I 

118TH CONGRESS 

2D SESSION H. R. 9132 

To amend the Employee Retirement Income Security Act of 1974, title 

XXVII of the Public Health Service Act, 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 additional preventive care for individuals with chronic conditions 

without the imposition of cost sharing requirement, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 25, 2024 

Ms. UNDERWOOD (for herself, Ms. SCHAKOWSKY, and Mrs. HAYES) introduced the following bill; which was referred to the Committee on Energy 

and 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 Employee Retirement Income Security Act 

of 1974, title XXVII of the Public Health Service Act, 

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 additional preventive care for individuals with 

chronic conditions without the imposition of cost sharing 

requirement, and for other purposes. 


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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 ‘‘Chronic Condition 

5 Copay Elimination Act’’. 

6 SEC. 2. COVERAGE OF ADDITIONAL PREVENTIVE CARE FOR 

7 INDIVIDUALS WITH CHRONIC CONDITIONS 

8 WITHOUT IMPOSITION OF COST SHARING RE9 QUIREMENTS. 

10 (a) ERISA.— 

11 (1) IN GENERAL.—Subpart B of part 7 of sub12 title B of title I of the Employee Retirement Income 

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

14 amended by adding at the end the following new sec15 tion: 

16 ‘‘SEC. 726. COVERAGE OF ADDITIONAL PREVENTIVE CARE 

17 FOR INDIVIDUALS WITH CHRONIC CONDI18 TIONS WITHOUT IMPOSITION OF COST SHAR19 ING REQUIREMENTS. 

20 ‘‘(a) IN GENERAL.—In addition to any item or serv21 ice described in section 2713(a) of the Public Health Serv22 ice Act, a group health plan and a health insurance issuer 

23 offering group health insurance coverage shall, at a min24 imum, provide coverage for, and shall not impose any cost 

25 sharing requirements for, with respect to individuals with 


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1 chronic conditions (as defined in subsection (b)), such ad2 ditional preventive care and screenings not described in 

3 paragraph (1) of such section 2713(a) that are determined 

4 by the Secretary to meet the criteria specified in sub5 section (c) with respect to the chronic condition involved. 

6 ‘‘(b) CHRONIC CONDITION DEFINED.—In this sec7 tion, the term ‘chronic condition’ has the meaning given 

8 such term by the Secretary and, at a minimum, includes 

9 the following conditions: 

10 ‘‘(1) Heart disease, including congestive heart 

11 failure and coronary artery disease. 

12 ‘‘(2) Diabetes. 

13 ‘‘(3) Osteoporosis and osteopenia. 

14 ‘‘(4) Hypertension. 

15 ‘‘(5) Asthma. 

16 ‘‘(6) Liver disease. 

17 ‘‘(7) Bleeding disorders. 

18 ‘‘(8) Depression. 

19 ‘‘(c) CRITERIA SPECIFIED.—For purposes of sub20 section (a), the criteria specified in this subsection, with 

21 respect to an item or service and a chronic condition, are 

22 the following: 

23 ‘‘(1) The item or service is low-cost. 

24 ‘‘(2) There is medical evidence supporting high25 cost efficiency, or a large expected impact, of the 


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1 item or service in preventing exacerbation of the 

2 chronic condition or the development of a secondary 

3 condition. 

4 ‘‘(3) There is a strong likelihood, documented 

5 by clinical evidence, that the item or service will pre6 vent the exacerbation of the chronic condition or the 

7 development of a secondary condition that requires 

8 significantly higher-cost treatments. 

9 ‘‘(d) UPDATES.— 

10 ‘‘(1) IN GENERAL.—Once every three years, the 

11 Secretary shall review and update— 

12 ‘‘(A) the list of conditions included within 

13 the meaning of the term ‘chronic condition’ 

14 under subsection (b); and 

15 ‘‘(B) the items and services determined to 

16 meet the criteria specified in subsection (c) for 

17 purposes of subsection (a). 

18 ‘‘(2) APPLICATION OF UPDATES.—The require19 ment under subsection (a) shall apply with respect 

20 to an update made under paragraph (1) beginning 

21 with the first plan year beginning after the date of 

22 such update.’’. 

23 (2) CLERICAL AMENDMENT.—The table of con24 tents in section 1 of such Act is amended by insertVerDate Sep 11 2014 02:03 Aug 21, 2024 Jkt 049200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H9132.IH H9132

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1 ing after the item relating to section 725 the fol2 lowing new items: 

‘‘726. Coverage of additional preventive care for individuals with chronic conditions without imposition of cost sharing requirements.’’. 

3 (b) PHSA.—Part D of title XXVII of the Public 

4 Health Service Act (42 U.S.C. 300gg–11 et seq.), is 

5 amended by adding at the end the following new section: 

6 ‘‘SEC. 2799A–11. COVERAGE OF ADDITIONAL PREVENTIVE 

7 CARE FOR INDIVIDUALS WITH CHRONIC CON8 DITIONS WITHOUT IMPOSITION OF COST 

9 SHARING REQUIREMENTS. 

10 ‘‘(a) IN GENERAL.—In addition to any item or serv11 ice described in section 2713(a), a group health plan and 

12 a health insurance issuer offering group or individual 

13 health insurance coverage shall, at a minimum, provide 

14 coverage for, and shall not impose any cost sharing re15 quirements for, with respect to individuals with chronic 

16 conditions (as defined in subsection (b)), such additional 

17 preventive care and screenings not described in paragraph 

18 (1) of section 2713(a) that are determined by the Sec19 retary to meet the criteria specified in subsection (c) with 

20 respect to the chronic condition involved. 

21 ‘‘(b) CHRONIC CONDITION DEFINED.—In this sec22 tion, the term ‘chronic condition’ has the meaning given 

23 such term by the Secretary and, at a minimum, includes 

24 the following conditions: 


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1 ‘‘(1) Heart disease, including congestive heart 

2 failure and coronary artery disease. 

3 ‘‘(2) Diabetes. 

4 ‘‘(3) Osteoporosis and osteopenia. 

5 ‘‘(4) Hypertension. 

6 ‘‘(5) Asthma. 

7 ‘‘(6) Liver disease. 

8 ‘‘(7) Bleeding disorders. 

9 ‘‘(8) Depression. 

10 ‘‘(c) CRITERIA SPECIFIED.—For purposes of sub11 section (a), the criteria specified in this subsection, with 

12 respect to an item or service and a chronic condition, are 

13 the following: 

14 ‘‘(1) The item or service is low-cost. 

15 ‘‘(2) There is medical evidence supporting high16 cost efficiency, or a large expected impact, of the 

17 item or service in preventing exacerbation of the 

18 chronic condition or the development of a secondary 

19 condition. 

20 ‘‘(3) There is a strong likelihood, documented 

21 by clinical evidence, that the item or service will pre22 vent the exacerbation of the chronic condition or the 

23 development of a secondary condition that requires 

24 significantly higher-cost treatments. 

25 ‘‘(d) UPDATES.— 


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1 ‘‘(1) IN GENERAL.—Once every three years, the 

2 Secretary shall review and update— 

3 ‘‘(A) the list of conditions included within 

4 the meaning of the term ‘chronic condition’ 

5 under subsection (b); and 

6 ‘‘(B) the items and services determined to 

7 meet the criteria specified in subsection (c) for 

8 purposes of subsection (a). 

9 ‘‘(2) APPLICATION OF UPDATES.—The require10 ment under subsection (a) shall apply with respect 

11 to an update made under paragraph (1) beginning 

12 with the first plan year beginning after the date of 

13 such update.’’. 

