraph 
                        (A), by striking ``, in the case such request 
                        is made through a telephone call''; and
                            (ii) in subparagraph (A), by striking 
                        ``call is received, through a written 
                        electronic or print (as requested by such 
                        individual) communication'' and inserting ``a 
                        request is received, by telephone, or through a 
                        written electronic or print communication (as 
                        requested by such individual)'';
                    (D) in paragraph (4)--
                            (i) in subparagraph (A), by striking 
                        ``and'' at the end;
                            (ii) in subparagraph (B), by striking the 
                        period and inserting ``; and''; and
                            (iii) by adding at the end the following:
                    ``(C) information, in plain language, concerning 
                the rights of the participant, beneficiary, or enrollee 
                to cost-sharing protections pursuant to subsection (b) 
                in the event of reliance on inaccurate provider network 
                information supplied by a group health plan, and 
                contact information for the State consumer assistance 
                program or ombudsman for more information.'';
                    (E) in paragraph (5), by adding at the end the 
                following: ``Such information shall include a 
                statement, in plain language, concerning the rights of 
                the participant, beneficiary, or enrollee to cost-
                sharing protections pursuant to subsection (b) in the 
                event of reliance on inaccurate provider directory 
                information supplied by a group health plan, and 
                contact information for the State consumer assistance 
                program or ombudsman for more information.'';
                    (F) by redesignating paragraphs (6) and (7) as 
                paragraphs (8) and (9), respectively;
                    (G) by inserting after paragraph (5) the following:
            ``(6) Protecting participants, beneficiaries, and enrollees 
        from ghost networks.--The Secretary, in collaboration with the 
        Secretary of Labor and the Secretary of Health and Human 
        Services, shall--
                    ``(A) not later than 180 days after the date of 
                enactment of the Behavioral Health Network and 
                Directory Improvement Act, issue interim final 
                regulations (without prior notice and comment as 
                required under section 553 of title 5, United States 
                Code) further defining the term `ghost network' (as 
                defined in paragraph (8)); and
                    ``(B) not later than 18 months after the date of 
                enactment of the Behavioral Health Network and 
                Directory Improvement Act, issue interim final 
                regulations (without prior notice and comment as 
                required under section 553 of title 5, United States 
                Code), subregulatory guidance, or program instruction 
                on how to assess ghost networks in health plan 
                directories including reasonable assumptions related to 
                statistics and research methods.
            ``(7) Database reporting and auditing to protect against 
        ghost networks.--
                    ``(A) Reporting requirements.--Beginning not later 
                than 3 years after the date of enactment of the 
                Behavioral Health Network and Directory Improvement 
                Act, each group health plan shall submit to the 
                Secretary, at such time as the Secretary, in 
                coordination with the Secretary of Labor and the 
                Secretary of Health and Human Services, shall require, 
                but not less frequently than annually, the directory 
                data described in paragraph (a)(4), in a machine 
                readable format (as defined in section 
                147.210(a)(2)(xiv) of title 45, Code of Federal 
                Regulations (or any successor regulations)). The 
                Secretary, in coordination with the Secretary of Labor 
                and the Secretary of Health and Human Services, shall 
                make data submitted under this subparagraph available 
                on a public website.
                    ``(B) Provider directory independent audit 
                requirements.--
                            ``(i) In general.--Beginning not later than 
                        3 years after the date of enactment of the 
                        Behavioral Health Network and Directory 
                        Improvement Act, each group health plan shall 
                        conduct an annual directory audit, through an 
                        independent entity not associated with the 
                        health plan, that considers the factors 
                        described in clause (ii)(I)(aa) and follows the 
                        guidelines developed under clause (ii)(I)(bb).
                            ``(ii) Factors.--
                                    ``(I) In general.--For purposes of 
                                carrying out the audits under this 
                                subparagraph, the Secretary shall--
                                            ``(aa) develop a list of 
                                        factors to be considered; and
                                            ``(bb) provide guidelines 
                                        for carrying out such audits, 
                                        for use by group health plans, 
                                        on--

                                                    ``(AA) the 
                                                reasonable assumptions 
                                                and research methods to 
                                                select a reasonable 
                                                sample in order to 
                                                assess provider 
                                                directory information 
                                                accuracy; and

                                                    ``(BB) determining 
                                                the criteria of an 
                                                eligible auditor.

