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:

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:

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 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

(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:

9826.

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. 9826. 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.