Below is federal legislation related to parity that has become law since the Federal Parity Law passed in 2008. Beneath that is federal legislation related to parity that has been introduced but not signed into law during that same time span. The legislation passed since 2008 is usually designed to increase compliance with the federal law. Please scroll to the bottom of the page to learn about the Federal Parity Law.

Legislation Signed into Law

2016

SPONSORS: REP. BONAMICI (D-OR)
INTROCUDED: 1/2015
STATUS: SIGNED INTO LAW 12/2016

Summary This bill addresses many issues related to behavioral health, including parity . The majority of these provisions fall within Title XIII of the bill. The parity sections within this bill are the exact same provisions found within S 2680 and HR 2646 from the same legislative session with the exception of one section.

Section 13001 requires the Secretary of Health and Human Services (HHS), the Secretary of the Department of Labor (DOL), and the Treasury (DOT) Secretary to issue a compliance program guidance document. The goal of this document is to help improve compliance with the Federal Parity Law . This document will include examples of compliance and noncompliance. The bill specifically calls for examples on disclosure and nonquantitative treatment limitations (NQTLs) . This documents will be updated every two years.

This section also requires the Secretaries of HHS, DOL, and the Treasury to issue additional guidance on disclosure and NQTLs . For disclosure , these documents would include examples of the methods health plans can use to provide documents to authorized individuals. The NQTL section contains an illustrative list of NQTL examples, including medical necessity , drug formulary design, fail-first protocols, and network admission standards.

In addition, Section 13001 requires HHS, DOL, and DoT to audit any plan under its jurisdiction with at least five instances of potential non-compliance with the Federal Parity Law . Section 13001 is identical to section 605 from S 2680 and section 802 HR 2646 from the 2015-2016 legislative session. This last provision is also found in section 903 of S 1945 from the 2015-2016 legislative session.

Section 13002 requires the Secretary of HHS to convene a stakeholder meeting to create an action plan for improved federal and state coordination of parity enforcement. The action plan must be released no later than 6 months after this meeting and must contain specific information regarding a number of topics. This section is identical to section 606 from S 2680 and section 802 from HR 2646 from the same legislative session.

Section 13003 requires HHS, DOL, and DoT to release an annual report for the following 6 years that details the number of federal investigations of non-compliance with the Federal Parity Law and the nature of and results of those investigations. This section is identical to section 607 from S 2680 and section 803 from HR 2646 from the same legislative session. A nearly identical section is also found in section 802 from HR 4425 and section 902 from S 1945 of the 2015-2016 legislative session.

Section 13004 requires the Comptroller General, in consultation with HHS, DOL, and DoT, to submit a report to the Senate Committee on Health, Education, Labor, and Pensions and the House of Representative Committee on Energy and Commerce that describes the extent to which plans comply with the Federal Parity Law regarding NQTLs , the methods the Federal Agencies use to ensure compliance, how the Federal agencies and state agencies have improved enforcement activities, and recommendations as to how Federal and State agencies can improve enforcement of the Federal Parity Law . This section is identical to section 608 from S 2680 and section 804 from HR 2646 from the same legislative session.

Section 13007 clarifies that any plan that covers treatment for eating disorders, including residential treatment , must comply with the Federal Parity Law . This section is identical to section 604 from S 2680 and section 808 from HR 2646 from the same legislative session.

2010

INTRODUCED: 9/2009
STATUS: SIGNED INTO LAW 3/2010

Summary
The Affordable Care Act (ACA) was signed into law in October, 2010, and impacts who is covered under the Federal Parity Law . The ACA lists 10 Essential Health Benefits that must be covered by individual plans and small employer fully-insured plans created after March 23rd, 2010. Mental Health and substance use disorders are included as an Essential Health Benefit, and in order to satisfy the ACA, these plans must comply with the Federal Parity Law as well. The ACA also required that any insurance plans that were sold on the Health Insurance Marketplaces must follow the Federal Parity Law. Because of these rules in the ACA, the Federal Parity Law now applies to many more insurance plans, and will continue to apply to more as people buy their health insurance on the Insurance Marketplaces.

