Ally’s Act

II 116TH CONGRESS 2D SESSION S. 4532 To amend title XXVII of the Public Health Service Act and the Patient Protection and Affordable Care Act to require coverage of hearing devices and systems in certain private health insurance plans, and for other purposes. IN THE SENATE OF THE UNITED STATES SEPTEMBER 8, 2020 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 title XXVII of the Public Health Service Act and the Patient Protection and Affordable Care Act to require coverage of hearing devices and systems in cer- tain private health insurance plans, and for other pur- poses. 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 01:41 Sep 09, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S4532.IS S4532 pamtmann on DSKBC07HB2PROD with BILLS 2 •S 4532 IS SEC. 2. COVERAGE OF HEARING DEVICES AND SYSTEMS IN 1 CERTAIN PRIVATE HEALTH INSURANCE 2 PLANS. 3 (a) IN GENERAL.—Part A of the Public Health Serv- 4 ice Act (42 U.S.C. 300gg et seq.) is amended by inserting 5 after 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, 2021, 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 01:41 Sep 09, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S4532.IS S4532 pamtmann on DSKBC07HB2PROD with BILLS 3 •S 4532 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, 2021, 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 01:41 Sep 09, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S4532.IS S4532 pamtmann on DSKBC07HB2PROD with BILLS 4 •S 4532 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) APPLICATION TO GRANDFATHERED HEALTH 14 PLANS.—Section 1251(a)(4)(A) of the Patient Protection 15 and Affordable Care Act (42 U.S.C. 18011(a)(4)(A)) is 16 amended— 17 (1) by striking ‘‘title’’ and inserting ‘‘title, or as 18 added after the date of the enactment of this Act)’’; 19 and 20 (2) by adding at the end the following new 21 clause: 22 ‘‘(v) Section 2713A (relating to hear- 23 ing devices and systems).’’. 24 VerDate Sep 11 2014 01:41 Sep 09, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S4532.IS S4532 pamtmann on DSKBC07HB2PROD with BILLS 5 •S 4532 IS (c) EFFECTIVE DATE.—The amendments made by 1 this section shall apply with respect to plan years begin- 2 ning on or after January 1, 2021. 3 Æ VerDate Sep 11 2014 01:41 Sep 09, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6301 E:\BILLS\S4532.IS S4532 pamtmann on DSKBC07HB2PROD with BILLS