What This Bill Does
This bill changes rules for high deductible health plans (health insurance plans with higher out-of-pocket costs before insurance kicks in). It allows these plans to pay for certain prevention services for chronic conditions (long-term health problems) even before a person meets their deductible (the amount they must pay themselves before insurance starts covering costs). The bill is called the Chronic Disease Management Act of 2023.
Who It Affects
People enrolled in high deductible health plans who have chronic conditions. Insurance companies offering high deductible health plans.
Key Provisions
- High deductible health plans can now cover preventive care services and items for chronic conditions before enrollees satisfy their plan deductible (Sec. 2(a))
- A preventive care service or item qualifies if it is low-cost, has medical evidence showing it prevents a chronic condition from getting worse or stops a secondary condition from developing, and clinical evidence shows it will prevent worse problems requiring higher cost treatment (Sec. 2(a))
- A person prescribed preventive care for a chronic condition can be considered to have that diagnosis if the care is typically prescribed for that condition (Sec. 2(a))
What Changes
High deductible health plans will be required to cover certain low-cost preventive services for chronic conditions without requiring enrollees to first pay their deductible.
Important Definitions
None explicitly defined in the bill text.
Effective Date
The changes apply to coverage for months beginning after this bill becomes law (Sec. 2(b)).
II
118TH CONGRESS
1ST SESSION
S. 655
To amend the Internal Revenue Code of 1986 to permit high deductible
health plans to provide chronic disease prevention services to plan enroll-
ees prior to satisfying their plan deductible.
IN THE SENATE OF THE UNITED STATES
MARCH 6, 2023
Mr. THUNE (for himself and Mr. CARPER) introduced the following bill; which
was read twice and referred to the Committee on Finance
A BILL
To amend the Internal Revenue Code of 1986 to permit
high deductible health plans to provide chronic disease
prevention services to plan enrollees prior to satisfying
their plan deductible.
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 the ‘‘Chronic Disease Man-
4
agement Act of 2023’’.
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•S 655 IS
SEC. 2. CHRONIC DISEASE PREVENTION.
1
(a) IN GENERAL.—Section 223(c)(2) of the Internal
2
Revenue Code of 1986 is amended by adding at the end
3
the following:
4
‘‘(F) PREVENTIVE
CARE
SERVICES
AND
5
ITEMS
FOR
CHRONIC
CONDITIONS.—For pur-
6
poses of subparagraph (C)—
7
‘‘(i) preventive care shall include any
8
service or item used to treat an individual
9
with a chronic condition if—
10
‘‘(I) such service or item is low-
11
cost,
12
‘‘(II) in regards to such service
13
or item, there is medical evidence sup-
14
porting high cost efficiency of pre-
15
venting exacerbation of the chronic
16
condition or the development of a sec-
17
ondary condition, and
18
‘‘(III) there is a strong likeli-
19
hood, documented by clinical evidence,
20
that with respect to the class of indi-
21
viduals utilizing such service or item,
22
the specific service or use of the item
23
will prevent the exacerbation of the
24
chronic condition or the development
25
of a secondary condition that requires
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•S 655 IS
significantly higher cost treatments,
1
and
2
‘‘(ii) an individual who has been pre-
3
scribed preventive care for any chronic
4
condition may be presumed to have been
5
diagnosed with such condition if such pre-
6
ventive care is customarily prescribed for
7
such condition.’’.
8
(b) EFFECTIVE DATE.—The amendment made by
9
this section shall apply to coverage for months beginning
10
after the date of the enactment of this Act.
11
Æ
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