H.R. 4276

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 the analyses performed to ensure compliance of plans or coverage with the law and regulations. Disclosures must include findings and conclusions regarding whether nonquantitative treatment limitations (e.g., tiered benefits, step therapy, or preauthorization) applied to mental health or substance use disorder benefits are comparable to, and applied no more stringently than, such limitations on medical and surgical 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 between mental health and substance use disorder benefits and medical and surgical benefits, (2) conduct audits of plans and insurers to determine compliance with parity requirements and publish information from those audits, and (3) publish information on denials of claims by plans and insurers for mental health and substance use disorder services compared to denials of claims for medical and surgical services.

HHS must establish a consumer parity portal website that allows for submission of complaints and provides information to consumers on parity.

The Government Accountability Office must report on HHS, Labor, and Treasury efforts to enforce parity.