I 

116TH CONGRESS 

1ST SESSION H. R. 5485 

To amend title XXVII of the Public Health Service Act 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 

DECEMBER 18, 2019 

Mr. NEGUSE (for himself, Mr. THOMPSON of California, and Mr. MCKINLEY) 

introduced the following bill; which was referred to the Committee on Energy and Commerce 

A BILL 

To amend title XXVII of the Public Health Service Act 

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. 

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 ‘‘Ally’s Act’’. 


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1 SEC. 2. COVERAGE OF HEARING DEVICES AND SYSTEMS IN 

2 CERTAIN PRIVATE HEALTH INSURANCE 

3 PLANS. 

4 (a) IN GENERAL.—Part A of the Public Health Serv5 ice Act (42 U.S.C. 300gg et seq.) is amended by inserting 

6 after section 2713 the following new section: 

7 ‘‘SEC. 2713A. COVERAGE OF HEARING DEVICES AND SYS8 TEMS. 

9 ‘‘(a) IN GENERAL.—Beginning with plan years begin10 ning on or after January 1, 2021, a group health plan 

11 and a health insurance issuer offering group or individual 

12 health insurance coverage shall, at a minimum provide 

13 coverage for and may impose cost-sharing requirements 

14 in accordance with subsection (b) for an individual that 

15 a physician (as defined in section 1861(r) of the Social 

16 Security Act) or qualified audiologist (as defined in section 

17 1861(ll)(4)(B) of such Act) determines meets an indica18 tion (including unilateral or bilateral hearing loss) for an 

19 auditory device as approved by the Food and Drug Admin20 istration for— 

21 ‘‘(1) auditory implant devices (including audi22 tory osseointegrated (bone conduction) implants and 

23 cochlear implants) and external sound processors; 

24 ‘‘(2) the maintenance of auditory implant de25 vices and external sound processors described in 

26 paragraph (1); 


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1 ‘‘(3) every 5 years, the upgrade (or replacement 

2 if an upgrade is not available) of auditory implant 

3 devices and external sound processors described in 

4 paragraph (1); 

5 ‘‘(4) adhesive adapters and softband headbands; 

6 ‘‘(5) the repair of auditory implant devices and 

7 external sound processors described in paragraph 

8 (1); 

9 ‘‘(6) a comprehensive hearing assessment; 

10 ‘‘(7) a preoperative medical assessment; 

11 ‘‘(8) surgery (as appropriate); 

12 ‘‘(9) postoperative medical appointments for 

13 purposes of ensuring appropriate recovery from sur14 gery; 

15 ‘‘(10) postoperative audiological appointments 

16 for activation and fitting of the implant device and 

17 external sound processor; and 

18 ‘‘(11) aural rehabilitation and treatment serv19 ices (as appropriate). 

20 ‘‘(b) COST-SHARING.—Beginning with plan years be21 ginning on or after January 1, 2021, the cost-sharing in22 curred under a plan or coverage described in subsection 

23 (a)— 

24 ‘‘(1) for an auditory implant device and exter25 nal sound processors under this section, shall not exVerDate Sep 11 2014 00:39 Dec 28, 2019 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H5485.IH H5485

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1 ceed a dollar amount that is the highest cost-sharing 

2 requirement for the amount of the charges imposed 

3 for such device that is provided by a physician or 

4 qualified audiologist that has a contractual relation5 ship with such plan or coverage for the providing of 

6 such device; 

7 ‘‘(2) for an item or service under this section, 

8 shall not exceed a dollar amount that is imposed for 

9 similar items and services under that plan that are 

10 provided by a physician or qualified audiologist; and 

11 ‘‘(3) that has a contractual relationship with 

12 such plan or coverage for the providing of such 

13 items and services.’’. 

14 (b) APPLICATION TO GRANDFATHERED HEALTH

15 PLANS.—Section 1251(a)(4)(A) of the Patient Protection 

16 and Affordable Care Act (42 U.S.C. 18011(a)(4)(A)) is 

17 amended— 

18 (1) by striking ‘‘title’’ and inserting ‘‘title, or as 

19 added after the date of the enactment of this Act)’’; 

20 and 

21 (2) by adding at the end the following new 

22 clause: 

23 ‘‘(v) Section 2713A (relating to hear24 ing devices and systems).’’. 


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1 (3) EFFECTIVE DATE.—The amendments made 

2 by this subsection shall apply with respect to plan 

3 years beginning on or after January 1, 2021. 

Æ 


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