[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 4331 Introduced in Senate (IS)]
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118th CONGRESS
2d Session
S. 4331
To amend the Public Health Service Act, the Employee Retirement Income
Security Act of 1974, and the Internal Revenue Code of 1986 to require
that group health plans and health insurance issuers offering group or
individual health insurance that provide coverage for mental health
services and substance use disorder services provide such services
without the imposition of cost-sharing from the diagnosis of pregnancy
through the 1-year period following such pregnancy, and for other
purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 14, 2024
Mrs. Shaheen (for herself and Ms. Baldwin) introduced the following
bill; which was read twice and referred to the Committee on Health,
Education, Labor, and Pensions
_______________________________________________________________________
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
that group health plans and health insurance issuers offering group or
individual health insurance that provide coverage for mental health
services and substance use disorder services provide such services
without the imposition of cost-sharing from the diagnosis of pregnancy
through the 1-year period following such pregnancy, and for other
purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Mental Health and Making Access More
Affordable Act of 2024'' or the ``Mental Health and MAMA Act of 2024''.
SEC. 2. COST-SHARING WITH RESPECT TO MENTAL HEALTH SERVICES AND
SUBSTANCE USE DISORDER SERVICES FOR PREGNANT AND
POSTPARTUM INDIVIDUALS.
(a) PHSA.--
(1) In general.--Part D of title XXVII of the Public Health
Service Act (42 U.S.C. 300gg-111 et seq.) is amended by adding
at the end the following new section:
``SEC. 2799A-11. COST-SHARING REQUIREMENTS WITH RESPECT TO MENTAL
HEALTH SERVICES AND SUBSTANCE USE DISORDER SERVICES FOR
PREGNANT AND POSTPARTUM INDIVIDUALS.
``(a) In General.--In the case of a group health plan or a health
insurance issuer offering group or individual health insurance coverage
that provides a benefit for mental health services or substance use
disorder services (including such services which are telehealth
services and are provided under such plan or coverage) with respect to
plan years beginning on or after the date that is 2 years after the
date of enactment of this section, the plan or coverage shall not
impose any cost-sharing requirement for such services that are
furnished by an in-network provider to a participant, beneficiary, or
enrollee under the plan or coverage from the diagnosis of pregnancy (as
defined by the Secretary) through the 1-year period beginning on the
day after the last day of such pregnancy of such participant,
beneficiary, or enrollee (or, in the case of an individual enrolled in
such plan or coverage for a portion of such period, during such
portion).
``(b) Definitions.--In this section:
``(1) The terms `mental health services' and `substance use
disorder services' have the meaning given such terms for
purposes of section 2726.
``(2) The term `telehealth service' means a service that is
furnished through telehealth technologies (as defined in
section 330I(a)).''.
(2) Continuity of care.--Section 2799A-3 of the Public
Health Service Act (42 U.S.C. 300gg-113) is amended--
(A) in subsection (a)(2)(C), by inserting ``, in
the case of a continuing care patient described in
subsection (b)(1)(D)(ii), the date on which such
individual is no longer such a continuing care patient
with respect to such provider or facility, or in the
case of a continuing care patient described in
subsection (b)(1) other than in subparagraph (D)(ii) of
such subsection,'' after ``is provided and ending on'';
and
(B) by amending subsection (b)(1)(D) to read as
follows:
``(D)(i) is pregnant and undergoing a course of
treatment for the pregnancy from the provider or
facility; or
``(ii)(I) requires mental health services or
substance use disorder services from a provider or
facility following a pregnancy;
``(II) received a course of mental health or
substance use disorder treatment from such provider or
facility while pregnant; and
``(III) the last day of such pregnancy occurred
during the previous 1-year period; or''.
(b) ERISA.--
(1) 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:
``SEC. 726. COST-SHARING REQUIREMENTS WITH RESPECT TO MENTAL HEALTH
SERVICES AND SUBSTANCE USE DISORDER SERVICES FOR PREGNANT
AND POSTPARTUM INDIVIDUALS.
``(a) In General.--In the case of a group health plan or a health
insurance issuer offering group health insurance coverage that provides
a benefit for mental health services or substance use disorder services
(including such services which are telehealth services and are provided
under such plan or coverage) with respect to plan years beginning on or
after the date that is 2 years after the date of enactment of this
section, the plan or coverage shall not impose any cost-sharing
requirement for such services that are furnished by an in-network
provider to a participant or beneficiary under the plan or coverage
from the diagnosis of pregnancy (as defined by the Secretary) through
the 1-year period beginning on the day after the last day of such
pregnancy of such participant or beneficiary (or, in the case of an
individual enrolled in such plan or coverage for a portion of such
period, during such portion).
