[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4794 Introduced in House (IH)]

111th CONGRESS
  2d Session
                                H. R. 4794

 To prohibit the use of any recommendation of the Preventive Services 
 Task Force (or any successor task force) to deny or restrict coverage 
  of an item or service under a Federal health care program, a group 
   health plan, or a health insurance issuer, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 9, 2010

 Mr. Lance (for himself, Mrs. Emerson, Mr. Paulsen, and Mrs. McMorris 
   Rodgers) introduced the following bill; which was referred to the 
Committee on Energy and Commerce, and in addition to the Committees on 
Ways and Means and Education and Labor, 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 prohibit the use of any recommendation of the Preventive Services 
 Task Force (or any successor task force) to deny or restrict coverage 
  of an item or service under a Federal health care program, a group 
   health plan, or a health insurance issuer, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Safeguarding Access to Preventative 
Services Act of 2010''.

SEC. 2. NO DENIAL OR RESTRICTION OF COVERAGE BASED ON TASK FORCE 
              RECOMMENDATIONS.

    (a) Federal Health Care Program.--
            (1) In general.--Notwithstanding any other provision of 
        law, the Secretary of Health and Human Services shall not, 
        directly or as a condition on the receipt of Federal funds, use 
        any recommendation of the Preventive Services Task Force 
        convened under section 915(a) of the Public Health Service Act 
        (42 U.S.C. 299b-4) (or any successor task force) to deny or 
        restrict coverage of an item or service under a Federal health 
        care program (including the Medicare program under title XVIII 
        of the Social Security Act (42 U.S.C. 1395 et seq.), the 
        Medicaid program under title XIX of the Social Security Act (42 
        U.S.C. 1396-1 et seq.), and the National Breast and Cervical 
        Cancer Early Detection Program under title XV of the Public 
        Health Service Act (42 U.S.C. 300k et seq.).
            (2) Definitions.--In this subsection:
                    (A) The terms ``group health plan'', ``health 
                insurance coverage'', and ``health insurance issuer'' 
                have the meanings given to those terms in section 2791 
                of the Public Health Service Act (42 U.S.C. 300gg-91).
                    (B) The term ``Federal health care program'' has 
                the meaning given to such term in section 1128B(f) of 
                the Social Security Act (42 U.S.C. 1320a-7b(f)).
    (b) Group Health Plans and Health Insurance.--
            (1) Amendments to public health service act.--
                    (A) Group market.--Subpart 2 of part A of title 
                XXVII of the Public Health Service Act (42 U.S.C. 300gg 
                et seq.) is amended by adding at the end the following:

``SEC. 2708. NO DENIAL OR RESTRICTION OF COVERAGE BASED ON TASK FORCE 
              RECOMMENDATIONS.

    ``A group health plan, and a health insurance issuer offering group 
health insurance coverage, shall not use any recommendation of the 
Preventive Services Task Force convened under section 915(a) (or any 
successor task force) to deny or restrict coverage of an item or 
service.''.
                    (B) Individual market.--Subpart 1 of part B of 
                title XXVII of the Public Health Service Act (42 U.S.C. 
                300gg-41 et seq.) is amended by adding at the end the 
                following:

``SEC. 2746. NO DENIAL OR RESTRICTION OF COVERAGE BASED ON TASK FORCE 
              RECOMMENDATIONS.

    ``The provisions of section 2708 shall apply to health insurance 
coverage offered by a health insurance issuer in the individual market 
in the same manner as such provisions 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.''.
            (2) Amendments to erisa.--
                    (A) 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:

``SEC. 715. NO DENIAL OR RESTRICTION OF COVERAGE BASED ON TASK FORCE 
              RECOMMENDATIONS.

    ``A group health plan, and a health insurance issuer offering group 
health insurance coverage, shall not use any recommendation of the 
Preventive Services Task Force convened under section 915(a) (or any 
successor task force) to deny or restrict coverage of an item or 
service.''.
                    (B) Clerical amendment.--The table of contents in 
                section 1 of such Act is amended by inserting after the 
                item relating to section 714 the following new item:

``Sec. 715. No denial or restriction of coverage based on Task Force 
                            recommendations.''.
            (3) Amendments to internal revenue code.--
                    (A) In general.--Subchapter B of chapter 100 of the 
                Internal Revenue Code of 1986 (relating to group health 
                plan requirements) is amended by adding at the end the 
                following:

``SEC. 9814. NO DENIAL OR RESTRICTION OF COVERAGE BASED ON TASK FORCE 
              RECOMMENDATIONS.

    ``A group health plan shall not use any recommendation of the 
Preventive Services Task Force convened under section 915(a) (or any 
successor task force) to deny or restrict coverage of an item or 
service.''.
                    (B) Clerical amendment.--The table of sections for 
                subchapter B of chapter 100 of such Code is amended by 
                inserting after the item relating to section 9813 the 
                following new item:

``Sec. 9814. No denial or restriction of coverage based on Task Force 
                            recommendations.''.
            (4) Effective date.--The amendments made by paragraphs 
        (1)(A), (2), and (3) of this subsection shall apply with 
        respect to plan years beginning on or after the date of the 
        enactment of this Act. The amendment made by paragraph (1)(B) 
        of this subsection applies with respect to health insurance 
        coverage offered, sold, issued, renewed, in effect, or operated 
        in the individual market on or after such date.

