I

106TH CONGRESS

1ST SESSION H. R. 989

To amend the Public Health Service Act, Employee Retirement Income Security Act of 1974, and titles XVIII and XIX of the Social Security

Act to require that group and individual health insurance coverage and

group health plans and managed care plans under the Medicare and

Medicaid Programs provide coverage for hospital lengths of stay as

determined by the attending health care provider in consultation with

the patient.

IN THE HOUSE OF REPRESENTATIVES

MARCH 4, 1999

Mr. COBURN (for himself and Mr. STRICKLAND) introduced the following bill;

which was referred to the Committee on Commerce, and in addition to

the Committees on Education and the Workforce, 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, Employee Retirement Income Security Act of 1974, and titles XVIII

and XIX of the Social Security Act to require that

group and individual health insurance coverage and

group health plans and managed care plans under the

Medicare and Medicaid Programs provide coverage for

hospital lengths of stay as determined by the attending

health care provider in consultation with the patient.
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1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Hospital Length of

5 Stay Act of 1999’’.

6 SEC. 2. COVERAGE OF HOSPITAL LENGTH OF STAY.

7 (a) GROUP HEALTH PLANS.—

8 (1) PUBLIC HEALTH SERVICE ACT AMEND9 MENTS.—

10 (A) IN GENERAL.—Subpart 2 of part A of

11 title XXVII of the Public Health Service Act

12 (42 U.S.C. 300gg–4 et seq.) is amended by

13 adding at the end the following new section:

14 ‘‘SEC. 2707. STANDARDS RELATING TO COVERAGE OF HOS15 PITAL LENGTHS OF STAY.

16 ‘‘(a) REQUIREMENT.—A group health plan and a

17 health insurance issuer offering group health insurance

18 coverage in connection with a group health plan (including

19 a self-insured issuer) that provides coverage for inpatient

20 hospital services—

21 ‘‘(1) shall provide coverage for the length of an

22 inpatient hospital stay as determined by the attend23 ing physician (or other attending health care pro24 vider to the extent permitted under State law) in
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1 consultation with the patient to be medically appro2 priate; and

3 ‘‘(2) may not require that a provider obtain au4 thorization from the plan or the issuer for prescrib5 ing any length of stay required under paragraph (1).

6 ‘‘(b) PROHIBITIONS.—A group health plan and a

7 health insurance issuer offering group health insurance

8 coverage in connection with a group health plan (including

9 a self-insured issuer) may not—

10 ‘‘(1) deny to an individual eligibility, or contin11 ued eligibility, to enroll or to renew coverage under

12 the terms of the plan, solely for the purpose of

13 avoiding the requirements of this section;

14 ‘‘(2) provide monetary payments or rebates to

15 an individual to encourage the individual to accept

16 less than the minimum protections available under

17 this section;

18 ‘‘(3) penalize or otherwise reduce or limit the

19 reimbursement of an attending provider because

20 such provider provided care to an individual partici21 pant or beneficiary in accordance with this section;

22 ‘‘(4) provide incentives (monetary or otherwise)

23 to an attending provider to induce such provider to

24 provide care to an individual participant or bene25 ficiary in a manner inconsistent with this section; or
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1 ‘‘(5) subject to subsection (c)(4), restrict bene2 fits for any portion of a period within a hospital

3 length of stay required under subsection (a) in a

4 manner which is less favorable than the benefits pro5 vided for any preceding portion of such stay.

6 ‘‘(c) RULES OF CONSTRUCTION.—

7 ‘‘(1) NO REQUIREMENT TO STAY.—Nothing in

8 this section shall be construed to require an individ9 ual who is a participant or beneficiary to stay in the

10 hospital for a fixed period of time for any procedure.

11 ‘‘(2) NO EFFECT ON REQUIREMENTS FOR MINI12 MUM HOSPITAL STAY FOLLOWING BIRTH.—Nothing

13 in this section shall be construed as modifying the

14 requirements of section 2704.

15 ‘‘(3) NONAPPLICABILITY.—This section shall

16 not apply with respect to any group health plan, or

17 any group health insurance coverage offered by a

18 health insurance issuer (including a self-insured

19 issuer), which does not provide benefits for hospital

20 lengths of stay.

