I 

112TH CONGRESS 

1ST SESSION H. R. 1311 

To provide for the coverage of medically necessary food under Federal health 

programs and private health insurance. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 1, 2011 

Ms. BALDWIN (for herself, Mr. POLIS, Ms. JACKSON LEE of Texas, Ms. 

EDDIE BERNICE JOHNSON of Texas, and Mr. JOHNSON of Georgia) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and 

Means, Armed Services, and 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 provide for the coverage of medically necessary food under 

Federal health programs and private health insurance. 

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 ‘‘Medical Foods Equity 

5 Act of 2011’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 


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1 (1) Newborns are screened for inborn errors of 

2 metabolism, but treatment for such conditions is not 

3 uniformly covered by insurance. 

4 (2) Each year approximately 2,550 children in 

5 the United States are diagnosed with an inborn 

6 error of metabolism disorder, requiring foods modi7 fied to be void of the nutrient or nutrients the 

8 child’s body is incapable of processing, or requiring 

9 supplementation with vitamins or amino acids. 

10 (3) More than 35 States have passed laws to at 

11 least partially address the inequity in coverage for 

12 medically necessary foods, critical treatment for such 

13 disorders. 

14 (4) The cost associated with providing medically 

15 necessary foods presents a large financial burden for 

16 many families. 

17 (5) There is no current cure for inborn errors 

18 of metabolism disorders and treatment is necessary 

19 during the entire lifespan of the individual. 

20 SEC. 3. COVERAGE IN FEDERAL HEALTH PROGRAMS OF 

21 MEDICALLY NECESSARY FOOD AND FOOD 

22 MODIFIED TO BE LOW PROTEIN. 

23 (a) COVERAGE UNDER THE MEDICARE PROGRAM.— 


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1 (1) COVERAGE OF MEDICALLY NECESSARY

2 FOOD UNDER THE ORIGINAL MEDICARE FEE-FOR3 SERVICE PROGRAM.— 

4 (A) IN GENERAL.—Section 1861(s)(2) of 

5 the Social Security Act (42 U.S.C. 1395x(s)(2)) 

6 is amended— 

7 (i) in subparagraph (EE), by striking 

8 ‘‘and’’ at the end; 

9 (ii) in subparagraph (FF), by insert10 ing ‘‘and’’ at the end; and 

11 (iii) by adding at the end the fol12 lowing new subparagraph: 

13 ‘‘(GG) medically necessary food (as defined in 

14 subsection (iii)) and food modified to be low protein 

15 that is formulated to be consumed or administered 

16 under the supervision of a qualified medical pro17 vider, for the treatment of conditions as rec18 ommended by the Advisory Committee on Heritable 

19 Disorders in Newborns and Children, and the med20 ical equipment and supplies necessary to administer 

21 such food;’’. 

22 (B) DEFINITION.—Section 1861 of the So23 cial Security Act (42 U.S.C. 1395x) is amended 

24 by adding at the end the following new sub25 section: 


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1 ‘‘(iii)(1) The term ‘medically necessary food’— 

2 ‘‘(A) means a food which is formulated to be 

3 consumed or administered enterally under the super4 vision of a physician and which is intended for the 

5 specific dietary management of a disease or condi6 tion for which distinctive nutritional requirements, 

7 based on recognized scientific principles, are estab8 lished by medical evaluation; and 

9 ‘‘(B) includes nutritionally modified counter10 parts of traditional foods and other forms of foods 

11 such as formulas, pills, capsules, and bars, so long 

12 as consumed or administered enterally. 

13 ‘‘(2) For purposes of paragraph (1), the term 

14 ‘enterally’ refers to consumption or administration 

15 through the gastrointestinal tract, whether orally or by 

16 tube.’’. 

