[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4371 Introduced in House (IH)]
<DOC>
117th CONGRESS
1st Session
H. R. 4371
To amend the Employee Retirement Income Security Act of 1974, title
XXVII of the Public Health Service Act, and the Internal Revenue Code
of 1986 to require group health plans and health insurance issuers
offering group or individual health insurance coverage to provide
coverage for additional preventive care for individuals with chronic
conditions without the imposition of cost sharing requirement, and for
other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 6, 2021
Ms. Underwood (for herself, Mrs. Hayes, Mr. Danny K. Davis of Illinois,
and Ms. Schakowsky) introduced the following bill; which was referred
to the Committee on Energy and Commerce, and in addition to the
Committees on Education and Labor, and Ways and Means, for a period to
be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the
committee concerned
_______________________________________________________________________
A BILL
To amend the Employee Retirement Income Security Act of 1974, title
XXVII of the Public Health Service Act, and the Internal Revenue Code
of 1986 to require group health plans and health insurance issuers
offering group or individual health insurance coverage to provide
coverage for additional preventive care for individuals with chronic
conditions without the imposition of cost sharing requirement, 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 ``Chronic Condition Copay Elimination
Act''.
SEC. 2. COVERAGE OF ADDITIONAL PREVENTIVE CARE FOR INDIVIDUALS WITH
CHRONIC CONDITIONS WITHOUT IMPOSITION OF COST SHARING
REQUIREMENTS.
(a) ERISA.--
(1) In general.--Subpart B of part 7 of subtitle B of title
I of the Employee Retirement Income Security Act of 1974 (29
U.S.C. 1185 et seq.) is amended by adding at the end the
following new section:
``SEC. 726. COVERAGE OF ADDITIONAL PREVENTIVE CARE FOR INDIVIDUALS WITH
CHRONIC CONDITIONS WITHOUT IMPOSITION OF COST SHARING
REQUIREMENTS.
``(a) In General.--In addition to any item or service described in
section 2713(a) of the Public Health Service Act, a group health plan
and a health insurance issuer offering group health insurance coverage
shall, at a minimum, provide coverage for, and shall not impose any
cost sharing requirements for, with respect to individuals with chronic
conditions (as defined in subsection (b)), such additional preventive
care and screenings not described in paragraph (1) of such section
2713(a) that are determined by the Secretary to meet the criteria
specified in subsection (c) with respect to the chronic condition
involved.
``(b) Chronic Condition Defined.--In this section, the term
`chronic condition' has the meaning given such term by the Secretary
and, at a minimum, includes the following conditions:
``(1) Heart disease, including congestive heart failure and
coronary artery disease.
``(2) Diabetes.
``(3) Osteoporosis and osteopenia.
``(4) Hypertension.
``(5) Asthma.
``(6) Liver disease.
``(7) Bleeding disorders.
``(8) Depression.
``(c) Criteria Specified.--For purposes of subsection (a), the
criteria specified in this subsection, with respect to an item or
service and a chronic condition, are the following:
``(1) The item or service is low-cost.
``(2) There is medical evidence supporting high-cost
efficiency, or a large expected impact, of the item or service
in preventing exacerbation of the chronic condition or the
development of a secondary condition.
``(3) There is a strong likelihood, documented by clinical
evidence, that the item or service will prevent the
exacerbation of the chronic condition or the development of a
secondary condition that requires significantly higher-cost
treatments.
``(d) Updates.--
``(1) In general.--Once every three years, the Secretary
shall review and update--
``(A) the list of conditions included within the
meaning of the term `chronic condition' under
subsection (b); and
``(B) the items and services determined to meet the
criteria specified in subsection (c) for purposes of
subsection (a).
``(2) Application of updates.--The requirement under
subsection (a) shall apply with respect to an update made under
paragraph (1) beginning with the first plan year beginning
after the date of such update.''.
(2) Clerical amendment.--The table of contents in section 1
of such Act is amended by inserting after the item relating to
section 725 the following new items:
``726. Coverage of additional preventive care for individuals with
chronic conditions without imposition of
cost sharing requirements.''.
(b) PHSA.--Part D of title XXVII of the Public Health Service Act
(42 U.S.C. 300gg-11 et seq.), is amended by adding at the end the
following new section:
``SEC. 2799A-11. COVERAGE OF ADDITIONAL PREVENTIVE CARE FOR INDIVIDUALS
WITH CHRONIC CONDITIONS WITHOUT IMPOSITION OF COST
SHARING REQUIREMENTS.
