Behavioral Health Coverage Transparency Act of 2016
Behavioral Health Coverage Transparency Act of 2015
This bill amends the Public Health Service Act, Employee Retirement Income Security Act of 1974 (ERISA), and Internal Revenue Code to direct the Departments of Health and Human Services (HHS), Labor, and the Treasury to require group health plans and health insurers to disclose specified information regarding compliance of plans or coverage with requirements for parity between mental health and substance use disorder benefits and medical and surgical benefits. Information that must be disclosed includes the specific analyses performed to ensure parity, findings and conclusions regarding parity in applying nonquantitative treatment limitations (e.g., tiered benefits, step therapy, or preauthorization), and a comparison of denials of claims between types of benefits.
HHS, Labor, and Treasury must: (1) issue guidance on the process for current and potential participants and beneficiaries to file formal complaints of plans or insurers being in violation of the requirement for parity, and (2) conduct audits of plans and insurers to determine compliance with parity requirements and publish information from those audits.
HHS must establish a consumer parity unit to collect and respond to complaints and provide information to consumers on parity. Plans and insurers must respond to consumer complaints received by the unit.
State health insurance commissioners must report on compliance of plans and insurers with parity requirements and include a comparison of benefits.
The Government Accountability Office must report on HHS, Labor, and Treasury efforts to enforce parity.Read twice and referred to the Committee on Health, Education, Labor, and Pensions.