Helping Families Access Pediatric Care Act of 2020

I 116TH CONGRESS 2D SESSION H. R. 8573 To prohibit group health plans, health insurance issuers offering group or individual health insurance coverage, State plans under title XIX of the Social Security Act, State child health plans under title XXI of such Act, and the TRICARE program from applying a deductible to outpatient pediatric services. IN THE HOUSE OF REPRESENTATIVES OCTOBER 9, 2020 Ms. SCHRIER introduced the following bill; which was referred to the Com- mittee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and Labor, and Armed Services, for a period to be subsequently determined by the Speaker, in each case for consider- ation of such provisions as fall within the jurisdiction of the committee concerned A BILL To prohibit group health plans, health insurance issuers of- fering group or individual health insurance coverage, State plans under title XIX of the Social Security Act, State child health plans under title XXI of such Act, and the TRICARE program from applying a deductible to outpatient pediatric services. 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 23:05 Oct 31, 2020 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H8573.IH H8573 pbinns on DSKJLVW7X2PROD with BILLS 2 •HR 8573 IH SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘Helping Families Ac- 2 cess Pediatric Care Act of 2020’’. 3 SEC. 2. PROHIBITING CERTAIN HEALTH PLANS FROM AP- 4 PLYING A DEDUCTIBLE TO OUTPATIENT PE- 5 DIATRIC SERVICES. 6 (a) ERISA.— 7 (1) IN GENERAL.—Subpart B of part 7 of title 8 I of the Employee Retirement Income Security Act 9 of 1974 (29 U.S.C. 1185 et seq.) is amended by 10 adding at the end the following new section: 11 ‘‘SEC. 716. PROHIBITION ON APPLICATION OF DEDUCTIBLE 12 TO OUTPATIENT PEDIATRIC SERVICES. 13 ‘‘(a) IN GENERAL.—A group health plan and a health 14 insurance issuer offering group health insurance coverage 15 may not impose any deductible under such plan or cov- 16 erage (as applicable) with respect to outpatient pediatric 17 services (as defined in subsection (b)) for which benefits 18 are provided under such plan or coverage. 19 ‘‘(b) OUTPATIENT PEDIATRIC SERVICES DEFINED.— 20 For purposes of subsection (a), the term ‘outpatient pedi- 21 atric services’ means any item or service furnished to an 22 individual under the age of 18 as an outpatient by a health 23 care provider acting within the scope of such provider’s 24 license, regardless of whether such service is furnished in- 25 person or through use of a telecommunications system.’’. 26 VerDate Sep 11 2014 23:05 Oct 31, 2020 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H8573.IH H8573 pbinns on DSKJLVW7X2PROD with BILLS 3 •HR 8573 IH (2) CLERICAL AMENDMENT.—The table of con- 1 tents of the Employee Retirement Income Security 2 Act of 1974 is amended by inserting after the item 3 relating to section 714 the following: 4 ‘‘Sec. 715. Additional market reforms. ‘‘Sec. 716. Prohibition on application of deductible to outpatient pediatric serv- ices.’’. (b) PHSA.—Subpart II of part A of title XXVII of 5 the Public Health Service Act (42 U.S.C. 300gg–11 et 6 seq.) is amended by adding at the end the following new 7 section: 8 ‘‘SEC. 2730. PROHIBITION ON APPLICATION OF DEDUCT- 9 IBLE TO OUTPATIENT PEDIATRIC SERVICES. 10 ‘‘(a) IN GENERAL.—A group health plan and a health 11 insurance issuer offering group or individual health insur- 12 ance coverage may not impose any deductible under such 13 plan or coverage (as applicable) with respect to outpatient 14 pediatric services (as defined in subsection (b)) for which 15 benefits are provided under such plan or coverage. 16 ‘‘(b) OUTPATIENT PEDIATRIC SERVICES DEFINED.