``(b) Definitions.--In this section:
``(1) The terms `mental health services' and `substance use
disorder services' have the meaning given such terms for
purposes of section 712.
``(2) The term `telehealth service' means a service that is
furnished through telehealth technologies (as defined in
section 330I(a) of the Public Health Service Act).''.
(2) Continuity of care.--Section 718 of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1185g) is
amended--
(A) in subsection (a)(2)(C), by inserting ``, in
the case of a continuing care patient described in
subsection (b)(1)(D)(ii), the date on which such
individual is no longer such a continuing care patient
with respect to such provider or facility, or in the
case of a continuing care patient described in
subsection (b)(1) other than in subparagraph (D)(ii) of
such subsection,'' after ``is provided and ending on'';
and
(B) by amending subsection (b)(1)(D) to read as
follows:
``(D)(i) is pregnant and undergoing a course of
treatment for the pregnancy from the provider or
facility; or
``(ii)(I) requires mental health services or
substance use disorder services from a provider or
facility following a pregnancy;
``(II) received a course of mental health or
substance use disorder treatment from such provider or
facility while pregnant; and
``(III) the last day of such pregnancy occurred
during the previous 1-year period; or''.
(3) Clerical amendment.--The table of contents in section 1
of the Employee Retirement Income Security Act of 1974 (29
U.S.C. 1001 et seq.) is amended by inserting after the item
relating to section 725 the following new item:
``Sec. 726. Cost-sharing requirements with respect to mental health
services and substance use disorder
services for pregnant and postpartum
individuals.''.
(c) IRC.--
(1) 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:
``SEC. 9826. COST-SHARING REQUIREMENTS WITH RESPECT TO MENTAL HEALTH
SERVICES AND SUBSTANCE USE DISORDER SERVICES FOR PREGNANT
AND POSTPARTUM INDIVIDUALS.
``(a) In General.--In the case of a group health plan that provides
a benefit for mental health services or substance use disorder services
(including such services which are telehealth services and are provided
under such plan) with respect to plan years beginning on or after the
date that is 2 years after the date of enactment of this section, the
plan shall not impose any cost-sharing requirement for such services
that are furnished by an in-network provider to a participant or
beneficiary under the plan from the diagnosis of pregnancy (as defined
by the Secretary) through the 1-year period beginning on the day after
the last day of such pregnancy of such participant or beneficiary (or,
in the case of an individual enrolled in such plan for a portion of
such period, during such portion).
``(b) Definitions.--In this section:
``(1) The terms `mental health services' and `substance use
disorder services' have the meaning given such terms for
purposes of section 9812.
``(2) The term `telehealth service' means a service that is
furnished through telehealth technologies (as defined in
section 330I(a) of the Public Health Service Act).''.
(2) Continuity of care.--Section 9818 of the Internal
Revenue Code of 1986 is amended--
(A) in subsection (a)(2)(C), by inserting ``, in
the case of a continuing care patient described in
subsection (b)(1)(D)(ii), the date on which such
individual is no longer such a continuing care patient
with respect to such provider or facility, or in the
case of a continuing care patient described in
subsection (b)(1) other than in subparagraph (D)(ii) of
such subsection,'' after ``is provided and ending on'';
and
(B) by amending subsection (b)(1)(D) to read as
follows:
``(D)(i) is pregnant and undergoing a course of
treatment for the pregnancy from the provider or
facility; or
``(ii)(I) requires mental health services or
substance use disorder services from a provider or
facility following a pregnancy;
``(II) received a course of mental health or
substance use disorder treatment from such provider or
facility while pregnant; and
``(III) the last day of such pregnancy occurred
during the previous 1-year period; or''.
(3) Clerical amendment.--The table of sections for
subchapter B of chapter 100 of the Internal Revenue Code of
1986 is amended by adding at the end the following new item:
``Sec. 9826. Cost-sharing requirements with respect to mental health
services and substance use disorder
services for pregnant and postpartum
individuals.''.
(d) Effective Date.--The amendments made by subsections (a), (b),
and (c) shall apply with respect to plan years beginning on or after
the date that is 2 years after the date of enactment of this Act.
(e) FEHBP.--
(1) In general.--Section 8902(p) of title 5, United States
Code, is amended--
(A) by striking ``and 2799A-7'' and inserting
``2799A-7, and 2799A-11'';
(B) by striking ``and 722'' and inserting ``722,
and 726''; and
(C) by striking ``and 9822'' and inserting ``9822,
and 9826''.
(2) Effective date.--The amendments made by paragraph (1)
shall apply with respect to contracts entered into or renewed
for contract years beginning on or after the date that is 2
years after the date of enactment of this Act.
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