[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8891 Introduced in House (IH)]
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117th CONGRESS
2d Session
H. R. 8891
To amend the Public Health Service Act, the Employee Retirement Income
Security Act of 1974, and the Internal Revenue Code of 1986 to require
group health plans and health insurance issuers offering group or
individual health insurance coverage to provide coverage for forensic
medical exams with no cost sharing, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
September 19, 2022
Ms. Sanchez (for herself, Ms. Moore of Wisconsin, and Mrs. Miller of
West Virginia) 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, and the Internal Revenue Code of 1986 to require
group health plans and health insurance issuers offering group or
individual health insurance coverage to provide coverage for forensic
medical exams with no cost sharing, 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 ``No Surprises for Survivors Act of
2022''.
SEC. 2. REQUIRING COVERAGE OF FORENSIC MEDICAL EXAMS WITH NO COST
SHARING.
(a) PHSA.--Part D of title XXVII of the Public Health Service Act
(42 U.S.C. 300gg-111 et seq.) is amended--
(1) in section 2799A-1(a)(3)(C)(ii), by inserting
``forensic medical exams (as defined in section 2799A-11(d))
furnished on or after January 1, 2025 and'' after ``shall
include''; and
(2) by adding at the end the following new section:
``SEC. 2799A-11. REQUIRED COVERAGE OF FORENSIC MEDICAL EXAMS WITH NO
COST SHARING.
``(a) In General.--Except as provided in subsection (b), a group
health plan and a health insurance issuer offering group or individual
health insurance coverage shall provide coverage for and shall not
impose any cost sharing requirements for a forensic medical exam (as
defined in subsection (d)) furnished by a sexual assault forensic
examiner (as defined for purposes of section 304 of the DNA Sexual
Assault Justice Act of 2004), a sexual assault nurse examiner (as so
defined), or any other provider specified by the Secretary, regardless
of whether such forensic examiner, nurse examiner, or other provider
has in effect a contractual relationship with such plan or coverage for
the furnishing of such exam or item or service.
``(b) Nonapplication to Certain Forensic Medical Exams Otherwise
Covered.--
``(1) In general.--The provisions of subsection (a) shall
not apply with respect to a forensic medical exam furnished in
a State for which such State is responsible for incurring the
full out-of-pocket costs under section 2010 of the Omnibus
Crime Control and Safe Streets Act of 1968.
``(2) Notification.--In the case that a group health plan
or health insurance issuer offering group or individual health
insurance coverage receives a claim for a forensic medical exam
to which the provisions of subsection (a) would apply but for
application of paragraph (1) and such plan or issuer denies
such claim or imposes cost sharing on such claim, such plan or
issuer shall--
``(A) at the time of such denial or imposition,
notify the individual with respect to whom such exam
was furnished of the manner in which such individual
may seek reimbursement for such exam (or for the amount
of such cost sharing so imposed, as applicable) from
the State in which such exam was furnished; and
``(B) after receiving authorization from such
individual, notify the appropriate State agency of the
State in which such exam was furnished of such claim.
``(c) Application of Surprise Billing Provisions.--
``(1) In general.--The provisions of sections 2799A-1 and
2799B-1, 716 of the Employee Retirement Income Security Act of
1974, and 9816 of the Internal Revenue Code of 1986 shall apply
to a forensic medical exam for which a group health plan or
health insurance issuer offering group or individual health
insurance coverage is responsible for providing coverage at no
cost sharing under this section furnished to an enrollee of
such plan or group or individual health insurance coverage by a
provider that does not have in effect a contractual
relationship described in subsection (a) with such plan or
coverage (as applicable) for furnishing such exam as if such
exam was an emergency service furnished by a nonparticipating
provider in an emergency department of a hospital.
``(2) Definitions.--In this subsection, the terms
`emergency service' and `nonparticipating provider' have the
meanings given such terms in subparagraphs (C)(i) and (G),
respectively, of sections 2799A-1(a)(3), 716(a)(3) of the
Employee Retirement Income Security Act of 1974, and section
9816(a)(3) of the Internal Revenue Code of 1986.
