Ally's Act

II 117TH CONGRESS 1ST SESSION S. 41 To amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, the Internal Revenue Code of 1986, and the Patient Protection and Affordable Care Act to require coverage of hear- ing devices and systems in certain private health insurance plans, and for other purposes. IN THE SENATE OF THE UNITED STATES JANUARY 25, 2021 Mrs. CAPITO (for herself and Ms. WARREN) introduced the following bill; which was read twice and referred to the Committee on Health, Edu- cation, Labor, and Pensions A BILL To amend the Public Health Service Act, the Employee Re- tirement Income Security Act of 1974, the Internal Rev- enue Code of 1986, and the Patient Protection and Af- fordable Care Act to require coverage of hearing devices and systems in certain private health insurance plans, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as ‘‘Ally’s Act’’. 4 VerDate Sep 11 2014 04:10 Feb 06, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S41.IS S41 kjohnson on DSK79L0C42PROD with BILLS 2 •S 41 IS SEC. 2. COVERAGE OF HEARING DEVICES AND SYSTEMS IN 1 CERTAIN PRIVATE HEALTH INSURANCE 2 PLANS. 3 (a) PHSA.—Part A of the Public Health Service Act 4 (42 U.S.C. 300gg et seq.) is amended by inserting after 5 section 2713 the following new section: 6 ‘‘SEC. 2713A. COVERAGE OF HEARING DEVICES AND SYS- 7 TEMS. 8 ‘‘(a) IN GENERAL.—Beginning with plan years begin- 9 ning on or after January 1, 2022, a group health plan 10 and a health insurance issuer offering group or individual 11 health insurance coverage shall, at a minimum provide 12 coverage for and may impose cost-sharing requirements 13 in accordance with subsection (b) for an individual that 14 a physician (as defined in section 1861(r) of the Social 15 Security Act) or qualified audiologist (as defined in section 16 1861(ll)(4)(B) of such Act) determines meets an indica- 17 tion (including unilateral or bilateral hearing loss) for an 18 auditory device as approved by the Food and Drug Admin- 19 istration for— 20 ‘‘(1) auditory implant devices (including audi- 21 tory osseointegrated (bone conduction) implants and 22 cochlear implants) and external sound processors; 23 ‘‘(2) the maintenance of auditory implant de- 24 vices and external sound processors described in 25 paragraph (1); 26 VerDate Sep 11 2014 04:10 Feb 06, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S41.IS S41 kjohnson on DSK79L0C42PROD with BILLS 3 •S 41 IS ‘‘(3) every 5 years, the upgrade (or replacement 1 if an upgrade is not available) of auditory implant 2 devices and external sound processors described in 3 paragraph (1); 4 ‘‘(4) adhesive adapters and softband headbands; 5 ‘‘(5) the repair of auditory implant devices and 6 external sound processors described in paragraph 7 (1); 8 ‘‘(6) a comprehensive hearing assessment; 9 ‘‘(7) a preoperative medical assessment; 10 ‘‘(8) surgery (as appropriate); 11 ‘‘(9) postoperative medical appointments for 12 purposes of ensuring appropriate recovery from sur- 13 gery; 14 ‘‘(10) postoperative audiological appointments 15 for activation and fitting of the implant device and 16 external sound processor; and 17 ‘‘(11) aural rehabilitation and treatment serv- 18 ices (as appropriate). 19 ‘‘(b) COST-SHARING.—Beginning with plan years be- 20 ginning on or after January 1, 2022, the cost-sharing in- 21 curred under a plan or coverage described in subsection 22 (a)— 23 ‘‘(1) for an auditory implant device and exter- 24 nal sound processors under this section, shall not ex- 25 VerDate Sep 11 2014 04:10 Feb 06, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S41.IS S41 kjohnson on DSK79L0C42PROD with BILLS 4 •S 41 IS ceed a dollar amount that is the highest cost-sharing 1 requirement for the amount of the charges imposed 2 for such device that is provided by a physician or 3 qualified audiologist that has a contractual relation- 4 ship with such plan or coverage for the providing of 5 such device; 6 ‘‘(2) for an item or service under this section, 7 shall not exceed a dollar amount that is imposed for 8 similar items and services under that plan that are 9 provided by a physician or qualified audiologist; and 10 ‘‘(3) that has a contractual relationship with 11 such plan or coverage for the providing of such 12 items and services.’’