2008

SPONSORS: REP. KENNEDY (D-RI)
INTROCUDED: 9/2008
STATUS: SIGNED INTO LAW 10/2008

Summary
The Mental Health Parity and Addiction Equity Act (MHPAEA), known as the Federal Parity Law was signed into law in October, 2008, and is summarized below under “Federal Parity Law”

Introduced Legislation

2016

SPONSOR: SEN. CASSIDY (R-LA)
INTRODUCED: 1/2017
STATUS: PENDING

Summary This is a comprehensive health care reform bill which allows states to choose between three options for implementing Title I of the Affordable Care Act . Those three options include (1) the state chooses to continue to implement Title I of the Affordable Care Act , (2) the state establishes an alternative option that incorporates health savings accounts, and (3) the state completely rejects Title I of the Affordable Care Act .

The bill exempts the states that do not select the first option from the majority of requirements within Title I of the Affordable Care Act . However, section 101(b)(3) of the bill continues the application of the Federal Parity Law to all qualified health plans. This means that regardless of the option selected by a state all qualified health plans are required to comply with the Federal Parity Law .

SPONSOR: SEN. ALEXANDER (R-TN)
INTRODUCED: 3/2016
STATUS: DEAD 04/2016

Summary

This bill addresses many issues related to behavioral health , including parity . Most of the sections of Title VI are relevant to parity . The parity sections within this bill are the exact same provisions found within HR 34 and HR 2646 from the samelegislative session with the exception of one section.

Section 605 requires the Secretary of Health and Human Services (HHS), the Secretary of the Department of Labor (DOL), and the Treasury (DOT) Secretary to issue a compliance program guidance document. The goal of this document is to help improve compliance with the Federal Parity Law . This document will include examples of compliance and noncompliance. The bill specifically calls for examples on disclosure and nonquantitative treatment limitations (NQTLs) . This documents will be updated every two years.

This section also requires the Secretaries of HHS, DOL, and the Treasury to issue additional guidance on disclosure and NQTLs . For disclosure , these documents would include examples of the methods health plans can use to provide documents to authorized individuals. The NQTL section contains an illustrative list of NQTL examples, including medical necessity , drug formulary design, fail-first protocols, and network admission standards.

In addition, Section 605 requires HHS, DOL, and DoT to audit any plan under its jurisdiction with at least five instances of potential non-compliance with the Federal Parity Law . Section 605 is identical to section 13301 from HR 34 and section 802 HR 2646 from the 2015-2016 legislative session. This last provision is also found in section 903 of S 1945 from the 2015-2016 legislative session.

Section 606 requires the Secretary of HHS to convene a stakeholder meeting to create an action plan for improved federal and state coordination of parity enforcement. The action plan must be released no later than 6 months after this meeting and must contain specific information regarding a number of topics. This section is identical to section 13302 from HR 34 and section 802 from HR 2646 from the same legislative session.

Section 607 requires HHS, DOL, and DoT to release an annual report for the following 6 years that details the number of federal investigations of non-compliance with the Federal Parity Law and the nature of and results of those investigations. This section is identical to section 13003 from HR 34 and section 803 from HR 2646 from the same legislative session. A nearly identical section is also found in section 802 from HR 4425 and section 902 from S 1945 of the 2015-2016 legislative session.

Section 608 requires the Comptroller General, in consultation with HHS, DOL, and DoT, to submit a report to the Senate Committee on Health, Education, Labor, and Pensions and the House of Representative Committee on Energy and Commerce that describes the extent to which plans comply with the Federal Parity Law regarding NQTLs , the methods the Federal Agencies use to ensure compliance, how the Federal agencies and state agencies have improved enforcement activities, and recommendations as to how Federal and State agencies can improve enforcement of the Federal Parity Law . This section is identical to section section 13304 from HR 34 and section 804 from HR 2646 from the same legislative session.

Section 604 clarifies that any plan that covers treatment for eating disorders, including residential treatment , must comply with the Federal Parity Law . This section is identical to section 13007 from HR 34 and section 808 from HR 2646 from the same legislative session.

