Chronic Condition Copay Elimination Act

I 116TH CONGRESS 1ST SESSION H. R. 4457 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 pur- poses. IN THE HOUSE OF REPRESENTATIVES SEPTEMBER 24, 2019 Ms. UNDERWOOD 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 subse- quently 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 cov- erage 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 Representa- 1 tives of the United States of America in Congress assembled, 2 VerDate Sep 11 2014 22:16 Sep 26, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H4457.IH H4457 pamtmann on DSKBC07HB2PROD with BILLS 2 •HR 4457 IH SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘Chronic Condition 2 Copay Elimination Act’’. 3 SEC. 2. COVERAGE OF ADDITIONAL PREVENTIVE CARE FOR 4 INDIVIDUALS WITH CHRONIC CONDITIONS 5 WITHOUT IMPOSITION OF COST SHARING RE- 6 QUIREMENTS. 7 (a) ERISA.— 8 (1) IN GENERAL.—Subpart B of part 7 of sub- 9 title B of title I of the Employee Retirement Income 10 Security Act of 1974 (29 U.S.C. 1185 et seq.) is 11 amended by adding at the end the following new sec- 12 tion: 13 ‘‘SEC. 716. COVERAGE OF ADDITIONAL PREVENTIVE CARE 14 FOR INDIVIDUALS WITH CHRONIC CONDI- 15 TIONS WITHOUT IMPOSITION OF COST SHAR- 16 ING REQUIREMENTS. 17 ‘‘(a) IN GENERAL.—In addition to any item or serv- 18 ice described in section 2713(a) of the Public Health Serv- 19 ice Act, a group health plan and a health insurance issuer 20 offering group health insurance coverage shall, at a min- 21 imum, provide coverage for, and shall not impose any cost 22 sharing requirements for, with respect to individuals with 23 chronic conditions (as defined in subsection (b)), such ad- 24 ditional preventive care and screenings not described in 25 paragraph (1) of such section 2713(a) that are determined 26 VerDate Sep 11 2014 22:16 Sep 26, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H4457.IH H4457 pamtmann on DSKBC07HB2PROD with BILLS 3 •HR 4457 IH by the Secretary to meet the criteria specified in sub- 1 section (c) with respect to the chronic condition involved. 2 ‘‘(b) CHRONIC CONDITION DEFINED.—In this sec- 3 tion, the term ‘chronic condition’ has the meaning given 4 such term by the Secretary and, at a minimum, includes 5 the following conditions: 6 ‘‘(1) Heart disease, including congestive heart 7 failure and coronary artery disease. 8 ‘‘(2) Diabetes. 9 ‘‘(3) Osteoporosis and osteopenia. 10 ‘‘(4) Hypertension. 11 ‘‘(5) Asthma. 12 ‘‘(6) Liver disease. 13 ‘‘(7) Bleeding disorders. 14 ‘‘(8) Depression. 15 ‘‘(c) CRITERIA SPECIFIED.—For purposes of sub- 16 section (a), the criteria specified in this subsection, with 17 respect to an item or service and a chronic condition, are 18 the following: 19 ‘‘(1) The item or service is low-cost. 20 ‘‘(2) There is medical evidence supporting high- 21 cost efficiency, or a large expected impact, of the 22 item or service in preventing exacerbation of the 23 chronic condition or the development of a secondary 24 condition. 25 VerDate Sep 11 2014 22:16 Sep 26, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4457.IH H4457 pamtmann on DSKBC07HB2PROD with BILLS 4 •HR 4457 IH ‘‘(3) There is a strong likelihood, documented 1 by clinical evidence, that the item or service will pre- 2 vent the exacerbation of the chronic condition or the 3 development of a secondary condition that requires 4 significantly higher-cost treatments. 5 ‘‘(d) UPDATES.— 6 ‘‘(1) IN GENERAL.—Once every three years, the 7 Secretary shall review and update— 8 ‘‘(A) the list of conditions included within 9 the meaning of the term ‘chronic condition’ 10 under subsection (b); and 11 ‘‘(B) the items and services determined to 12 meet the criteria specified in subsection (c) for 13 purposes of subsection (a). 14 ‘‘(2) APPLICATION OF UPDATES.