                                    ``(II) Contents.--The factors under 
                                subclause (I)(aa) shall include the 
                                following:
                                            ``(aa) A list of every 
                                        health care provider and health 
                                        care facility that was part of 
                                        the network of the applicable 
                                        plan, the months during the 
                                        plan year during which each 
                                        such provider or facility was 
                                        part of the network, and the 
                                        number of participants, 
                                        beneficiaries, and enrollees in 
                                        the plan (including 
                                        participants, beneficiaries, 
                                        and enrollees who are new 
                                        patients of the provider) each 
                                        such provider or facility 
                                        treated during such period.
                                            ``(bb) The proportion of 
                                        directory listings of the plan 
                                        with inaccurate information, 
                                        including incorrect contact 
                                        information, including 
                                        incorrect contact information, 
                                        as specified by the Secretary, 
                                        during the audit period.
                                            ``(cc) The number of in-
                                        network items or services paid 
                                        on behalf of participants, 
                                        beneficiaries, and enrollees in 
                                        the plan to providers or 
                                        facilities who have a network 
                                        provider contract with the 
                                        health plan and were not listed 
                                        in the directory of the health 
                                        plan for the audit period.
                                            ``(dd) The resources of the 
                                        plan to help participants, 
                                        beneficiaries, and enrollees 
                                        locate an accurately listed in-
                                        network provider who is 
                                        accepting new patients.
                                            ``(ee) The proportion of 
                                        participants, beneficiaries, 
                                        and enrollees using out-of-
                                        network providers for mental 
                                        health and substance use 
                                        disorder services, and the 
                                        proportion of participants, 
                                        beneficiaries, and enrollees 
                                        using out-of-network providers 
                                        and facilities for medical and 
                                        surgical services.
                                            ``(ff) Documentation that 
                                        the plan verifies the accuracy 
                                        of the provider directory 
                                        information every 30 days.
                                            ``(gg) Other factors as 
                                        determined by the Secretary.
                            ``(iii) Requirements of the independent 
                        audit.--An audit under this subparagraph is 
                        complete if all of the following conditions are 
                        met:
                                    ``(I) The audit report includes the 
                                following:
                                            ``(aa) A statement by the 
                                        independent auditor that, to 
                                        the best of the auditor's 
                                        knowledge, the report is 
                                        complete and accurate, and that 
                                        reasonable assumptions related 
                                        to statistics and research 
                                        methods have been complied 
                                        with.
                                            ``(bb) A statement 
                                        explaining the assumptions, 
                                        statistics, and methods used to 
                                        select the sample and assess 
                                        provider directory information 
                                        accuracy.
                                            ``(cc) Such other 
                                        information as the Secretary 
                                        determines necessary.
                                    ``(II) The group health plan makes 
                                the independent audit available on a 
                                public website.
                            ``(iv) Rulemaking.--The Secretary, the 
                        Secretary of Labor, and the Secretary of Health 
                        and Human Services shall issue interim final 
                        regulations (without prior notice and comment 
                        as required under section 553 of title 5, 
                        United States Code) concerning the national 
                        standards for conducting audits under this 
                        subparagraph, not later than 2 years after the 
                        date of enactment of the Behavioral Health 
                        Network and Directory Improvement Act.
                    ``(C) Audits by the secretary.--
                            ``(i) In general.--Beginning not later than 
                        the third plan year after the date of enactment 
                        of the Behavioral Health Network and Directory 
                        Improvement Act, the Secretary shall conduct 
                        annual audits to ensure compliance with the 
                        provider directory requirements of this 
                        subsection.
                            ``(ii) Requirements.--Audits conducted by 
                        the Secretary under this subparagraph shall--
                                    ``(I) assess the accuracy of the 
                                information provided in health plan 
                                directories required under this 
                                subsection, including the proportion of 
                                listings with incorrect information, 
                                the last date on which the behavioral 
                                health network of the group health plan 
                                was updated, and other information 
                                determined appropriate by the 
                                Secretary; and
                                    ``(II) use reasonable assumptions 
                                related to statistics and research 
                                methods to identify a representative 
                                sample of listings for analysis and 
                                such methods as the Secretary 
                                determines appropriate, which may 
                                include retrospective analysis of 
                                billing data.
                            ``(iii) Selection of plans.--The Secretary 
                        shall conduct annual audits of a total of not 
                        fewer than 10 group health plans, as determined 
                        by the Secretary, that are the subjects of 
                        complaints about ghost networks or other 
                        complaints, or that are randomly selected by 
                        the Secretary.''; and
                    (H) in paragraph (8), as so redesignated--
                            (i) in the paragraph heading, by striking 
                        ``Definition'' and inserting ``Definitions'';
                            (ii) by striking ``For purposes of this 
                        subsection, the term'' and inserting the 
                        following: ``For purposes of this subsection:
                    ``(A) Provider directory information.--The term'';
                            (iii) by striking ``group health plan, the 
                        name'' and inserting ``group health plan--
                            ``(i) the name'';
                            (iv) by striking the period and inserting 
                        ``; and''; and
                            (v) by adding at the end the following:
                            ``(ii) with respect to each such provider 
                        or facility--
                                    ``(I) whether such provider or 
                                facility is accepting new patients;
                                    ``(II) the languages spoken and the 
                                availability of language translators 
                                for specified languages at each health 
                                care facility listed in the directory;
                                    ``(III) whether the provider or 
                                facility offers medication-assisted 
                                treatment for opioid use disorder;
                                    ``(IV) the State license number;
                                    ``(V) the national provider 
                                identifier;
                                    ``(VI) the age groups served by the 
                                provider or facility, such as 
                                pediatric, adolescent, adult, or 
                                geriatric populations;
                                    ``(VII) whether such provider or 
                                facility offers in-person services, 
                                telehealth services, or both; and
                                    ``(VIII) the cost-sharing tier, if 
                                applicable.
                    ``(B) Ghost network.--The term `ghost network' 
                means a group health plan for which the provider 
                directory information describing the network of such 
                plan--
                            ``(i) does not include accurate required 
                        information for purposes of making an 
                        appointment for in-network care within a 
                        reasonable time period;
                            ``(ii) includes a meaningful number of 
                        providers and facilities (as specified by the 
                        Secretary, in coordination with the Secretary 
                        of Labor and the Secretary of Health and Human 
                        Services) in a specialty who are not accepting 
                        new patients within a time period specified by 
                        such secretaries;
                            ``(iii) includes providers that are not 
                        part of the network; or
                            ``(iv) omits providers that are part of the 
                        network.''; and
            (2) in subsection (b)--
                    (A) in paragraph (1), by striking ``and if either 
                of the criteria described in paragraph (2) applies with 
                respect to such participant, beneficiary, or enrollee 
                and item or service''; and
                    (B) by striking paragraph (2) and inserting the 
                following:
            ``(2) Reconciliation requirement.--For purposes of 
        paragraph (1), a group health plan, on a regular basis, shall 
        reconcile payment requests for items or services furnished by a 
        nonparticipating provider or a nonparticipating facility and 
        the posted provider directory database for the day the 
        delivered item or service was provided. If a nonparticipating 
        provider was listed as a participating provider in the 
        directory, the group health plan shall notify the participant, 
        beneficiary, or enrollee, in plain language, that the 
        participant, beneficiary, or enrollee may be eligible for a 
        refund from the group health plan if such participant, 
        beneficiary, or enrollee paid the out of network cost-sharing 
        and did not receive a refund under section 2799B-9(b) of the 
        Public Health Service Act (42 U.S.C. 300gg-139).''.

