I 

112TH CONGRESS 

2D SESSION H. R. 4175 

To amend the Employee Retirement Income Security Act of 1974 and the 

Public Health Service Act to provide parity under group health plans 

and group health insurance coverage for the provision of benefits for 

prosthetics and custom orthotics and benefits for other medical and 

surgical services. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 8, 2012 

Mr. DENT (for himself and Mr. ANDREWS) introduced the following bill; which 

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

to the Committee on Education and the Workforce, 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 Employee Retirement Income Security Act 

of 1974 and the Public Health Service Act to provide 

parity under group health plans and group health insurance coverage for the provision of benefits for prosthetics 

and custom orthotics and benefits for other medical and 

surgical services. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Insurance Fairness 

3 for Amputees Act’’. 

4 SEC. 2. FINDINGS AND PURPOSE. 

5 (a) FINDINGS.—Congress makes the following find6 ings: 

7 (1) There are more than 1,700,000 people in 

8 the United States living with limb loss, many of 

9 whom are appropriate candidates for prosthetic care. 

10 A comparable number experience trauma, illness, or 

11 disability that results in musculoskeletal or neuro12 muscular impairment of the limbs, back, and neck 

13 requiring the use of orthotic care. 

14 (2) Every year, there are more than 130,000 

15 people in the United States who undergo amputation 

16 procedures. 

17 (3) In addition, United States military per18 sonnel serving in Iraq and Afghanistan and around 

19 the world have sustained traumatic injuries resulting 

20 in amputation and musculoskeletal or neuromuscular 

21 injury. 

22 (4) The number of amputations in the United 

23 States is projected to increase in the years ahead 

24 due to the rising incidence of diabetes and other 

25 chronic illness. 


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1 (5) Those experiencing limb loss and limb dys2 function can and want to regain their lives as pro3 ductive members of society. 

4 (6) Prosthetic and orthotic care often enables 

5 amputees and others with orthopedic impairments to 

6 continue working and living productive lives. 

7 (7) Insurance companies have begun to limit re8 imbursement of prosthetic and custom orthotic care 

9 costs to unrealistic levels and often restrict coverage 

10 over an individual’s lifetime, which shifts costs onto 

11 the Medicare and Medicaid programs. 

12 (8) Eighteen States have addressed this prob13 lem and have prosthetic or orthotic parity legisla14 tion. 

15 (9) Prosthetic and orthotic parity legislation 

16 has been introduced and is being actively considered 

17 in 20 States. 

18 (10) The States in which prosthetic or orthotic 

19 parity laws have been enacted have found there to 

20 be minimal or no increases in insurance premiums 

21 and have reduced Medicare and Medicaid costs. 

22 (11) Prosthetic or orthotic parity legislation will 

23 not add to the size of government or to the costs as24 sociated with the Medicare and Medicaid programs. 


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1 (12) If coverage for prosthetics and custom 

2 orthotics are offered by a group health insurance 

3 policy, then providing such prosthetic coverage on 

4 par with other medical and surgical benefits will not 

5 increase the incidence of amputations or the number 

6 of individuals for which a prosthetic or custom 

7 orthotic device would be medically necessary and ap8 propriate. 

9 (13) In States where prosthetic or orthotic par10 ity legislation has been enacted, amputees and oth11 ers with orthopedic impairments are able to return 

12 to productive lives, State funds have been saved, and 

13 the health insurance industry has continued to pros14 per. 

15 (14) Prosthetic and orthotic devices and related 

16 services allow people to return more quickly to their 

17 preexisting work. 

18 (15) States have, and should continue to be 

19 permitted to, create consumer protections that ex20 ceed the Federal floor of protection provided for in 

21 this Act. 

22 (b) PURPOSE.—It is the purpose of this Act to re23 quire that each group health plan that provides medical 

24 and surgical benefits and also provides coverage for pros25 thetics or custom orthotics (or both), provide such covVerDate Mar 15 2010 00:17 Mar 09, 2012 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H4175.IH H4175

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1 erage under terms and conditions that are no less favor2 able than the terms and conditions under which medical 

3 and surgical benefits are provided under such plan. 

4 SEC. 3. PROSTHETICS AND CUSTOM ORTHOTICS PARITY. 

5 (a) ERISA.— 

6 (1) IN GENERAL.—Subpart B of part 7 of sub7 title B of title I of the Employee Retirement Income 

8 Security Act of 1974 (29 U.S.C. 1185 et seq.) is 

9 amended by adding at the end the following: 

10 ‘‘SEC. 716. PROSTHETICS AND CUSTOM ORTHOTICS PARITY. 