—The require- 15 ment under subsection (a) shall apply with respect 16 to an update made under paragraph (1) beginning 17 with the first plan year beginning after the date of 18 such update.’’. 19 (2) CLERICAL AMENDMENT.—The table of con- 20 tents in section 1 of such Act is amended by insert- 21 ing after the item relating to section 714 the fol- 22 lowing new items: 23 ‘‘715. Additional market reforms. ‘‘716. Coverage of additional preventive care for individuals with chronic condi- tions without imposition of cost sharing requirements.’’. VerDate Sep 11 2014 22:16 Sep 26, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6211 E:\BILLS\H4457.IH H4457 pamtmann on DSKBC07HB2PROD with BILLS 5 •HR 4457 IH (b) PHSA.—Subpart II of part A of title XXVII of 1 the Public Health Service Act (42 U.S.C. 300gg–11 et 2 seq.) is amended by adding at the end the following new 3 section: 4 ‘‘SEC. 2730. COVERAGE OF ADDITIONAL PREVENTIVE CARE 5 FOR INDIVIDUALS WITH CHRONIC CONDI- 6 TIONS WITHOUT IMPOSITION OF COST SHAR- 7 ING REQUIREMENTS. 8 ‘‘(a) IN GENERAL.—In addition to any item or serv- 9 ice described in section 2713(a), a group health plan and 10 a health insurance issuer offering group or individual 11 health insurance coverage shall, at a minimum, provide 12 coverage for, and shall not impose any cost sharing re- 13 quirements for, with respect to individuals with chronic 14 conditions (as defined in subsection (b)), such additional 15 preventive care and screenings not described in paragraph 16 (1) of section 2713(a) that are determined by the Sec- 17 retary to meet the criteria specified in subsection (c) with 18 respect to the chronic condition involved. 19 ‘‘(b) CHRONIC CONDITION DEFINED.—In this sec- 20 tion, the term ‘chronic condition’ has the meaning given 21 such term by the Secretary and, at a minimum, includes 22 the following conditions: 23 ‘‘(1) Heart disease, including congestive heart 24 failure and coronary artery disease. 25 VerDate Sep 11 2014 22:16 Sep 26, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H4457.IH H4457 pamtmann on DSKBC07HB2PROD with BILLS 6 •HR 4457 IH ‘‘(2) Diabetes. 1 ‘‘(3) Osteoporosis and osteopenia. 2 ‘‘(4) Hypertension. 3 ‘‘(5) Asthma. 4 ‘‘(6) Liver disease. 5 ‘‘(7) Bleeding disorders. 6 ‘‘(8) Depression. 7 ‘‘(c) CRITERIA SPECIFIED.—For purposes of sub- 8 section (a), the criteria specified in this subsection, with 9 respect to an item or service and a chronic condition, are 10 the following: 11 ‘‘(1) The item or service is low-cost. 12 ‘‘(2) There is medical evidence supporting high- 13 cost efficiency, or a large expected impact, of the 14 item or service in preventing exacerbation of the 15 chronic condition or the development of a secondary 16 condition. 17 ‘‘(3) There is a strong likelihood, documented 18 by clinical evidence, that the item or service will pre- 19 vent the exacerbation of the chronic condition or the 20 development of a secondary condition that requires 21 significantly higher-cost treatments. 22 ‘‘(d) UPDATES.— 23 ‘‘(1) IN GENERAL.—Once every three years, the 24 Secretary shall review and update— 25 VerDate Sep 11 2014 22:16 Sep 26, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H4457.IH H4457 pamtmann on DSKBC07HB2PROD with BILLS 7 •HR 4457 IH ‘‘(A) the list of conditions included within 1 the meaning of the term ‘chronic condition’ 2 under subsection (b); and 3 ‘‘(B) the items and services determined to 4 meet the criteria specified in subsection (c) for 5 purposes of subsection (a). 6 ‘‘(2) APPLICATION OF UPDATES.—The require- 7 ment under subsection (a) shall apply with respect 8 to an update made under paragraph (1) beginning 9 with the first plan year beginning after the date of 10 such update.’’. 11 (c) IRC.— 12 (1) IN GENERAL.—Subchapter B of chapter 13 100 of subtitle K of the Internal Revenue Code of 14 1986 is amended by adding at the end the following 15 new section: 16 ‘‘SEC. 9816. COVERAGE OF ADDITIONAL PREVENTIVE CARE 17 FOR INDIVIDUALS WITH CHRONIC CONDI- 18 TIONS WITHOUT IMPOSITION OF COST SHAR- 19 ING REQUIREMENTS. 