Section 1 Short title
This Act may be cited as the “Mental Health Transparency Act”.
Mental Health Transparency Act
A BILL
To amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to require group health plans and health insurance issuers offering group or individual health insurance coverage to disclose the percentage of in-network participation for certain provider types, and for other purposes.
Sec. 2 Requiring disclosure of percentage of in-network participation for certain provider types
PHSA— Part D of title XXVII of the Public Health Service Act (42 U.S.C. 300g–111 et seq.) is amended by adding at the end the following new section:
“2799A–11. Required disclosure of percentage of in-network participation for certain provider types
“(a) In general—A group health plan and a health insurance issuer offering group or individual health insurance coverage shall, along with any summary of benefits and coverage provided under section 2715 (and in accordance with the timing and manner specified under such section and the implementing regulations of such section), and on the public website of such plan or issuer, make available the following information with respect to each type of provider specified in subsection (b):
“(1) The number and percentage of providers of such type located in the service area of such plan or coverage that have a contractual relationship (as defined by the Secretary) in effect with such plan or coverage for furnishing items and services under such plan or coverage, determined in accordance with information made available by the Secretary under subsection (d).
“(2) The designation established by the Secretary under subsection (c) corresponding to the percentage described in paragraph (1).
“(b) Specified providers—For purposes of this section, the types of providers and facilities specified in this subsection are the following (as defined by the Secretary and broken down by subspecialty as specified by the Secretary):
“(1) Behavioral health care providers and facilities.
“(2) Substance use disorder treatment providers and facilities.
“(c) Establishment of designations of in-Network participation
“(1) In general—Not later than 1 year after the date of the enactment of this section, the Secretary, in consultation with the Secretaries of Labor and of the Treasury, shall establish a system of designations (such as “high”, “medium”, and “low”, a star rating, or such other designation determined appropriate by the Secretary) that correspond to ranges of percentages (from 0 to 100) described in subsection (a)(1) to qualitatively reflect the breadth of the networks of group health plans and group and individual health insurance coverage with respect to each type of provider specified in subsection (b).
“(2) Variation permitted—Designations corresponding to percentage ranges established under paragraph (1) may vary by type of service area (such as rural or urban), size of service area, and other factors determined appropriate by the Secretary in consultation with the Secretaries of Labor and of the Treasury.
“(d) Information on providers
“(1) In general—Not later than June 30, 2026, the Secretary, in consultation with the Secretaries of Labor and of the Treasury, shall, based on information submitted under section 2799B–10, post on the public website of the Department of Health and Human Services, a list of each specified provider in the country, including—
“(A) the location of each such provider in which such provider furnishes items and services;
“(B) each specialty designation (if any) of each such provider;
“(C) whether such provider treats individuals under the age of 19; and
“(D) whether such provider accepts telehealth appointments. The Secretary shall update the information published under the previous sentence not less frequently than annually.
“(2) Treatment of group practices—For purposes of the list described in paragraph (1), the Secretary shall list each individual health care provider separately, regardless of whether such provider is part of a group practice.
“(e) Service area definition—For purposes of this section, the term “service area” means, with respect to a group health plan and group or individual health insurance coverage, the area or areas in which in-person participants and beneficiaries are covered, as determined by the plan or issuer of such coverage in accordance with rules specified by the Secretary in consultation with the Secretaries of Labor and of the Treasury.”
ERISA—
In general— Subpart B of part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 is amended by adding at the end the following new section:
“726. Required disclosure of percentage of in-network participation for certain provider types
“(a) In general—A group health plan and a health insurance issuer offering group health insurance coverage shall, along with any summary of benefits and coverage provided under section 2715 of the Public Health Service Act (and in accordance with the timing and manner specified under such section and the implementing regulations of such section), and on the public website of such plan or issuer, make available the following information with respect to each type of provider specified in subsection (b):
“(1) The number and percentage of providers of such type located in the service area of such plan or coverage that have a contractual relationship (as defined by the Secretary) in effect with such plan or coverage for furnishing items and services under such plan or coverage, determined in accordance with information made available by the Secretary under subsection (d).
“(2) The designation established by the Secretary under subsection (c) corresponding to the percentage described in paragraph (1).
“(b) Specified providers—For purposes of this section, the types of providers and facilities specified in this subsection are the following (as defined by the Secretary and broken down by subspecialty as specified by the Secretary):
“(1) Behavioral health care providers and facilities.
“(2) Substance use disorder treatment providers and facilities.
“(c) Establishment of designations of in-Network participation
“(1) In general—Not later than 1 year after the date of the enactment of this section, the Secretary, in consultation with the Secretaries of Health and Human Services and of the Treasury, shall establish a system of designations (such as “high”, “medium”, and “low”, a star rating, or such other designation determined appropriate by the Secretary) that correspond to ranges of percentages (from 0 to 100) described in subsection (a)(1) to qualitatively reflect the breadth of the networks of group health plans and group health insurance coverage with respect to each type of provider specified in subsection (b).
“(2) Variation permitted—Designations corresponding to percentage ranges established under paragraph (1) may vary by type of service area (such as rural or urban), size of service area, and other factors determined appropriate by the Secretary in consultation with the Secretaries of Health and Human Services and of the Treasury.
“(d) Information on providers
“(1) In general—Not later than June 30, 2026, the Secretary, in consultation with the Secretaries of Health and Human Services and of the Treasury, shall, based on information submitted under section 2799B–10, post on the public website of the Department of Labor, a list of each specified provider in the country, including—
“(A) the location of each such provider in which such provider furnishes items and services;
“(B) each specialty designation (if any) of each such provider;
“(C) whether such provider treats individuals under the age of 19; and
“(D) whether such provider accepts telehealth appointments. The Secretary shall update the information published under the previous sentence not less frequently than annually.