11 ‘‘(a) IN GENERAL.—In the case of a group health 

12 plan (or health insurance coverage offered in connection 

13 with a group health plan) that provides medical and sur14 gical benefits and also provides benefits for prosthetics or 

15 custom orthotics (as defined under paragraphs (1) and (2) 

16 of subsection (e)) (or both)— 

17 ‘‘(1) such benefits for prosthetics or custom 

18 orthotics (or both) under the plan (or coverage) shall 

19 be provided under terms and conditions that are no 

20 less favorable than the terms and conditions applica21 ble to substantially all medical and surgical benefits 

22 provided under the plan (or coverage); 

23 ‘‘(2) such benefits for prosthetics or custom 

24 orthotics (or both) under the plan (or coverage) may 

25 not be subject to separate financial requirements (as 


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1 defined in subsection (e)(2)) that are applicable only 

2 with respect to such benefits, and any financial re3 quirements applicable to such benefits shall be no 

4 more restrictive than the financial requirements ap5 plicable to substantially all medical and surgical ben6 efits provided under the plan (or coverage); and 

7 ‘‘(3) any treatment limitations (as defined in 

8 subsection (e)(3)) applicable to such benefits for 

9 prosthetics or custom orthotics (or both) under the 

10 plan (or coverage) may not be more restrictive than 

11 the treatment limitations applicable to substantially 

12 all medical and surgical benefits provided under the 

13 plan (or coverage). 

14 ‘‘(b) IN-NETWORK AND OUT-OF-NETWORK STAND15 ARDS.— 

16 ‘‘(1) IN GENERAL.—In the case of a group 

17 health plan (or health insurance coverage offered in 

18 connection with a group health plan) that provides 

19 medical or surgical benefits and also provides bene20 fits for prosthetics or custom orthotics (or both), 

21 and that provides both in-network benefits for pros22 thetics and custom orthotics and out-of-network ben23 efits for prosthetics and custom orthotics, the re24 quirements of this section shall apply separately with 

25 respect to benefits under the plan (or coverage) on 


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1 an in-network basis and benefits provided under the 

2 plan (or coverage) on an out-of-network basis. 

3 ‘‘(2) CLARIFICATION.—Nothing in paragraph 

4 (1) shall be construed as requiring that a group 

5 health plan (or health insurance coverage offered in 

6 connection with a group health plan) eliminate an 

7 out-of-network provider option from such plan (or 

8 coverage) pursuant to the terms of the plan (or cov9 erage). 

10 ‘‘(c) PATIENT ACCESS.—A group health plan (or 

11 health insurance coverage offered in connection with a 

12 group health plan) described in subsection (a) that does 

13 not provide coverage for benefits outside of a network shall 

14 ensure that such provider network is adequate to ensure 

15 enrollee access to prosthetic and custom orthotic devices 

16 and related services provided by appropriately credentialed 

17 practitioners and accredited suppliers of prosthetics and 

18 custom orthotics. 

19 ‘‘(d) ADDITIONAL REQUIREMENTS.— 

20 ‘‘(1) PRIOR AUTHORIZATION.—In the case of a 

21 group health plan (or health insurance coverage of22 fered in connection with a group health plan) that 

23 requires, as a condition of coverage or payment for 

24 prosthetics or custom orthotics (or both) under the 

25 plan (or coverage), prior authorization, such prior 


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1 authorization must be required in the same manner 

2 as prior authorization is required by the plan (or 

3 coverage) as a condition of coverage or payment for 

4 all similar medical and surgical benefits provided 

5 under the plan (or coverage). 

6 ‘‘(2) LIMITATION ON MANDATED BENEFITS.— 

7 Coverage for required benefits for prosthetics and 

8 custom orthotics under this section may be limited 

9 to coverage of the most appropriate device or compo10 nent model that meets the medical requirements of 

11 the patient, as determined by the treating physician 

12 of the patient involved. 

13 ‘‘(3) COVERAGE FOR REPAIR OR REPLACE14 MENT.—Benefits for prosthetics and custom 

15 orthotics required under this section shall include 

16 coverage for the repair or replacement of prosthetics 

17 and custom orthotics, if the repair or replacement is 

18 due to normal wear and tear, irreparable damage, a 

19 change in the condition of the patient as determined 

20 by the treating physician, or otherwise determined 

21 appropriate by the treating physician of the patient 

22 involved. 