20 ‘‘(a) IN GENERAL.—In addition to any item or serv- 21 ice described in section 2713(a) of the Public Health Serv- 22 ice Act, a group health plan shall, at a minimum, provide 23 coverage for, and shall not impose any cost sharing re- 24 quirements for, with respect to individuals with chronic 25 VerDate Sep 11 2014 22:16 Sep 26, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H4457.IH H4457 pamtmann on DSKBC07HB2PROD with BILLS 8 •HR 4457 IH conditions (as defined in subsection (b)), such additional 1 preventive care and screenings not described in paragraph 2 (1) of such section 2713(a) that are determined by the 3 Secretary to meet the criteria specified in subsection (c) 4 with respect to the chronic condition involved. 5 ‘‘(b) CHRONIC CONDITION DEFINED.—In this sec- 6 tion, the term ‘chronic condition’ has the meaning given 7 such term by the Secretary and, at a minimum, includes 8 the following conditions: 9 ‘‘(1) Heart disease, including congestive heart 10 failure and coronary artery disease. 11 ‘‘(2) Diabetes. 12 ‘‘(3) Osteoporosis and osteopenia. 13 ‘‘(4) Hypertension. 14 ‘‘(5) Asthma. 15 ‘‘(6) Liver disease. 16 ‘‘(7) Bleeding disorders. 17 ‘‘(8) Depression. 18 ‘‘(c) CRITERIA SPECIFIED.—For purposes of sub- 19 section (a), the criteria specified in this subsection, with 20 respect to an item or service and a chronic condition, are 21 the following: 22 ‘‘(1) The item or service is low-cost. 23 ‘‘(2) There is medical evidence supporting high- 24 cost efficiency, or a large expected impact, of the 25 VerDate Sep 11 2014 22:16 Sep 26, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H4457.IH H4457 pamtmann on DSKBC07HB2PROD with BILLS 9 •HR 4457 IH item or service in preventing exacerbation of the 1 chronic condition or the development of a secondary 2 condition. 3 ‘‘(3) There is a strong likelihood, documented 4 by clinical evidence, that the item or service will pre- 5 vent the exacerbation of the chronic condition or the 6 development of a secondary condition that requires 7 significantly higher-cost treatments. 8 ‘‘(d) UPDATES.— 9 ‘‘(1) IN GENERAL.—Once every three years, the 10 Secretary shall review and update— 11 ‘‘(A) the list of conditions included within 12 the meaning of the term ‘chronic condition’ 13 under subsection (b); and 14 ‘‘(B) the items and services determined to 15 meet the criteria specified in subsection (c) for 16 purposes of subsection (a). 17 ‘‘(2) APPLICATION OF UPDATES.—The require- 18 ment under subsection (a) shall apply with respect 19 to an update made under paragraph (1) beginning 20 with the first plan year beginning after the date of 21 such update.’’. 22 (2) CLERICAL AMENDMENT.—The table of con- 23 tents for subchapter B of chapter 100 of subtitle K 24 VerDate Sep 11 2014 22:16 Sep 26, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H4457.IH H4457 pamtmann on DSKBC07HB2PROD with BILLS 10 •HR 4457 IH of such Code is amended by adding at the end the 1 following new item: 2 ‘‘9816. Coverage of additional preventive care for individuals with chronic condi- tions without imposition of cost sharing requirements.’’. (3) HIGH DEDUCTIBLE HEALTH PLANS.—Sec- 3 tion 223(c)(2)(C) of the Internal Revenue Code of 4 1986 is amended by inserting ‘‘or for additional pre- 5 ventive care for individuals with chronic conditions 6 described in section 9816’’ before the period. 7 (d) EFFECTIVE DATE.—The amendments made by 8 this section shall apply with respect to plan years begin- 9 ning on or after the date that is one year after the date 10 of the enactment of this Act. 11 Æ VerDate Sep 11 2014 22:16 Sep 26, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6301 E:\BILLS\H4457.IH H4457 pamtmann on DSKBC07HB2PROD with BILLS