SEC. 3. PROVIDER REQUIREMENTS TO PROTECT PATIENTS AND IMPROVE THE 
              ACCURACY OF PROVIDER DIRECTORY INFORMATION.

    Section 2799B-9 of the Public Health Service Act (42 U.S.C. 300gg-
139) is amended--
            (1) in subsection (a)--
                    (A) in paragraph (3), by striking ``; and'' and 
                inserting a semicolon;
                    (B) by redesignating paragraph (4) as paragraph 
                (6); and
                    (C) by inserting after paragraph (3) the following:
            ``(4) subject to paragraph (5), when a provider or facility 
        that is not accepting new patients determines that it has the 
        ability to accept new patients, within 5 business days of such 
        determination;
            ``(5) when a solo practitioner or small provider, as 
        determined by the Secretary, determines that it has the ability 
        to accept new patients, within 10 business days of such 
        determination; and''; and
            (2) by amending subsection (d) to read as follows:
    ``(d) Definition.--For purposes of this section, the term `provider 
directory information' includes--
            ``(1) the name, address, specialty, telephone number, and 
        digital contact information of each individual health care 
        provider contracted to participate in any of the networks of 
        the group health plan or health insurance coverage involved;
            ``(2) the name, address, specialty, telephone number, and 
        digital contact information of each medical group, clinic, or 
        facility contracted to participate in any of the networks of 
        the group health plan or health insurance coverage involved; 
        and
            ``(3) with respect to each such provider, medical group, 
        clinic, or facility--
                    ``(A) whether such provider, medical group, clinic, 
                or facility is accepting new patients;
                    ``(B) the languages spoken and the availability of 
                language translators for specified languages at each 
                provider, medical group, clinic, or facility listed in 
                the directory;
                    ``(C) whether the provider, medical group, clinic, 
                or facility offers medication-assisted treatment for 
                opioid use disorder;
                    ``(D) the State license number;
                    ``(E) the national provider identifier;
                    ``(F) the age groups served by such provider, 
                group, clinic, or facility, such as pediatric, 
                adolescent, adult, or geriatric populations;
                    ``(G) whether such provider, group, clinic, or 
                facility offers in-person services, telehealth 
                services, or both; and
                    ``(H) the cost-sharing tier, if applicable.''.

SEC. 4. STRENGTHENING MENTAL HEALTH AND SUBSTANCE USE DISORDER PARITY 
              REQUIREMENTS.