23 ‘‘(4) ANNUAL OR LIFETIME DOLLAR LIMITA24 TIONS.—A group health plan (or health insurance 

25 coverage offered in connection with a group health 


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1 plan) shall not impose any annual or lifetime dollar 

2 limitation on benefits for prosthetics and custom 

3 orthotics required to be covered under this section 

4 unless such limitation applies in the aggregate to all 

5 medical and surgical benefits provided under the 

6 plan (or coverage) and benefits for prosthetics and 

7 custom orthotics. 

8 ‘‘(e) DEFINITIONS.—In this section: 

9 ‘‘(1) PROSTHETICS.—The term ‘prosthetics’ 

10 means those devices and components that may be 

11 used to replace, in whole or in part, an arm or leg, 

12 as well as the services required to do so and includes 

13 external breast prostheses incident to mastectomy 

14 resulting from breast cancer. 

15 ‘‘(2) CUSTOM ORTHOTICS.—The term ‘custom 

16 orthotics’ means the following: 

17 ‘‘(A) Custom-fabricated orthotics and re18 lated services, which include custom-fabricated 

19 devices that are individually made for a specific 

20 patient, as well as all services and supplies that 

21 are medically necessary for the effective use of 

22 the orthotic device and instructing the patient 

23 in the use of the device. No other patient would 

24 be able to use this particular orthosis. A cus25 tom-fabricated orthosis is a device which is fabVerDate Mar 15 2010 00:17 Mar 09, 2012 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H4175.IH H4175

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1 ricated based on clinically derived and rectified 

2 castings, tracings, measurements, or other im3 ages (such as x-rays) of the body part. The fab4 rication may involve using calculations, tem5 plates and component parts. This process re6 quires the use of basic materials and involves 

7 substantial work such as vacuum forming, cut8 ting, bending, molding, sewing, drilling and fin9 ishing prior to fitting on the patient. Custom10 fabricated devices may be furnished only by an 

11 appropriately credentialed (certified or licensed) 

12 practitioner and accredited supplier in Orthotics 

13 or Prosthetics. Such devices and related serv14 ices are represented by the set of L-codes under 

15 the Healthcare Common Procedure Coding Sys16 tem describing this care listed on the date of 

17 enactment of this section in Centers for Medi18 care & Medicaid Services Transmittal 656. 

19 ‘‘(B) Custom-fitted high orthotics and re20 lated services, which include prefabricated de21 vices that are manufactured with no specific pa22 tient in mind, but that are appropriately sized, 

23 adapted, modified, and configured (with the re24 quired tools and equipment) to a specific pa25 tient in accordance with a prescription, and 


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1 which no other patient would be able to use, as 

2 well as all services and supplies that are medi3 cally necessary for the effective use of the 

4 orthotic device and instructing the patient in 

5 the use of the device. Custom-fitted high devices 

6 may be furnished only by an appropriately 

7 credentialed (certified or licensed) practitioner 

8 and accredited supplier in Orthotics or Pros9 thetics. Such devices and related services are 

10 represented by the existing set of L-codes under 

11 the Healthcare Common Procedure Coding Sys12 tem describing this care listed on the date of 

13 enactment of this section in Centers for Medi14 care & Medicaid Services Transmittal 656. 

15 For purposes of subparagraphs (A) and (B), Centers 

16 for Medicare & Medicaid Services Transmittal 656, 

17 upon modification or reissuance by the Centers for 

18 Medicare & Medicaid Services to reflect new code ad19 ditions and coding changes for prosthetics and cus20 tom orthotics, shall be the version of the Transmittal 

21 used for purposes of such subparagraphs. 

22 ‘‘(3) FINANCIAL REQUIREMENTS.—The term 

23 ‘financial requirements’ includes deductibles, coin24 surance, co-payments, other cost sharing, and limita25 tions on the total amount that may be paid by a 


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1 participant or beneficiary with respect to benefits 

2 under the plan or health insurance coverage and also 

3 includes the application of annual and lifetime lim4 its. 

5 ‘‘(4) TREATMENT LIMITATIONS.—The term 

6 ‘treatment limitations’ includes limits on the fre7 quency of treatment, number of visits, days of cov8 erage, or other similar limits on the scope or dura9 tion of treatment. 

10 ‘‘(f) DIFFERENTIATION FROM DURABLE MEDICAL

11 EQUIPMENT.—For purposes of this section, prosthetics 

12 and custom orthotics shall be treated as distinct from du13 rable medical equipment.’’. 

