12 2 STA T .38 81 PUBLIC LA W 11 0– 3 4 3 —O CT. 3 , 2008 Subti t leB—Pa ul W ell s t on ean d Pete D o m eni c i M ental H ealt h Pa r it y and A d - diction Eq uity Act o f20 0 8SEC.51 1.S HORT T I T L E. This s ubt it lemay be c ite d as the ‘ ‘ P aul W ellst on e and Pete D omenici M ental H ealth Pa r ity and A ddiction Eq uity Act o f20 0 8’ ’ . SEC. 51 2 . M E N T A L HEALTH P ARIT Y . ( a ) A MEND MEN TS T O E RIS A. — Section 71 2oftheEm p loyee Retirement Income Security Act of 1 9 7 4 (29 U .S. C . 118 5 a) is amended— (1) in subsection (a) , by addin g at the end the follo w ing
‘‘( 3 ) FI N A N C IA LR E QU IREMENTS AND TREATMENT LIMITA - TIONS.— ‘‘(A) IN G ENERAL.—In the case of a group health plan (or health insurance co v erage offered in connection with such a plan) that provides both medical and surgical bene- fits and mental health or substance use disorder benefits, such plan or coverage shall ensure that— ‘‘(i) the financial requirements applicable to such mental health or substance use disorder benefits are no more restrictive than the predominant financial requirements applied to substantially all medical and surgical benefits covered by the plan (or coverage), and there are no separate cost sharing requirements that are applicable only with respect to mental health or substance use disorder benefits
and ‘‘(ii) the treatment limitations applicable to such mental health or substance use disorder benefits are no more restrictive than the predominant treatment limitations applied to substantially all medical and surgical benefits covered by the plan (or coverage) and there are no separate treatment limitations that are applicable only with respect to mental health or sub- stance use disorder benefits. ‘‘( B )DE F INITIONS.—In this paragraph: ‘‘(i) FINANCIAL REQUIREMENT.—The term ‘financial requirement’ includes deductibles, copayments, coinsurance, and out-of-poc k ete x penses, but excludes an aggregate lifetime limit and an annual limit sub j ect to paragraphs (1) and (2), ‘‘(ii) PREDOMINANT.—A financial requirement or treatment limit is considered to be predominant if it is the most common or frequent of such type of limit or requirement. ‘‘(iii) TREATMENT LIMITATION.—The term ‘treat- ment limitation’ includes limits on the frequency of treatment, number of visits, days of coverage, or other similar limits on the scope or duration of treatment. ‘‘(4) A V AILA B ILIT Y OF P LAN INFORMATION.—The criteria for medical necessity determinations made under the plan with respect to mental health or substance use disorder benefits (or the health insurance coverage offered in connection with the plan with respect to such benefits) shall be made available 42USC 2 01note.PaulW ell s tone an d Pete D o m en ic i M ental H ealt h Pa r it y and A ddiction Eq uity Act o f 200 8 .
�
