I 

115TH CONGRESS 

2D SESSION H. R. 4978 

To amend the Internal Revenue Code of 1986 to permit high-deductible 

health plans to provide chronic disease prevention services to plan enrollees prior to satisfying their plan deductible. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 8, 2018 

Mrs. BLACK (for herself and Mr. BLUMENAUER) introduced the following bill; 

which was referred to the Committee on Ways and Means 

A BILL 

To amend the Internal Revenue Code of 1986 to permit 

high-deductible health plans to provide chronic disease 

prevention services to plan enrollees prior to satisfying 

their plan deductible. 

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; FINDINGS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Chronic Disease Management Act of 2018’’. 

6 (b) FINDINGS.—Congress finds the following: 


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1 (1) A small number of chronic diseases account 

2 for the majority of health care spending in the 

3 United States. 

4 (2) Limited and targeted interventions for 

5 many chronic diseases prevent the need for addi6 tional, more costly therapies associated with un7 treated or unmanaged chronic diseases that lead to 

8 adverse effects on quality of life for patients. 

9 (3) These types of chronic care preventive serv10 ices should be encouraged to maximize the effective11 ness and positive outcomes of the care provided 

12 under high-deductible health plans. 

13 (4) Section 223(c)(2)(C) of the Internal Rev14 enue Code of 1986 explicitly grants the Secretary of 

15 the Treasury flexibility in defining the scope of pre16 ventive care for purposes of the preventive care safe 

17 harbor. As of the date of introduction of this Act, 

18 the Secretary of the Treasury has refrained from ex19 ercising existing authority under such section to ex20 pand the preventive care safe harbor to include 

21 chronic disease prevention. 

22 (5) In the absence of an expansion of the pre23 ventive care safe harbor by the Secretary of the 

24 Treasury, the Chronic Disease Management Act of 

25 2018 would expressly permit high-deductible health 


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1 plans to provide chronic disease prevention and 

2 treatment, subject to certain limitations, prior to a 

3 plan enrollee having met their plan deductible. 

4 (6) Allowing HSA-eligible high-deductible 

5 health plans to cover chronic disease prevention and 

6 treatment on a pre-deductible basis promotes the 

7 concept of Value-Based Insurance Design, which is 

8 an effective tool to improve the quality and reduce 

9 the cost of care for Americans with chronic diseases, 

10 with improved outcomes via increased medication ad11 herence, reduced complications, and decreased emer12 gency department visits. 

13 SEC. 2. CHRONIC DISEASE PREVENTION. 

14 (a) IN GENERAL.—Section 223(c)(2) of the Internal 

15 Revenue Code of 1986 is amended by redesignating sub16 paragraph (D) as subparagraph (E) and by inserting after 

17 subparagraph (C) the following new subparagraph: 

18 ‘‘(D) SAFE HARBOR FOR ABSENCE OF DE19 DUCTIBLE FOR CARE RELATED TO CHRONIC

20 CONDITIONS.—A plan shall not fail to be treat21 ed as a high-deductible health plan by reason of 

22 failing to have a deductible for care and pre23 scription medicines related to the treatment of 

24 medically complex chronic conditions which— 


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1 ‘‘(i) are substantially disabling or life 

2 threatening, 

3 ‘‘(ii) have a high risk of hospitaliza4 tion or other significant adverse health 

5 outcomes, and 

6 ‘‘(iii) require specialized delivery sys7 tems across domains of care.’’. 

8 (b) EFFECTIVE DATE.—The amendments made by 

9 this section shall apply to coverage for months beginning 

10 after the date of the enactment of this Act. 

Æ 


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