14 (2) CLERICAL AMENDMENT.—The table of con15 tents in section 1 of the Employee Retirement In16 come Security Act of 1974 is amended by inserting 

17 after the item relating to section 714 the following: 

‘‘Sec. 716. Prosthetics and custom orthotics parity.’’. 

18 (b) PHSA.—Title XXVII of the Public Health Serv19 ice Act is amended by inserting after section 2728 of such 

20 Act (42 U.S.C. 300gg–28), as redesignated by section 

21 1001(2) of the Patient Protection and Affordable Care Act 

22 (Public Law 111–148), the following: 


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1 ‘‘SEC. 2729. PROSTHETICS AND CUSTOM ORTHOTICS PAR2 ITY. 

3 ‘‘(a) IN GENERAL.—In the case of a group health 

4 plan (or health insurance coverage offered in connection 

5 with a group health plan) that provides medical and sur6 gical benefits and also provides benefits for prosthetics or 

7 custom orthotics (as defined under paragraphs (1) and (2) 

8 of subsection (e)) (or both)— 

9 ‘‘(1) such benefits for prosthetics or custom 

10 orthotics (or both) under the plan (or coverage) shall 

11 be provided under terms and conditions that are no 

12 less favorable than the terms and conditions applica13 ble to substantially all medical and surgical benefits 

14 provided under the plan (or coverage); 

15 ‘‘(2) such benefits for prosthetics or custom 

16 orthotics (or both) under the plan (or coverage) may 

17 not be subject to separate financial requirements (as 

18 defined in subsection (e)(2)) that are applicable only 

19 with respect to such benefits, and any financial re20 quirements applicable to such benefits shall be no 

21 more restrictive than the financial requirements ap22 plicable to substantially all medical and surgical ben23 efits provided under the plan (or coverage); and 

24 ‘‘(3) any treatment limitations (as defined in 

25 subsection (e)(3)) applicable to such benefits for 

26 prosthetics or custom orthotics (or both) under the 


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1 plan (or coverage) may not be more restrictive than 

2 the treatment limitations applicable to substantially 

3 all medical and surgical benefits provided under the 

4 plan (or coverage). 

5 ‘‘(b) IN-NETWORK AND OUT-OF-NETWORK STAND6 ARDS.— 

7 ‘‘(1) IN GENERAL.—In the case of a group 

8 health plan (or health insurance coverage offered in 

9 connection with a group health plan) that provides 

10 medical and surgical benefits and also provides bene11 fits for prosthetics or custom orthotics (or both), 

12 and that provides both in-network and out-of-net13 work benefits for prosthetics or custom orthotics (or 

14 both), the requirements of this section shall apply 

15 separately with respect to benefits under the plan 

16 (or coverage) on an in-network basis and benefits 

17 provided under the plan (or coverage) on an out-of18 network basis. 

19 ‘‘(2) CLARIFICATION.—Nothing in paragraph 

20 (1) shall be construed as requiring that a group 

21 health plan (or health insurance coverage offered in 

22 connection with a group health plan) eliminate an 

23 out-of-network provider option from such plan (or 

24 coverage) pursuant to the terms of the plan (or cov25 erage). 


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1 ‘‘(c) PATIENT ACCESS.—A group health plan (or 

2 health insurance coverage offered in connection with a 

3 group health plan) described in subsection (a) that does 

4 not provide coverage for benefits outside of a network shall 

5 ensure that such provider network is adequate to ensure 

6 enrollee access to prosthetic and custom orthotic devices 

7 and related services provided by appropriately credentialed 

8 practitioners and accredited suppliers of prosthetics and 

9 custom orthotics. 

10 ‘‘(d) ADDITIONAL REQUIREMENTS.— 

11 ‘‘(1) PRIOR AUTHORIZATION.—In the case of a 

12 group health plan (or health insurance coverage of13 fered in connection with a group health plan) that 

14 requires, as a condition of coverage or payment for 

15 prosthetics or custom orthotics (or both) under the 

16 plan (or coverage), prior authorization, such prior 

17 authorization must be required in the same manner 

18 as prior authorization is required by the plan (or 

19 coverage) as a condition of coverage or payment for 

20 all similar medical and surgical benefits provided 

21 under the plan (or coverage). 

22 ‘‘(2) LIMITATION ON MANDATED BENEFITS.— 

23 Coverage for required benefits for prosthetics and 

24 custom orthotics under this section may be limited 

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1 nent model that adequately meets the medical re2 quirements of the patient, as determined by the 

3 treating physician of the patient involved. 