 

SPONSOR: SEN. WARREN (D-MA)
INTRODUCED: 3/2016
STATUS: DEAD 3/2016

Summary This bill addresses parity in several ways by amending the Public Health Service Act, the Employee Retirement Income Security Act, and the Internal Revenue Code. It requires the Secretary of Health and Human Services (HHS), Department of Labor (DOL), and the Treasury (DOT) to issue additional regulations or sub-regulatory guidance on disclosure requirements and nonquantitative treatment limitations. It also requires group health plans to disclose to the Secretary the following information –

It also requires the Secretary of HHS, DOL, and the Treasury to conduct at least 12 random audits of health plans per year for parity compliance. These provisions are similar to section 801 from HR 4431, section 903 from S 1945, section 2 from HR 4276, and section 308 from S 2562/HR 4396.

This bill also requires the Secretaries of HHS, DOL, and DoT to issue guidance on the process and timeline for enrollees to file formal complaints about parity violations. This section is identical to a provision within HR 4276 and section 308 of S 2562/HR 4396.

In addition, this bill requires the Comptroller General of the United States, in consultation with HHS, DOL, and DOT, to submit a report to Congress and make available on the Consumer Parity Portal on parity enforcement activities. This report will include the number of investigations and audits that been conducted into potential parity violations and the details of the investigation, audits, or enforcement actions when carried out. This section is similar to provisions within HR 4276.

The bill also requires the Secretaries of HHS, DOL, and DoT to establish a consumer parity unit. This unit is responsible for administering a toll-free telephone number, a website, and a database to facilitate the centralized collection, monitoring of, and response to consumer complaints and inquiries related to the Federal Parity Law . In addition, these Secretaries are required to establish procedures to provide a timely response to consumer complaints and inquiries.

The bill also requires group and individual health plans to provide a timely response to the state or federal enforcement agency with jurisdiction over the plan concerning a consumer complaint or inquiry. This response must include the steps that have been taken by the plan to respond to the complaint or inquiry, any responses received by the plan from the consumer, and follow-up actions by the plan.

In addition, the bill requires state health insurance commissioners to annually submit to the HHS Secretary a report on compliance with this bill. The content of this report will also include information broken down by health plan. For example, the state health insurance commissioner is required to compare the financial requirements and [[term 57 “treatment limitations” imposed by health plans on behavioral health benefits and physical health benefits. The report will also contain information on the behavioral health benefits offered by a plan, standards admission for networks, and non-quantitative treatment limitations. This information will be available on the consumer parity unit’s website.

The bill also authorizes the appropriates $2,000,00 for each fiscal year between 2016 through 2020 to carry out the provisions within this section.

SPONSOR: REP. GREEN (D-TX)
INTRODUCED: 2/2016
STATUS: DEAD 02/2016

Summary

This bill addresses many issues related to behavioral health, including parity. The majority of these provisions fall within Title VIII. Sec 801 amends the Public Health Service Act, the Employee Retirement Income Security Act, and the Internal Revenue Code in several ways related to parity . Section 801 requires the Secretary of Health and Human Services (HHS), Department of Labor (DOL), and the Treasury (DOT) to issue additional regulations or sub-regulatory guidance on disclosure and nonquantitative treatment limitations (NQTLs) . This section is nearly identical to section 903 from S 1945 from the same legislative session. his section is nearly identical to section 903 from S 1945 and provisions within section 308 from S 2562/HR 4396, HR 4276, and S 2647 from the same legislative session.

This section also requires the Secretary of HHS, DOL, and the DOT to create a Consumer Parity Portal. This website will act as a one-stop portal where individuals can submit potential parity complaints and violations and access educational materials created by the federal government. This section is identical to provisions within section 308 from S 2562/HR 4396 and HR 4276.

In addition, it requires these Secretaries to conduct at least 12 random audits of health plans per year for parity compliance. This section is identical to section 903 from S 1945 and provisions within section 308 from S 2562/HR 4396, HR 4276, and S 2647 from the same legislative session.