    (a) PHSA.--
            (1) Network adequacy requirements.--Section 2726(a) of the 
        Public Health Service Act (42 U.S.C. 300gg-26(a)) is amended by 
        adding at the end the following:
            ``(9) Network adequacy requirements.--
                    ``(A) In general.--The Secretary, the Secretary of 
                Labor, and the Secretary of the Treasury shall issue 
                regulations establishing national quantitative 
                standards for mental health and substance use disorder 
                network adequacy. Such standards shall consider--
                            ``(i) the ratio of in-network mental health 
                        providers, separated by professional type of 
                        mental health provider, to participants, 
                        beneficiaries, and enrollees in a group health 
                        plan or health insurance coverage;
                            ``(ii) the ratio of in-network substance 
                        use disorder providers, separated by 
                        professional type of substance use disorder 
                        provider, to participants, beneficiaries, and 
                        enrollees in a group health plan or health 
                        insurance coverage;
                            ``(iii) separately, for each of mental 
                        health services and substance use disorder 
                        services--
                                    ``(I) geographic accessibility of 
                                providers;
                                    ``(II) geographic variation and 
                                population dispersion;
                                    ``(III) waiting times for 
                                appointments with participating 
                                providers;
                                    ``(IV) hours of operation for 
                                participating providers;
                                    ``(V) the ability of the network to 
                                meet the needs of participants, 
                                beneficiaries, and enrollees, including 
                                low-income individuals, individuals who 
                                are members of a racial or ethnic 
                                minority, individuals who live in a 
                                health professional shortage area, 
                                children and adults with serious, 
                                chronic, and complex health conditions, 
                                individuals with physical or mental 
                                disabilities or substance use 
                                disorders, pediatric populations, and 
                                individuals with limited English 
                                proficiency;
                                    ``(VI) the availability of in-
                                person services, telehealth services, 
                                and hybrid services to serve the needs 
                                of participants, beneficiaries, and 
                                enrollees; and
                                    ``(VII) the percentage of in-
                                network providers who have submitted a 
                                claim for payment during the previous 6 
                                months; and
                            ``(iv) other standards as determined by the 
                        Secretary, the Secretary of Labor, and the 
                        Secretary of the Treasury.
                    ``(B) Timing.--
                            ``(i) Issuance.--The Secretary, the 
                        Secretary of Labor, and the Secretary of the 
                        Treasury shall--
                                    ``(I) issue proposed regulations 
                                required under subparagraph (A) not 
                                later than 2 years after the date of 
                                enactment of the Behavioral Health 
                                Network and Directory Improvement Act; 
                                and
                                    ``(II) issue final regulations 
                                under subparagraph (A) not later than 1 
                                year thereafter.
                            ``(ii) Effective date.--The regulations 
                        promulgated under this paragraph shall take 
                        effect in the first plan year that begins after 
                        the date on which such final regulations are 
                        issued.
                    ``(C) Audits.--The Secretary, the Secretary of 
                Labor, and the Secretary of the Treasury shall conduct 
                annual, targeted audits of not fewer than 10 group 
                health plans and health insurance issuers offering 
                group or individual health insurance coverage that the 
                Secretaries determine to be the subject of the greatest 
                number of complaints about mental health and substance 
                use disorder network adequacy to ensure compliance with 
                the requirements of this paragraph. Such audits shall 
                begin not earlier than one year after the final 
                regulations implementing this paragraph begin to apply 
                to group health plans and health insurance issuers.''.
            (2) Definitions.--Paragraphs (4) and (5) of section 2726(e) 
        of the Public Health Service Act (42 U.S.C. 300gg-26(e)) are 
        amended to read as follows:
            ``(4) Mental health benefits.--The term `mental health 
        benefits' means benefits with respect to services related to a 
        mental health condition, defined consistently with generally 
        recognized independent standards of current medical practice, 
        such as the Diagnostic and Statistical Manual of Mental 
        Disorders of the American Psychiatric Association.
            ``(5) Substance use disorder benefits.--The term `substance 
        use disorder benefits' means benefits with respect to services 
        related to a substance use disorder, defined consistently with 
        generally recognized independent standards of current medical 
        practice, such as the Diagnostic and Statistical Manual of 
        Mental Disorders of the American Psychiatric Association.''.
            (3) Standards for parity in reimbursement rates.--Section 
        2726(a) of the Public Health Service Act (42 U.S.C. 300gg-
        26(a)), as amended by paragraph (1), is further amended by 
        adding at the end the following:
            ``(10) Standards for parity in reimbursement rates.--
                    ``(A) In general.--Not later than 2 years after the 
                date of enactment of the Behavioral Health Network and 
                Directory Improvement Act, the Secretary, the Secretary 
                of Labor, and the Secretary of the Treasury shall issue 
                regulations on a standard for parity in reimbursement 
                rates for mental health or substance use disorder 
                benefits and medical and surgical benefits, based on a 
                comparative analysis conducted by such Secretaries 
                using data submitted by group health plans and health 
                insurance issuers, provider associations, and other 
                experts related to the cost of care delivery for mental 
                health and substance use disorder benefits.
                    ``(B) Requests for data.--Group health plans and 
                health insurance issuers shall comply with any request 
                for data issued by the Secretary, the Secretary of 
                Labor, and the Secretary of the Treasury for purposes 
                of developing the standards under subparagraph (A).
                    ``(C) Effective date.--The regulations promulgated 
                under subparagraph (A) shall apply to group health 
                plans and health insurance issuers offering group or 
                individual health insurance coverage beginning in the 
                first plan year that begins after issuance of the final 
