[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 477 Introduced in House (IH)]
<DOC>
117th CONGRESS
1st Session
H. R. 477
To amend the Public Health Service Act, the Employee Retirement Income
Security Act of 1974, the Internal Revenue Code of 1986, and the
Patient Protection and Affordable Care Act to require coverage of
hearing devices and systems in certain private health insurance plans,
and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
January 25, 2021
Mr. Neguse (for himself, Mr. McKinley, and Mr. Thompson of California)
introduced the following bill; which was referred to the Committee on
Energy and Commerce, and in addition to the Committees on Education and
Labor, and Ways and Means, 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 Public Health Service Act, the Employee Retirement Income
Security Act of 1974, the Internal Revenue Code of 1986, and the
Patient Protection and Affordable Care Act to require coverage of
hearing devices and systems in certain private health insurance plans,
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 ``Ally's Act''.
SEC. 2. COVERAGE OF HEARING DEVICES AND SYSTEMS IN CERTAIN PRIVATE
HEALTH INSURANCE PLANS.
(a) PHSA.--Part A of the Public Health Service Act (42 U.S.C. 300gg
et seq.) is amended by inserting after section 2713 the following new
section:
``SEC. 2713A. COVERAGE OF HEARING DEVICES AND SYSTEMS.
``(a) In General.--Beginning with plan years beginning on or after
January 1, 2022, a group health plan and a health insurance issuer
offering group or individual health insurance coverage shall, at a
minimum provide coverage for and may impose cost-sharing requirements
in accordance with subsection (b) for an individual that a physician
(as defined in section 1861(r) of the Social Security Act) or qualified
audiologist (as defined in section 1861(ll)(4)(B) of such Act)
determines meets an indication (including unilateral or bilateral
hearing loss) for an auditory device as approved by the Food and Drug
Administration for--
``(1) auditory implant devices (including auditory
osseointegrated (bone conduction) implants and cochlear
implants) and external sound processors;
``(2) the maintenance of auditory implant devices and
external sound processors described in paragraph (1);
``(3) every 5 years, the upgrade (or replacement if an
upgrade is not available) of auditory implant devices and
external sound processors described in paragraph (1);
``(4) adhesive adapters and softband headbands;
``(5) the repair of auditory implant devices and external
sound processors described in paragraph (1);
``(6) a comprehensive hearing assessment;
``(7) a preoperative medical assessment;
``(8) surgery (as appropriate);
``(9) postoperative medical appointments for purposes of
ensuring appropriate recovery from surgery;
``(10) postoperative audiological appointments for
activation and fitting of the implant device and external sound
processor; and
``(11) aural rehabilitation and treatment services (as
appropriate).
``(b) Cost-Sharing.--Beginning with plan years beginning on or
after January 1, 2022, the cost-sharing incurred under a plan or
coverage described in subsection (a)--
``(1) for an auditory implant device and external sound
processors under this section, shall not exceed a dollar amount
that is the highest cost-sharing requirement for the amount of
the charges imposed for such device that is provided by a
physician or qualified audiologist that has a contractual
relationship with such plan or coverage for the providing of
such device;
``(2) for an item or service under this section, shall not
exceed a dollar amount that is imposed for similar items and
services under that plan that are provided by a physician or
qualified audiologist; and
``(3) that has a contractual relationship with such plan or
coverage for the providing of such items and services.''.
(b) ERISA.--
(1) In general.--Subpart B of part 7 of subtitle B of title
I of the Employee Retirement Income Security Act of 1974 (29
U.S.C. 1185 et seq.) by adding at the end the following new
section:
``SEC. 726. COVERAGE OF HEARING DEVICES AND SYSTEMS.
``(a) In General.--Beginning with plan years beginning on or after
January 1, 2022, a group health plan and a health insurance issuer
offering group or health insurance coverage shall, at a minimum provide
coverage for and may impose cost-sharing requirements in accordance
with subsection (b) for an individual that a physician (as defined in
section 1861(r) of the Social Security Act) or qualified audiologist
(as defined in section 1861(ll)(4)(B) of such Act) determines meets an
indication (including unilateral or bilateral hearing loss) for an
auditory device as approved by the Food and Drug Administration for--
``(1) auditory implant devices (including auditory
osseointegrated (bone conduction) implants and cochlear
implants) and external sound processors;
``(2) the maintenance of auditory implant devices and
external sound processors described in paragraph (1);
``(3) every 5 years, the upgrade (or replacement if an
upgrade is not available) of auditory implant devices and
external sound processors described in paragraph (1);
``(4) adhesive adapters and softband headbands;
``(5) the repair of auditory implant devices and external
sound processors described in paragraph (1);
``(6) a comprehensive hearing assessment;
``(7) a preoperative medical assessment;
``(8) surgery (as appropriate);
``(9) postoperative medical appointments for purposes of
ensuring appropriate recovery from surgery;
``(10) postoperative audiological appointments for
activation and fitting of the implant device and external sound
processor; and
``(11) aural rehabilitation and treatment services (as
appropriate).
