[House Report 110-538]
[From the U.S. Government Publishing Office]



110th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 2d Session                                                     110-538

======================================================================

 
 PROVIDING FOR CONSIDERATION OF THE BILL (H.R. 1424) TO AMEND SECTION 
  712 OF THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974, SECTION 
2705 OF THE PUBLIC HEALTH SERVICE ACT, AND SECTION 9812 OF THE INTERNAL 
   REVENUE CODE OF 1986 TO REQUIRE EQUITY IN THE PROVISION OF MENTAL 
HEALTH AND SUBSTANCE-RELATED DISORDER BENEFITS UNDER GROUP HEALTH PLANS

                                _______
                                

   March 4, 2008.--Referred to the House Calendar and ordered to be 
                                printed

                                _______
                                

    Ms. Castor, from the Committee on Rules, submitted the following

                              R E P O R T

                      [To accompany H. Res. 1014]

    The Committee on Rules, having had under consideration 
House Resolution 1014, by a nonrecord vote report the same to 
the House with the recommendation that the resolution be 
adopted.

                SUMMARY OF PROVISIONS OF THE RESOLUTION

    The resolution provides for consideration of H.R. 1424, the 
Paul Wellstone Mental Health and Addiction Equity Act of 2007, 
under a closed rule providing two hours of general debate in 
the House with 40 minutes equally divided and controlled by the 
Chairman and Ranking Minority Member of the Committee on Energy 
and Commerce, 40 minutes equally divided and controlled by the 
Chairman and Ranking Minority Member of the Committee on Ways 
and Means, and 40 minutes equally divided and controlled by the 
Chairman and Ranking Minority Member of the Committee on 
Education and Labor. The rule waives all points of order 
against consideration of the bill except for clauses 9 and 10 
of rule XXI. The rule provides that the bill shall be 
considered as read. The rule provides that in lieu of the 
amendments recommended by the Committees on Energy and 
Commerce, Ways and Means, and Education and Labor, the 
amendment in the nature of a substitute printed in this report 
shall be considered as adopted. The rule waives all points of 
order against the bill as amended. This waiver does not affect 
the point of order available under clause 9 of rule XXI 
(regarding earmark disclosure). The rule provides one motion to 
recommit with or without instructions. The rule provides that 
in the engrossment of H.R. 1424, the text of H.R. 493, as 
passed the House, shall be added at the end of H.R. 1424. 
Finally, the rule provides that the Chair may postpone further 
consideration of the bill to a time designated by the Speaker.

                         EXPLANATION OF WAIVERS

    The waiver of all points of order against consideration of 
the bill (except for clauses 9 and 10 of rule XXI) includes a 
waiver of rule XIII, clause 4(a), requiring a three-day layover 
of the committee report and a waiver of rule XIII clause 3(c) 
regarding the statement of performance goals in committee 
reports. Although the rule waives all points of order against 
the provisions in the bill, as amended, the Committee is not 
aware of any points of order. The waiver of all points of order 
is prophylactic.

                            COMMITTEE VOTES

    The results of each record vote on an amendment or motion 
to report, together with the names of those voting for and 
against, are printed below:

Rules Committee record vote No. 441

    Date: March 4, 2008.
    Measure: H.R. 1424.
    Motion by: Mr. Dreier.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment submitted by Reps. Wilson, Heather 
(NM)/Kline (MN)/Camp (MI), #11, which provides a substitute for 
the language of H.R. 1424 by incorporating the text of S. 558. 
The amendment also includes a provision that requires all 
states to implement an electronic asset-verification program 
for Medicaid eligibility verification.
    Results: Defeated 2-7.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Welch--Nay; Castor--Nay; Arcuri--Nay; Sutton--Nay; 
Dreier--Yea; Hastings (WA)--Yea.

Rules Committee record vote No. 442

    Date: March 4, 2008.
    Measure: H.R. 1424.
    Motion by: Mr. Dreier.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Barton (TX), #3, which 
provides that, to the extent the requirements of DSM apply, 
plans shall also maintain coverage for mental health disorders 
or conditions arising out of abortions, or loss of an unborn 
child.
    Results: Defeated 2-7.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Welch--Nay; Castor--Nay; Arcuri--Nay; Sutton--Nay; 
Dreier--Yea; Hastings (WA)--Yea.

Rules Committee record vote No. 443

    Date: March 4, 2008.
    Measure: H.R. 1424.
    Motion by: Mr. Dreier.
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Barton (TX), #4, which 
provides that nothing about codification of the DSM creates a 
defense in criminal cases including for child abusers. Nothing 
about the codification of the DSM overrides any requirements 
for reporting of criminal conduct, including for child abusers, 
or creates any new privilege against disclosure.
    Results: Defeated 2-7.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Welch--Nay; Castor--Nay; Arcuri--Nay; Sutton--Nay; 
Dreier--Yea; Hastings (WA)--Yea.

Rules Committee record vote No. 444

    Date: March 4, 2008.
    Measure: H.R. 1424.
    Motion by: Mr. Hastings (WA).
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Hastings (WA) and Rep. 
McMorris (WA), #7, which removes the prohibition on physician 
referral to hospitals that are more than 40 percent doctor 
owned. The amendment also removes the limitation on hospital 
facility expansion.
    Results: Defeated 2-7.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Welch--Nay; Castor--Nay; Arcuri--Nay; Sutton--Nay; 
Dreier--Yea; Hastings (WA)--Yea.

Rules Committee record vote No. 445

    Date: March 4, 2008.
    Measure: H.R. 1424.
    Motion by: Mr. Hastings (WA).
    Summary of motion: To make in order and provide appropriate 
waivers for the amendments en bloc by Reps. Hastings (WA) and 
McMorris (WA), #8, which removes the prohibition on physician 
referral to hospitals that are more than 40 percent doctor 
owned and the limitation on hospital facility expansion for 
hospitals that meet the following requirements: (1) over half 
of their care is provided to Medicare and Medicaid patients and 
(2) have obtained a certificate of need from the state; and the 
amendment by Rep. Hastings (WA) and Rep. McMorris (WA), #9, 
which removes the prohibition on physician referral to 
hospitals that are more than 40 percent doctor owned and the 
limitation on hospital facility expansion in cases where the 
Governor submits written notice to the Secretary that the 
hospital is needed to maintain an adequate level of access to 
care in the state.
    Results: Defeated 2-7.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Welch--Nay; Castor--Nay; Arcuri--Nay; Sutton--Nay; 
Dreier--Yea; Hastings (WA)--Yea.

Rules Committee record vote No. 446

    Date: March 4, 2008.
    Measure: H.R. 1424.
    Motion by: Mr. Hastings (WA).
    Summary of motion: To make in order and provide appropriate 
waivers for an amendment by Rep. Hinojosa (TX), #5, which 
exempts large full service hospitals from the ownership 
requirements and would make it easier for large full service 
hospitals to qualify for the expansion exception. The amendment 
would allow the Secretary to disallow the grandfather if there 
is overutilization.
    Results: Defeated 2-7.
    Vote by Members: McGovern--Nay; Hastings (FL)--Nay; 
Matsui--Nay; Welch--Nay; Castor--Nay; Arcuri--Nay; Sutton--Nay; 
Dreier--Yea; Hastings (WA)--Yea.

 Rules Committee record vote No. 447.

     Date: March 4, 2008.
     Measure: H.R. 1424.
     Motion by: Mr. Hastings (WA).
     Summary of motion: To make in order and provide 
appropriate waivers for an amendment by Rep. Broun (GA), #2, 
which strikes the increased cost exemption for plans in the 
bill, reverting to the existing law which exempts firms whose 
costs rise 1% as a result of the federal mandates.
     Results: Defeated 2-7.
     Vote by Members: McGovern--Nay, Hastings (FL)--Nay; 
Matsui--Nay; Welch--Nay; Castor--Nay; Arcuri--Nay; Sutton--Nay; 
Dreier--Yea; Hastings (WA)--Yea.

      SUMMARY OF THE AMENDMENT IN THE NATURE OF A SUBSTITUTE TO BE 
                         CONSIDERED AS ADOPTED

     The Amendment in the Nature of a Substitute expands the 
Mental Health Parity Act of 1996 to provide for equity in the 
terms of employer sponsored health benefits for mental health 
and substance-related disorders compared to medical and 
surgical disorders. It ensures that health plans do not charge 
higher copayments, coinsurance, deductibles, and impose maximum 
out-of-pocket limits and lower day and visit limits on mental 
health and addiction care than for medical and surgical 
benefits. The Department of Health and Human Services, the 
Department of Labor, and the Internal Revenue Service can 
penalize insurers for discriminatory practices in plan design 
under this bill and individuals may sue in court to obtain 
promised benefits. It includes an increase in the rebate, or 
discount, that pharmaceutical companies are required to provide 
to State Medicaid programs for drugs provided to Medicaid 
beneficiaries. It includes language to prohibit physicians from 
referring patients to hospitals in which they have an ownership 
interest, but also provides the ability to grandfather and grow 
existing physician-owned hospitals.

TEXT OF THE AMENDMENT IN THE NATURE OF A SUBSTITUTE TO BE CONSIDERED AS 
                                ADOPTED

  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

  (a) Short Title.--This Act may be cited as the ``Paul 
Wellstone Mental Health and Addiction Equity Act of 2007''.
  (b) Table of Contents.--The table of contents of this Act is 
as follows:

Sec. 1. Short title; table of contents.
Sec. 2. Amendments to the Employee Retirement Income Security Act of 
          1974.
Sec. 3. Amendments to the Public Health Service Act relating to the 
          group market.
Sec. 4. Amendments to the Internal Revenue Code of 1986.
Sec. 5. Medicaid drug rebate.
Sec. 6. Limitation on Medicare exception to the prohibition on certain 
          physician referrals for hospitals.
Sec. 7. Studies and reports.

