Amends Medicare Advantage plans to ensure mental health and substance use benefits parity. Mandates standards-based necessity determination and NQTL analyses. Imposes penalties for non-compliance. Extends parity to drug plans. Directs regulation issuance within 18 months. Allocates $10 million for implementation.
Analysis summaries, actor details, and coverage mappings were LLM-classified and may contain errors.
This is a binding federal statute enacted by the United States Congress that amends the Social Security Act. It contains mandatory obligations with enforcement mechanisms including civil monetary penalties for non-compliance.
This document has minimal coverage of AI risk domains. It primarily addresses healthcare policy and insurance regulation with only one explicit mention of AI-related technology in the context of medical necessity determinations (subdomain 7.4). The document does not substantively address AI risks, harms, or safety concerns.
This document primarily governs the Health Care and Social Assistance sector, specifically Medicare Advantage organizations and prescription drug plan sponsors. It also has implications for the Finance and Insurance sector as these organizations provide health insurance products.
The document does not comprehensively address AI lifecycle stages. It mentions AI and related technologies only in the context of medical necessity determinations and NQTL analyses, requiring disclosure of their use but not governing their development, deployment, or monitoring as AI systems.
The document mentions AI technology, machine learning, and clinical decision-making technology only as examples of tools that may be used in medical necessity determinations. It does not define these terms, distinguish between AI models and systems, or specify any technical characteristics, compute thresholds, or model types.
United States Congress
The document is a Congressional statute (Section 201 of the Better Mental Health Care for Americans Act) enacted by the United States Congress, which has constitutional authority to legislate on matters affecting Medicare and federal healthcare programs.
Secretary of Health and Human Services; Centers for Medicare & Medicaid Services
The Secretary of Health and Human Services is designated as the primary enforcement authority with power to request analyses, issue regulations, impose penalties for non-compliance, and report to Congress on compliance status.
Secretary of Health and Human Services; United States Congress
The Secretary is required to monitor compliance through mandatory analysis requests (minimum 20 per year) and biennial reporting to Congress. Congress receives reports and maintains oversight through the legislative process.
MA organizations (Medicare Advantage organizations); PDP sponsors (Prescription Drug Plan sponsors)
The statute explicitly targets MA organizations offering Medicare Advantage plans and PDP sponsors offering prescription drug plans, requiring them to ensure parity in mental health benefits and comply with NQTL analysis requirements including disclosure of AI technology use.
1 subdomain (1 Minimal)