21 ‘‘(4) COST-SHARING.—Nothing in this section

22 shall be construed as preventing a group health

23 plan, or a health insurance issuer offering group

24 health insurance coverage in connection with a group

25 health plan (including a self-insured issuer), from
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1 imposing deductibles, coinsurance, or other cost2 sharing in relation to benefits for hospital lengths of

3 stay under the plan, health insurance coverage of4 fered in connection with a group health plan, or the

5 supplemental policy, except that such coinsurance or

6 other cost-sharing for any portion of a period within

7 a hospital length of stay required under subsection

8 (a) may not be greater than such coinsurance or

9 cost-sharing for any preceding portion of such stay.

10 ‘‘(d) NOTICE.—A group health plan under this part

11 shall comply with the notice requirement under section

12 714(d) of the Employee Retirement Income Security Act

13 of 1974 with respect to the requirements of this section

14 as if such section applied to such plan.

15 ‘‘(e) LEVEL AND TYPE OF REIMBURSEMENTS.—

16 Nothing in this section shall be construed to prevent a

17 group health plan or a health insurance issuer offering

18 group health insurance coverage in connection with a

19 group health plan (including a self-insured issuer) from

20 negotiating the level and type of reimbursement with a

21 provider for care provided in accordance with this section.

22 ‘‘(f) PREEMPTION; EXCEPTION FOR HEALTH INSUR23 ANCE COVERAGE IN CERTAIN STATES.—

24 ‘‘(1) IN GENERAL.—The requirements of this

25 section shall not apply with respect to health insur-
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1 ance coverage if there is a State law (as defined in

2 section 2723(d)(1)) for a State that regulates such

3 coverage and provides greater protections to patients

4 than those provided under this section.

5 ‘‘(2) CONSTRUCTION.—Section 2723(a)(1) shall

6 not be construed as superseding a State law de7 scribed in paragraph (1).’’.

8 (B) CONFORMING AMENDMENT.—Section

9 2723(c) of the Public Health Service Act (42

10 U.S.C. 300gg–23(c)) is amended by striking

11 ‘‘section 2704’’ and inserting ‘‘sections 2704

12 and 2707’’.

13 (2) ERISA AMENDMENTS.—

14 (A) IN GENERAL.—Subpart B of part 7 of

15 subtitle B of title I of the Employee Retirement

16 Income Security Act of 1974 (29 U.S.C. 1185

17 et seq.) is amended by adding at the end the

18 following new section:

19 ‘‘SEC. 714. STANDARDS RELATING TO COVERAGE OF HOS20 PITAL LENGTHS OF STAY.

21 ‘‘(a) REQUIREMENT.—A group health plan and a

22 health insurance issuer offering group health insurance

23 coverage in connection with a group health plan (including

24 a self-insured issuer), that provides coverage for inpatient

25 hospital services—
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1 ‘‘(1) shall provide coverage for the length of an

2 inpatient hospital stay as determined by the attend3 ing physician (or other attending health care pro4 vider to the extent permitted under State law) in

5 consultation with the patient to be medically appro6 priate; and

7 ‘‘(2) may not require that a provider obtain au8 thorization from the plan or the issuer for prescrib9 ing any length of stay required under paragraph (1).

10 ‘‘(b) PROHIBITIONS.—A group health plan and a

11 health insurance issuer offering group health insurance

12 coverage in connection with a group health plan (including

13 a self-insured issuer), may not—

14 ‘‘(1) deny to an individual eligibility, or contin15 ued eligibility, to enroll or to renew coverage under

16 the terms of the plan, solely for the purpose of

17 avoiding the requirements of this section;

18 ‘‘(2) provide monetary payments or rebates to

19 an individual to encourage the individual to accept

20 less than the minimum protections available under

21 this section;

22 ‘‘(3) penalize or otherwise reduce or limit the

23 reimbursement of an attending provider because

24 such provider provided care to an individual partici25 pant or beneficiary in accordance with this section;
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1 ‘‘(4) provide incentives (monetary or otherwise)

2 to an attending provider to induce such provider to

3 provide care to an individual participant or bene4 ficiary in a manner inconsistent with this section; or

5 ‘‘(5) subject to subsection (c)(4), restrict bene6 fits for any portion of a period within a hospital

7 length of stay required under subsection (a) in a

8 manner which is less favorable than the benefits pro9 vided for any preceding portion of such stay.

10 ‘‘(c) RULES OF CONSTRUCTION.—

11 ‘‘(1) NO REQUIREMENT TO STAY.—Nothing in

12 this section shall be construed to require an individ13 ual who is a participant or beneficiary to stay in the

14 hospital for a fixed period of time for any procedure.