4 ‘‘(3) COVERAGE FOR REPAIR OR REPLACE5 MENT.—Benefits for prosthetics and custom 

6 orthotics required under this section shall include 

7 coverage for the repair or replacement of prosthetics 

8 and custom orthotics, if the repair or replacement is 

9 due to normal wear and tear, irreparable damage, a 

10 change in the condition of the patient as determined 

11 by the treating physician, or otherwise determined 

12 appropriate by the treating physician of the patient 

13 involved. 

14 ‘‘(4) ANNUAL OR LIFETIME DOLLAR LIMITA15 TIONS.—A group health plan (or health insurance 

16 coverage offered in connection with a group health 

17 plan) shall not impose any annual or lifetime dollar 

18 limitation on benefits for prosthetics and custom 

19 orthotics required to be covered under this section 

20 unless such limitation applies in the aggregate to all 

21 medical and surgical benefits provided under the 

22 plan (or coverage) and benefits for prosthetics and 

23 custom orthotics. 

24 ‘‘(e) DEFINITIONS.—In this section: 


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1 ‘‘(1) PROSTHETICS.—The term ‘prosthetics’ 

2 means those devices and components that may be 

3 used to replace, in whole or in part, an arm or leg, 

4 as well as the services required to do so and includes 

5 external breast prostheses incident to mastectomy 

6 resulting from breast cancer. 

7 ‘‘(2) CUSTOM ORTHOTICS.—The term ‘custom 

8 orthotics’ means the following: 

9 ‘‘(A) Custom-fabricated orthotics and re10 lated services, which include custom-fabricated 

11 devices that are individually made for a specific 

12 patient, as well as all services and supplies that 

13 are medically necessary for the effective use of 

14 the orthotic device and instructing the patient 

15 in the use of the device. No other patient would 

16 be able to use this particular orthosis. A cus17 tom-fabricated orthosis is a device which is fab18 ricated based on clinically derived and rectified 

19 castings, tracings, measurements, or other im20 ages (such as x-rays) of the body part. The fab21 rication may involve using calculations, tem22 plates and component parts. This process re23 quires the use of basic materials and involves 

24 substantial work such as vacuum forming, cut25 ting, bending, molding, sewing, drilling and finVerDate Mar 15 2010 00:17 Mar 09, 2012 Jkt 019200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\H4175.IH H4175

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1 ishing prior to fitting on the patient. Custom2 fabricated devices may be furnished only by an 

3 appropriately credentialed (certified or licensed) 

4 practitioner and accredited supplier in Orthotics 

5 or Prosthetics. Such devices and related serv6 ices are represented by the set of L-codes under 

7 the Healthcare Common Procedure Coding Sys8 tem describing this care listed on the date of 

9 enactment of this section in Centers for Medi10 care & Medicaid Services Transmittal 656. 

11 ‘‘(B) Custom-fitted high orthotics and re12 lated services, which include prefabricated de13 vices that are manufactured with no specific pa14 tient in mind, but that are appropriately sized, 

15 adapted, modified, and configured (with the re16 quired tools and equipment) to a specific pa17 tient in accordance with a prescription, and 

18 which no other patient would be able to use, as 

19 well as all services and supplies that are medi20 cally necessary for the effective use of the 

21 orthotic device and instructing the patient in 

22 the use of the device. Custom-fitted high devices 

23 may be furnished only by an appropriately 

24 credentialed (certified or licensed) practitioner 

25 and accredited supplier in Orthotics or ProsVerDate Mar 15 2010 00:17 Mar 09, 2012 Jkt 019200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 E:\BILLS\H4175.IH H4175

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1 thetics. Such devices and related services are 

2 represented by the existing set of L-codes under 

3 the Healthcare Common Procedure Coding Sys4 tem describing this care listed on the date of 

5 enactment of this section in Centers for Medi6 care & Medicaid Services Transmittal 656. 

7 For purposes of subparagraphs (A) and (B), Centers 

8 for Medicare & Medicaid Services Transmittal 656, 

9 upon modification or reissuance by the Centers for 

10 Medicare & Medicaid Services to reflect new code ad11 ditions and coding changes for prosthetics and cus12 tom orthotics, shall be the version of the Transmittal 

13 used for purposes of such subparagraphs. 

14 ‘‘(3) FINANCIAL REQUIREMENTS.—The term 

15 ‘financial requirements’ includes deductibles, coin16 surance, co-payments, other cost sharing, and limita17 tions on the total amount that may be paid by a 

18 participant or beneficiary with respect to benefits 

19 under the plan or health insurance coverage and also 

20 includes the application of annual and lifetime lim21 its. 