                regulations.''.
    (b) ERISA.--
            (1) Network adequacy requirements.--Section 712(a) of the 
        Employee Retirement Income Security Act of 1974 (29 U.S.C. 
        1185a(a)) is amended by adding at the end the following:
            ``(9) Network adequacy requirements.--
                    ``(A) In general.--The Secretary, the Secretary of 
                Health and Human Services, and the Secretary of the 
                Treasury shall issue regulations establishing national 
                quantitative standards for mental health and substance 
                use disorder network adequacy. Such standards shall 
                consider--
                            ``(i) the ratio of in-network mental health 
                        providers, separated by professional type of 
                        mental health provider, to participants, 
                        beneficiaries, and enrollees in a group health 
                        plan or health insurance coverage;
                            ``(ii) the ratio of in-network substance 
                        use disorder providers, separated by 
                        professional type of substance use disorder 
                        provider, to participants, beneficiaries, and 
                        enrollees in a group health plan or health 
                        insurance coverage;
                            ``(iii) separately, for each of mental 
                        health services and substance use disorder 
                        services--
                                    ``(I) geographic accessibility of 
                                providers;
                                    ``(II) geographic variation and 
                                population dispersion;
                                    ``(III) waiting times for 
                                appointments with participating 
                                providers;
                                    ``(IV) hours of operation for 
                                participating providers;
                                    ``(V) the ability of the network to 
                                meet the needs of participants, 
                                beneficiaries, and enrollees, including 
                                low-income individuals, individuals who 
                                are members of a racial or ethnic 
                                minority, individuals who live in a 
                                health professional shortage area, 
                                children and adults with serious, 
                                chronic, and complex health conditions, 
                                individuals with physical or mental 
                                disabilities or substance use 
                                disorders, pediatric populations, and 
                                individuals with limited English 
                                proficiency;
                                    ``(VI) the availability of in-
                                person services, telehealth services, 
                                and hybrid services to serve the needs 
                                of participants, beneficiaries, and 
                                enrollees; and
                                    ``(VII) the percentage of in-
                                network providers who have submitted a 
                                claim for payment during the previous 6 
                                months; and
                            ``(iv) other standards as determined by the 
                        Secretary, the Secretary of Health and Human 
                        Services, and the Secretary of the Treasury.
                    ``(B) Timing.--
                            ``(i) Issuance.--The Secretary, the 
                        Secretary of Health and Human Services, and the 
                        Secretary of the Treasury shall--
                                    ``(I) issue proposed regulations 
                                required under subparagraph (A) not 
                                later than 2 years after the date of 
                                enactment of the Behavioral Health 
                                Network and Directory Improvement Act; 
                                and
                                    ``(II) issue final regulations 
                                under subparagraph (A) not later than 1 
                                year thereafter.
                            ``(ii) Effective date.--The regulations 
                        promulgated under this paragraph shall take 
                        effect in the first plan year that begins after 
                        the date on which such final regulations are 
                        issued.
                    ``(C) Audits.--The Secretary, the Secretary of 
                Health and Human Services, and the Secretary of the 
                Treasury shall conduct annual, targeted audits of not 
                fewer than 10 group health plans and health insurance 
                issuers offering group health insurance coverage that 
                the Secretaries determine to be the subject of the 
                greatest number of complaints about mental health and 
                substance use disorder network adequacy to ensure 
                compliance with the requirements of this paragraph. 
                Such audits shall begin not earlier than one year after 
                the final regulations implementing this paragraph begin 
                to apply to group health plans and health insurance 
                issuers.''.
            (2) Definitions.--Paragraphs (4) and (5) of section 712(e) 
        of the Employee Retirement Income Security Act of 1974 (29 
        U.S.C. 1185a(e)) are amended to read as follows:
            ``(4) Mental health benefits.--The term `mental health 
        benefits' means benefits with respect to services related to a 
        mental health condition, defined consistently with generally 
        recognized independent standards of current medical practice, 
        such as the Diagnostic and Statistical Manual of Mental 
        Disorders of the American Psychiatric Association.
            ``(5) Substance use disorder benefits.--The term `substance 
        use disorder benefits' means benefits with respect to services 
        related to a substance use disorder, defined consistently with 
        generally recognized independent standards of current medical 
        practice, such as the Diagnostic and Statistical Manual of 
        Mental Disorders of the American Psychiatric Association.''.
            (3) Standards for parity in reimbursement rates.--Section 
        712(a) of the Employee Retirement Income Security Act of 1974 
        (29 U.S.C. 1185a(a)), as amended by paragraph (1), is further 
        amended by adding at the end the following:
            ``(10) Standards for parity in reimbursement rates.--
                    ``(A) In general.--Not later than 2 years after the 
                date of enactment of the Behavioral Health Network and 
                Directory Improvement Act, the Secretary, the Secretary 
                of Health and Human Services, and the Secretary of the 
                Treasury shall issue regulations on a standard for 
                parity in reimbursement rates for mental health or 
                substance use disorder benefits and medical and 
                surgical benefits, based on a comparative analysis 
                conducted by such Secretaries using data submitted by 
                group health plans and health insurance issuers, 
                provider associations, and other experts related to the 
                cost of care delivery for mental health and substance 
                use disorder benefits.
                    ``(B) Requests for data.--Group health plans and 
                health insurance issuers shall comply with any request 
                for data issued by the Secretary, the Secretary of 
                Health and Human Services, and the Secretary of the 
                Treasury for purposes of developing the standards under 
                subparagraph (A).
                    ``(C) Effective date.--The regulations promulgated 