SEC. 2. AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 
                    1974.

  (a) Extension of Parity to Treatment Limits and Beneficiary 
Financial Requirements.--Section 712 of the Employee Retirement 
Income Security Act of 1974 (29 U.S.C. 1185a) is amended--
          (1) in subsection (a), by adding at the end the 
        following new paragraphs:
          ``(3) Treatment limits.--In the case of a group 
        health plan that provides both medical and surgical 
        benefits and mental health or substance-related 
        disorder benefits--
                  ``(A) No treatment limit.--If the plan or 
                coverage does not include a treatment limit (as 
                defined in subparagraph (D)) on substantially 
                all medical and surgical benefits in any 
                category of items or services, the plan or 
                coverage may not impose any treatment limit on 
                mental health or substance-related disorder 
                benefits that are classified in the same 
                category of items or services.
                  ``(B) Treatment limit.--If the plan or 
                coverage includes a treatment limit on 
                substantially all medical and surgical benefits 
                in any category of items or services, the plan 
                or coverage may not impose such a treatment 
                limit on mental health or substance-related 
                disorder benefits for items and services within 
                such category that is more restrictive than the 
                predominant treatment limit that is applicable 
                to medical and surgical benefits for items and 
                services within such category.
                  ``(C) Categories of items and services for 
                application of treatment limits and beneficiary 
                financial requirements.--For purposes of this 
                paragraph and paragraph (4), there shall be the 
                following five categories of items and services 
                for benefits, whether medical and surgical 
                benefits or mental health and substance-related 
                disorder benefits, and all medical and surgical 
                benefits and all mental health and substance 
                related benefits shall be classified into one 
                of the following categories:
                          ``(i) Inpatient, in-network.--Items 
                        and services not described in clause 
                        (v) furnished on an inpatient basis and 
                        within a network of providers 
                        established or recognized under such 
                        plan or coverage.
                          ``(ii) Inpatient, out-of-network.--
                        Items and services not described in 
                        clause (v) furnished on an inpatient 
                        basis and outside any network of 
                        providers established or recognized 
                        under such plan or coverage.
                          ``(iii) Outpatient, in-network.--
                        Items and services not described in 
                        clause (v) furnished on an outpatient 
                        basis and within a network of providers 
                        established or recognized under such 
                        plan or coverage.
                          ``(iv) Outpatient, out-of-network.--
                        Items and services not described in 
                        clause (v) furnished on an outpatient 
                        basis and outside any network of 
                        providers established or recognized 
                        under such plan or coverage.
                          ``(v) Emergency care.--Items and 
                        services, whether furnished on an 
                        inpatient or outpatient basis or within 
                        or outside any network of providers, 
                        required for the treatment of an 
                        emergency medical condition (as defined 
                        in section 1867(e) of the Social 
                        Security Act, including an emergency 
                        condition relating to mental health or 
                        substance-related disorders).
                  ``(D) Treatment limit defined.--For purposes 
                of this paragraph, the term `treatment limit' 
                means, with respect to a plan or coverage, 
                limitation on the frequency of treatment, 
                number of visits or days of coverage, or other 
                similar limit on the duration or scope of 
                treatment under the plan or coverage.
                  ``(E) Predominance.--For purposes of this 
                subsection, a treatment limit or financial 
                requirement with respect to a category of items 
                and services is considered to be predominant if 
                it is the most common or frequent of such type 
                of limit or requirement with respect to such 
                category of items and services.
          ``(4) Beneficiary financial requirements.--In the 
        case of a group health plan that provides both medical 
        and surgical benefits and mental health or substance-
        related disorder benefits--
                  ``(A) No beneficiary financial requirement.--
                If the plan or coverage does not include a 
                beneficiary financial requirement (as defined 
                in subparagraph (C)) on substantially all 
                medical and surgical benefits within a category 
                of items and services (specified under 
                paragraph (3)(C)), the plan or coverage may not 
                impose such a beneficiary financial requirement 
                on mental health or substance-related disorder 
                benefits for items and services within such 
                category.
                  ``(B) Beneficiary financial requirement.--
                          ``(i) Treatment of deductibles, out-
                        of-pocket limits, and similar financial 
                        requirements.--If the plan or coverage 
                        includes a deductible, a limitation on 
                        out-of-pocket expenses, or similar 
                        beneficiary financial requirement that 
                        does not apply separately to individual 
                        items and services on substantially all 
                        medical and surgical benefits within a 
                        category of items and services (as 
                        specified in paragraph (3)(C)), the 
                        plan or coverage shall apply such 
                        requirement (or, if there is more than 
                        one such requirement for such category 
                        of items and services, the predominant 
                        requirement for such category) both to 
                        medical and surgical benefits within 
                        such category and to mental health and 
                        substance-related disorder benefits 
                        within such category and shall not 
                        distinguish in the application of such 
                        requirement between such medical and 
                        surgical benefits and such mental 
                        health and substance-related disorder 
                        benefits.
                          ``(ii) Other financial 
                        requirements.--If the plan or coverage 
                        includes a beneficiary financial 
                        requirement not described in clause (i) 
                        on substantially all medical and 
                        surgical benefits within a category of 
                        items and services, the plan or 
                        coverage may not impose such financial 
                        requirement on mental health or 
                        substance-related disorder benefits for 
                        items and services within such category 
                        in a way that results in greater out-
                        of-pocket expenses to the participant 
                        or beneficiary than the predominant 
                        beneficiary financial requirement 
                        applicable to medical and surgical 
                        benefits for items and services within 
                        such category.
                  ``(C) Beneficiary financial requirement 
                defined.--For purposes of this paragraph, the 
                term `beneficiary financial requirement' 
                includes, with respect to a plan or coverage, 
                any deductible, coinsurance, co-payment, other 
                cost sharing, and limitation on the total 
                amount that may be paid by a participant or 
                beneficiary with respect to benefits under the 
                plan or coverage, but does not include the 
                application of any aggregate lifetime limit or 
                annual limit.''; and
          (2) in subsection (b)--
                  (A) by striking ``construed--'' and all that 
                follows through ``(1) as requiring'' and 
                inserting ``construed as requiring'';
                  (B) by striking ``; or'' and inserting a 
                period; and
                  (C) by striking paragraph (2).
  (b) Expansion to Substance-Related Disorder Benefits and 
Revision of Definition.--Such section is further amended--
          (1) by striking ``mental health benefits'' each place 
        it appears (other than in any provision amended by 
        paragraph (2)) and inserting ``mental health or 
        substance-related disorder benefits'',
          (2) by striking ``mental health benefits'' each place 
        it appears in subsections (a)(1)(B)(i), (a)(1)(C), 
        (a)(2)(B)(i), and (a)(2)(C) and inserting ``mental 
        health and substance-related disorder benefits'', and
          (3) in subsection (e), by striking paragraph (4) and 
        inserting the following new paragraphs:
          ``(4) Mental health benefits.--The term `mental 
        health benefits' means benefits with respect to 
        services for mental health conditions, as defined under 
        the terms of the plan and in accordance with applicable 
        law, but does not include substance-related disorder 
        benefits.
          ``(5) Substance-related disorder benefits.--The term 
        `substance-related disorder benefits' means benefits 
        with respect to services for substance-related 
        disorders, as defined under the terms of the plan and 
        in accordance with applicable law.''.
  (c) Availability of Plan Information About Criteria for 
Medical Necessity.--Subsection (a) of such section, as amended 
by subsection (a)(1), is further amended by adding at the end 
the following new paragraph:
          ``(5) Availability of plan information.--The criteria 
        for medical necessity determinations made under the 
        plan with respect to mental health and substance-
        related disorder benefits (or the health insurance 
        coverage offered in connection with the plan with 
        respect to such benefits) shall be made available by 
        the plan administrator (or the health insurance issuer 
        offering such coverage) in accordance with regulations 
        to any current or potential participant, beneficiary, 
        or contracting provider upon request. The reason for 
        any denial under the plan (or coverage) of 
        reimbursement or payment for services with respect to 
        mental health and substance-related disorder benefits 
        in the case of any participant or beneficiary shall, on 
        request or as otherwise required, be made available by 
        the plan administrator (or the health insurance issuer 
        offering such coverage) to the participant or 
        beneficiary in accordance with regulations.''.
  (d) Minimum Benefit Requirements.--Subsection (a) of such 
section is further amended by adding at the end the following 
new paragraph:
          ``(6) Minimum scope of coverage and equity in out-of-
        network benefits.--
                  ``(A) Minimum scope of mental health and 
                substance-related disorder benefits.--In the 
                case of a group health plan (or health 
                insurance coverage offered in connection with 
                such a plan) that provides any mental health or 
                substance-related disorder benefits, the plan 
                or coverage shall include benefits for any 
                mental health condition or substance-related 
                disorder included in the most recent edition of 
                the Diagnostic and Statistical Manual of Mental 
                Disorders published by the American Psychiatric 
                Association.
                  ``(B) Equity in coverage of out-of-network 
                benefits.--
                          ``(i) In general.--In the case of a 
                        plan or coverage that provides both 
                        medical and surgical benefits and 
                        mental health or substance-related 
                        disorder benefits, if medical and 
                        surgical benefits are provided for 
                        substantially all items and services in 
                        a category specified in clause (ii) 
                        furnished outside any network of 
                        providers established or recognized 
                        under such plan or coverage, the mental 
                        health and substance-related disorder 
                        benefits shall also be provided for 
                        items and services in such category 
                        furnished outside any network of 
                        providers established or recognized 
                        under such plan or coverage in 
                        accordance with the requirements of 
                        this section.
                          ``(ii) Categories of items and 
                        services.--For purposes of clause (i), 
                        there shall be the following three 
                        categories of items and services for 
                        benefits, whether medical and surgical 
                        benefits or mental health and 
                        substance-related disorder benefits, 
                        and all medical and surgical benefits 
                        and all mental health and substance-
                        related disorder benefits shall be 
                        classified into one of the following 
                        categories:
                                  ``(I) Emergency.--Items and 
                                services, whether furnished on 
                                an inpatient or outpatient 
                                basis, required for the 
                                treatment of an emergency 
                                medical condition (as defined 
                                in section 1867(e) of the 
                                Social Security Act, including 
                                an emergency condition relating 
                                to mental health or substance-
                                related disorders).
                                  ``(II) Inpatient.--Items and 
                                services not described in 
                                subclause (I) furnished on an 
                                inpatient basis.
                                  ``(III) Outpatient.--Items 
                                and services not described in 
                                subclause (I) furnished on an 
                                outpatient basis.''.
  (e) Revision of Increased Cost Exemption.--Paragraph (2) of 
subsection (c) of such section is amended to read as follows:
          ``(2) Increased cost exemption.--
                  ``(A) In general.--With respect to a group 
                health plan (or health insurance coverage 
                offered in connection with such a plan), if the 
                application of this section to such plan (or 
                coverage) results in an increase for the plan 
                year involved of the actual total costs of 
                coverage with respect to medical and surgical 
                benefits and mental health and substance-
                related disorder benefits under the plan (as 
                determined and certified under subparagraph 
                (C)) by an amount that exceeds the applicable 
                percentage described in subparagraph (B) of the 
                actual total plan costs, the provisions of this 
                section shall not apply to such plan (or 
                coverage) during the following plan year, and 
                such exemption shall apply to the plan (or 
                coverage) for 1 plan year.
                  ``(B) Applicable percentage.--With respect to 
                a plan (or coverage), the applicable percentage 
                described in this paragraph shall be--
                          ``(i) 2 percent in the case of the 
                        first plan year to which this paragraph 
                        applies; and
                          ``(ii) 1 percent in the case of each 
                        subsequent plan year.
                  ``(C) Determinations by actuaries.--
                Determinations as to increases in actual costs 
                under a plan (or coverage) for purposes of this 
                subsection shall be made in writing and 
                prepared and certified by a qualified and 
                licensed actuary who is a member in good 
                standing of the American Academy of Actuaries. 
                Such determinations shall be made available by 
                the plan administrator (or health insurance 
                issuer, as the case may be) to the general 
                public.
                  ``(D) 6-month determinations.--If a group 
                health plan (or a health insurance issuer 
                offering coverage in connection with such a 
                plan) seeks an exemption under this paragraph, 
                determinations under subparagraph (A) shall be 
                made after such plan (or coverage) has complied 
                with this section for the first 6 months of the 
                plan year involved.
                  ``(E) Notification.--An election to modify 
                coverage of mental health and substance-related 
                disorder benefits as permitted under this 
                paragraph shall be treated as a material 
                modification in the terms of the plan as 
                described in section 102(a) and notice of which 
                shall be provided a reasonable period in 
                advance of the change.
                  ``(F) Notification of appropriate agency.--
                          ``(i) In general.--A group health 
                        plan that, based on a certification 
                        described under subparagraph (C), 
                        qualifies for an exemption under this 
                        paragraph, and elects to implement the 
                        exemption, shall notify the Department 
                        of Labor of such election.
                          ``(ii) Requirement.--A notification 
                        under clause (i) shall include--
                                  ``(I) a description of the 
                                number of covered lives under 
                                the plan (or coverage) involved 
                                at the time of the 
                                notification, and as 
                                applicable, at the time of any 
                                prior election of the cost-
                                exemption under this paragraph 
                                by such plan (or coverage);
                                  ``(II) for both the plan year 
                                upon which a cost exemption is 
                                sought and the year prior, a 
                                description of the actual total 
                                costs of coverage with respect 
                                to medical and surgical 
                                benefits and mental health and 
                                substance-related disorder 
                                benefits under the plan; and
                                  ``(III) for both the plan 
                                year upon which a cost 
                                exemption is sought and the 
                                year prior, the actual total 
                                costs of coverage with respect 
                                to mental health and substance-
                                related disorder benefits under 
                                the plan.
                          ``(iii) Confidentiality.--A 
                        notification under clause (i) shall be 
                        confidential. The Department of Labor 
                        shall make available, upon request to 
                        the appropriate committees of Congress 
                        and on not more than an annual basis, 
                        an anonymous itemization of such 
                        notifications, that includes--
                                  ``(I) a breakdown of States 
                                by the size and any type of 
                                employers submitting such 
                                notification; and
                                  ``(II) a summary of the data 
                                received under clause (ii).
                  ``(G) No impact on application of state 
                law.--The fact that a plan or coverage is 
                exempt from the provisions of this section 
                under subparagraph (A) shall not affect the 
                application of State law to such plan or 
                coverage.
                  ``(H) Construction.--Nothing in this 
                paragraph shall be construed as preventing a 
                group health plan (or health insurance coverage 
                offered in connection with such a plan) from 
                complying with the provisions of this section 
                notwithstanding that the plan or coverage is 
                not required to comply with such provisions due 
                to the application of subparagraph (A).''.
  (f) Change in Exclusion for Smallest Employers.--Subsection 
(c)(1)(B) of such section is amended--
          (1) by inserting ``(or 1 in the case of an employer 
        residing in a State that permits small groups to 
        include a single individual)'' after ``at least 2'' the 
        first place it appears; and
          (2) by striking ``and who employs at least 2 
        employees on the first day of the plan year''.
  (g) Elimination of Sunset Provision.--Such section is amended 
by striking subsection (f).
  (h) Clarification Regarding Preemption.--Such section is 
further amended by inserting after subsection (e) the following 
new subsection:
  ``(f) Preemption, Relation to State Laws.--
          ``(1) In general.--This part shall not be construed 
        to supersede any provision of State law which 
        establishes, implements, or continues in effect any 
        consumer protections, benefits, methods of access to 
        benefits, rights, external review programs, or remedies 
        solely relating to health insurance issuers in 
        connection with group health insurance coverage 
        (including benefit mandates or regulation of group 
        health plans of 50 or fewer employees) except to the 
        extent that such provision prevents the application of 
        a requirement of this part.
          ``(2) Continued preemption with respect to group 
        health plans.--Nothing in this section shall be 
        construed to affect or modify the provisions of section 
        514 with respect to group health plans.
          ``(3) Other state laws.--Nothing in this section 
        shall be construed to exempt or relieve any person from 
        any laws of any State not solely related to health 
        insurance issuers in connection with group health 
        coverage insofar as they may now or hereafter relate to 
        insurance, health plans, or health coverage.'''.
  (i) Conforming Amendments to Heading.--
          (1) In general.--The heading of such section is 
        amended to read as follows:

``SEC. 712. EQUITY IN MENTAL HEALTH AND SUBSTANCE-RELATED DISORDER 
                    BENEFITS.''.

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

``Sec. 712. Equity in mental health and substance-related disorder 
          benefits.''.

  (j) Effective Date.--
          (1) In general.--The amendments made by this section 
        shall apply with respect to plan years beginning on or 
        after January 1, 2009.
          (2) Special rule for collective bargaining 
        agreements.--In the case of a group health plan 
        maintained pursuant to one or more collective 
        bargaining agreements between employee representatives 
        and one or more employers ratified before the date of 
        the enactment of this Act, the amendments made by this 
        section shall not apply to plan years beginning before 
        the later of--
                  (A) the date on which the last of the 
                collective bargaining agreements relating to 
                the plan terminates (determined without regard 
                to any extension thereof agreed to after the 
                date of the enactment of this Act), or
                  (B) January 1, 2009.
        For purposes of subparagraph (A), any plan amendment 
        made pursuant to a collective bargaining agreement 
        relating to the plan which amends the plan solely to 
        conform to any requirement added by this section shall 
        not be treated as a termination of such collective 
        bargaining agreement.
  (k) DOL Annual Sample Compliance.--The Secretary of Labor 
shall annually sample and conduct random audits of group health 
plans (and health insurance coverage offered in connection with 
such plans) in order to determine their compliance with the 
amendments made by this Act and shall submit to the appropriate 
committees of Congress an annual report on such compliance with 
such amendments. The Secretary shall share the results of such 
audits with the Secretaries of Health and Human Services and of 
the Treasury.
  (l) Assistance to Participants and Beneficiaries.--The 
Secretary of Labor shall provide assistance to participants and 
beneficiaries of group health plans with any questions or 
problems with compliance with the requirements of this Act. The 
Secretary shall notify participants and beneficiaries how they 
can obtain assistance from State consumer and insurance 
agencies and the Secretary shall coordinate with State agencies 
to ensure that participants and beneficiaries are protected and 
afforded the rights provided under this Act.

SEC. 3. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT RELATING TO THE 
                    GROUP MARKET.