The Secretary of HHS is also required to collect information on the rates and reasons for denial of inpatient and outpatient mental health and substance use disorder services and submit this information to the Senate Committee on Energy and Commerce and the House of Representative Committee on Health, Education, Labor, and Pensions. This section is identical to provisions within section 308 from S 2562/HR 4396 and HR 4276.

Section 802 of this bill also requires HHS, DOL, and DoT to release an annual report that details the number of federal investigations of non-compliance with the Federal Parity Law and the nature of and results of those investigations. This section is identical to section 902 from S 1945 and nearly identical to section 13003 from HR 34, section 607 from 2680, and section 803 from HR 2646. All of these bills are from the 2015-2016 legislative session.

Section 803 requires the Comptroller General, in consultation with HHS, DOL, and DoT, to submit a report to Congress that describes the extent to which plans comply with the Federal Parity Law with respect to nonquantitative treatment limitations , how Federal agencies ensure plans comply with the law, and recommendations as to how Federal and state agencies can improve enforcement of the Federal Parity Law . This section is nearly identical to section 807 from HR 2646 and section 901 from S 1945 from the same legislative session.

Section 804 of the bill requires the Secretary of HHS to submit a report to Congress on state regulatory enforcement of the Federal Parity Law . This report would focus on the ways states are empowered, their capacity, and technical assistance support.

SPONSOR: SEN. BROWN (D-MA) AND REP. PALLONE (D-NJ)
INTRODUCED: 2/2016
STATUS: DEAD 2/2016

Summary This is a comprehensive bill that aims to address the opioid crisis. Among other provisions, Section 308 contains several provisions related to parity . This section is identical to HR 4276 with the exception of one section. It amends the Public Health Service Act, the Employee Retirement Income Security Act, and the Internal Revenue Code of 1986 in several ways related to parity .

It requires the Secretary of HHS, DOL, and the Treasury to issue additional regulations or sub-regulatory guidance on disclosure requirements and nonquantitative treatment limitations . It also requires these departments to conduct at least 12 random audits of health plans per year for paritycompliance. This section is the identical to section 801 from HR 4435 and section 2 from HR 4276 and similar to provisions within to section 903 from S 1945 and S 2647 from the same legislative cycle.

This bill also requires the Secretary of HHS, DOL, and the Treasury to create a Consumer Parity Portal. This website will act as a one-stop portal where individuals can submit potential parity complaints and violations and access educational materials created by the federal government. It also requires the Secretary of Health and Human Services to collect information on the rates and reasons for denial of inpatient and outpatient mental health and substance use disorder services and submit this information to Senate Committee on Energy and Commerce and the House of Representatives Committee on Health, Education, Labor, and Pensions. These sections are identical to provisions within section 801 from HR 4435 and section 2 from HR 4276 from the same legislative session.

The bill also requires the Secretaries of HHS, DOL, and DoT to issue guidance on the process and timeline for enrollees to file formal complaints about parity violations. This section is identical to provisions within HR 4276 and S2647.

Perhaps most significantly, this bill authorizes the appropriation of $2,000,000 for each fiscal year between 2016 through 2020 to carry out the provisions within this bill. This section is identical to provisions with HR 4276 and S 2657 from the same legislative session.

SPONSOR: REP. KENNEDY (D-MA)
INTRODUCED: 12/2015
STATUS: DEAD 3/2016

Summary
This bill addresses parity in several ways by amending the Public Health Service Act, the Employee Retirement Income Security Act, and the Internal Revenue Code.

It requires the Secretary of HHS, DOL, and the Treasury to issue additional regulations or sub-regulatory guidance on disclosure requirements and nonquantitative treatment limitations (NQTLs) . It also requires these departments to conduct at least 12 random audits of health plans per year for parity compliance. This section is the identical to section 801 from HR 4435 and section 308 from S 2562/HR 4396 and nearly identical to HR 903 from S 1945 and provisions within S 2647 from the same legislative cycle.