22 ‘‘(4) TREATMENT LIMITATIONS.—The term 

23 ‘treatment limitations’ includes limits on the fre24 quency of treatment, number of visits, days of covVerDate Mar 15 2010 00:17 Mar 09, 2012 Jkt 019200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\H4175.IH H4175

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1 erage, or other similar limits on the scope or dura2 tion of treatment. 

3 ‘‘(f) DIFFERENTIATION FROM DURABLE MEDICAL

4 EQUIPMENT.—For purposes of this section, prosthetics 

5 and custom orthotics shall be treated as distinct from du6 rable medical equipment.’’. 

7 (c) EFFECTIVE DATE.—The amendments made by 

8 this section shall apply with respect to group health plans 

9 (and health insurance coverage offered in connection with 

10 group health plans) for plan years beginning on or after 

11 the date of the enactment of this Act. 

12 SEC. 4. UPDATING STANDARD DEFINITIONS TO INCLUDE 

13 PROSTHETICS AND CUSTOM ORTHOTICS. 

14 Section 2715(g)(3) of the Public Health Service Act 

15 (42 U.S.C. 300gg–15(g)(3)) is amended by inserting 

16 ‘‘prosthetics, custom orthotics,’’ after ‘‘emergency medical 

17 transportation,’’. 

18 SEC. 5. FEDERAL ADMINISTRATIVE RESPONSIBILITIES. 

19 (a) ASSISTANCE TO ENROLLEES.—The Secretary of 

20 Labor, in consultation with the Secretary of Health and 

21 Human Services, shall provide assistance to enrollees 

22 under group health plans (and health insurance coverage 

23 offered in connection with such plans) to which the amend24 ment made by section 3 apply with any questions or probVerDate Mar 15 2010 00:17 Mar 09, 2012 Jkt 019200 PO 00000 Frm 00020 Fmt 6652 Sfmt 6201 E:\BILLS\H4175.IH H4175

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1 lems with respect to compliance with the requirements of 

2 such amendment. 

3 (b) AUDITS.—The Secretary of Labor, in consulta4 tion with the Secretary of Health and Human Services, 

5 shall provide for the conduct of random audits of group 

6 health plans (and health insurance coverage offered in 

7 connection with such plans) to ensure that such plans (or 

8 coverage) are in compliance with the amendments made 

9 by section (3). 

10 (c) GAO STUDY.— 

11 (1) STUDY.—The Comptroller General of the 

12 United States shall conduct a study that evaluates 

13 the effect of the implementation of the amendments 

14 made by this Act on the cost of the health insurance 

15 coverage, on access to health insurance coverage (in16 cluding the availability of in-network providers), on 

17 the quality of health care, on benefits and coverage 

18 for prosthetics and custom orthotics on any addi19 tional cost or savings to group health plans, on State 

20 prosthetics and custom orthotics benefit laws, on the 

21 business community and the Federal Government, 

22 and on other issues as determined appropriate by 

23 the Comptroller General. 

24 (2) REPORT.—Not later than 2 years after the 

25 date of the enactment of this Act, the Comptroller 


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1 General of the United States shall prepare and sub2 mit to the appropriate committee of Congress a re3 port containing the results of the study conducted 

4 under paragraph (1). 

5 (d) REGULATIONS.—Not later than 1 year after the 

6 date of the enactment of this Act, the Secretary of Labor, 

7 in consultation with the Secretary of Health and Human 

8 Services, shall promulgate final regulations to carry out 

9 this Act and the amendments made by this Act. 

10 SEC. 6. DEFINITIONS. 

11 In this Act: 

12 (1) CUSTOM ORTHOTICS AND PROSTHETICS.— 

13 The terms ‘‘custom orthotics’’ and ‘‘prosthetics’’ 

14 have the meanings given such terms in section 

15 716(e) of the Employee Retirement and Income Se16 curity Act of 1974 (as added by section 3). 

17 (2) GROUP HEALTH PLAN.—The term ‘‘group 

18 health plan’’ has the meaning given such term in 

19 section 733(a) of such Act (29 U.S.C. 1191b(a)). 

20 (3) HEALTH INSURANCE COVERAGE.—The term 

21 ‘‘health insurance coverage’’ has the meaning given 

22 such term in section 733(b)(1) of such Act (29 

23 U.S.C. 1191b(b)(1)). 

Æ 


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