  (a) Extension of Parity to Treatment Limits and Beneficiary 
Financial Requirements.--Section 2705 of the Public Health 
Service Act (42 U.S.C. 300gg-5) is amended--
          (1) in subsection (a), by adding at the end the 
        following new paragraphs:
          ``(3) Treatment limits.--In the case of a group 
        health plan that provides both medical and surgical 
        benefits and mental health or substance-related 
        disorder benefits--
                  ``(A) No treatment limit.--If the plan or 
                coverage does not include a treatment limit (as 
                defined in subparagraph (D)) on substantially 
                all medical and surgical benefits in any 
                category of items or services (specified in 
                subparagraph (C)), the plan or coverage may not 
                impose any treatment limit on mental health or 
                substance-related disorder benefits that are 
                classified in the same category of items or 
                services.
                  ``(B) Treatment limit.--If the plan or 
                coverage includes a treatment limit on 
                substantially all medical and surgical benefits 
                in any category of items or services, the plan 
                or coverage may not impose such a treatment 
                limit on mental health or substance-related 
                disorder benefits for items and services within 
                such category that is more restrictive than the 
                predominant treatment limit that is applicable 
                to medical and surgical benefits for items and 
                services within such category.
                  ``(C) Categories of items and services for 
                application of treatment limits and beneficiary 
                financial requirements.--For purposes of this 
                paragraph and paragraph (4), there shall be the 
                following five categories of items and services 
                for benefits, whether medical and surgical 
                benefits or mental health and substance-related 
                disorder benefits, and all medical and surgical 
                benefits and all mental health and substance 
                related benefits shall be classified into one 
                of the following categories:
                          ``(i) Inpatient, in-network.--Items 
                        and services not described in clause 
                        (v) furnished on an inpatient basis and 
                        within a network of providers 
                        established or recognized under such 
                        plan or coverage.
                          ``(ii) Inpatient, out-of-network.--
                        Items and services not described in 
                        clause (v) furnished on an inpatient 
                        basis and outside any network of 
                        providers established or recognized 
                        under such plan or coverage.
                          ``(iii) Outpatient, in-network.--
                        Items and services not described in 
                        clause (v) furnished on an outpatient 
                        basis and within a network of providers 
                        established or recognized under such 
                        plan or coverage.
                          ``(iv) Outpatient, out-of-network.--
                        Items and services not described in 
                        clause (v) furnished on an outpatient 
                        basis and outside any network of 
                        providers established or recognized 
                        under such plan or coverage.
                          ``(v) Emergency care.--Items and 
                        services, whether furnished on an 
                        inpatient or outpatient basis or within 
                        or outside any network of providers, 
                        required for the treatment of an 
                        emergency medical condition (as defined 
                        in section 1867(e) of the Social 
                        Security Act, including an emergency 
                        condition relating to mental health or 
                        substance-related disorders).
                  ``(D) Treatment limit defined.--For purposes 
                of this paragraph, the term `treatment limit' 
                means, with respect to a plan or coverage, 
                limitation on the frequency of treatment, 
                number of visits or days of coverage, or other 
                similar limit on the duration or scope of 
                treatment under the plan or coverage.
                  ``(E) Predominance.--For purposes of this 
                subsection, a treatment limit or financial 
                requirement with respect to a category of items 
                and services is considered to be predominant if 
                it is the most common or frequent of such type 
                of limit or requirement with respect to such 
                category of items and services.
          ``(4) Beneficiary financial requirements.--In the 
        case of a group health plan that provides both medical 
        and surgical benefits and mental health or substance-
        related disorder benefits--
                  ``(A) No beneficiary financial requirement.--
                If the plan or coverage does not include a 
                beneficiary financial requirement (as defined 
                in subparagraph (C)) on substantially all 
                medical and surgical benefits within a category 
                of items and services (specified in paragraph 
                (3)(C)), the plan or coverage may not impose 
                such a beneficiary financial requirement on 
                mental health or substance-related disorder 
                benefits for items and services within such 
                category.
                  ``(B) Beneficiary financial requirement.--
                          ``(i) Treatment of deductibles, out-
                        of-pocket limits, and similar financial 
                        requirements.--If the plan or coverage 
                        includes a deductible, a limitation on 
                        out-of-pocket expenses, or similar 
                        beneficiary financial requirement that 
                        does not apply separately to individual 
                        items and services on substantially all 
                        medical and surgical benefits within a 
                        category of items and services, the 
                        plan or coverage shall apply such 
                        requirement (or, if there is more than 
                        one such requirement for such category 
                        of items and services, the predominant 
                        requirement for such category) both to 
                        medical and surgical benefits within 
                        such category and to mental health and 
                        substance-related disorder benefits 
                        within such category and shall not 
                        distinguish in the application of such 
                        requirement between such medical and 
                        surgical benefits and such mental 
                        health and substance-related disorder 
                        benefits.
                          ``(ii) Other financial 
                        requirements.--If the plan or coverage 
                        includes a beneficiary financial 
                        requirement not described in clause (i) 
                        on substantially all medical and 
                        surgical benefits within a category of 
                        items and services, the plan or 
                        coverage may not impose such financial 
                        requirement on mental health or 
                        substance-related disorder benefits for 
                        items and services within such category 
                        in a way that results in greater out-
                        of-pocket expenses to the participant 
                        or beneficiary than the predominant 
                        beneficiary financial requirement 
                        applicable to medical and surgical 
                        benefits for items and services within 
                        such category.
                  ``(C) Beneficiary financial requirement 
                defined.--For purposes of this paragraph, the 
                term `beneficiary financial requirement' 
                includes, with respect to a plan or coverage, 
                any deductible, coinsurance, co-payment, other 
                cost sharing, and limitation on the total 
                amount that may be paid by a participant or 
                beneficiary with respect to benefits under the 
                plan or coverage, but does not include the 
                application of any aggregate lifetime limit or 
                annual limit.''; and
          (2) in subsection (b)--
                  (A) by striking ``construed--'' and all that 
                follows through ``(1) as requiring'' and 
                inserting ``construed as requiring'';
                  (B) by striking ``; or'' and inserting a 
                period; and
                  (C) by striking paragraph (2).
  (b) Expansion to Substance-Related Disorder Benefits and 
Revision of Definition.--Such section is further amended--
          (1) by striking ``mental health benefits'' each place 
        it appears (other than in any provision amended by 
        paragraph (2)) and inserting ``mental health or 
        substance-related disorder benefits'',
          (2) by striking ``mental health benefits'' each place 
        it appears in subsections (a)(1)(B)(i), (a)(1)(C), 
        (a)(2)(B)(i), and (a)(2)(C) and inserting ``mental 
        health and substance-related disorder benefits'', and
          (3) in subsection (e), by striking paragraph (4) and 
        inserting the following new paragraphs:
          ``(4) Mental health benefits.--The term `mental 
        health benefits' means benefits with respect to 
        services for mental health conditions, as defined under 
        the terms of the plan and in accordance with applicable 
        law, but does not include substance-related disorder 
        benefits.
          ``(5) Substance-related disorder benefits.--The term 
        `substance-related disorder benefits' means benefits 
        with respect to services for substance-related 
        disorders, as defined under the terms of the plan and 
        in accordance with applicable law.''.
  (c) Availability of Plan Information About Criteria for 
Medical Necessity.--Subsection (a) of such section, as amended 
by subsection (a)(1), is further amended by adding at the end 
the following new paragraph:
          ``(5) Availability of plan information.--The criteria 
        for medical necessity determinations made under the 
        plan with respect to mental health and substance-
        related disorder benefits (or the health insurance 
        coverage offered in connection with the plan with 
        respect to such benefits) shall be made available by 
        the plan administrator (or the health insurance issuer 
        offering such coverage) in accordance with regulations 
        to any current or potential participant, beneficiary, 
        or contracting provider upon request. The reason for 
        any denial under the plan (or coverage) of 
        reimbursement or payment for services with respect to 
        mental health and substance-related disorder benefits 
        in the case of any participant or beneficiary shall, on 
        request or as otherwise required, be made available by 
        the plan administrator (or the health insurance issuer 
        offering such coverage) to the participant or 
        beneficiary in accordance with regulations.''.
  (d) Minimum Benefit Requirements.--Subsection (a) of such 
section is further amended by adding at the end the following 
new paragraph:
          ``(6) Minimum scope of coverage and equity in out-of-
        network benefits.--
                  ``(A) Minimum scope of mental health and 
                substance-related disorder benefits.--In the 
                case of a group health plan (or health 
                insurance coverage offered in connection with 
                such a plan) that provides any mental health or 
                substance-related disorder benefits, the plan 
                or coverage shall include benefits for any 
                mental health condition or substance-related 
                disorder included in the most recent edition of 
                the Diagnostic and Statistical Manual of Mental 
                Disorders published by the American Psychiatric 
                Association.
                  ``(B) Equity in coverage of out-of-network 
                benefits.--
                          ``(i) In general.--In the case of a 
                        group health plan (or health insurance 
                        coverage offered in connection with 
                        such a plan) that provides both medical 
                        and surgical benefits and mental health 
                        or substance-related disorder benefits, 
                        if medical and surgical benefits are 
                        provided for substantially all items 
                        and services in a category specified in 
                        clause (ii) furnished outside any 
                        network of providers established or 
                        recognized under such plan or coverage, 
                        the mental health and substance-related 
                        disorder benefits shall also be 
                        provided for items and services in such 
                        category furnished outside any network 
                        of providers established or recognized 
                        under such plan or coverage in 
                        accordance with the requirements of 
                        this section.
                          ``(ii) Categories of items and 
                        services.--For purposes of clause (i), 
                        there shall be the following three 
                        categories of items and services for 
                        benefits, whether medical and surgical 
                        benefits or mental health and 
                        substance-related disorder benefits, 
                        and all medical and surgical benefits 
                        and all mental health and substance-
                        related disorder benefits shall be 
                        classified into one of the following 
                        categories:
                                  ``(I) Emergency.--Items and 
                                services, whether furnished on 
                                an inpatient or outpatient 
                                basis, required for the 
                                treatment of an emergency 
                                medical condition (as defined 
                                in section 1867(e) of the 
                                Social Security Act, including 
                                an emergency condition relating 
                                to mental health or substance-
                                related disorders).
                                  ``(II) Inpatient.--Items and 
                                services not described in 
                                subclause (I) furnished on an 
                                inpatient basis.
                                  ``(III) Outpatient.--Items 
                                and services not described in 
                                subclause (I) furnished on an 
                                outpatient basis.''.
  (e) Revision of Increased Cost Exemption.--Paragraph (2) of 
subsection (c) of such section is amended to read as follows:
          ``(2) Increased cost exemption.--
                  ``(A) In general.--With respect to a group 
                health plan (or health insurance coverage 
                offered in connection with such a plan), if the 
                application of this section to such plan (or 
                coverage) results in an increase for the plan 
                year involved of the actual total costs of 
                coverage with respect to medical and surgical 
                benefits and mental health and substance-
                related disorder benefits under the plan (as 
                determined and certified under subparagraph 
                (C)) by an amount that exceeds the applicable 
                percentage described in subparagraph (B) of the 
                actual total plan costs, the provisions of this 
                section shall not apply to such plan (or 
                coverage) during the following plan year, and 
                such exemption shall apply to the plan (or 
                coverage) for 1 plan year.
                  ``(B) Applicable percentage.--With respect to 
                a plan (or coverage), the applicable percentage 
                described in this paragraph shall be--
                          ``(i) 2 percent in the case of the 
                        first plan year to which this paragraph 
                        applies; and
                          ``(ii) 1 percent in the case of each 
                        subsequent plan year.
                  ``(C) Determinations by actuaries.--
                Determinations as to increases in actual costs 
                under a plan (or coverage) for purposes of this 
                subsection shall be made in writing and 
                prepared and certified by a qualified and 
                licensed actuary who is a member in good 
                standing of the American Academy of Actuaries. 
                Such determinations shall be made available by 
                the plan administrator (or health insurance 
                issuer, as the case may be) to the general 
                public.
                  ``(D) 6-month determinations.--If a group 
                health plan (or a health insurance issuer 
                offering coverage in connection with such a 
                plan) seeks an exemption under this paragraph, 
                determinations under subparagraph (A) shall be 
                made after such plan (or coverage) has complied 
                with this section for the first 6 months of the 
                plan year involved.
                  ``(E) Notification.--A group health plan 
                under this part shall comply with the notice 
                requirement under section 712(c)(2)(E) of the 
                Employee Retirement Income Security Act of 1974 
                with respect to a modification of mental health 
                and substance-related disorder benefits as 
                permitted under this paragraph as if such 
                section applied to such plan.
                  ``(F) Notification of appropriate agency.--
                          ``(i) In general.--A group health 
                        plan that, based on a certification 
                        described under subparagraph (C), 
                        qualifies for an exemption under this 
                        paragraph, and elects to implement the 
                        exemption, shall notify the Secretary 
                        of Health and Human Services of such 
                        election.
                          ``(ii) Requirement.--A notification 
                        under clause (i) shall include--
                                  ``(I) a description of the 
                                number of covered lives under 
                                the plan (or coverage) involved 
                                at the time of the 
                                notification, and as 
                                applicable, at the time of any 
                                prior election of the cost-
                                exemption under this paragraph 
                                by such plan (or coverage);
                                  ``(II) for both the plan year 
                                upon which a cost exemption is 
                                sought and the year prior, a 
                                description of the actual total 
                                costs of coverage with respect 
                                to medical and surgical 
                                benefits and mental health and 
                                substance-related disorder 
                                benefits under the plan; and
                                  ``(III) for both the plan 
                                year upon which a cost 
                                exemption is sought and the 
                                year prior, the actual total 
                                costs of coverage with respect 
                                to mental health and substance-
                                related disorder benefits under 
                                the plan.
                          ``(iii) Confidentiality.--A 
                        notification under clause (i) shall be 
                        confidential. The Secretary of Health 
                        and Human Services shall make 
                        available, upon request to the 
                        appropriate committees of Congress and 
                        on not more than an annual basis, an 
                        anonymous itemization of such 
                        notifications, that includes--
                                  ``(I) a breakdown of States 
                                by the size and any type of 
                                employers submitting such 
                                notification; and
                                  ``(II) a summary of the data 
                                received under clause (ii).
                  ``(G) Construction.--Nothing in this 
                paragraph shall be construed as preventing a 
                group health plan (or health insurance coverage 
                offered in connection with such a plan) from 
                complying with the provisions of this section 
                notwithstanding that the plan or coverage is 
                not required to comply with such provisions due 
                to the application of subparagraph (A).''.
  (f) Change in Exclusion for Smallest Employers.--Subsection 
(c)(1)(B) of such section is amended--
          (1) by inserting ``(or 1 in the case of an employer 
        residing in a State that permits small groups to 
        include a single individual)'' after ``at least 2'' the 
        first place it appears; and
          (2) by striking ``and who employs at least 2 
        employees on the first day of the plan year''.
  (g) Elimination of Sunset Provision.--Such section is amended 
by striking out subsection (f).
  (h) Clarification Regarding Preemption.--Such section is 
further amended by inserting after subsection (e) the following 
new subsection:
  ``(f) Preemption, Relation to State Laws.--
          ``(1) In general.--Nothing in this section shall be 
        construed to preempt any State law that provides 
        greater consumer protections, benefits, methods of 
        access to benefits, rights or remedies that are greater 
        than the protections, benefits, methods of access to 
        benefits, rights or remedies provided under this 
        section.
          ``(2) Construction.--Nothing in this section shall be 
        construed to affect or modify the provisions of section 
        2723 with respect to group health plans.''.
  (i) Conforming Amendment to Heading.--The heading of such 
section is amended to read as follows:

``SEC. 2705. EQUITY IN MENTAL HEALTH AND SUBSTANCE-RELATED DISORDER 
                    BENEFITS.''.

  (j) Effective Date.--
          (1) In general.--Except as otherwise provided in this 
        subsection, the amendments made by this section shall 
        apply with respect to plan years beginning on or after 
        January 1, 2009.
          (2) Elimination of sunset.--The amendment made by 
        subsection (g) shall apply to benefits for services 
        furnished after December 31, 2007.
          (3) Special rule for collective bargaining 
        agreements.--In the case of a group health plan 
        maintained pursuant to one or more collective 
        bargaining agreements between employee representatives 
        and one or more employers ratified before the date of 
        the enactment of this Act, the amendments made by this 
        section shall not apply to plan years beginning before 
        the later of--
                  (A) the date on which the last of the 
                collective bargaining agreements relating to 
                the plan terminates (determined without regard 
                to any extension thereof agreed to after the 
                date of the enactment of this Act), or
                  (B) January 1, 2009.
        For purposes of subparagraph (A), any plan amendment 
        made pursuant to a collective bargaining agreement 
        relating to the plan which amends the plan solely to 
        conform to any requirement added by this section shall 
        not be treated as a termination of such collective 
        bargaining agreement.

SEC. 4. AMENDMENTS TO THE INTERNAL REVENUE CODE OF 1986.