SEC. 3. DETERMINATIONS OF COVERAGE OF PREVENTIVE ITEMS AND SERVICES.

    (a) Amendments to Public Health Service Act.--
            (1) Group market.--Subpart 2 of part A of title XXVII of 
        the Public Health Service Act (42 U.S.C. 300gg et seq.), as 
        amended by section 2 of this Act, is amended by adding at the 
        end the following:

``SEC. 2709. DETERMINATIONS OF COVERAGE OF PREVENTIVE ITEMS AND 
              SERVICES.

    ``The plan sponsor of a group health plan and a health insurance 
issuer offering group health insurance coverage shall, in determining 
which preventive items and services to provide coverage for under the 
plan or coverage, consult the medical guidelines and recommendations of 
relevant professional medical organizations of relevant medical 
practice areas (such as the American Society of Clinical Oncology, the 
American College of Surgeons, the American College of Radiology, the 
Society of Breast Imaging, the American College of Radiation Oncology, 
the American College of Obstetricians and Gynecologists, and other 
similar organizations), including guidelines and recommendations 
relating to the coverage of women's preventive services (such as 
mammograms and cervical cancer screenings). The plan administrator 
shall disclose such guidelines and recommendations to enrollees as part 
of a summary of benefits and coverage provided to enrollees.''.
            (2) Individual market.--Subpart 1 of part B of title XXVII 
        of the Public Health Service Act (42 U.S.C. 300gg-41 et seq.) 
        is amended by adding at the end the following:

``SEC. 2747. DETERMINATIONS OF COVERAGE OF PREVENTIVE ITEMS AND 
              SERVICES.

    ``The provisions of section 2708 shall apply to health insurance 
coverage offered by a health insurance issuer in the individual market 
in the same manner as such provisions 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.''.
    (b) Amendments to ERISA.--
            (1) In general.--Subpart B of part 7 of title I of the 
        Employee Retirement Income Security Act of 1974 (as amended by 
        section 2) is amended by adding at the end the following:

``SEC. 716. DETERMINATIONS OF COVERAGE OF PREVENTIVE ITEMS AND 
              SERVICES.

    ``The plan sponsor of a group health plan and a health insurance 
issuer offering group health insurance coverage shall, in determining 
which preventive items and services to provide coverage for under the 
plan or coverage, consult the medical guidelines and recommendations of 
relevant professional medical organizations of relevant medical 
practice areas (such as the American Society of Clinical Oncology, the 
American College of Surgeons, the American College of Radiology, the 
Society of Breast Imaging, the American College of Radiation Oncology, 
the American College of Obstetricians and Gynecologists, and other 
similar organizations), including guidelines and recommendations 
relating to the coverage of women's preventive services (such as 
mammograms and cervical cancer screenings). The plan administrator of 
the group health plan shall disclose such guidelines and 
recommendations to participants and beneficiaries as part of the 
summary plan description required to be provided under section 102, and 
any failure to so disclose such guidelines and recommendations shall be 
treated as a violation of section 102.''.
            (2) Clerical amendment.--The table of contents in section 1 
        of such Act (as amended by section 2) is amended by inserting 
        after the item relating to section 715 the following new item:

``Sec. 716. Determinations of coverage of preventive items and 
                            services.''.
    (c) Amendments to Internal Revenue Code.--
            (1) In general.--Subchapter B of chapter 100 of the 
        Internal Revenue Code of 1986 (as amended by section 2) is 
        amended by adding at the end the following:

``SEC. 9814. DETERMINATIONS OF COVERAGE OF PREVENTIVE ITEMS AND 
              SERVICES.

    ``The plan sponsor of a group health plan shall, in determining 
which preventive items and services to provide coverage for under the 
plan, consult the medical guidelines and recommendations of relevant 
professional medical organizations of relevant medical practice areas 
(such as the American Society of Clinical Oncology, the American 
College of Surgeons, the American College of Radiology, the Society of 
Breast Imaging, the American College of Radiation Oncology, the 
American College of Obstetricians and Gynecologists, and other similar 
organizations), including guidelines and recommendations relating to 
the coverage of women's preventive services (such as mammograms and 
cervical cancer screenings). The plan administrator shall disclose such 
guidelines and recommendations to participants and beneficiaries as 
part of a summary of benefits and coverage provided to participants and 
beneficiaries.''.
            (2) Clerical amendment.--The table of sections for 
        subchapter B of chapter 100 of such Code is amended by 
        inserting after the item relating to section 9813 the following 
        new item:

``Sec. 9814. Determinations of coverage of preventive items and 
                            services.''.
    (d) Effective Date.--The amendments made by subsections (a)(1), 
(b), and (c) of this section shall apply with respect to plan years 
beginning on or after the date of the enactment of this Act. The 
amendment made by subsection (a)(2) of this section applies with 
respect to health insurance coverage offered, sold, issued, renewed, in 
effect, or operated in the individual market on or after such date.
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