H.R. 7539 would require the Secretaries of the Departments of Labor (DOL), Health and Human Services (HHS), and Treasury to request a minimum of 20 comparative analyses per year from health insurance plans. The analyses would include potential violations of parity requirements between medical and mental health and substance abuse services and would involve potential noncompliance with nonquantitative treatment limitations (NQTLs). NQTLs are practices such as prior authorization, medical management standards, step therapy, and prescription drug formulary design. H.R. 7539 also would require the Secretaries to include a summary of the comparative analyses in a report to the Congress each year and to include examples of noncompliance found through those investigations in program guidance that is issued every two years.
Under current law, DOL, HHS and Treasury jointly enforce mental health parity requirements, including analyzing potential violations of NQTLs. Because H.R. 7539 would largely codify existing practices, CBO estimates that the bill would not affect direct spending or revenues.
Based on the cost of similar reporting requirements, CBO estimates that implementing the new activities required under H.R 7539 would cost less than $1 million over the 2021-2025 period; such spending would be subject to the availability of appropriated funds.