I 111th CONGRESS 1st Session H. R. 2292 IN THE HOUSE OF REPRESENTATIVES May 6, 2009 Mr. Thompson of California (for himself and Mr. Blumenauer) introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committees on Education and Labor and Energy and Commerce, for a period to be subsequently 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, the Public Health Service Act, and the Internal Revenue Code of 1986 to require coverage of preventive care for children.

1.

Short title

This Act may be cited as Healthy Kids for Healthy Futures Act of 2009.

2.

Coverage of preventive care for children

(a)

Amendments of ERISA

(1)

In general

Subpart B of part 7 of title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1185 et seq.) is amended by adding at the end the following:

714.

Coverage of preventive care for children

(a)

In general

A group health plan, and a health insurance issuer providing health insurance coverage in connection with a group health plan, shall provide coverage for appropriate preventive care for each qualified dependent child of the participant. (b)

Appropriate preventive care

For purposes of this section, the term appropriate preventive care means medical care which, under regulations prescribed by the Secretary of Health and Human Services, in consultation with the Secretary and the Secretary of the Treasury, meets the most recent Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents. (c)

Qualified dependent child

For purposes of this section, the term qualified dependent child means a child of the participant who— (1)is not more than 18 years of age, and (2)is a dependent child, under the terms of the plan or coverage, of the participant. (d)

Cost-sharing prohibited

A group health plan and health insurance coverage provided in connection with a group health plan may not impose deductibles, copayments, coinsurance, or other cost-sharing in relation to services provided pursuant to the requirements of subsection (a). (e)

Certain coverage restrictions prohibited

A group health plan, and a health insurance issuer providing coverage in connection with a group health plan, may not— (1)deny to a participant or beneficiary eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the plan solely for the purpose of avoiding the requirements of this section, or (2)penalize, or otherwise reduce or limit the reimbursement of, an attending provider, or provide incentives (monetary or otherwise) to an attending provider, so as to induce the provider to provide care to a beneficiary in a manner inconsistent with this section. (f)

Allowance for level or type of provider reimbursement

Nothing in this section shall be construed to prevent a group health plan or a health insurance issuer providing health insurance coverage in connection with a group health plan from negotiating the level and type of reimbursement with a provider for care provided in accordance with this section. (g)

Notice

A group health plan, and a health insurance issuer providing health insurance coverage in connection with a group health plan, shall provide notice to each participant and beneficiary under such plan regarding the coverage required by this section in accordance with regulations which shall be promulgated by the Secretary, in consultation with the Secretary of Health and Human Services and the Secretary of the Treasury. Such notice shall be in writing and prominently positioned in any literature or correspondence made available or distributed to participants and beneficiaries by the plan or issuer on an annual or other more frequent periodic basis. (h)

Relation to State laws

Nothing in this section shall be construed to preempt or otherwise limit any State law with respect to health insurance coverage that requires more extensive coverage than is otherwise required under this section.

. (2)

Conforming amendment

The table of contents in section 1 of such Act is amended by inserting after the item relating to section 713 the following new item: Sec. 714. Coverage of preventive care for children. . (b)

Amendments to the Public Health Service Act

(1)

Group markets

Subpart 2 of part A of title XXVII of the Public Health Service Act (42 U.S.C. 300gg–4 et seq.) is amended by adding at the end the following new section:

2707.

Coverage of preventive care for children

(a)

In general

A group health plan, and a health insurance issuer providing health insurance coverage in connection with a group health plan, shall provide coverage for appropriate preventive care for each qualified dependent child of the participant. (b)

Appropriate preventive care

For purposes of this section, the term appropriate preventive care means medical care which, under regulations prescribed by the Secretary, in consultation with the Secretary of Labor and the Secretary of the Treasury, meets the most recent Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents. (c)

Qualified dependent child

For purposes of this section, the term qualified dependent child means a child of the participant who— (1)is not more than 18 years of age, and (2)is a dependent child, under the terms of the plan or coverage, of the participant. (d)

Cost-sharing prohibited

A group health plan and health insurance coverage provided in connection with a group health plan may not impose deductibles, copayments, coinsurance, or other cost-sharing in relation to services provided pursuant to the requirements of subsection (a). (e)

Certain coverage restrictions prohibited

A group health plan, and a health insurance issuer providing coverage in connection with a group health plan, may not— (1)deny to a participant or beneficiary eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the plan solely for the purpose of avoiding the requirements of this section, or (2)penalize, or otherwise reduce or limit the reimbursement of, an attending provider, or provide incentives (monetary or otherwise) to an attending provider, so as to induce the provider to provide care to a beneficiary in a manner inconsistent with this section. (f)

Allowance for level or type of provider reimbursement

Nothing in this section shall be construed to prevent a group health plan or a health insurance issuer providing health insurance coverage in connection with a group health plan from negotiating the level and type of reimbursement with a provider for care provided in accordance with this section. (g)