. 13 (b) ERISA.— 14 (1) IN GENERAL.—Subpart B of part 7 of sub- 15 title B of title I of the Employee Retirement Income 16 Security Act of 1974 (29 U.S.C. 1185 et seq.) by 17 adding at the end the following new section: 18 ‘‘SEC. 726. COVERAGE OF HEARING DEVICES AND SYSTEMS. 19 ‘‘(a) IN GENERAL.—Beginning with plan years begin- 20 ning on or after January 1, 2022, a group health plan 21 and a health insurance issuer offering group health insur- 22 ance coverage shall, at a minimum provide coverage for 23 and may impose cost-sharing requirements in accordance 24 with subsection (b) for an individual that a physician (as 25 VerDate Sep 11 2014 04:10 Feb 06, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S41.IS S41 kjohnson on DSK79L0C42PROD with BILLS 5 •S 41 IS defined in section 1861(r) of the Social Security Act) or 1 qualified audiologist (as defined in section 1861(ll)(4)(B) 2 of such Act) determines meets an indication (including 3 unilateral or bilateral hearing loss) for an auditory device 4 as approved by the Food and Drug Administration for— 5 ‘‘(1) auditory implant devices (including audi- 6 tory osseointegrated (bone conduction) implants and 7 cochlear implants) and external sound processors; 8 ‘‘(2) the maintenance of auditory implant de- 9 vices and external sound processors described in 10 paragraph (1); 11 ‘‘(3) every 5 years, the upgrade (or replacement 12 if an upgrade is not available) of auditory implant 13 devices and external sound processors described in 14 paragraph (1); 15 ‘‘(4) adhesive adapters and softband headbands; 16 ‘‘(5) the repair of auditory implant devices and 17 external sound processors described in paragraph 18 (1); 19 ‘‘(6) a comprehensive hearing assessment; 20 ‘‘(7) a preoperative medical assessment; 21 ‘‘(8) surgery (as appropriate); 22 ‘‘(9) postoperative medical appointments for 23 purposes of ensuring appropriate recovery from sur- 24 gery; 25 VerDate Sep 11 2014 04:10 Feb 06, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S41.IS S41 kjohnson on DSK79L0C42PROD with BILLS 6 •S 41 IS ‘‘(10) postoperative audiological appointments 1 for activation and fitting of the implant device and 2 external sound processor; and 3 ‘‘(11) aural rehabilitation and treatment serv- 4 ices (as appropriate). 5 ‘‘(b) COST-SHARING.—Beginning with plan years be- 6 ginning on or after January 1, 2022, the cost-sharing in- 7 curred under a plan or coverage described in subsection 8 (a)— 9 ‘‘(1) for an auditory implant device and exter- 10 nal sound processors under this section, shall not ex- 11 ceed a dollar amount that is the highest cost-sharing 12 requirement for the amount of the charges imposed 13 for such device that is provided by a physician or 14 qualified audiologist that has a contractual relation- 15 ship with such plan or coverage for the providing of 16 such device; 17 ‘‘(2) for an item or service under this section, 18 shall not exceed a dollar amount that is imposed for 19 similar items and services under that plan that are 20 provided by a physician or qualified audiologist; and 21 ‘‘(3) that has a contractual relationship with 22 such plan or coverage for the providing of such 23 items and services.’’. 24 VerDate Sep 11 2014 04:10 Feb 06, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S41.IS S41 kjohnson on DSK79L0C42PROD with BILLS 7 •S 41 IS (2) CLERICAL AMENDMENT.—The table of con- 1 tents in section 1 of the Employee Retirement In- 2 come Security Act of 1974 (29 U.S.C. 1001 et seq.) 3 is amended by inserting after the item relating to 4 section 725 the following new item: 5 ‘‘Sec. 726. Coverage of hearing devices and systems.’’. (c) IRC.— 6 (1) IN GENERAL.—Subchapter B of chapter 7 100 of the Internal Revenue Code of 1986, is 8 amended by adding at the end the following new sec- 9 tion: 10 ‘‘SEC. 9826. COVERAGE OF HEARING DEVICES AND SYS- 11 TEMS. 12 ‘‘(a) IN GENERAL.