This bill also requires the Secretary of HHS, DOL, and the Treasury to create a Consumer Parity Portal. This website will act as a one-stop portal where individuals can submit potential parity complaints and violations and access educational materials created by the federal government. It also requires the Secretary of HHS to collect information on the rates and reasons for denial of inpatient and outpatientmental health and substance use disorder services and submit this information to Senate Committee on Energy and Commerce and the House of Representatives Committee on Health, Education, Labor, and Pensions. These sections are identical to provisions within section 801 from HR 4435 and section 308 from S 2562/HR 4396 from the same legislative session.

The bill also requires the Secretaries of HHS, DOL, and DoT to issue guidance on the process and timeline for enrollees to file formal complaints about parity violations. This section is identical to provisions within section 308 from S 2562/HR 4396 and S2647.

In addition, the bill requires the Comptroller General of the United States, in consultation with HHS, DOL, and DOT, to submit a report to Congress on parity enforcement activities. This report must also be made available of the Consumer Parity Portal. This report will include the number of investigations and audits that been conducted into potential parity violations and the details of the investigations, audits, or enforcement actions when carried out. This section is identical to provisions within section 308 from S 2562/HR 4396 and S2647.

Perhaps most significantly, this bill authorizes the appropriation of $2,000,000 for each fiscal year between 2016 through 2020 to carry out the provisions within this bill. This section is identical to provisions within section 308 from S 2562/HR 4396 and S2647.

SPONSORS: SEN. CASSIDY (R-LA), SEN. MURPHY (D- CT), AND SEN. COLLINS (R- ME)
INTRODUCED: 8/2015
STATUS: DEAD 8/2015

Summary
This bill addresses many issues related to behavioral health , including parity . The majority of these provisions fall within Title IX.

Section 903 requires the Secretary of Health and Human Services (HHS), Department of Labor (DOL), and the Treasury (DOT) to issue additional regulations or sub-regulatory guidance on disclosure and nonquantitative treatment limitations (NQTLs) . This section also requires the Secretary of HHS, DOL, and the Treasury to conduct at least 12 random audits of health plans per year for paritycompliance. This section is nearly identical to section 903 from S 1945 and provisions within section 308 from S 2562/HR 4396, HR 4276, and S 2647 from the same legislative session.

In addition, this section requires HHS, DOL, and DoT to audit any plan under its jurisdiction with at least five instances of potential non-compliance with the Federal Parity Law . This last provision is also found in section 13001 from HR 34, section 605 from S 2680, and section 801 from HR 2646 from the 2015-2016 legislative session.

Section 902 of this bill also requires HHS, DOL, and DoT to release an annual report that details the number of federal investigations of non-compliance with the Federal Parity Law and the nature of and results of those investigations. This section is identical to section 802 from HR 4435 and nearly identical to section 13003 from HR 34, section 607 from 2680, and section 803 from HR 2646. All of these bills are from the 2015-2016 legislative session.

Section 901 requires the Comptroller General, in consultation with HHS, DOL, and DoT, to submit a report to Congress that describes the extent to which plans comply with the Federal Parity Law with respect to NQTLs , how Federal agencies ensure plans comply with the law, and recommendations as to how Federal and State agencies can improve enforcement of the Federal Parity Law . This section is nearly identical to section 807 from HR 2646 and section 803 from HR 4435 from the same legislative session.

SPONSOR: REP. MURPHY (R-PA)
INTRODUCED: 6/2015
STATUS: DEAD 7/2016

Summary
This bill addresses many issues related to behavioral health , including parity . The majority of these provisions fall within Title XIII of the bill. The parity sections within this bill are the exact same provisions found within HR 34 and HS 2680 from the 2015-2016 legislative session with the exception of one section.

Section 801 requires the Secretary of Health and Human Services (HHS), the Secretary of Department of Labor (DOL), and the Treasury (DoT) Secretary to issue a compliance program guidance document. The goal of this document is to help improve compliance with the Federal Parity Law . This document will include examples of compliance and noncompliance. The bill specifically calls for examples on disclosure requirements and nonquantitative treatment limitations (NQTLs) . This documents will be updated every two years.