“(2) Treatment of group practices—For purposes of the list described in paragraph (1), the Secretary shall list each individual health care provider separately, regardless of whether such provider is part of a group practice.
“(e) Service area definition—For purposes of this section, the term “service area” means, with respect to a group health plan and group health insurance coverage, the area or areas in which in-person participants and beneficiaries are covered, as determined by the plan or issuer of such coverage in accordance with rules specified by the Secretary in consultation with the Secretaries of Health and Human Services and of the Treasury.”
Technical amendment— The table of contents in section 1 of such Act is amended by inserting after the item relating to section 725 the following new item:
IRC—
In general— Subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following new section:
“9826. Required disclosure of percentage of in-network participation for certain provider types
“(a) In general—A group health plan shall, along with any summary of benefits and coverage provided under section 2715 of the Public Health Service Act (and in accordance with the timing and manner specified under such section and the implementing regulations of such section), and on the public website of such plan, make available the following information with respect to each type of provider specified in subsection (b):
“(1) The number and percentage of providers of such type located in the service area of such plan that have a contractual relationship (as defined by the Secretary) in effect with such plan for furnishing items and services under such plan, determined in accordance with information made available by the Secretary under subsection (d).
“(2) The designation established by the Secretary under subsection (c) corresponding to the percentage described in paragraph (1).
“(b) Specified providers—For purposes of this section, the types of providers and facilities specified in this subsection are the following (as defined by the Secretary and broken down by subspecialty as specified by the Secretary):
“(1) Behavioral health care providers and facilities.
“(2) Substance use disorder treatment providers and facilities.
“(c) Establishment of designations of in-Network participation
“(1) In general—Not later than 1 year after the date of the enactment of this section, the Secretary, in consultation with the Secretaries of Health and Human Services and of Labor, shall establish a system of designations (such as “high”, “medium”, and “low”, a star rating, or such other designation determined appropriate by the Secretary) that correspond to ranges of percentages (from 0 to 100) described in subsection (a)(1) to qualitatively reflect the breadth of the networks of group health plans with respect to each type of provider specified in subsection (b).
“(2) Variation permitted—Designations corresponding to percentage ranges established under paragraph (1) may vary by type of service area (such as rural or urban), size of service area, and other factors determined appropriate by the Secretary in consultation with the Secretaries of Health and Human Services and of Labor.
“(d) Information on providers
“(1) In general—Not later than June 30, 2026, the Secretary, in consultation with the Secretaries of Health and Human Services and of Labor, shall, based on information submitted under section 2799B–10, post on the public website of the Department of the Treasury, a list of each specified provider in the country, including—
“(A) the location of each such provider in which such provider furnishes items and services;
“(B) each specialty designation (if any) of each such provider;
“(C) whether such provider treats individuals under the age of 19; and
“(D) whether such provider accepts telehealth appointments. The Secretary shall update the information published under the previous sentence not less frequently than annually.
“(2) Treatment of group practices—For purposes of the list described in paragraph (1), the Secretary shall list each individual health care provider separately, regardless of whether such provider is part of a group practice.
“(e) Service area definition—For purposes of this section, the term “service area” means, with respect to a group health plan, the area or areas in which in-person participants and beneficiaries are covered, as determined by the plan in accordance with rules specified by the Secretary in consultation with the Secretaries of Health and Human Services and of Labor.”
Technical amendment— The table of sections for such subchapter is amended by adding at the end the following new item:
Provider requirements— Part E of title XXVII of the Public Health Service Act (42 U.S.C. 300gg–131 et seq.) is amended by adding at the end the following new section:
“2799B–10. Provision of certain information to the Secretary
“(a) In general—Subject to subsection (b), in the case of a health care provider or health care facility that is a specified provider (as described in subsection (b) of section 2799A–11), such provider or facility shall, annually at a time and in a manner specified by the Secretary, provide to the Secretary such information as the Secretary determines necessary to carry out subsection (d) of such section.
“(b) Exception—Subsection (a) shall not apply in the case of a specified provider that has not, during the 1-year period ending on the date that information described in subsection (a) would be required to be submitted to the Secretary by such provider without application of this subsection, submitted any claim for an item or service under a Federal health care program (as defined in section 1128B of the Social Security Act), the program established under chapter 89 of title 5, United States Code, or a group health plan or group or individual health insurance coverage.”
Report— Not later than December 31, 2027, and annually thereafter, the Secretary of Health and Human Services shall submit to Congress a report on the participation of behavioral health care and substance use disorder treatment providers in networks established by group health plan and health insurance issuers offering group or individual health insurance coverage (as such terms are defined in section 2791 of the Public Health Service Act (42 U.S.C. 300gg–91)). Each such report shall include data and analysis relating to service areas (as defined in section 2799A–11 of such Act) of such plans and issuers that the Secretary has identified as having low participation rates with respect to such providers’ participation in such networks.
Implementation— The Secretaries of Labor, Health and Human Services, and the Treasury may implement the amendments made by this section through interim final rule, subregulatory guidance, program instruction, or otherwise.
Funding— In addition to amounts otherwise available for such purposes, there is appropriated $15,000,000, to remain available until expended, for purposes of carrying out this section.
Effective date— The amendments made by this section shall apply with respect to plan years beginning on or after January 1, 2027.