                under subparagraph (A) shall apply to group health 
                plans and health insurance issuers offering group 
                health insurance coverage beginning in the first plan 
                year that begins after issuance of the final 
                regulations.''.
    (c) IRC.--
            (1) Network adequacy requirements.--Section 9812(a) of the 
        Internal Revenue Code of 1986 is amended by adding at the end 
        the following:
            ``(9) Network adequacy requirements.--
                    ``(A) In general.--The Secretary, the Secretary of 
                Health and Human Services, and the Secretary of Labor 
                shall issue regulations establishing national 
                quantitative standards for mental health and substance 
                use disorder network adequacy. Such standards shall 
                consider--
                            ``(i) the ratio of in-network mental health 
                        providers, separated by professional type of 
                        mental health provider, to participants, 
                        beneficiaries, and enrollees in a group health 
                        plan;
                            ``(ii) the ratio of in-network substance 
                        use disorder providers, separated by 
                        professional type of substance use disorder 
                        provider, to participants, beneficiaries, and 
                        enrollees in a group health plan;
                            ``(iii) separately, for each of mental 
                        health services and substance use disorder 
                        services--
                                    ``(I) geographic accessibility of 
                                providers;
                                    ``(II) geographic variation and 
                                population dispersion;
                                    ``(III) waiting times for 
                                appointments with participating 
                                providers;
                                    ``(IV) hours of operation for 
                                participating providers;
                                    ``(V) the ability of the network to 
                                meet the needs of participants, 
                                beneficiaries, and enrollees, including 
                                low-income individuals, individuals who 
                                are members of a racial or ethnic 
                                minority, individuals who live in a 
                                health professional shortage area, 
                                children and adults with serious, 
                                chronic, and complex health conditions, 
                                individuals with physical or mental 
                                disabilities or substance use 
                                disorders, pediatric populations, and 
                                individuals with limited English 
                                proficiency;
                                    ``(VI) the availability of in-
                                person services, telehealth services, 
                                and hybrid services to serve the needs 
                                of participants, beneficiaries, and 
                                enrollees; and
                                    ``(VII) the percentage of in-
                                network providers who have submitted a 
                                claim for payment during the previous 6 
                                months; and
                            ``(iv) other standards as determined by the 
                        Secretary, the Secretary of Health and Human 
                        Services, and the Secretary of Labor.
                    ``(B) Timing.--
                            ``(i) Issuance.--The Secretary, the 
                        Secretary of Health and Human Services, and the 
                        Secretary of Labor shall--
                                    ``(I) issue proposed regulations 
                                required under subparagraph (A) not 
                                later than 2 years after the date of 
                                enactment of the Behavioral Health 
                                Network and Directory Improvement Act; 
                                and
                                    ``(II) issue final regulations 
                                under subparagraph (A) not later than 1 
                                year thereafter.
                            ``(ii) Effective date.--The regulations 
                        promulgated under this paragraph shall take 
                        effect in the first plan year that begins after 
                        the date on which such final regulations are 
                        issued.
                    ``(C) Audits.--The Secretary, the Secretary of 
                Health and Human Services, and the Secretary of Labor 
                shall conduct annual, targeted audits of not fewer than 
                10 group health plans that the Secretaries determine to 
                be the subject of the greatest number of complaints 
                about mental health and substance use disorder network 
                adequacy to ensure compliance with the requirements of 
                this paragraph. Such audits shall begin not earlier 
                than one year after the final regulations implementing 
                this paragraph begin to apply to group health plans.''.
            (2) Definitions.--Paragraphs (4) and (5) of section 9812(e) 
        of the Internal Revenue Code of 1986 are amended to read as 
        follows:
            ``(4) Mental health benefits.--The term `mental health 
        benefits' means benefits with respect to services related to a 
        mental health condition, defined consistently with generally 
        recognized independent standards of current medical practice, 
        such as the Diagnostic and Statistical Manual of Mental 
        Disorders of the American Psychiatric Association.
            ``(5) Substance use disorder benefits.--The term `substance 
        use disorder benefits' means benefits with respect to services 
        related to a substance use disorder, defined consistently with 
        generally recognized independent standards of current medical 
        practice, such as the Diagnostic and Statistical Manual of 
        Mental Disorders of the American Psychiatric Association.''.
            (3) Standards for parity in reimbursement rates.--Section 
        9812(a) of the Internal Revenue Code of 1986, as amended by 
        paragraph (1), is further amended by adding at the end the 
        following:
            ``(10) Standards for parity in reimbursement rates.--
                    ``(A) In general.--Not later than 2 years after the 
                date of enactment of the Behavioral Health Network and 
                Directory Improvement Act, the Secretary, the Secretary 
                of Health and Human Services, and the Secretary of 
                Labor shall issue regulations on a standard for parity 
                in reimbursement rates for mental health or substance 
                use disorder benefits and medical and surgical 
                benefits, based on a comparative analysis conducted by 
                such Secretaries using data submitted by group health 
                plans, provider associations, and other experts related 
                to the cost of care delivery for mental health and 
                substance use disorder benefits.
                    ``(B) Requests for data.--Group health plans shall 
                comply with any request for data issued by the 
                Secretary, the Secretary of Health and Human Services, 
                and the Secretary of Labor for purposes of developing 
                the standards under subparagraph (A).
                    ``(C) Effective date.--The regulations promulgated 
                under subparagraph (A) shall apply to group health 
                plans beginning in the first plan year that begins 
                after issuance of the final regulations.''.

