HELP Copays Act

II 118TH CONGRESS 1ST SESSION S. 1375 To amend title XXVII of the Public Health Service Act to apply additional payments, discounts, and other financial assistance towards the cost- sharing requirements of health insurance plans, and for other purposes. IN THE SENATE OF THE UNITED STATES APRIL 27, 2023 Mr. MARSHALL (for himself, Mr. KAINE, Ms. ERNST, Mr. MARKEY, and Ms. MURKOWSKI) introduced the following bill; which was read twice and re- ferred to the Committee on Health, Education, Labor, and Pensions A BILL To amend title XXVII of the Public Health Service Act to apply additional payments, discounts, and other finan- cial assistance towards the cost-sharing requirements of 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 the ‘‘Help Ensure Lower 4 Patient Copays Act’’ or the ‘‘HELP Copays Act’’. 5 VerDate Sep 11 2014 23:58 May 04, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1375.IS S1375 kjohnson on DSK79L0C42PROD with BILLS 2 •S 1375 IS SEC. 2. APPLICATION OF ADDITIONAL PAYMENTS, DIS- 1 COUNTS, AND OTHER FINANCIAL ASSIST- 2 ANCE TOWARD COST-SHARING REQUIRE- 3 MENTS. 4 (a) APPLICATION TOWARD COST-SHARING REQUIRE- 5 MENTS.—Section 2715(g)(1) of the Public Health Service 6 Act (42 U.S.C. 300gg–15(g)(1)) is amended by adding at 7 the end the following: ‘‘In developing the standards for 8 defining the terms ‘deductible’, ‘co-insurance’, ‘co-pay- 9 ment’, and ‘out-of-pocket limit’ (as described in paragraph 10 (2)), such standards shall provide that such terms include 11 amounts paid by, or on behalf of, an individual enrolled 12 in a group health plan or group or individual health insur- 13 ance coverage, including third-party payments, financial 14 assistance, discounts, product vouchers, and other reduc- 15 tions in out-of-pocket expenses and that such amounts 16 shall be counted toward such deductible, co-insurance, co- 17 payment, or limit, respectively.’’. 18 (b) CONFORMING AMENDMENTS.— 19 (1) PPACA.—Section 1302(c)(3) of the Patient 20 Protection and Affordable Care Act (42 U.S.C. 21 18022(c)(3)) is amended by adding at the end the 22 following new subparagraph: 23 ‘‘(C) APPLICATION OF TERMS.—For pur- 24 poses of subparagraph (A), the terms ‘deduct- 25 ible’, ‘coinsurance’, ‘copayment’, or ‘similar 26 VerDate Sep 11 2014 23:58 May 04, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1375.IS S1375 kjohnson on DSK79L0C42PROD with BILLS 3 •S 1375 IS charge’ and any other expenditure described in 1 clause (ii) of such subparagraph shall include 2 amounts paid by, or on behalf of, an individual 3 enrolled in a group health plan or group or in- 4 dividual health insurance coverage, including 5 third-party payments, financial assistance, dis- 6 counts, product vouchers, and other reductions 7 in out-of-pocket expenses and such amounts 8 shall be counted toward such deductible, coin- 9 surance, copayment, charge, or other expendi- 10 ture, respectively.’’. 11 (2) PHSA.—Section 2707(b) of the Public 12 Health Service Act (42 U.S.C. 300gg–6(b)) is 13 amended by adding at the end the following new 14 sentence: ‘‘For purposes of the previous sentence, 15 such limitation shall be applied as if the reference to 16 ‘essential health benefits’ in section 1302(c)(3) of 17 the Patient Protection and Affordable Care Act were 18 a reference to ‘any item or service covered under the 19 plan included within a category of essential health 20 benefits as described in (b)(1) of such section’.’’. 21 Æ VerDate Sep 11 2014 23:58 May 04, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6301 E:\BILLS\S1375.IS S1375 kjohnson on DSK79L0C42PROD with BILLS