— 17 For purposes of subsection (a), the term ‘outpatient pedi- 18 atric services’ means any item or service furnished to an 19 individual under the age of 18 as an outpatient by a health 20 care provider acting within the scope of such provider’s 21 license, regardless of whether such service is furnished in- 22 person or through use of a telecommunications system.’’. 23 (c) IRC.— 24 VerDate Sep 11 2014 23:05 Oct 31, 2020 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H8573.IH H8573 pbinns on DSKJLVW7X2PROD with BILLS 4 •HR 8573 IH (1) IN GENERAL.—Subchapter B of chapter 1 100 of the Internal Revenue Code of 1986 is amend- 2 ed by adding at the end the following new section: 3 ‘‘SEC. 9816. PROHIBITION ON APPLICATION OF DEDUCT- 4 IBLE TO OUTPATIENT PEDIATRIC SERVICES. 5 ‘‘(a) IN GENERAL.—A group health plan may not im- 6 pose any deductible under such plan with respect to out- 7 patient pediatric services (as defined in subsection (b)) for 8 which benefits are provided under such plan. 9 ‘‘(b) OUTPATIENT PEDIATRIC SERVICES DEFINED.— 10 For purposes of subsection (a), the term ‘outpatient pedi- 11 atric services’ means any item or service furnished to an 12 individual under the age of 18 as an outpatient by a health 13 care provider acting within the scope of such provider’s 14 license, regardless of whether such service is furnished in- 15 person or through use of a telecommunications system.’’. 16 (2) CLERICAL AMENDMENT.—The table of sec- 17 tions for subchapter B of chapter 100 of the Inter- 18 nal Revenue Code of 1986 is amended by adding at 19 the end the following new items: 20 ‘‘Sec. 9815. Additional market reforms. ‘‘Sec. 9816. Prohibition on application of deductible to outpatient pediatric services.’’. (d) MEDICAID.—Section 1916A of the Social Security 21 Act (42 U.S.C. 1396o–1) is amended— 22 (1) in subsection (a)— 23 VerDate Sep 11 2014 23:05 Oct 31, 2020 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H8573.IH H8573 pbinns on DSKJLVW7X2PROD with BILLS 5 •HR 8573 IH (A) in paragraph (1), by striking ‘‘para- 1 graph (2)’’ and inserting ‘‘paragraphs (2) and 2 (4)’’; and 3 (B) by adding at the end the following new 4 paragraph: 5 ‘‘(4) PROHIBITION ON APPLICATION OF DEDUC- 6 TION TO OUTPATIENT PEDIATRIC SERVICES.—A 7 State may not impose a deduction under the plan 8 with respect to outpatient pediatric services (as de- 9 fined in subsection (f)).’’; and 10 (2) by adding at the end the following new sub- 11 section: 12 ‘‘(f) OUTPATIENT PEDIATRIC SERVICES DEFINED.— 13 For purposes of this section, the term ‘outpatient pediatric 14 services’ means any item or service furnished to an indi- 15 vidual under the age of 18 as an outpatient by a health 16 care provider acting within the scope of such provider’s 17 license, regardless of whether such service is furnished in- 18 person or through use of a telecommunications system.’’. 19 (e) CHIP.—Section 2103(e) of the Social Security 20 Act (42 U.S.C. 1397cc) is amended by adding at the end 21 the following new paragraph: 22 ‘‘(5) PROHIBITION ON APPLICATION OF DEDUC- 23 TION TO OUTPATIENT PEDIATRIC SERVICES.— 24 VerDate Sep 11 2014 23:05 Oct 31, 2020 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H8573.IH H8573 pbinns on DSKJLVW7X2PROD with BILLS 6 •HR 8573 IH ‘‘(A) IN GENERAL.—The State child health 1 plan may not impose a deductible with respect 2 to outpatient pediatric services (as defined in 3 subparagraph (B)). 4 ‘‘(B) OUTPATIENT PEDIATRIC SERVICES 5 DEFINED.—For purposes of this paragraph, the 6 term ‘outpatient pediatric services’ means any 7 item or service furnished to an individual under 8 the age of 18 as an outpatient by a health care 9 provider acting within the scope of such pro- 10 vider’s license, regardless of whether such serv- 11 ice is furnished in-person or through use of a 12 telecommunications system.’’. 