—Beginning with plan years begin- 13 ning on or after January 1, 2022, a group health plan 14 shall, at a minimum provide coverage for and may impose 15 cost-sharing requirements in accordance with subsection 16 (b) for an individual that a physician (as defined in section 17 1861(r) of the Social Security Act) or qualified audiologist 18 (as defined in section 1861(ll)(4)(B) of such Act) deter- 19 mines meets an indication (including unilateral or bilateral 20 hearing loss) for an auditory device as approved by the 21 Food and Drug Administration for— 22 ‘‘(1) auditory implant devices (including audi- 23 tory osseointegrated (bone conduction) implants and 24 cochlear implants) and external sound processors; 25 VerDate Sep 11 2014 04:10 Feb 06, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S41.IS S41 kjohnson on DSK79L0C42PROD with BILLS 8 •S 41 IS ‘‘(2) the maintenance of auditory implant de- 1 vices and external sound processors described in 2 paragraph (1); 3 ‘‘(3) every 5 years, the upgrade (or replacement 4 if an upgrade is not available) of auditory implant 5 devices and external sound processors described in 6 paragraph (1); 7 ‘‘(4) adhesive adapters and softband headbands; 8 ‘‘(5) the repair of auditory implant devices and 9 external sound processors described in paragraph 10 (1); 11 ‘‘(6) a comprehensive hearing assessment; 12 ‘‘(7) a preoperative medical assessment; 13 ‘‘(8) surgery (as appropriate); 14 ‘‘(9) postoperative medical appointments for 15 purposes of ensuring appropriate recovery from sur- 16 gery; 17 ‘‘(10) postoperative audiological appointments 18 for activation and fitting of the implant device and 19 external sound processor; and 20 ‘‘(11) aural rehabilitation and treatment serv- 21 ices (as appropriate). 22 ‘‘(b) COST-SHARING.—Beginning with plan years be- 23 ginning on or after January 1, 2022, the cost-sharing in- 24 curred under a plan described in subsection (a)— 25 VerDate Sep 11 2014 04:10 Feb 06, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S41.IS S41 kjohnson on DSK79L0C42PROD with BILLS 9 •S 41 IS ‘‘(1) for an auditory implant device and exter- 1 nal sound processors under this section, shall not ex- 2 ceed a dollar amount that is the highest cost-sharing 3 requirement for the amount of the charges imposed 4 for such device that is provided by a physician or 5 qualified audiologist that has a contractual relation- 6 ship with such plan for the providing of such device; 7 ‘‘(2) for an item or service under this section, 8 shall not exceed a dollar amount that is imposed for 9 similar items and services under that plan that are 10 provided by a physician or qualified audiologist; and 11 ‘‘(3) that has a contractual relationship with 12 such plan for the providing of such items and serv- 13 ices.’’. 14 (2) CLERICAL AMENDMENT.—The table of sec- 15 tions for subchapter B of chapter 100 of the Inter- 16 nal Revenue Code of 1986 is amended by inserting 17 after the item relating to section 9825 the following 18 new item: 19 ‘‘Sec. 9826. Coverage of hearing devices and systems.’’. (d) APPLICATION TO GRANDFATHERED HEALTH 20 PLANS.—Section 1251(a)(4)(A) of the Patient Protection 21 and Affordable Care Act (42 U.S.C. 18011(a)(4)(A)) is 22 amended— 23 VerDate Sep 11 2014 04:10 Feb 06, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S41.IS S41 kjohnson on DSK79L0C42PROD with BILLS 10 •S 41 IS (1) by striking ‘‘title’’ and inserting ‘‘title, or as 1 added after the date of the enactment of this Act)’’; 2 and 3 (2) by adding at the end the following new 4 clause: 5 ‘‘(v) Section 2713A (relating to hear- 6 ing devices and systems).’’. 7 (3) EFFECTIVE DATE.—The amendments made 8 by this subsection shall apply with respect to plan 9 years beginning on or after January 1, 2022. 10 Æ VerDate Sep 11 2014 04:10 Feb 06, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6301 E:\BILLS\S41.IS S41 kjohnson on DSK79L0C42PROD with BILLS