17 (C) PAYMENT.—Section 1833(a)(1) of the 

18 Social Security Act (42 U.S.C. 1395l(a)(1)) is 

19 amended— 

20 (i) by striking ‘‘and’’ before ‘‘(Z)’’; 

21 and 

22 (ii) by inserting before the semicolon 

23 at the end the following: ‘‘, and (AA) with 

24 respect to medically necessary food and 

25 pharmacological doses of vitamins and 


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1 amino acids under section 1861(s)(2)(GG), 

2 the amounts paid shall be 80 percent of 

3 the lesser of the actual charge for the serv4 ices or 85 percent of the amount deter5 mined under the fee schedule established 

6 under section 1848(b) for the same serv7 ices if furnished by a physician’’. 

8 (2) INCLUSION OF PHARMACOLOGICAL DOSES

9 OF VITAMINS AND AMINO ACIDS AS A COVERED PART

10 D DRUG.— 

11 (A) IN GENERAL.—Section 1860D–2(e)(1) 

12 of the Social Security Act (42 U.S.C. 1395w– 

13 102(e)(1)) is amended— 

14 (i) in subparagraph (A), by striking 

15 ‘‘or’’ at the end; 

16 (ii) in subparagraph (B), by striking 

17 the comma at the end and inserting ‘‘; or’’; 

18 and 

19 (iii) by inserting after subparagraph 

20 (B) the following new subparagraph: 

21 ‘‘(C) pharmacological doses of vitamins 

22 and amino acids used for the treatment of in23 born errors of metabolism, for the treatment of 

24 conditions as recommended by the Advisory 

25 Committee on Heritable Disorders in Newborns 


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1 and Children and as prescribed by a qualified 

2 medical provider,’’. 

3 (B) EFFECTIVE DATE.—The amendments 

4 made by subparagraph (A) shall apply to plan 

5 years beginning on or after the date that is 6 

6 months after date of enactment of this Act. 

7 (b) COVERAGE UNDER THE MEDICAID PROGRAM.— 

8 (1) IN GENERAL.—Section 1905 of the Social 

9 Security Act (42 U.S.C. 1396d) is amended— 

10 (A) in subsection (a)— 

11 (i) in paragraph (12), by inserting 

12 ‘‘including pharmacological doses of vita13 mins and amino acids used for the treat14 ment of inborn errors of metabolism, for 

15 the treatment of conditions as rec16 ommended by the Advisory Committee on 

17 Heritable Disorders in Newborns and Chil18 dren and as prescribed by a qualified med19 ical provider,’’ after ‘‘prescribed drugs,’’; 

20 (ii) in paragraph (28), by striking 

21 ‘‘and’’ at the end; 

22 (iii) in paragraph (29), by striking the 

23 comma at the end and inserting ‘‘; and’’; 

24 and 


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1 (iv) by inserting after paragraph (29) 

2 the following new paragraph: 

3 ‘‘(30) medically necessary food (as defined in 

4 subsection (ee)) and food modified to be low protein 

5 that is formulated to be consumed or administered 

6 under the supervision of a qualified medical pro7 vider, for the treatment of conditions as rec8 ommended by the Advisory Committee on Heritable 

9 Disorders in Newborns and Children, and the med10 ical equipment and supplies necessary to administer 

11 such food,’’; and 

12 (B) by adding at the end the following new 

13 subsection: 

14 ‘‘(ee) MEDICALLY NECESSARY FOOD DEFINED.— 

15 ‘‘(1) IN GENERAL.—For purposes of subsection 

16 (a)(30), the term ‘medically necessary food’— 

17 ‘‘(A) means a food which is formulated to 

18 be consumed or administered enterally under 

19 the supervision of a physician and which is in20 tended for the specific dietary management of 

21 a disease or condition for which distinctive nu22 tritional requirements, based on recognized sci23 entific principles, are established by medical 

24 evaluation; and 


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1 ‘‘(B) includes nutritionally modified coun2 terparts of traditional foods and other forms of 

3 foods such as formulas, pills, capsules, and 

4 bars, so long as consumed or administered 

5 enterally. 