  (a) Extension of Parity to Treatment Limits and Beneficiary 
Financial Requirements.--Section 9812 of the Internal Revenue 
Code of 1986 is amended--
          (1) in subsection (a), by adding at the end the 
        following new paragraphs:
          ``(3) Treatment limits.--In the case of a group 
        health plan that provides both medical and surgical 
        benefits and mental health or substance-related 
        disorder benefits--
                  ``(A) No treatment limit.--If the plan does 
                not include a treatment limit (as defined in 
                subparagraph (D)) on substantially all medical 
                and surgical benefits in any category of items 
                or services (specified in subparagraph (C)), 
                the plan may not impose any treatment limit on 
                mental health or substance-related disorder 
                benefits that are classified in the same 
                category of items or services.
                  ``(B) Treatment limit.--If the plan includes 
                a treatment limit on substantially all medical 
                and surgical benefits in any category of items 
                or services, the plan may not impose such a 
                treatment limit on mental health or substance-
                related disorder benefits for items and 
                services within such category that is more 
                restrictive than the predominant treatment 
                limit that is applicable to medical and 
                surgical benefits for items and services within 
                such category.
                  ``(C) Categories of items and services for 
                application of treatment limits and beneficiary 
                financial requirements.--For purposes of this 
                paragraph and paragraph (4), there shall be the 
                following five categories of items and services 
                for benefits, whether medical and surgical 
                benefits or mental health and substance-related 
                disorder benefits, and all medical and surgical 
                benefits and all mental health and substance 
                related benefits shall be classified into one 
                of the following categories:
                          ``(i) Inpatient, in-network.--Items 
                        and services not described in clause 
                        (v) furnished on an inpatient basis and 
                        within a network of providers 
                        established or recognized under such 
                        plan.
                          ``(ii) Inpatient, out-of-network.--
                        Items and services not described in 
                        clause (v) furnished on an inpatient 
                        basis and outside any network of 
                        providers established or recognized 
                        under such plan.
                          ``(iii) Outpatient, in-network.--
                        Items and services not described in 
                        clause (v) furnished on an outpatient 
                        basis and within a network of providers 
                        established or recognized under such 
                        plan.
                          ``(iv) Outpatient, out-of-network.--
                        Items and services not described in 
                        clause (v) furnished on an outpatient 
                        basis and outside any network of 
                        providers established or recognized 
                        under such plan.
                          ``(v) Emergency care.--Items and 
                        services, whether furnished on an 
                        inpatient or outpatient basis or within 
                        or outside any network of providers, 
                        required for the treatment of an 
                        emergency medical condition (as defined 
                        in section 1867(e) of the Social 
                        Security Act, including an emergency 
                        condition relating to mental health or 
                        substance-related disorders).
                  ``(D) Treatment limit defined.--For purposes 
                of this paragraph, the term `treatment limit' 
                means, with respect to a plan, limitation on 
                the frequency of treatment, number of visits or 
                days of coverage, or other similar limit on the 
                duration or scope of treatment under the plan.
                  ``(E) Predominance.--For purposes of this 
                subsection, a treatment limit or financial 
                requirement with respect to a category of items 
                and services is considered to be predominant if 
                it is the most common or frequent of such type 
                of limit or requirement with respect to such 
                category of items and services.
          ``(4) Beneficiary financial requirements.--In the 
        case of a group health plan that provides both medical 
        and surgical benefits and mental health or substance-
        related disorder benefits--
                  ``(A) No beneficiary financial requirement.--
                If the plan does not include a beneficiary 
                financial requirement (as defined in 
                subparagraph (C)) on substantially all medical 
                and surgical benefits within a category of 
                items and services (specified in paragraph 
                (3)(C)), the plan may not impose such a 
                beneficiary financial requirement on mental 
                health or substance-related disorder benefits 
                for items and services within such category.
                  ``(B) Beneficiary financial requirement.--
                          ``(i) Treatment of deductibles, out-
                        of-pocket limits, and similar financial 
                        requirements.--If the plan includes a 
                        deductible, a limitation on out-of-
                        pocket expenses, or similar beneficiary 
                        financial requirement that does not 
                        apply separately to individual items 
                        and services on substantially all 
                        medical and surgical benefits within a 
                        category of items and services, the 
                        plan shall apply such requirement (or, 
                        if there is more than one such 
                        requirement for such category of items 
                        and services, the predominant 
                        requirement for such category) both to 
                        medical and surgical benefits within 
                        such category and to mental health and 
                        substance-related disorder benefits 
                        within such category and shall not 
                        distinguish in the application of such 
                        requirement between such medical and 
                        surgical benefits and such mental 
                        health and substance-related disorder 
                        benefits.
                          ``(ii) Other financial 
                        requirements.--If the plan includes a 
                        beneficiary financial requirement not 
                        described in clause (i) on 
                        substantially all medical and surgical 
                        benefits within a category of items and 
                        services, the plan may not impose such 
                        financial requirement on mental health 
                        or substance-related disorder benefits 
                        for items and services within such 
                        category in a way that results in 
                        greater out-of-pocket expenses to the 
                        participant or beneficiary than the 
                        predominant beneficiary financial 
                        requirement applicable to medical and 
                        surgical benefits for items and 
                        services within such category.
                  ``(C) Beneficiary financial requirement 
                defined.--For purposes of this paragraph, the 
                term `beneficiary financial requirement' 
                includes, with respect to a plan, any 
                deductible, coinsurance, co-payment, other cost 
                sharing, and limitation on the total amount 
                that may be paid by a participant or 
                beneficiary with respect to benefits under the 
                plan, but does not include the application of 
                any aggregate lifetime limit or annual 
                limit.'', and
          (2) in subsection (b)--
                  (A) by striking ``construed--'' and all that 
                follows through ``(1) as requiring'' and 
                inserting ``construed as requiring'',
                  (B) by striking ``; or'' and inserting a 
                period, and
                  (C) by striking paragraph (2).
  (b) Expansion to Substance-Related Disorder Benefits and 
Revision of Definition.--Section 9812 of such Code is further 
amended--
          (1) by striking ``mental health benefits'' each place 
        it appears (other than in any provision amended by 
        paragraph (2)) and inserting ``mental health or 
        substance-related disorder benefits'',
          (2) by striking ``mental health benefits'' each place 
        it appears in subsections (a)(1)(B)(i), (a)(1)(C), 
        (a)(2)(B)(i), and (a)(2)(C) and inserting ``mental 
        health and substance-related disorder benefits'', and
          (3) in subsection (e), by striking paragraph (4) and 
        inserting the following new paragraphs:
          ``(4) Mental health benefits.--The term `mental 
        health benefits' means benefits with respect to 
        services for mental health conditions, as defined under 
        the terms of the plan and in accordance with applicable 
        law, but does not include substance-related disorder 
        benefits.
          ``(5) Substance-related disorder benefits.--The term 
        `substance-related disorder benefits' means benefits 
        with respect to services for substance-related 
        disorders, as defined under the terms of the plan and 
        in accordance with applicable law.''.
  (c) Availability of Plan Information About Criteria for 
Medical Necessity.--Subsection (a) of section 9812 of such 
Code, as amended by subsection (a)(1), is further amended by 
adding at the end the following new paragraph:
          ``(5) Availability of plan information.--The criteria 
        for medical necessity determinations made under the 
        plan with respect to mental health and substance-
        related disorder benefits shall be made available by 
        the plan administrator in accordance with regulations 
        to any current or potential participant, beneficiary, 
        or contracting provider upon request. The reason for 
        any denial under the plan of reimbursement or payment 
        for services with respect to mental health and 
        substance-related disorder benefits in the case of any 
        participant or beneficiary shall, on request or as 
        otherwise required, be made available by the plan 
        administrator to the participant or beneficiary in 
        accordance with regulations.''.
  (d) Minimum Benefit Requirements.--Subsection (a) of section 
9812 of such Code is further amended by adding at the end the 
following new paragraph:
          ``(6) Minimum scope of coverage and equity in out-of-
        network benefits.--
                  ``(A) Minimum scope of mental health and 
                substance-related disorder benefits.--In the 
                case of a group health plan that provides any 
                mental health or substance-related disorder 
                benefits, the plan shall include benefits for 
                any mental health condition or substance-
                related disorder included in the most recent 
                edition of the Diagnostic and Statistical 
                Manual of Mental Disorders published by the 
                American Psychiatric Association.
                  ``(B) Equity in coverage of out-of-network 
                benefits.--
                          ``(i) In general.--In the case of a 
                        group health plan that provides both 
                        medical and surgical benefits and 
                        mental health or substance-related 
                        disorder benefits, if medical and 
                        surgical benefits are provided for 
                        substantially all items and services in 
                        a category specified in clause (ii) 
                        furnished outside any network of 
                        providers established or recognized 
                        under such plan, the mental health and 
                        substance-related disorder benefits 
                        shall also be provided for items and 
                        services in such category furnished 
                        outside any network of providers 
                        established or recognized under such 
                        plan in accordance with the 
                        requirements of this section.
                          ``(ii) Categories of items and 
                        services.--For purposes of clause (i), 
                        there shall be the following three 
                        categories of items and services for 
                        benefits, whether medical and surgical 
                        benefits or mental health and 
                        substance-related disorder benefits, 
                        and all medical and surgical benefits 
                        and all mental health and substance-
                        related disorder benefits shall be 
                        classified into one of the following 
                        categories:
                                  ``(I) Emergency.--Items and 
                                services, whether furnished on 
                                an inpatient or outpatient 
                                basis, required for the 
                                treatment of an emergency 
                                medical condition (as defined 
                                in section 1867(e) of the 
                                Social Security Act, including 
                                an emergency condition relating 
                                to mental health or substance-
                                related disorders).
                                  ``(II) Inpatient.--Items and 
                                services not described in 
                                subclause (I) furnished on an 
                                inpatient basis.
                                  ``(III) Outpatient.--Items 
                                and services not described in 
                                subclause (I) furnished on an 
                                outpatient basis.''.
  (e) Revision of Increased Cost Exemption.--Paragraph (2) of 
section 9812(c) of such Code is amended to read as follows:
          ``(2) Increased cost exemption.--
                  ``(A) In general.--With respect to a group 
                health plan, if the application of this section 
                to such plan results in an increase for the 
                plan year involved of the actual total costs of 
                coverage with respect to medical and surgical 
                benefits and mental health and substance-
                related disorder benefits under the plan (as 
                determined and certified under subparagraph 
                (C)) by an amount that exceeds the applicable 
                percentage described in subparagraph (B) of the 
                actual total plan costs, the provisions of this 
                section shall not apply to such plan during the 
                following plan year, and such exemption shall 
                apply to the plan for 1 plan year.
                  ``(B) Applicable percentage.--With respect to 
                a plan, the applicable percentage described in 
                this paragraph shall be--
                          ``(i) 2 percent in the case of the 
                        first plan year to which this paragraph 
                        applies, and
                          ``(ii) 1 percent in the case of each 
                        subsequent plan year.
                  ``(C) Determinations by actuaries.--
                Determinations as to increases in actual costs 
                under a plan for purposes of this subsection 
                shall be made in writing and prepared and 
                certified by a qualified and licensed actuary 
                who is a member in good standing of the 
                American Academy of Actuaries. Such 
                determinations shall be made available by the 
                plan administrator to the general public.
                  ``(D) 6-month determinations.--If a group 
                health plan seeks an exemption under this 
                paragraph, determinations under subparagraph 
                (A) shall be made after such plan has complied 
                with this section for the first 6 months of the 
                plan year involved.
                  ``(E) Notification of appropriate agency.--
                          ``(i) In general.--A group health 
                        plan that, based on a certification 
                        described under subparagraph (C), 
                        qualifies for an exemption under this 
                        paragraph, and elects to implement the 
                        exemption, shall notify the Secretary 
                        of the Treasury of such election.
                          ``(ii) Requirement.--A notification 
                        under clause (i) shall include--
                                  ``(I) a description of the 
                                number of covered lives under 
                                the plan (or coverage) involved 
                                at the time of the 
                                notification, and as 
                                applicable, at the time of any 
                                prior election of the cost-
                                exemption under this paragraph 
                                by such plan (or coverage);
                                  ``(II) for both the plan year 
                                upon which a cost exemption is 
                                sought and the year prior, a 
                                description of the actual total 
                                costs of coverage with respect 
                                to medical and surgical 
                                benefits and mental health and 
                                substance-related disorder 
                                benefits under the plan; and
                                  ``(III) for both the plan 
                                year upon which a cost 
                                exemption is sought and the 
                                year prior, the actual total 
                                costs of coverage with respect 
                                to mental health and substance-
                                related disorder benefits under 
                                the plan.
                          ``(iii) Confidentiality.--A 
                        notification under clause (i) shall be 
                        confidential. The Secretary of the 
                        Treasury shall make available, upon 
                        request to the appropriate committees 
                        of Congress and on not more than an 
                        annual basis, an anonymous itemization 
                        of such notifications, that includes--
                                  ``(I) a breakdown of States 
                                by the size and any type of 
                                employers submitting such 
                                notification; and
                                  ``(II) a summary of the data 
                                received under clause (ii).
                  ``(F) Construction.--Nothing in this 
                paragraph shall be construed as preventing a 
                group health plan from complying with the 
                provisions of this section notwithstanding that 
                the plan is not required to comply with such 
                provisions due to the application of 
                subparagraph (A).''.
  (f) Change in Exclusion for Smallest Employers.--Paragraph 
(1) of section 9812(c) of such Code is amended to read as 
follows:
          ``(1) Small employer exemption.--
                  ``(A) In general.--This section shall not 
                apply to any group health plan for any plan 
                year of a small employer.
                  ``(B) Small employer.--For purposes of 
                subparagraph (A), the term `small employer' 
                means, with respect to a calendar year and a 
                plan year, an employer who employed an average 
                of at least 2 (or 1 in the case of an employer 
                residing in a State that permits small groups 
                to include a single individual) but not more 
                than 50 employees on business days during the 
                preceding calendar year. For purposes of the 
                preceding sentence, all persons treated as a 
                single employer under subsection (b), (c), (m), 
                or (o) of section 414 shall be treated as 1 
                employer and rules similar to rules of 
                subparagraphs (B) and (C) of section 
                4980D(d)(2) shall apply.''.
  (g) Elimination of Sunset Provision.--Section 9812 of such 
Code is amended by striking subsection (f).
  (h) Conforming Amendments to Heading.--
          (1) In general.--The heading of section 9812 of such 
        Code is amended to read as follows:

``SEC. 9812. EQUITY IN MENTAL HEALTH AND SUBSTANCE-RELATED DISORDER 
                    BENEFITS.''.

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

``Sec. 9812. Equity in mental health and substance-related disorder 
          benefits.''.

  (i) Effective Date.--
          (1) In general.--Except as otherwise provided in this 
        subsection, the amendments made by this section shall 
        apply with respect to plan years beginning on or after 
        January 1, 2009.
          (2) Elimination of sunset.--The amendment made by 
        subsection (g) shall apply to benefits for services 
        furnished after December 31, 2007.
          (3) Special rule for collective bargaining 
        agreements.--In the case of a group health plan 
        maintained pursuant to one or more collective 
        bargaining agreements between employee representatives 
        and one or more employers ratified before the date of 
        the enactment of this Act, the amendments made by this 
        section (other than subsection (g)) shall not apply to 
        plan years beginning before the later of--
                  (A) the date on which the last of the 
                collective bargaining agreements relating to 
                the plan terminates (determined without regard 
                to any extension thereof agreed to after the 
                date of the enactment of this Act), or
                  (B) January 1, 2009.
        For purposes of subparagraph (A), any plan amendment 
        made pursuant to a collective bargaining agreement 
        relating to the plan which amends the plan solely to 
        conform to any requirement added by this section shall 
        not be treated as a termination of such collective 
        bargaining agreement.

SEC. 5. MEDICAID DRUG REBATE.

  Paragraph (1)(B)(i) of section 1927(c) of the Social Security 
Act (42 U.S.C. 1396r-8(c)) is amended--
          (1) by striking ``and'' at the end of subclause (IV);
          (2) in subclause (V)--
                  (A) by inserting ``and before January 1, 
                2009, and after December 31, 2014,'' after 
                ``December 31, 1995,''; and
                  (B) by striking the period at the end and 
                inserting ``; and''; and
          (3) by adding at the end the following new subclause:
                                  ``(VI) after December 31, 
                                2008, and before January 1, 
                                2015, is 20.1 percent.''.

SEC. 6. LIMITATION ON MEDICARE EXCEPTION TO THE PROHIBITION ON CERTAIN 
                    PHYSICIAN REFERRALS FOR HOSPITALS.

