[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8792 Introduced in House (IH)]
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117th CONGRESS
2d Session
H. R. 8792
To prohibit group health plans, health insurance issuers offering group
or individual health insurance coverage, State plans under title XIX of
the Social Security Act, State child health plans under title XXI of
such Act, and the TRICARE program from applying a deductible to
outpatient pediatric services.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
September 9, 2022
Ms. Schrier (for herself and Ms. Underwood) introduced the following
bill; which was referred to the Committee on Energy and Commerce, and
in addition to the Committees on Education and Labor, Ways and Means,
and Armed Services, 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 group health plans, health insurance issuers offering group
or individual health insurance coverage, State plans under title XIX of
the Social Security Act, State child health plans under title XXI of
such Act, and the TRICARE program from applying a deductible to
outpatient pediatric services.
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 ``Helping Families Access Pediatric
Care Act of 2022''.
SEC. 2. PROHIBITING CERTAIN HEALTH PLANS FROM APPLYING A DEDUCTIBLE TO
OUTPATIENT PEDIATRIC SERVICES.
(a) 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 new
section:
``SEC. 716. PROHIBITION ON APPLICATION OF DEDUCTIBLE TO OUTPATIENT
PEDIATRIC SERVICES.
``(a) In General.--A group health plan and a health insurance
issuer offering group health insurance coverage may not impose any
deductible under such plan or coverage (as applicable) with respect to
outpatient pediatric services (as defined in subsection (b)) for which
benefits are provided under such plan or coverage.
``(b) Outpatient Pediatric Services Defined.--For purposes of
subsection (a), the term `outpatient pediatric services' means any item
or service furnished to an individual under the age of 18 as an
outpatient by a health care provider acting within the scope of such
provider's license, regardless of whether such service is furnished in-
person or through use of a telecommunications system.''.
(2) Clerical amendment.--The table of contents of the
Employee Retirement Income Security Act of 1974 is amended by
inserting after the item relating to section 714 the following:
``Sec. 715. Additional market reforms.
``Sec. 716. Prohibition on application of deductible to outpatient
pediatric services.''.
(b) PHSA.--Subpart II of part A of title XXVII of the Public Health
Service Act (42 U.S.C. 300gg-11 et seq.) is amended by adding at the
end the following new section:
``SEC. 2730. PROHIBITION ON APPLICATION OF DEDUCTIBLE TO OUTPATIENT
PEDIATRIC SERVICES.
``(a) In General.--A group health plan and a health insurance
issuer offering group or individual health insurance coverage may not
impose any deductible under such plan or coverage (as applicable) with
respect to outpatient pediatric services (as defined in subsection (b))
for which benefits are provided under such plan or coverage.
``(b) Outpatient Pediatric Services Defined.--For purposes of
subsection (a), the term `outpatient pediatric services' means any item
or service furnished to an individual under the age of 18 as an
outpatient by a health care provider acting within the scope of such
provider's license, regardless of whether such service is furnished in-
person or through use of a telecommunications system.''.
(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. 9816. PROHIBITION ON APPLICATION OF DEDUCTIBLE TO OUTPATIENT
PEDIATRIC SERVICES.
``(a) In General.--A group health plan may not impose any
deductible under such plan with respect to outpatient pediatric
services (as defined in subsection (b)) for which benefits are provided
under such plan.
``(b) Outpatient Pediatric Services Defined.--For purposes of
subsection (a), the term `outpatient pediatric services' means any item
or service furnished to an individual under the age of 18 as an
outpatient by a health care provider acting within the scope of such
provider's license, regardless of whether such service is furnished in-
person or through use of a telecommunications system.''.
(2) Clerical amendment.--The table of sections for
subchapter B of chapter 100 of the Internal Revenue Code of
1986 is amended by adding at the end the following new items:
``Sec. 9815. Additional market reforms.
``Sec. 9816. Prohibition on application of deductible to outpatient
pediatric services.''.
(d) Medicaid.--Section 1916A of the Social Security Act (42 U.S.C.