6 ‘‘(2) ENTERALLY.—For purposes of paragraph 

7 (1), the term ‘enterally’ refers to consumption or ad8 ministration through the gastrointestinal tract, 

9 whether orally or by tube.’’. 

10 (2) EXCEPTION TO REBATE EXCLUSION.—Sec11 tion 1927(d)(2)(E) of the Social Security Act (42 

12 U.S.C. 1396r–8(d)(2)(E)) is amended by inserting 

13 ‘‘, pharmacological doses of vitamins and amino 

14 acids used for the treatment of inborn errors of me15 tabolism, for the treatment of conditions as rec16 ommended by the Advisory Committee on Heritable 

17 Disorders in Newborns and Children and as pre18 scribed by a qualified medical provider,’’ after ‘‘pre19 natal vitamins’’. 

20 (3) CONFORMING AMENDMENT.—Section 

21 1902(a)(10)(A) of the Social Security Act (42 

22 U.S.C. 1396a(a)(10)(A)) is amended, in the matter 

23 preceding clause (i), by striking ‘‘and (28)’’ and in24 serting ‘‘(28), and (30)’’. 


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1 (4) EXCEPTION TO EFFECTIVE DATE IF STATE

2 LEGISLATION REQUIRED.—In the case of a State 

3 plan for medical assistance under title XIX of the 

4 Social Security Act which the Secretary of Health 

5 and Human Services (referred to in this Act as the 

6 ‘‘Secretary’’) determines requires State legislation 

7 (other than legislation appropriating funds) in order 

8 for the plan to meet the additional requirement im9 posed by the amendments made by this subsection, 

10 the State plan shall not be regarded as failing to 

11 comply with the requirements of such title solely on 

12 the basis of its failure to meet this additional re13 quirement before the first day of the first calendar 

14 quarter beginning after the close of the first regular 

15 session of the State legislature that begins after the 

16 date of the enactment of this Act. For purposes of 

17 the previous sentence, in the case of a State that has 

18 a 2-year legislative session, each year of such session 

19 shall be deemed to be a separate regular session of 

20 the State legislature. 

21 (c) COVERAGE UNDER CHIP.— 

22 (1) IN GENERAL.— 

23 (A) MEDICALLY NECESSARY FOOD.—Sec24 tion 2103(c) of the Social Security Act (42 


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1 U.S.C. 1397cc(c)) is amended by adding at the 

2 end the following: 

3 ‘‘(9) MEDICALLY NECESSARY FOOD.— 

4 ‘‘(A) IN GENERAL.—The child health as5 sistance provided to a targeted low-income child 

6 under the plan shall include coverage of medi7 cally necessary food and food modified to be low 

8 protein that is formulated to be consumed or 

9 administered under the supervision of a quali10 fied medical provider, for the treatment of con11 ditions as recommended by the Advisory Com12 mittee on Heritable Disorders in Newborns and 

13 Children, and the medical equipment and sup14 plies necessary to administer such food. 

15 ‘‘(B) DEFINITIONS.—In this paragraph— 

16 ‘‘(i) the term ‘medically necessary 

17 food’— 

18 ‘‘(I) means a food which is for19 mulated to be consumed or adminis20 tered enterally under the supervision 

21 of a physician and which is intended 

22 for the specific dietary management of 

23 a disease or condition for which dis24 tinctive nutritional requirements, 

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1 ciples, are established by medical eval2 uation; and 

3 ‘‘(II) includes nutritionally modi4 fied counterparts of traditional foods 

5 and other forms of foods such as for6 mulas, pills, capsules, and bars, so 

7 long as consumed or administered 

8 enterally; and 

9 ‘‘(ii) the term ‘enterally’ refers to con10 sumption or administration through the 

11 gastrointestinal tract, whether orally or by 

12 tube.’’. 