  (a) In General.--Section 1877 of the Social Security Act (42 
U.S.C. 1395nn) is amended--
          (1) in subsection (d)(2)--
                  (A) in subparagraph (A), by striking ``and'' 
                at the end;
                  (B) in subparagraph (B), by striking the 
                period at the end and inserting ``; and''; and
                  (C) by adding at the end the following new 
                subparagraph:
                  ``(C) in the case where the entity is a 
                hospital, the hospital meets the requirements 
                of paragraph (3)(D).'';
          (2) in subsection (d)(3)--
                  (A) in subparagraph (B), by striking ``and'' 
                at the end;
                  (B) in subparagraph (C), by striking the 
                period at the end and inserting ``; and''; and
                  (C) by adding at the end the following new 
                subparagraph:
                  ``(D) the hospital meets the requirements 
                described in subsection (i)(1) not later than 
                18 months after the date of the enactment of 
                this subparagraph.''; and
          (3) by adding at the end the following new 
        subsection:
  ``(i) Requirements for Hospitals To Qualify for Hospital 
Exception to Ownership or Investment Prohibition.--
          ``(1) Requirements described.--For purposes of 
        subsection (d)(3)(D), the requirements described in 
        this paragraph for a hospital are as follows:
                  ``(A) Provider agreement.--The hospital had--
                          ``(i) physician ownership on the date 
                        of enactment of this subsection; and
                          ``(ii) a provider agreement under 
                        section 1866 in effect on such date of 
                        enactment.
                  ``(B) Limitation on expansion of facility 
                capacity.--Except as provided in paragraph (3), 
                the number of operating rooms and beds of the 
                hospital at any time on or after the date of 
                the enactment of this subsection are no greater 
                than the number of operating rooms and beds as 
                of such date.
                  ``(C) Preventing conflicts of interest.--
                          ``(i) The hospital submits to the 
                        Secretary an annual report containing a 
                        detailed description of--
                                  ``(I) the identity of each 
                                physician owner and any other 
                                owners of the hospital; and
                                  ``(II) the nature and extent 
                                of all ownership interests in 
                                the hospital.
                          ``(ii) The hospital has procedures in 
                        place to require that any referring 
                        physician owner discloses to the 
                        patient being referred, by a time that 
                        permits the patient to make a 
                        meaningful decision regarding the 
                        receipt of care, as determined by the 
                        Secretary--
                                  ``(I) the ownership interest 
                                of such referring physician in 
                                the hospital; and
                                  ``(II) if applicable, any 
                                such ownership interest of the 
                                treating physician.
                          ``(iii) The hospital does not 
                        condition any physician ownership 
                        interests either directly or indirectly 
                        on the physician owner making or 
                        influencing referrals to the hospital 
                        or otherwise generating business for 
                        the hospital.
                          ``(iv) The hospital discloses the 
                        fact that the hospital is partially 
                        owned by physicians--
                                  ``(I) on any public website 
                                for the hospital; and
                                  ``(II) in any public 
                                advertising for the hospital.
                  ``(D) Ensuring bona fide investment.--
                          ``(i) Physician owners in the 
                        aggregate do not own more than 40 
                        percent of the total value of the 
                        investment interests held in the 
                        hospital or in an entity whose assets 
                        include the hospital.
                          ``(ii) The investment interest of any 
                        individual physician owner does not 
                        exceed 2 percent of the total value of 
                        the investment interests held in the 
                        hospital or in an entity whose assets 
                        include the hospital.
                          ``(iii) Any ownership or investment 
                        interests that the hospital offers to a 
                        physician owner are not offered on more 
                        favorable terms than the terms offered 
                        to a person who is not a physician 
                        owner.
                          ``(iv) The hospital (or any investors 
                        in the hospital) does not directly or 
                        indirectly provide loans or financing 
                        for any physician owner investments in 
                        the hospital.
                          ``(v) The hospital (or any investors 
                        in the hospital) does not directly or 
                        indirectly guarantee a loan, make a 
                        payment toward a loan, or otherwise 
                        subsidize a loan, for any individual 
                        physician owner or group of physician 
                        owners that is related to acquiring any 
                        ownership interest in the hospital.
                          ``(vi) Investment returns are 
                        distributed to each investor in the 
                        hospital in an amount that is directly 
                        proportional to the investment of 
                        capital by such investor in the 
                        hospital.
                          ``(vii) Physician owners do not 
                        receive, directly or indirectly, any 
                        guaranteed receipt of or right to 
                        purchase other business interests 
                        related to the hospital, including the 
                        purchase or lease of any property under 
                        the control of other investors in the 
                        hospital or located near the premises 
                        of the hospital.
                          ``(viii) The hospital does not offer 
                        a physician owner the opportunity to 
                        purchase or lease any property under 
                        the control of the hospital or any 
                        other investor in the hospital on more 
                        favorable terms than the terms offered 
                        to an individual who is not a physician 
                        owner.
                  ``(E) Patient safety.--
                          ``(i) Insofar as the hospital admits 
                        a patient and does not have any 
                        physician available on the premises to 
                        provide services during all hours in 
                        which the hospital is providing 
                        services to such patient, before 
                        admitting the patient--
                                  ``(I) the hospital discloses 
                                such fact to a patient; and
                                  ``(II) following such 
                                disclosure, the hospital 
                                receives from the patient a 
                                signed acknowledgment that the 
                                patient understands such fact.
                          ``(ii) The hospital has the capacity 
                        to--
                                  ``(I) provide assessment and 
                                initial treatment for patients; 
                                and
                                  ``(II) refer and transfer 
                                patients to hospitals with the 
                                capability to treat the needs 
                                of the patient involved.
          ``(2) Publication of information reported.--The 
        Secretary shall publish, and update on an annual basis, 
        the information submitted by hospitals under paragraph 
        (1)(C)(i) on the public Internet website of the Centers 
        for Medicare & Medicaid Services.
          ``(3) Exception to prohibition on expansion of 
        facility capacity.--
                  ``(A) Process.--
                          ``(i) Establishment.--The Secretary 
                        shall establish and implement a process 
                        under which an applicable hospital (as 
                        defined in subparagraph (E)) may apply 
                        for an exception from the requirement 
                        under paragraph (1)(B).
                          ``(ii) Opportunity for community 
                        input.--The process under clause (i) 
                        shall provide individuals and entities 
                        in the community that the applicable 
                        hospital applying for an exception is 
                        located with the opportunity to provide 
                        input with respect to the application.
                          ``(iii) Timing for implementation.--
                        The Secretary shall implement the 
                        process under clause (i) on the date 
                        that is 18 months after the date of 
                        enactment of this subsection.
                          ``(iv) Regulations.--Not later than 
                        the date that is 18 months after the 
                        date of enactment of this subsection, 
                        the Secretary shall promulgate 
                        regulations to carry out the process 
                        under clause (i).
                  ``(B) Frequency.--The process described in 
                subparagraph (A) shall permit an applicable 
                hospital to apply for an exception up to once 
                every 2 years.
                  ``(C) Permitted increase.--
                          ``(i) In general.--Subject to clause 
                        (ii) and subparagraph (D), an 
                        applicable hospital granted an 
                        exception under the process described 
                        in subparagraph (A) may increase the 
                        number of operating rooms and beds of 
                        the applicable hospital above the 
                        baseline number of operating rooms and 
                        beds of the applicable hospital (or, if 
                        the applicable hospital has been 
                        granted a previous exception under this 
                        paragraph, above the number of 
                        operating rooms and beds of the 
                        hospital after the application of the 
                        most recent increase under such an 
                        exception) by an amount determined 
                        appropriate by the Secretary.
                          ``(ii) Lifetime 50 percent increase 
                        limitation.--The Secretary shall not 
                        permit an increase in the number of 
                        operating rooms and beds of an 
                        applicable hospital under clause (i) to 
                        the extent such increase would result 
                        in the number of operating rooms and 
                        beds of the applicable hospital 
                        exceeding 150 percent of the baseline 
                        number of operating rooms and beds of 
                        the applicable hospital.
                          ``(iii) Baseline number of operating 
                        rooms and beds.--In this paragraph, the 
                        term `baseline number of operating 
                        rooms and beds' means the number of 
                        operating rooms and beds of the 
                        applicable hospital as of the date of 
                        enactment of this subsection.
                  ``(D) Increase limited to facilities on the 
                main campus of the hospital.--Any increase in 
                the number of operating rooms and beds of an 
                applicable hospital pursuant to this paragraph 
                may only occur in facilities on the main campus 
                of the applicable hospital.
                  ``(E) Applicable hospital.--In this 
                paragraph, the term `applicable hospital' means 
                a hospital--
                          ``(i) that is located in a county in 
                        which the percentage increase in the 
                        population during the most recent 5-
                        year period (as of the date of the 
                        application under subparagraph (A)) is 
                        at least 200 percent of the percentage 
                        increase in the population growth of 
                        the United States during that period, 
                        as estimated by Bureau of the Census;
                          ``(ii) whose annual percent of total 
                        inpatient admissions and outpatient 
                        visits that represent inpatient 
                        admissions and outpatient visits under 
                        the program under title XIX is equal to 
                        or greater than the average percent 
                        with respect to such admissions and 
                        visits for all hospitals located in the 
                        State;
                          ``(iii) that does not discriminate 
                        against beneficiaries of Federal health 
                        care programs and does not permit 
                        physicians practicing at the hospital 
                        to discriminate against such 
                        beneficiaries;
                          ``(iv) that is located in a State in 
                        which the average bed capacity in the 
                        State is less than the national average 
                        bed capacity; and
                          ``(v) in the case of a hospital 
                        located--
                                  ``(I) in a core-based 
                                statistical area, that is 
                                located in such an area in 
                                which the average bed occupancy 
                                rate in such area is greater 
                                than 80 percent; or
                                  ``(II) outside of a core-
                                based statistical area, that is 
                                located in a State in which the 
                                average bed occupancy rate is 
                                greater than 80 percent.
                  ``(F) Publication of final decisions.--The 
                Secretary shall publish final decisions with 
                respect to applications under this paragraph in 
                the Federal Register.
                  ``(G) Limitation on review.--There shall be 
                no administrative or judicial review under 
                section 1869, section 1878, or otherwise of the 
                process under this paragraph (including the 
                establishment of such process).
          ``(4) Collection of ownership and investment 
        information.--For purposes of clauses (i) and (ii) of 
        paragraph (1)(D), the Secretary shall collect physician 
        ownership and investment information for each hospital 
        as it existed on the date of the enactment of this 
        subsection.
          ``(5) Physician owner defined.--For purposes of this 
        subsection, the term `physician owner' means a 
        physician (or an immediate family member of such 
        physician) with a direct or an indirect ownership 
        interest in the hospital.''.
  (b) Enforcement.--
          (1) Ensuring compliance.--The Secretary of Health and 
        Human Services shall establish policies and procedures 
        to ensure compliance with the requirements described in 
        subsection (i)(1) of section 1877 of the Social 
        Security Act, as added by subsection (a)(3), beginning 
        on the date such requirements first apply. Such 
        policies and procedures may include unannounced site 
        reviews of hospitals.
          (2) Audits.--Beginning not later than 18 months after 
        the date of the enactment of this Act, the Secretary of 
        Health and Human Services shall conduct audits to 
        determine if hospitals violate the requirements 
        referred to in paragraph (1).
  (c) Adjustment to PAQI Fund.--Section 1848(l)(2)(A)(i)(III) 
of the Social Security Act (42 U.S.C. 1395w-
4(l)(2)(A)(i)(III)), as amended by section 101(a)(2) of the 
Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 
110-173), is amended by striking ``$4,960,000,000'' and 
inserting ``$5,120,000,000''.

SEC. 7. STUDIES AND REPORTS.

  (a) Implementation of Act.--
          (1) GAO study.--The Comptroller General of the United 
        States shall conduct a study that evaluates the effect 
        of the implementation of the amendments made by this 
        Act on--
                  (A) the cost of health insurance coverage;
                  (B) access to health insurance coverage 
                (including the availability of in-network 
                providers);
                  (C) the quality of health care;
                  (D) Medicare, Medicaid, and State and local 
                mental health and substance abuse treatment 
                spending;
                  (E) the number of individuals with private 
                insurance who received publicly funded health 
                care for mental health and substance-related 
                disorders;
                  (F) spending on public services, such as the 
                criminal justice system, special education, and 
                income assistance programs;
                  (G) the use of medical management of mental 
                health and substance-related disorder benefits 
                and medical necessity determinations by group 
                health plans (and health insurance issuers 
                offering health insurance coverage in 
                connection with such plans) and timely access 
                by participants and beneficiaries to 
                clinically-indicated care for mental health and 
                substance-use disorders; and
                  (H) other matters as determined appropriate 
                by the Comptroller General.
          (2) Report.--Not later than 2 years after the date of 
        enactment of this Act, the Comptroller General shall 
        prepare and submit to the appropriate committees of the 
        Congress a report containing the results of the study 
        conducted under paragraph (1).
  (b) GAO Report on Uniform Patient Placement Criteria.--Not 
later than 18 months after the date of the enactment of this 
Act, the Comptroller General shall submit to each House of the 
Congress a report on availability of uniform patient placement 
criteria for mental health and substance-related disorders that 
could be used by group health plans and health insurance 
issuers to guide determinations of medical necessity and the 
extent to which health plans utilize such criteria. If such 
criteria do not exist, the report shall include recommendations 
on a process for developing such criteria.
  (c) DOL Biannual Report on Any Obstacles in Obtaining 
Coverage.--Every two years, the Secretary of Labor, in 
consultation with the Secretaries of Health and Human Services 
and the Treasury, shall submit to the appropriate committees of 
each House of the Congress a report on obstacles, if any, that 
individuals face in obtaining mental health and substance-
related disorder care under their health plans.

                                  
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