1396o-1) is amended--
(1) in subsection (a)--
(A) in paragraph (1), by striking ``paragraph (2)''
and inserting ``paragraphs (2) and (4)''; and
(B) by adding at the end the following new
paragraph:
``(4) Prohibition on application of deduction to outpatient
pediatric services.--A State may not impose a deduction under
the plan with respect to outpatient pediatric services (as
defined in subsection (f)).''; and
(2) by adding at the end the following new subsection:
``(f) Outpatient Pediatric Services Defined.--For purposes of this
section, the term `outpatient pediatric services' means any item or
service furnished to an individual under the age of 18 as an outpatient
by a health care provider acting within the scope of such provider's
license, regardless of whether such service is furnished in-person or
through use of a telecommunications system.''.
(e) CHIP.--Section 2103(e) of the Social Security Act (42 U.S.C.
1397cc) is amended by adding at the end the following new paragraph:
``(5) Prohibition on application of deduction to outpatient
pediatric services.--
``(A) In general.--The State child health plan may
not impose a deductible with respect to outpatient
pediatric services (as defined in subparagraph (B)).
``(B) Outpatient pediatric services defined.--For
purposes of this paragraph, the term `outpatient
pediatric services' means any item or service furnished
to an individual under the age of 18 as an outpatient
by a health care provider acting within the scope of
such provider's license, regardless of whether such
service is furnished in-person or through use of a
telecommunications system.''.
(f) First-Dollar Coverage Allowance for Outpatient Pediatric
Services for High Deductible Plans.--Section 223(c)(2) of the Internal
Revenue Code of 1986 is amended by adding at the end the following new
subparagraph:
``(G) Safe harbor for absence of deductible for
outpatient pediatric services.--A plan shall not fail
to be treated as a high deductible health plan by
reason of failing to have a deductible for outpatient
pediatric services (as defined in section 9816(b)).''.
(g) TRICARE Program.--
(1) In general.--Section 1095d of title 10, United States
Code, is amended--
(A) in the section heading, by inserting
``prohibition on and'' before ``waiver'';
(B) by redesignating subsections (a) and (b) as
subsections (b) and (c), respectively;
(C) by inserting before subsection (b), as so
redesignated, the following new subsection (a):
``(a) Prohibition on Application of Deductible to Outpatient
Pediatric Services.--The Secretary of Defense may not impose any
deductible under the TRICARE program for medical care provided to a
covered beneficiary who is under the age of 18 as an outpatient,
regardless of whether such care is furnished in-person or through use
of a telecommunications system.''; and
(D) in subsection (b), as so redesignated, by
striking ``The Secretary'' and inserting ``In addition
to the requirement under subsection (a), the
Secretary''.
(2) Clerical amendment.--The table of sections at the
beginning of chapter 55 of title 10, United States Code, is
amended by striking the item relating to section 1095d and
inserting the following new item:
``1095d. TRICARE program: prohibition on and waiver of certain
deductibles.''.
(3) Conforming amendment.--Section 1075(d) of such title is
amended by adding at the end the following new paragraph:
``(5) The Secretary may not impose any deductible amounts for
outpatient pediatric services pursuant to section 1095d of this
title.''.
(h) GAO Study.--Not later than 4 years after the date of the
enactment of this Act, the Comptroller General of the United States
shall conduct a study and submit to Congress a report on the effects of
the amendments made by this Act on premiums, deductibles, and copayment
and coinsurance requirements with respect to group health plans and
group and individual health insurance coverage (as such terms are
defined in section 2791 of the Public Health Service Act (42 U.S.C.
300gg-91)).
(i) Effective Date.--The amendment (or amendments) made by--
(1) subsections (a) through (c) and subsections (f) and (g)
shall apply with respect to plan years beginning on or after
the date that is 2 years after the date of the enactment of
this Act;
(2) subsection (d) shall apply with respect to medical
assistance furnished in calendar quarters beginning on or after
the date that is 2 years after the date of the enactment of
this Act; and
(3) subsection (c) shall apply with respect to child health
assistance furnished calendar quarters described in paragraph
(2).
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