13 (B) VITAMINS AND AMINO ACIDS.—Section 

14 2110(a)(6) of the Social Security Act (42 

15 U.S.C. 1397jj(a)(6)) is amended by striking 

16 ‘‘and biologicals and the administration of such 

17 drugs and biologicals, only if such drugs and 

18 biologicals’’ and inserting ‘‘, pharmacological 

19 doses of vitamins and amino acids used for the 

20 treatment of inborn errors of metabolism, for 

21 the treatment of conditions as recommended by 

22 the Advisory Committee on Heritable Disorders 

23 in Newborns and Children and as prescribed by 

24 a qualified medical provider, and biologicals, 

25 and the administration of such drugs, vitamins 


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1 and amino acids, and biologicals, only if such 

2 drugs, vitamins and amino acids, and 

3 biologicals’’. 

4 (2) CONFORMING AMENDMENT.—Section 

5 2103(a) of the Social Security Act (42 U.S.C. 

6 1397cc(a)) is amended, in the matter preceding 

7 paragraph (1), by striking ‘‘, and (7)’’ and inserting 

8 ‘‘, (7), and (9)’’. 

9 (d) AVAILABILITY OF MEDICALLY NECESSARY FOOD, 

10 FOOD MODIFIED TO BE LOW PROTEIN, AND RELATED

11 ITEMS UNDER THE TRICARE PROGRAM.—Section 

12 1077(a)(8) of title 10, United States Code, is amended 

13 by striking ‘‘including’’ and all that follows and inserting 

14 ‘‘including the following: 

15 ‘‘(A) Well-baby care that includes one 

16 screening of an infant for the level of lead in 

17 the blood of the infant. 

18 ‘‘(B) Medically necessary food (as defined 

19 in section 1861(iii) of the Social Security Act) 

20 and food modified to be low protein that is for21 mulated to be consumed or administered under 

22 the supervision of a qualified medical provider, 

23 for the treatment of conditions as recommended 

24 by the Advisory Committee on Heritable Dis25 orders in Newborns and Children, and the medVerDate Mar 15 2010 22:57 Apr 04, 2011 Jkt 099200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H1311.IH H1311

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1 ical equipment and supplies necessary to admin2 ister such food. 

3 ‘‘(C) Pharmacological doses of vitamins 

4 and amino acids used for the treatment of in5 born errors of metabolism and other conditions 

6 as recommended by the Advisory Committee on 

7 Heritable Disorders in Newborns and Chil8 dren.’’. 

9 SEC. 4. COVERAGE IN THE PRIVATE INSURANCE MARKET 

10 OF MEDICALLY NECESSARY FOOD AND FOOD 

11 MODIFIED TO BE LOW PROTEIN. 

12 (a) GROUP HEALTH PLANS.— 

13 (1) AMENDMENTS TO ERISA.— 

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

15 title I of the Employee Retirement Income Se16 curity Act of 1974 (29 U.S.C. 1185 et seq.) is 

17 amended by adding at the end the following: 

18 ‘‘SEC. 716. COVERAGE OF MEDICALLY NECESSARY FOOD 

19 AND FOOD MODIFIED TO BE LOW PROTEIN. 

20 ‘‘(a) DEFINITION.—In this section— 

21 ‘‘(1) the term ‘medically necessary food’— 

22 ‘‘(A) means a food which is formulated to 

23 be consumed or administered enterally under 

24 the supervision of a physician and which is in25 tended for the specific dietary management of 


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1 a disease or condition for which distinctive nu2 tritional requirements, based on recognized sci3 entific principles, are established by medical 

4 evaluation; and 

5 ‘‘(B) includes nutritionally modified coun6 terparts of traditional foods and other forms of 

7 foods such as formulas, pills, capsules, and 

8 bars, so long as consumed or administered 

9 enterally; and 

10 ‘‘(2) the term ‘enterally’ refers to consumption 

11 or administration through the gastrointestinal tract, 

12 whether orally or by tube. 

