I 111th CONGRESS 2d Session H. R. 4794 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.
1.
Short title
This Act may be cited as the Safeguarding Access to Preventative Services Act of 2010.
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:
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:
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:
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:
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.
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:
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:
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:
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:
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.