Notice

A group health plan, and a health insurance issuer providing health insurance coverage in connection with a group health plan, shall provide notice to each participant and beneficiary under such plan regarding the coverage required by this section in accordance with regulations which shall be promulgated by the Secretary of Labor, in consultation with the Secretary and the Secretary of the Treasury. Such notice shall be in writing and prominently positioned in any literature or correspondence made available or distributed to participants and beneficiaries by the plan or issuer on an annual or other more frequent periodic basis. (h)

Relation to State laws

Nothing in this section shall be construed to preempt or otherwise limit any State law with respect to health insurance coverage that requires more extensive coverage than is otherwise required under this section.

. (2)

Individual market

Subpart 3 of part B of title XXVII of such Act (42 U.S.C. 300gg–51 et seq.) is amended by adding at the end the following new section:

2753.

Coverage of preventive care for children

The provisions of section 2707 shall apply to health insurance coverage offered by a health insurance issuer in the individual market in the same manner as they apply to health insurance coverage offered by a health insurance issuer in connection with a group health plan in the small or large group market.

. (c)

Amendments to the Internal Revenue Code

(1)

In general

Subchapter B of chapter 100 of the Internal Revenue Code of 1986 (relating to other group health plan requirements) is amended by inserting after section 9812 the following new section:

9813.

Coverage of preventive care for children

(a)

In general

A group health plan shall provide coverage for appropriate preventive care for each qualified dependent child of the participant. (b)

Appropriate preventive care

For purposes of this section, the term appropriate preventive care means medical care which, under regulations prescribed by the Secretary of Health and Human Services in consultation with the Secretary and the Secretary of Labor, meets the most recent Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents. (c)

Qualified dependent child

For purposes of this section, the term qualified dependent child means a child of the participant who— (1)is not more than 18 years of age, and (2)is a dependent child, under the terms of the plan or coverage, of the participant. (d)

Cost-sharing prohibited

A group health plan may not impose deductibles, copayments, coinsurance, or other cost-sharing in relation to services provided pursuant to the requirements of subsection (a). (e)

Certain coverage restrictions prohibited

A group health plan may not— (1)deny to a participant or beneficiary eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the plan solely for the purpose of avoiding the requirements of this section, or (2)penalize, or otherwise reduce or limit the reimbursement of, an attending provider, or provide incentives (monetary or otherwise) to an attending provider, so as to induce the provider to provide care to a beneficiary in a manner inconsistent with this section. (f)

Allowance for level or type of provider reimbursement

Nothing in this section shall be construed to prevent a group health plan or a health insurance issuer providing health insurance coverage in connection with a group health plan from negotiating the level and type of reimbursement with a provider for care provided in accordance with this section. (g)

Notice

A group health plan shall provide notice to each participant and beneficiary under such plan regarding the coverage required by this section in accordance with regulations which shall be promulgated by the Secretary of Labor, in consultation with the Secretary and the Secretary of Health and Human Services. Such notice shall be in writing and prominently positioned in any literature or correspondence made available or distributed to participants and beneficiaries by the plan or issuer on an annual or other more frequent periodic basis. (h)

Relation to State laws

Nothing in this section shall be construed to preempt or otherwise limit any State law with respect to health insurance coverage that requires more extensive coverage than is otherwise required under this section.

. (2)

Conforming amendment

The table of sections for subchapter B of chapter 100 of such Code is amended by inserting after the item relating to section 9812 the following new item: Sec. 9813. Coverage of preventive care for children. . (d)

Effective date

The amendments made by this Act shall apply with respect to plan years beginning on or after January 1, 2010. (e)

Initial notice

Each group health plan and health insurance issuer to which the notice requirements of section 714(g) of the Employee Retirement Income Security Act of 1974, section 2707(g) of the Public Health Service Act, or section 9813(g) of the Internal Revenue Code of 1986 apply shall be deemed not in compliance with such requirements with respect to the first plan year beginning on or after January 1, 2010, unless, not later than January 1, 2010, the plan or issuer includes the information described in such section in a notice which is provided to each participant and beneficiary in writing.

3.

Coverage of preventative care for children under health savings accounts

(a)

In general

Paragraph (2) of section 223(c) of the Internal Revenue Code of 1986 (defining high deductible health plan) is amended by adding at the end the following new subparagraph: (E)

Special rule for preventative care for children

(i)

In general

A plan shall not be treated as a high deductible health plan unless such plan meets the requirements of section 9813 (relating to coverage of preventative care for children). (ii)

Plan treated as group health plan

For purposes of clause (i), the plan shall be treated as a group health plan. . (b)

Effective date

The amendment made by this section shall apply to taxable years beginning after December 31, 2009.