``(d) Definition.--For purposes of this section, the term `forensic
medical exam' means, with respect to an individual--
``(1) an examination for physical trauma;
``(2) a determination of penetration or force;
``(3) an interview of such individual; and
``(4) the collection and evaluation of evidence from such
individual.''.
(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 is
amended--
(A) in section 716(a)(3)(C)(ii), by inserting
``forensic medical exams (as defined in section 726(d))
furnished on or after January 1, 2025 and'' after
``shall include''; and
(B) by adding at the end the following new section:
``SEC. 726. REQUIRED COVERAGE OF FORENSIC MEDICAL EXAMS WITH NO COST
SHARING.
``(a) In General.--Except as provided in subsection (b), a group
health plan and a health insurance issuer offering group health
insurance coverage shall provide coverage for and shall not impose any
cost sharing requirements for a forensic medical exam (as defined in
subsection (d)) furnished by a sexual assault forensic examiner (as
defined for purposes of section 304 of the DNA Sexual Assault Justice
Act of 2004), a sexual assault nurse examiner (as so defined), or any
other provider specified by the Secretary, regardless of whether such
forensic examiner, nurse examiner, or other provider has in effect a
contractual relationship with such plan or coverage for the furnishing
of such exam or item or service.
``(b) Nonapplication to Certain Forensic Medical Exams Otherwise
Covered.--
``(1) In general.--The provisions of subsection (a) shall
not apply with respect to a forensic medical exam furnished in
a State for which such State is responsible for incurring the
full out-of-pocket costs under section 2010 of the Omnibus
Crime Control and Safe Streets Act of 1968.
``(2) Notification.--In the case that a group health plan
or health insurance issuer offering group health insurance
coverage receives a claim for a forensic medical exam to which
the provisions of subsection (a) would apply but for
application of paragraph (1) and such plan or issuer denies
such claim or imposes cost sharing on such claim, such plan or
issuer shall--
``(A) at the time of such denial or imposition,
notify the individual with respect to whom such exam
was furnished of the manner in which such individual
may seek reimbursement for such exam (or for the amount
of such cost sharing so imposed, as applicable) from
the State in which such exam was furnished; and
``(B) after receiving authorization from such
individual, notify the appropriate State agency of the
State in which such exam was furnished of such claim.
``(c) Application of Surprise Billing Provisions.--
``(1) In general.--The provisions of sections 2799A-1 and
2799B-1 of the Public Health Service Act, 716, and 9816 of the
Internal Revenue Code of 1986 shall apply to a forensic medical
exam for which a group health plan or health insurance issuer
offering group health insurance coverage is responsible for
providing coverage at no cost sharing under this section
furnished to a participant or beneficiary of such plan or group
health insurance coverage by a provider that does not have in
effect a contractual relationship described in subsection (a)
with such plan or coverage (as applicable) for furnishing such
exam as if such exam was an emergency services furnished by a
nonparticipating provider in an emergency department of a
hospital.
``(2) Definitions.--In this subsection, the terms
`emergency service' and `nonparticipating provider' have the
meanings given such terms in subparagraphs (C)(i) and (G),
respectively, of sections 2799A-1(a)(3) of the Public Health
Service Act, 716(a)(3), and section 9816(a)(3) of the Internal
Revenue Code of 1986.
``(d) Definition.--For purposes of this section, the term `forensic
medical exam' means, with respect to an individual--
``(1) an examination for physical trauma;
``(2) a determination of penetration or force;
``(3) an interview of such individual; and
``(4) the collection and evaluation of evidence from such
individual.''.
(2) Technical amendment.--The table of contents in section
1 of such Act is amended by inserting after the item relating
to section 725 the following new item:
``Sec. 726. Required coverage of forensic medical exams with no cost
sharing.''.