``(a) In General.--In addition to any item or service described in
section 2713(a), a group health plan and a health insurance issuer
offering group or individual health insurance coverage shall, at a
minimum, provide coverage for, and shall not impose any cost sharing
requirements for, with respect to individuals with chronic conditions
(as defined in subsection (b)), such additional preventive care and
screenings not described in paragraph (1) of section 2713(a) that are
determined by the Secretary to meet the criteria specified in
subsection (c) with respect to the chronic condition involved.
``(b) Chronic Condition Defined.--In this section, the term
`chronic condition' has the meaning given such term by the Secretary
and, at a minimum, includes the following conditions:
``(1) Heart disease, including congestive heart failure and
coronary artery disease.
``(2) Diabetes.
``(3) Osteoporosis and osteopenia.
``(4) Hypertension.
``(5) Asthma.
``(6) Liver disease.
``(7) Bleeding disorders.
``(8) Depression.
``(c) Criteria Specified.--For purposes of subsection (a), the
criteria specified in this subsection, with respect to an item or
service and a chronic condition, are the following:
``(1) The item or service is low-cost.
``(2) There is medical evidence supporting high-cost
efficiency, or a large expected impact, of the item or service
in preventing exacerbation of the chronic condition or the
development of a secondary condition.
``(3) There is a strong likelihood, documented by clinical
evidence, that the item or service will prevent the
exacerbation of the chronic condition or the development of a
secondary condition that requires significantly higher-cost
treatments.
``(d) Updates.--
``(1) In general.--Once every three years, the Secretary
shall review and update--
``(A) the list of conditions included within the
meaning of the term `chronic condition' under
subsection (b); and
``(B) the items and services determined to meet the
criteria specified in subsection (c) for purposes of
subsection (a).
``(2) Application of updates.--The requirement under
subsection (a) shall apply with respect to an update made under
paragraph (1) beginning with the first plan year beginning
after the date of such update.''.
(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. COVERAGE OF ADDITIONAL PREVENTIVE CARE FOR INDIVIDUALS
WITH CHRONIC CONDITIONS WITHOUT IMPOSITION OF COST
SHARING REQUIREMENTS.
``(a) In General.--In addition to any item or service described in
section 2713(a) of the Public Health Service Act, a group health plan
shall, at a minimum, provide coverage for, and shall not impose any
cost sharing requirements for, with respect to individuals with chronic
conditions (as defined in subsection (b)), such additional preventive
care and screenings not described in paragraph (1) of such section
2713(a) that are determined by the Secretary to meet the criteria
specified in subsection (c) with respect to the chronic condition
involved.
``(b) Chronic Condition Defined.--In this section, the term
`chronic condition' has the meaning given such term by the Secretary
and, at a minimum, includes the following conditions:
``(1) Heart disease, including congestive heart failure and
coronary artery disease.
``(2) Diabetes.
``(3) Osteoporosis and osteopenia.
``(4) Hypertension.
``(5) Asthma.
``(6) Liver disease.
``(7) Bleeding disorders.
``(8) Depression.
``(c) Criteria Specified.--For purposes of subsection (a), the
criteria specified in this subsection, with respect to an item or
service and a chronic condition, are the following:
``(1) The item or service is low-cost.
``(2) There is medical evidence supporting high-cost
efficiency, or a large expected impact, of the item or service
in preventing exacerbation of the chronic condition or the
development of a secondary condition.
``(3) There is a strong likelihood, documented by clinical
evidence, that the item or service will prevent the
exacerbation of the chronic condition or the development of a
secondary condition that requires significantly higher-cost
treatments.
``(d) Updates.--
``(1) In general.--Once every three years, the Secretary
shall review and update--
``(A) the list of conditions included within the
meaning of the term `chronic condition' under
subsection (b); and
``(B) the items and services determined to meet the
criteria specified in subsection (c) for purposes of
subsection (a).
``(2) Application of updates.--The requirement under
subsection (a) shall apply with respect to an update made under
paragraph (1) beginning with the first plan year beginning
after the date of such update.''.
(2) Clerical amendment.--The table of contents for
subchapter B of chapter 100 of such Code is amended by adding
at the end the following new item:
``9826. Coverage of additional preventive care for individuals with
chronic conditions without imposition of
cost sharing requirements.''.
(3) High deductible health plans.--Section 223(c)(2)(C) of
the Internal Revenue Code of 1986 is amended by inserting ``or
for additional preventive care for individuals with chronic
conditions described in section 9826'' before the period.
(d) Effective Date.--The amendments made by this section shall
apply with respect to plan years beginning on or after the date that is
one year after the date of the enactment of this Act.
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