SEC. 5. STATE AND TRIBAL OMBUDSMAN PROGRAMS RELATING TO MENTAL HEALTH 
              AND SUBSTANCE USE DISORDER PARITY.

    Part C of title XXVII of the Public Health Service Act (42 U.S.C. 
300gg-91 et seq.) is amended--
            (1) by redesignating section 2794 (42 U.S.C. 300gg-95) 
        (regarding uniform fraud and abuse referral format), as added 
        by section 6603 of the Patient Protection and Affordable Care 
        Act (Public Law 111-148), as section 2795; and
            (2) by adding at the end the following:

``SEC. 2796. STATE AND TRIBAL OMBUDSMAN PROGRAMS RELATING TO MENTAL 
              HEALTH AND SUBSTANCE USE DISORDER PARITY.

    ``(a) In General.--The Secretary shall make grants to eligible 
entities, designated by a State, Indian Tribe, or Tribal organization, 
as described in subsection (b), for the purpose of--
            ``(1) establishing or supporting State and Tribal mental 
        health and substance use disorder parity ombudsman programs 
        to--
                    ``(A) educate consumers about the mental health and 
                substance use disorder coverage in individual plans, 
                group health plans, self-insured plans, and State 
                Medicaid managed care plans;
                    ``(B) assist consumers in understanding their 
                rights as health benefits plan members, including 
                appeal processes and how to use such benefits, and how 
                to access appropriate medical information;
                    ``(C) assist consumers in exercising their rights 
                under the provisions of part D, including resolving 
                problems related to a group health plan or health 
                insurance issuer erroneously charging a consumer out-
                of-network rates for services listed in-network on the 
                group health plan or health insurance issuer's provider 
                directory;
                    ``(D) identify, investigate, and help resolve 
                complaints related to mental health and substance use 
                disorder coverage (including potential violations of 
                the mental health and substance use disorder parity 
                laws) on behalf of consumers;
                    ``(E) maintain a toll-free hotline and website for 
                consumers;
                    ``(F) collect, track, and quantify problems and 
                inquiries encountered by consumers; and
                    ``(G) other activities as defined by the Secretary; 
                and
            ``(2) provide support and training for such State and 
        Tribal mental health parity ombudsman programs (such as through 
        the establishment of a mental health parity ombudsman program 
        resource center).
    ``(b) Eligibility.--To be eligible to receive a grant under this 
section, a State, Indian Tribe, or Tribal organization shall designate 
an ombudsman or consumer assistance program or other independent entity 
that--
            ``(1) has specialized knowledge of mental health conditions 
        and substance use disorders and experience resolving inquiries 
        and complaints; and
            ``(2) directly, or in coordination with departments of 
        insurance, and consumer assistance organizations, receives and 
        responds to inquiries and complaints concerning access to 
        mental health and substance use disorder services.
    ``(c) Criteria.--A State, Indian Tribe, or Tribal organization that 
receives a grant under this section shall comply with criteria 
established by the Secretary for carrying out activities under such 
grant.
    ``(d) Data Collection.--As a condition of receiving a grant, an 
eligible entity shall agree to--
            ``(1) collect and report data to the Secretary, State 
        legislature, and relevant State agencies, including the 
        departments of insurance and the State attorney general, on the 
        numbers and types of problems and inquiries encountered by 
        individuals with respect to access to behavioral health 
        services; and
            ``(2) report to the Secretary on how identified problems 
        were addressed, including through promising practices related 
        to responding to mental health and substance use disorder 
        coverage issues, including appeals and education.
    ``(e) Report to Congress.--Not later than 4 years after the date of 
the enactment of the Behavioral Health Network and Directory 
Improvement Act, the Secretary shall submit to Congress a report on the 
data collected under subsection.
    ``(f) Definitions.--In this section, the terms `Indian Tribe' and 
`Tribal organization' have the meanings given such terms in section 4 
of the Indian Self-Determination and Education Assistance Act.
    ``(g) Authorization of Appropriations.--To carry out this section, 
there are authorized to be appropriated $20,000,000 for fiscal year 
2024 and $10,000,000 for fiscal year 2025 and each fiscal year 
thereafter.''.