15 ‘‘(2) NO EFFECT ON REQUIREMENTS FOR MINI16 MUM HOSPITAL STAY FOLLOWING BIRTH.—Nothing

17 in this section shall be construed as modifying the

18 requirements of section 711.

19 ‘‘(3) NONAPPLICABILITY.—This section shall

20 not apply with respect to any group health plan or

21 any group health insurance coverage offered by a

22 health insurance issuer (including a self-insured

23 issuer), which does not provide benefits for hospital

24 lengths of stay.
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1 ‘‘(4) COST-SHARING.—Nothing in this section

2 shall be construed as preventing a group health plan

3 or a health insurance issuer offering group health

4 insurance coverage in connection with a group health

5 plan (including a self-insured issuer), from imposing

6 deductibles, coinsurance, or other cost-sharing in re7 lation to benefits for hospital lengths of stay under

8 the plan or health insurance coverage offered in con9 nection with a group health plan, except that such

10 coinsurance or other cost-sharing for any portion of

11 a period within a hospital length of stay required

12 under subsection (a) may not be greater than such

13 coinsurance or cost-sharing for any preceding por14 tion of such stay.

15 ‘‘(d) NOTICE UNDER GROUP HEALTH PLAN.—The

16 imposition of the requirements of this section shall be

17 treated as a material modification in the terms of the plan

18 described in section 102(a)(1), for purposes of assuring

19 notice of such requirements under the plan; except that

20 the summary description required to be provided under the

21 last sentence of section 104(b)(1) with respect to such

22 modification shall be provided by not later than 60 days

23 after the first day of the first plan year in which such

24 requirements apply.
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1 ‘‘(e) LEVEL AND TYPE OF REIMBURSEMENTS.—

2 Nothing in this section shall be construed to prevent a

3 group health plan or a health insurance issuer offering

4 group health insurance coverage in connection with a

5 group health plan (including a self-insured issuer), from

6 negotiating the level and type of reimbursement with a

7 provider for care provided in accordance with this section.

8 ‘‘(f) PREEMPTION; EXCEPTION FOR HEALTH INSUR9 ANCE COVERAGE IN CERTAIN STATES.—

10 ‘‘(1) IN GENERAL.—The requirements of this

11 section shall not apply with respect to health insur12 ance coverage if there is a State law (as defined in

13 section 731(d)(1)) for a State that regulates such

14 coverage and provides greater protections to patients

15 than those provided under this section.

16 ‘‘(2) CONSTRUCTION.—Section 731(a)(1) shall

17 not be construed as superseding a State law de18 scribed in paragraph (1).’’.

19 (B) CONFORMING AMENDMENTS.—

20 (i) Section 731(c) of the Employee

21 Retirement Income Security Act of 1974

22 (29 U.S.C. 1191(c)) is amended by strik23 ing ‘‘section 711’’ and inserting ‘‘sections

24 711 and 714’’.
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1 (ii) Section 732(a) of the Employee

2 Retirement Income Security Act of 1974

3 (29 U.S.C. 1191a(a)), as amended by sec4 tion 603(b)(2) of Public Law 104–204, is

5 amended by striking ‘‘section 711’’ and in6 serting ‘‘sections 711 and 714’’.

7 (iii) The table of contents in section 1

8 of the Employee Retirement Income Secu9 rity Act of 1974 is amended by inserting

10 after the item relating to section 713 the

11 following new item:

‘‘Sec. 714. Standards relating to coverage of hospital lengths of stay.’’.

12 (b) INDIVIDUAL MARKET.—Subpart 3 of part B of

13 title XXVII of the Public Health Service Act (42 U.S.C.

14 300gg–51 et seq.) is amended by adding at the end the

15 following new section:

16 ‘‘SEC. 2753. STANDARDS RELATING TO COVERAGE OF HOS17 PITAL LENGTHS OF STAY.

18 ‘‘The provisions of section 2707 shall apply to health

19 insurance coverage offered by a health insurance issuer

20 in the individual market in the same manner as they apply

21 to health insurance coverage offered by a health insurance

22 issuer in connection with a group health plan in the small

23 or large group market.’’.

24 (c) EFFECTIVE DATES.—
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1 (1) GROUP HEALTH PLANS.—Subject to para2 graph (3), the amendments made by subsection (a)

3 shall apply with respect to group health plans for

4 plan years beginning on or after January 1, 2000.