14 (c) IRC.— 

15 (1) IN GENERAL.—Subchapter B of chapter 

16 100 of the Internal Revenue Code of 1986 is amend17 ed by adding at the end the following new section: 

18 ‘‘SEC. 9826. COVERAGE OF ADDITIONAL PREVENTIVE CARE 

19 FOR INDIVIDUALS WITH CHRONIC CONDI20 TIONS WITHOUT IMPOSITION OF COST SHAR21 ING REQUIREMENTS. 

22 ‘‘(a) IN GENERAL.—In addition to any item or serv23 ice described in section 2713(a) of the Public Health Serv24 ice Act, a group health plan shall, at a minimum, provide 

25 coverage for, and shall not impose any cost sharing reVerDate Sep 11 2014 02:03 Aug 21, 2024 Jkt 049200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H9132.IH H9132

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1 quirements for, with respect to individuals with chronic 

2 conditions (as defined in subsection (b)), such additional 

3 preventive care and screenings not described in paragraph 

4 (1) of such section 2713(a) that are determined by the 

5 Secretary to meet the criteria specified in subsection (c) 

6 with respect to the chronic condition involved. 

7 ‘‘(b) CHRONIC CONDITION DEFINED.—In this sec8 tion, the term ‘chronic condition’ has the meaning given 

9 such term by the Secretary and, at a minimum, includes 

10 the following conditions: 

11 ‘‘(1) Heart disease, including congestive heart 

12 failure and coronary artery disease. 

13 ‘‘(2) Diabetes. 

14 ‘‘(3) Osteoporosis and osteopenia. 

15 ‘‘(4) Hypertension. 

16 ‘‘(5) Asthma. 

17 ‘‘(6) Liver disease. 

18 ‘‘(7) Bleeding disorders. 

19 ‘‘(8) Depression. 

20 ‘‘(c) CRITERIA SPECIFIED.—For purposes of sub21 section (a), the criteria specified in this subsection, with 

22 respect to an item or service and a chronic condition, are 

23 the following: 

24 ‘‘(1) The item or service is low-cost. 


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1 ‘‘(2) There is medical evidence supporting high2 cost efficiency, or a large expected impact, of the 

3 item or service in preventing exacerbation of the 

4 chronic condition or the development of a secondary 

5 condition. 

6 ‘‘(3) There is a strong likelihood, documented 

7 by clinical evidence, that the item or service will pre8 vent the exacerbation of the chronic condition or the 

9 development of a secondary condition that requires 

10 significantly higher-cost treatments. 

11 ‘‘(d) UPDATES.— 

12 ‘‘(1) IN GENERAL.—Once every three years, the 

13 Secretary shall review and update— 

14 ‘‘(A) the list of conditions included within 

15 the meaning of the term ‘chronic condition’ 

16 under subsection (b); and 

17 ‘‘(B) the items and services determined to 

18 meet the criteria specified in subsection (c) for 

19 purposes of subsection (a). 

20 ‘‘(2) APPLICATION OF UPDATES.—The require21 ment under subsection (a) shall apply with respect 

22 to an update made under paragraph (1) beginning 

23 with the first plan year beginning after the date of 

24 such update.’’. 


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1 (2) CLERICAL AMENDMENT.—The table of con2 tents for subchapter B of chapter 100 of such Code 

3 is amended by adding at the end the following new 

4 item: 

‘‘9826. Coverage of additional preventive care for individuals with chronic conditions without imposition of cost sharing requirements.’’. 

5 (3) HIGH DEDUCTIBLE HEALTH PLANS.—Sec6 tion 223(c)(2)(C) of the Internal Revenue Code of 

7 1986 is amended by inserting ‘‘or for additional pre8 ventive care for individuals with chronic conditions 

9 described in section 9826’’ before the period. 

10 (d) EFFECTIVE DATE.—The amendments made by 

11 this section shall apply with respect to plan years begin12 ning on or after the date that is one year after the date 

13 of the enactment of this Act. 

Æ 


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