(c) IRC.--
(1) In general.--Subchapter B of chapter 100 of the
Internal Revenue Code of 1986 is amended--
(A) in section 9816(a)(3)(C)(ii), by inserting
``forensic medical exams (as defined in section
9826(d)) furnished on or after January 1, 2025 and''
after ``shall include''; and
(B) by adding at the end the following new section:
``SEC. 9826. REQUIRED COVERAGE OF FORENSIC MEDICAL EXAMS WITH NO COST
SHARING.
``(a) In General.--Except as provided in subsection (b), a group
health plan shall provide coverage for and shall not impose any cost
sharing requirements for a forensic medical exam (as defined in
subsection (d)) furnished by a sexual assault forensic examiner (as
defined for purposes of section 304 of the DNA Sexual Assault Justice
Act of 2004), a sexual assault nurse examiner (as so defined), or any
other provider specified by the Secretary, regardless of whether such
forensic examiner, nurse examiner, or other provider has in effect a
contractual relationship with such plan for the furnishing of such exam
or item or service.
``(b) Nonapplication to Certain Forensic Medical Exams Otherwise
Covered.--
``(1) In general.--The provisions of subsection (a) shall
not apply with respect to a forensic medical exam furnished in
a State for which such State is responsible for incurring the
full out-of-pocket costs under section 2010 of the Omnibus
Crime Control and Safe Streets Act of 1968.
``(2) Notification.--In the case that a group health plan
receives a claim for a forensic medical exam to which the
provisions of subsection (a) would apply but for application of
paragraph (1) and such plan denies such claim or imposes cost
sharing on such claim, such plan shall--
``(A) at the time of such denial or imposition,
notify the individual with respect to whom such exam
was furnished of the manner in which such individual
may seek reimbursement for such exam (or for the amount
of such cost sharing so imposed, as applicable) from
the State in which such exam was furnished; and
``(B) after receiving authorization from such
individual, notify the appropriate State agency of the
State in which such exam was furnished of such claim.
``(c) Application of Surprise Billing Provisions.--
``(1) In general.--The provisions of sections 2799A-1 and
2799B-1 of the Public Health Service Act, 716 of the Employee
Retirement Income Security Act of 1974, and 9816 shall apply to
a forensic medical exam for which a group health plan is
responsible for providing coverage at no cost sharing under
this section furnished to an enrollee, participant, or
beneficiary of such plan by a provider that does not have in
effect a contractual relationship described in subsection (a)
with such plan for furnishing such exam as if such exam was an
emergency service furnished by a nonparticipating provider in
an emergency department of a hospital.
``(2) Definitions.--In this subsection, the terms
`emergency service' and `nonparticipating provider' have the
meanings given such terms in subparagraphs (C)(i) and (G),
respectively, of sections 2799A-1(a)(3) of the Public Health
Service Act, 716(a)(3) of the Employee Retirement Income
Security Act of 1974, and section 9816(a)(3).
``(d) Definition.--For purposes of this section, the term `forensic
medical exam' means, with respect to an individual--
``(1) an examination for physical trauma;
``(2) a determination of penetration or force;
``(3) an interview of such individual; and
``(4) the collection and evaluation of evidence from such
individual.''.
(2) Technical amendment.--The table of sections for such
subchapter is amended by adding at the end the following new
item:
``Sec. 9826. Required coverage of forensic medical exams with no cost
sharing.''.
(d) Conforming Amendment.--Section 223(c)(2) of the Internal
Revenue Code of 1986 is amended by adding at the end the following new
subparagraph:
``(H) Safe harbor for forensic medical exams.--A
plan shall not fail to be treated as a high deductible
health plan by reason of failing to have a deductible
for any item or service for which such plan is required
to provide coverage at no cost sharing under section
9826.''.
(e) Implementation.--The Secretaries of Labor, Health and Human
Services, and the Treasury may implement the amendments made by this
section through interim final rules, subregulatory guidance, program
instruction, or otherwise.
(f) Effective Date.--The amendments made by subsections (a) through
(d) shall apply with respect to plan years beginning on or after
January 1, 2025.
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