5 (2) HEALTH INSURANCE COVERAGE.—The

6 amendment made by subsection (b) shall apply with

7 respect to health insurance coverage offered, sold,

8 issued, renewed, in effect, or operated in the individ9 ual market on or after such date.

10 (3) COLLECTIVE BARGAINING AGREEMENTS.—

11 In the case of a group health plan maintained pur12 suant to 1 or more collective bargaining agreements

13 between employee representatives and 1 or more em14 ployers ratified before the date of enactment of this

15 Act, the amendments made subsection (a) shall not

16 apply to plan years beginning before the later of—

17 (A) the date on which the last collective

18 bargaining agreements relating to the plan ter19 minates (determined without regard to any ex20 tension thereof agreed to after the date of en21 actment of this Act), or

22 (B) January 1, 2000.

23 For purposes of subparagraph (A), any plan amend24 ment made pursuant to a collective bargaining

25 agreement relating to the plan which amends the
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1 plan solely to conform to any requirement added by

2 subsection (a) shall not be treated as a termination

3 of such collective bargaining agreement.

4 SEC. 3. APPLICATION TO MEDICARE AND MEDICAID BENE5 FICIARIES.

6 (a) MEDICARE.—

7 (1) IN GENERAL.—Title XVIII of the Social Se8 curity Act (42 U.S.C. 1395 et seq.) is amended by

9 adding at the end the following:

10 ‘‘STANDARDS RELATING TO COVERAGE OF HOSPITAL

11 LENGTHS OF STAY

12 ‘‘SEC. 1897. (a) APPLICATION TO MEDICARE.—Not13 withstanding the limitation on benefits described in sec14 tion 1812, or any other limitation on benefits imposed

15 under this title, the provisions of section 2707 of the Pub16 lic Health Service Act shall apply to the provision of items

17 and services under this title.

18 ‘‘(b) MEDICARE+CHOICE AND ELIGIBLE ORGANIZA19 TIONS.—The Secretary may not enter into a contract with

20 a Medicare+Choice organization under part C, or with an

21 eligible organization with a risk-sharing contract under

22 section 1876, unless the organization meets the require23 ments of section 2707 of the Public Health Service Act

24 with respect to individuals enrolled with the organiza25 tion.’’.

26 (2) MEDICARE SUPPLEMENTAL POLICIES.—
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1 (A) IN GENERAL.—Section 1882(c) of the

2 Social Security Act (42 U.S.C. 1395ss(c)) is

3 amended—

4 (i) in paragraph (4), by striking

5 ‘‘and’’ at the end;

6 (ii) in paragraph (5), by striking the

7 period and inserting ‘‘, and’’; and

8 (iii) by adding at the end the follow9 ing:

10 ‘‘(6) meets the requirements of section 2707 of

11 the Public Health Service Act with respect to indi12 viduals enrolled under the policy.’’.

13 (B) CONFORMING AMENDMENT.—Section

14 1882(b)(1)(B) of the Social Security Act (42

15 U.S.C. 1395ss(b)(1)(B)) is amended by striking

16 ‘‘(5)’’ and inserting ‘‘(6)’’.

17 (3) COST SHARING.—Nothing in this subsection

18 or section 2707(c) of the Public Health Service Act

19 shall be construed as authorizing the imposition of

20 cost sharing with respect to the coverage or benefits

21 required to be provided under the amendments to

22 the Social Security Act made by paragraphs (1) and

23 (2) that is inconsistent with the cost sharing that is

24 otherwise permitted under title XVIII of the Social

25 Security Act.
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1 (b) MEDICAID.—Title XIX of the Social Security Act

2 (42 U.S.C. 1396 et seq.) is amended by redesignating sec3 tion 1935 as section 1936 and by inserting after section

4 1934 the following:

5 ‘‘STANDARDS RELATING TO COVERAGE OF HOSPITAL

6 LENGTHS OF STAY

7 ‘‘SEC. 1935. (a) IN GENERAL.—A State plan may

8 not be approved under this title unless the plan requires

9 each health insurance issuer or other entity with a con10 tract with such plan to provide coverage or benefits to in11 dividuals eligible for medical assistance under the plan, in12 cluding a managed care entity, as defined in section

13 1932(a)(1)(B), to comply with the provisions of section

14 2707 of the Public Health Service Act with respect to such

15 coverage or benefits.