This section also requires the Secretaries of HHS, DOL, and DoT to issue additional guidance on disclosure and NQTLs . For disclosure , these documents would include examples on the methods health plans can use to provide documents to authorized individuals. The NQTLs sections contains an illustrative list of NQTL examples, including medical necessity , drug formulary design, fail-first protocols , and network admission standards.

In addition, section 801 requires HHS, DOL, and DoT to audit any plan under its jurisdiction with at least five instances of potential non-compliance with the Federal Parity Law . Section 13001 is identical to 13001 from HR 34 and section 605 from S 2680 from the 2015-2016 legislative session. This last provision is also found in section 903 of S 1945 from the 2015-2016 legislative session.

Section 802 requires the Secretary of HHS to convene a stakeholder meeting to create an action plan for improved federal and state coordination of parity enforcement. The action plan must be released no later than 6 months after this meeting and must contain specific information regarding a number of topics. This section is identical to 13002 from HR 34 and section 606 from S 2680 from the same legislative session.

Section 803 requires HHS, DOL, and DoT to release an annual report for the following 6 years that details the number of federal investigations of non-compliance with the Federal Parity Law and the nature of and results of those investigations. This section is identical to section 607 from S 2680 and section 13003 from HR 34 from the same legislative session. A nearly identical section is also found in section 802 from HR 4435 and section 902 from S 1945 of the 2015-2016 legislative session.

Section 804 requires the Comptroller General, in consultation with HHS, DOL, and DoT, to submit a report to the Senate Committee on Health, Education, Labor, and Pensions and the House of Representative Committee on Energy and Commerce that describes the extent to which plans comply with the Federal Parity Law regarding NQTLs , the methods the Federal Agencies use to ensure compliance, how the Federal and state agencies have improved enforcement activities, and recommendations as to how Federal and state agencies can improve enforcement of the Federal Parity Law . This section is identical to 13004 from HR 34 and section 608 from S 2680 from the same legislative session.

Section 808 clarifies that any plan that covers treatment for eating disorders, including residential treatment , must comply with the Federal Parity Law . This section is identical to 13007 from HR 34 and section 605 from S 2680 from the same legislative session.

SPONSORS: REPS. DEUTCH (D- FL) & LEHTINEN (R- FL); SENS. KLOBUCHAR (D- MN), AYOTTE (R- NH), CAPITO (R- WV), & BALDWIN (D- WI)
INTRODUCED: 5/2015
STATUS: DEAD 6/2016

Summary
The Anna Westin Act is a federal bill about eating disorders. There is a version in the House of Representatives and a version in the Senate. Both of these bills have identical paritysections that would add two new components to the Federal Parity Law:

  • Forbids insurance plans from permanently excluding coverage for particular disorders (such as eating disorders)
  • Clarifies that residential treatment must be included in any plan that covers behavioral health services

Federal Parity Law

The Federal Parity Law includes protections for insurance coverage of mental health conditions and substance use disorders. The Federal Parity Law does not require insurance plans to cover behavioral health treatment, but if they do cover behavioral health treatment, the coverage must be to equal to other medical coverage. The law forbids insurance plans from using quantitative treatment limitations and financial requirements for behavioral health services that are less favorable than those in place for other medical services. Plans are forbidden from using non-quantitative treatment limitations (NQTLs) more restrictively for behavioral health services than how they are used for other medical services. Examples of NQTLs include prior authorization, step therapy,and various utilization review techniques, among others.

The Federal Parity Law currently applies to most types of health insurance offered in the country. However, there are some notable exceptions, like Medicare, for example.

The Federal Parity Law sets the baseline for protection of parity rights when both the federal law and state parity lawsapply to an insurance plan. If a plan is covered by the Federal Parity Law, people will get at least the level of rights afforded by the federal law. If a state law gives even more rights to the consumer, then it supersedes the federal law.

In 2013, Regulations were released that explain the scope of the Federal Parity Law in greater detail. Read more about these regulations here.