SEC. 6. REPORT TO CONGRESS.

    (a) In General.--Not later than 6 years after the date of enactment 
of this Act and every 2 years for the next 10 years, the Secretary of 
Health and Human Services, the Secretary of Labor, and the Secretary of 
the Treasury (collectively referred to in this section as the 
``Secretaries'') shall jointly submit to Congress and make publicly 
available a report to assess the prevalence of ghost networks and the 
adequacy of mental health and substance use disorder networks, in 
accordance with section 2726(a)(9) of the Public Health Service Act, 
section 712(a)(9) of the Employee Retirement Income Security Act of 
1974, and section 9812(a)(9) of the Internal Revenue Code of 1986, as 
amended by section 4. Such report shall include the following:
            (1) Aggregate information about group health plans and 
        health insurance issuers determined by the Secretaries to be 
        out of compliance with the provider directory requirements 
        under section 2799A-5 of the Public Health Service Act, section 
        720 of the Employee Retirement Income Security Act of 1974, and 
        section 9820 of the Internal Revenue Code of 1986, as amended 
        by section 2.
            (2) Aggregate information about group health plans and 
        health insurance issuers determined by the Secretaries to be 
        out of compliance with the requirements for parity in mental 
        health and substance use disorder benefits under section 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), and section 9812 of the Internal Revenue Code of 
        1986, as amended by section 4.
            (3) A summary of findings through audits, in the aggregate, 
        under section 2799A-5(a)(7)(C) of the Public Health Service 
        Act, section 720(a)(7)(C) of the Employee Retirement Income 
        Security Act of 1974, and section 9820(a)(7)(C) of the Internal 
        Revenue Code of 1986, as amended by section 2, including--
                    (A) the provider directory accuracy rating assigned 
                by the Secretaries;
                    (B) the accuracy of provider directory information, 
                sectioned out by accuracy of the provider's name, 
                address, specialty, telephone number, digital contact 
                information, whether the providers are accepting new 
                patients, in-network status, linguistic- and cultural-
                competency, and availability of medications for opioid 
                use disorder;
                    (C) the number of plans and individuals enrolled in 
                a group health plan or group or individual health 
                insurance coverage that offers a mental health and 
                substance use disorder network that meets the network 
                adequacy standards under, as applicable, section 2799A-
                5 of the Public Health Service Act, section 720 of the 
                Employee Retirement Income Security Act of 1974, or 
                section 9820 of the Internal Revenue Code of 1986, as 
                amended by section 2; and
                    (D) the number of individuals enrolled in a group 
                health plan or group or individual health insurance 
                coverage with a ghost network.
            (4) A comparative analysis of in-network and out-of-network 
        reimbursement rates for mental health and substance use 
        disorder services compared to medical and surgical services by 
        group health plans and health insurance issuers.
    (b) Definition.--In this section, the term ``ghost network'' has 
the meaning given such term in section 2799A-5(a)(8) of the Public 
Health Service Act, section 720(a)(8) of the Employee Retirement Income 
Security Act of 1974, and section 9820(a)(8) of the Internal Revenue 
Code of 1986, as amended by section 2.

SEC. 7. AUTHORIZATION OF APPROPRIATIONS.

    To carry out this Act, including the amendments made by this Act, 
in addition to amounts otherwise made available for such purposes, 
there are authorized to be appropriated $28,000,000 for each of fiscal 
years 2023 through 2032.
                                 <all>