16 ‘‘(b) COST SHARING.—Nothing in this section or sec17 tion 2707(c) of the Public Health Service Act shall be con18 strued as authorizing a health insurance issuer or entity

19 to impose cost sharing with respect to the coverage or ben20 efits required to be provided under section 2707 of the

21 Public Health Service Act that is inconsistent with the

22 cost sharing that is otherwise permitted under this title.

23 ‘‘(c) WAIVERS PROHIBITED.—The requirement of

24 subsection (a) may not be waived under section 1115 or

25 section 1915(b) of the Social Security Act.’’.
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1 (c) EFFECTIVE DATE.—The amendments made by

2 this section apply to contract years under titles XVIII and

3 XIX of the Social Security Act beginning on or after Jan4 uary 1, 2000.

5 (d) MEDIGAP TRANSITION PROVISIONS.—

6 (1) IN GENERAL.—If the Secretary of Health

7 and Human Services identifies a State as requiring

8 a change to its statutes or regulations to conform its

9 regulatory program to the changes made by sub10 section (a)(2), the State regulatory program shall

11 not be considered to be out of compliance with the

12 requirements of section 1882 of the Social Security

13 Act due solely to failure to make such change until

14 the date specified in paragraph (4).

15 (2) NAIC STANDARDS.—If, within 9 months

16 after the date of the enactment of this Act, the Na17 tional Association of Insurance Commissioners (in

18 this subsection referred to as the ‘‘NAIC’’) modifies

19 its NAIC Model Regulation relating to section 1882

20 of the Social Security Act (referred to in such sec21 tion as the 1991 NAIC Model Regulation, as modi22 fied pursuant to section 171(m)(2) of the Social Se23 curity Act Amendments of 1994 (Public Law 103–

24 432) and as modified pursuant to section

25 1882(d)(3)(A)(vi)(IV) of the Social Security Act, as
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1 added by section 271(a) of the Health Insurance

2 Portability and Accountability Act of 1996 (Public

3 Law 104–191) to conform to the amendments made

4 by this section, such revised regulation incorporating

5 the modifications shall be considered to be the appli6 cable NAIC model regulation (including the revised

7 NAIC model regulation and the 1991 NAIC Model

8 Regulation) for the purposes of such section.

9 (3) SECRETARY STANDARDS.—If the NAIC

10 does not make the modifications described in para11 graph (2) within the period specified in such para12 graph, the Secretary of Health and Human Services

13 shall make the modifications described in such para14 graph and such revised regulation incorporating the

15 modifications shall be considered to be the appro16 priate Regulation for the purposes of such section.

17 (4) DATE SPECIFIED.—

18 (A) IN GENERAL.—Subject to subpara19 graph (B), the date specified in this paragraph

20 for a State is the earlier of—

21 (i) the date the State changes its stat22 utes or regulations to conform its regu23 latory program to the changes made by

24 this section, or
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1 (ii) 1 year after the date the NAIC or

2 the Secretary first makes the modifications

3 under paragraph (2) or (3), respectively.

4 (B) ADDITIONAL LEGISLATIVE ACTION RE5 QUIRED.—In the case of a State which the Sec6 retary identifies as—

7 (i) requiring State legislation (other

8 than legislation appropriating funds) to

9 conform its regulatory program to the

10 changes made in this section, but

11 (ii) having a legislature which is not

12 scheduled to meet in 2000 in a legislative

13 session in which such legislation may be

14 considered,

15 the date specified in this paragraph is the first

16 day of the first calendar quarter beginning after

17 the close of the first legislative session of the

18 State legislature that begins on or after July 1,

19 2000. For purposes of the previous sentence, in

20 the case of a State that has a 2-year legislative

21 session, each year of such session shall be

22 deemed to be a separate regular session of the

23 State legislature.
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1 SEC. 4. APPLICATION TO OTHER HEALTH CARE COVERAGE.

2 (a) FEHBP.—Chapter 89 of title 5, United States

3 Code, is amended by adding at the end the following:

4 ‘‘§ 8915. Standards relating to coverage of hospital

5 lengths of stay

6 ‘‘(a) The provisions of section 2707 of the Public

7 Health Service Act shall apply to the provision of items

8 and services under this chapter.

9 ‘‘(b) Nothing in this section or section 2707(c) of the

10 Public Health Service Act shall be construed as authoriz11 ing a health insurance issuer or entity to impose cost shar12 ing with respect to the coverage or benefits required to

13 be provided under section 2707 of the Public Health Serv14 ice Act that is inconsistent with the cost sharing that is

15 otherwise permitted under this chapter.’’.