13 (f) FIRST-DOLLAR COVERAGE ALLOWANCE FOR 14 OUTPATIENT PEDIATRIC SERVICES FOR HIGH DEDUCT- 15 IBLE PLANS.—Section 226(c)(2) of the Internal Revenue 16 Code of 1986 is amended by adding at the end the fol- 17 lowing new subparagraph: 18 ‘‘(F) SAFE HARBOR FOR ABSENCE OF DE- 19 DUCTIBLE FOR OUTPATIENT PEDIATRIC SERV- 20 ICES.—A plan shall not fail to be treated as a 21 high deductible health plan by reason of failing 22 to have a deductible for outpatient pediatric 23 services (as defined in section 9816(b)).’’. 24 (g) TRICARE PROGRAM.— 25 VerDate Sep 11 2014 00:58 Nov 03, 2020 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H8573.IH H8573 pbinns on DSKJLVW7X2PROD with BILLS 7 •HR 8573 IH (1) IN GENERAL.—Section 1095d of title 10, 1 United States Code, is amended— 2 (A) in the section heading, by inserting 3 ‘‘prohibition on and’’ before ‘‘waiver’’; 4 (B) by redesignating subsections (a) and 5 (b) as subsections (b) and (c), respectively; 6 (C) by inserting before subsection (b), as 7 so redesignated, the following new subsection 8 (a): 9 ‘‘(a) PROHIBITION ON APPLICATION OF DEDUCTIBLE 10 TO OUTPATIENT PEDIATRIC SERVICES.—The Secretary of 11 Defense may not impose any deductible under the 12 TRICARE program for medical care provided to a covered 13 beneficiary who is under the age of 18 as an outpatient, 14 regardless of whether such care is furnished in-person or 15 through use of a telecommunications system.’’; and 16 (D) in subsection (b), as so redesignated, 17 by striking ‘‘The Secretary’’ and inserting ‘‘In 18 addition to the requirement under subsection 19 (a), the Secretary’’. 20 (2) CLERICAL AMENDMENT.—The table of sec- 21 tions at the beginning of chapter 55 of title 10, 22 United States Code, is amended by striking the item 23 relating to section 1095d and inserting the following 24 new item: 25 ‘‘1095d. TRICARE program: prohibition on and waiver of certain deductibles.’’. VerDate Sep 11 2014 23:05 Oct 31, 2020 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6211 E:\BILLS\H8573.IH H8573 pbinns on DSKJLVW7X2PROD with BILLS 8 •HR 8573 IH (3) CONFORMING AMENDMENT.—Section 1 1075(d) of such title is amended by adding at the 2 end the following new paragraph: 3 ‘‘(5) The Secretary may not impose any deductible 4 amounts for outpatient pediatric services pursuant to sec- 5 tion 1095d of this title.’’. 6 (h) GAO STUDY.—Not later than 4 years after the 7 date of the enactment of this Act, the Comptroller General 8 of the United States shall conduct a study and submit to 9 Congress a report on the effects of the amendments made 10 by this Act on premiums, deductibles, and copayment and 11 coinsurance requirements with respect to group health 12 plans and group and individual health insurance coverage 13 (as such terms are defined in section 2791 of the Public 14 Health Service Act (42 U.S.C. 300gg–91)). 15 (i) EFFECTIVE DATE.—The amendment (or amend- 16 ments) made by— 17 (1) subsections (a) through (c) and subsections 18 (f) and (g) shall apply with respect to plan years be- 19 ginning on or after the date that is 2 years after the 20 date of the enactment of this Act; 21 (2) subsection (d) shall apply with respect to 22 medical assistance furnished in calendar quarters be- 23 ginning on or after the date that is 2 years after the 24 date of the enactment of this Act; and 25 VerDate Sep 11 2014 23:05 Oct 31, 2020 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H8573.IH H8573 pbinns on DSKJLVW7X2PROD with BILLS 9 •HR 8573 IH (3) subsection (c) shall apply with respect to 1 child health assistance furnished calendar quarters 2 described in paragraph (2). 3 Æ VerDate Sep 11 2014 23:05 Oct 31, 2020 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6301 E:\BILLS\H8573.IH H8573 pbinns on DSKJLVW7X2PROD with BILLS