``(b) Cost-Sharing.--Beginning with plan years beginning on or
after January 1, 2022, the cost-sharing incurred under a plan or
coverage described in subsection (a)--
``(1) for an auditory implant device and external sound
processors under this section, shall not exceed a dollar amount
that is the highest cost-sharing requirement for the amount of
the charges imposed for such device that is provided by a
physician or qualified audiologist that has a contractual
relationship with such plan or coverage for the providing of
such device;
``(2) for an item or service under this section, shall not
exceed a dollar amount that is imposed for similar items and
services under that plan that are provided by a physician or
qualified audiologist; and
``(3) that has a contractual relationship with such plan or
coverage for the providing of such items and services.''.
(2) Clerical amendment.--The table of contents in section 1
of the Employee Retirement Income Security Act of 1974 (29
U.S.C. 1001 et seq.) is amended by inserting after the item
relating to section 725 the following new item:
``Sec. 726. Coverage of hearing devices and systems.''.
(c) IRC.--
(1) In general.--Subchapter B of chapter 100 of the
Internal Revenue Code of 1986, is amended by adding at the end
the following new section:
``SEC. 9286. COVERAGE OF HEARING DEVICES AND SYSTEMS.
``(a) In General.--Beginning with plan years beginning on or after
January 1, 2022, a group health plan shall, at a minimum provide
coverage for and may impose cost-sharing requirements in accordance
with subsection (b) for an individual that a physician (as defined in
section 1861(r) of the Social Security Act) or qualified audiologist
(as defined in section 1861(ll)(4)(B) of such Act) determines meets an
indication (including unilateral or bilateral hearing loss) for an
auditory device as approved by the Food and Drug Administration for--
``(1) auditory implant devices (including auditory
osseointegrated (bone conduction) implants and cochlear
implants) and external sound processors;
``(2) the maintenance of auditory implant devices and
external sound processors described in paragraph (1);
``(3) every 5 years, the upgrade (or replacement if an
upgrade is not available) of auditory implant devices and
external sound processors described in paragraph (1);
``(4) adhesive adapters and softband headbands;
``(5) the repair of auditory implant devices and external
sound processors described in paragraph (1);
``(6) a comprehensive hearing assessment;
``(7) a preoperative medical assessment;
``(8) surgery (as appropriate);
``(9) postoperative medical appointments for purposes of
ensuring appropriate recovery from surgery;
``(10) postoperative audiological appointments for
activation and fitting of the implant device and external sound
processor; and
``(11) aural rehabilitation and treatment services (as
appropriate).
``(b) Cost-Sharing.--Beginning with plan years beginning on or
after January 1, 2022, the cost-sharing incurred under a plan described
in subsection (a)--
``(1) for an auditory implant device and external sound
processors under this section, shall not exceed a dollar amount
that is the highest cost-sharing requirement for the amount of
the charges imposed for such device that is provided by a
physician or qualified audiologist that has a contractual
relationship with such plan for the providing of such device;
``(2) for an item or service under this section, shall not
exceed a dollar amount that is imposed for similar items and
services under that plan that are provided by a physician or
qualified audiologist; and
``(3) that has a contractual relationship with such plan
for the providing of such items and services.''.
(2) Clerical amendment.--The table of sections for
subchapter B of chapter 100 of the Internal Revenue Code of
1986 is amended by inserting after the item relating to section
9825 the following new item:
``Sec. 9286. Coverage of hearing devices and systems.''.
(d) Application to Grandfathered Health Plans.--Section
1251(a)(4)(A) of the Patient Protection and Affordable Care Act (42
U.S.C. 18011(a)(4)(A)) is amended--
(1) by striking ``title'' and inserting ``title, or as
added after the date of the enactment of this Act)''; and
(2) by adding at the end the following new clause:
``(v) Section 2713A (relating to hearing
devices and systems).''.
(3) Effective date.--The amendments made by this subsection
shall apply with respect to plan years beginning on or after
January 1, 2022.
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