16 (b) MEDICAL CARE FOR MEMBERS AND CERTAIN

17 FORMER MEMBERS OF THE UNIFORMED SERVICES AND

18 THEIR DEPENDENTS.—Chapter 55 of title 10, United

19 States Code, is amended by adding at the end the follow20 ing:

21 ‘‘§ 1110. Standards relating to coverage of hospital

22 lengths of stay

23 ‘‘(a) APPLICATION OF STANDARDS.—The provisions

24 of section 2707 of the Public Health Service Act shall

25 apply to the provision of items and services under this

26 chapter.
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1 ‘‘(b) COST-SHARING.—Nothing in this section or sec2 tion 2707(c) of the Public Health Service Act shall be con3 strued as authorizing the imposition of cost sharing with

4 respect to the coverage or benefits required to be provided

5 under section 2707 of the Public Health Service Act that

6 is inconsistent with the cost sharing that is otherwise per7 mitted under this chapter.’’.

8 (c) VETERANS.—Subchapter II of chapter 17 of title

9 38, United States Code, is amended by adding at the end

10 the following:

11 ‘‘§ 1720E. Standards relating to coverage of hospital

12 lengths of stay

13 ‘‘(a) The provisions of section 2707 of the Public

14 Health Service Act shall apply to the provision of items

15 and services under this chapter.

16 ‘‘(b) Nothing in this section or section 2707(c) of the

17 Public Health Service Act shall be construed as authoriz18 ing the imposition of cost sharing with respect to the cov19 erage or benefits required to be provided under section

20 2706 of the Public Health Service Act that is inconsistent

21 with the cost sharing that is otherwise permitted under

22 this chapter.’’.

23 (d) STATE CHILDREN’S HEALTH INSURANCE PRO24 GRAM.—Section 2109 of the Social Security Act (42
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1 U.S.C. 1397ii) is amended by adding at the end the follow2 ing:

3 ‘‘(b) APPLICATION OF STANDARDS RELATING TO

4 COVERAGE OF HOSPITAL LENGTHS OF STAY.—

5 ‘‘(1) IN GENERAL.—The provisions of section

6 2707 of the Public Health Service Act shall apply to

7 the provision of items and services under this title.

8 ‘‘(2) COST-SHARING.—Nothing in this section

9 or section 2707(c) of the Public Health Service Act

10 shall be construed as authorizing a health insurance

11 issuer or entity to impose cost sharing with respect

12 to the coverage or benefits required to be provided

13 under section 2707 of the Public Health Service Act

14 that is inconsistent with the cost sharing that is oth15 erwise permitted under this title.’’.

16 (e) INDIAN HEALTH SERVICE AND HEALTH CARE

17 PROVIDED BY TRIBAL ORGANIZATIONS.—Title VIII of the

18 Indian Health Care Improvement Act (25 U.S.C. 1671 et

19 seq.) is amended by adding at the end the following:

20 ‘‘STANDARDS RELATING TO COVERAGE OF HOSPITAL

21 LENGTHS OF STAY

22 ‘‘SEC. 826. (a) The provisions of section 2707 of the

23 Public Health Service Act shall apply to the provision of

24 items and services under this Act by the Service or a tribal

25 organization.
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1 ‘‘(b) Nothing in this section or section 2707(c) of the

2 Public Health Service Act shall be construed as authoriz3 ing the imposition of cost sharing with respect to the cov4 erage or benefits required to be provided under section

5 2707 of the Public Health Service Act that is inconsistent

6 with the cost sharing that is otherwise permitted under

7 this Act.’’.

8 (f) HEALTH CARE PROVIDED TO PEACE CORPS VOL9 UNTEERS.—Section 5(e) of the Peace Corps Act (22

10 U.S.C. 2504(e)) is amended by adding at the end the fol11 lowing: ‘‘The provisions of section 2707 of the Public

12 Health Service Act shall apply to the provision of items

13 and services under this section. Nothing in this section

14 or section 2707(c) of the Public Health Service Act shall

15 be construed as authorizing the imposition of cost sharing

16 with respect to the coverage or benefits required to be pro17 vided under section 2707 of the Public Health Service Act

18 that is inconsistent with the cost sharing that is otherwise

19 permitted under this section.’’.

Æ