13 ‘‘(b) COVERAGE.— 

14 ‘‘(1) MEDICALLY NECESSARY FOOD AND FOOD

15 MODIFIED TO BE LOW PROTEIN.—A group health 

16 plan, or a health insurance issuer that provides 

17 health insurance coverage in connection with a group 

18 health plan, shall provide coverage for medically nec19 essary food and food modified to be low protein that 

20 is formulated to be consumed or administered under 

21 the supervision of a qualified medical provider, for 

22 the treatment of conditions as recommended by the 

23 Advisory Committee on Heritable Disorders in 

24 Newborns and Children, and the medical equipment 

25 and supplies necessary to administer such food. 


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1 ‘‘(2) VITAMINS AND AMINO ACIDS.—A group 

2 health plan, or a health insurance issuer that pro3 vides health insurance coverage in connection with a 

4 group health plan, that provides prescription drug 

5 coverage shall provide coverage for pharmacological 

6 doses of vitamins and amino acids used for the 

7 treatment of inborn errors of metabolism, for the 

8 treatment of conditions as recommended by the Ad9 visory Committee on Heritable Disorders in 

10 Newborns and Children and as prescribed by a 

11 qualified medical provider, to the same extent as 

12 other prescription drug coverage under such plan or 

13 coverage.’’. 

14 (B) CONFORMING AMENDMENT.—The 

15 table of contents in section 1 of such Act is 

16 amended by inserting after the item relating to 

17 section 714 the following new items: 

‘‘Sec. 715. Additional market reforms. 

‘‘Sec. 716. Coverage of medically necessary food and food modified to be low 

protein.’’. 

18 (2) AMENDMENTS TO THE PUBLIC HEALTH

19 SERVICE ACT.—Subpart 2 of part A of title XXVII 

20 of the Public Health Service Act (42 U.S.C. 300gg– 

21 4 et seq.) is amended by adding at the end the fol22 lowing new section: 


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1 ‘‘SEC. 2729. COVERAGE OF MEDICALLY NECESSARY FOOD 

2 AND FOOD MODIFIED TO BE LOW PROTEIN. 

3 ‘‘(a) DEFINITIONS.—In this section— 

4 ‘‘(1) the term ‘medically necessary food’— 

5 ‘‘(A) means a food which is formulated to 

6 be consumed or administered enterally under 

7 the supervision of a physician and which is in8 tended for the specific dietary management of 

9 a disease or condition for which distinctive nu10 tritional requirements, based on recognized sci11 entific principles, are established by medical 

12 evaluation; and 

13 ‘‘(B) includes nutritionally modified coun14 terparts of traditional foods and other forms of 

15 foods such as formulas, pills, capsules, and 

16 bars, so long as consumed or administered 

17 enterally; and 

18 ‘‘(2) the term ‘enterally’ refers to consumption 

19 or administration through the gastrointestinal tract, 

20 whether orally or by tube. 

21 ‘‘(b) COVERAGE.— 

22 ‘‘(1) MEDICALLY NECESSARY FOOD AND FOOD

23 MODIFIED TO BE LOW PROTEIN.—A group health 

24 plan, or a health insurance issuer that provides 

25 health insurance coverage in connection with a group 

26 health plan, shall provide coverage for medically necVerDate Mar 15 2010 22:57 Apr 04, 2011 Jkt 099200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\H1311.IH H1311

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1 essary food and food modified to be low protein that 

2 is formulated to be consumed or administered under 

3 the supervision of a qualified medical provider, for 

4 the treatment of conditions as recommended by the 

5 Advisory Committee on Heritable Disorders in 

6 Newborns and Children, and the medical equipment 

7 and supplies necessary to administer such food. 

8 ‘‘(2) VITAMINS AND AMINO ACIDS.—A group 

9 health plan, or a health insurance issuer that pro10 vides health insurance coverage in connection with a 

11 group health plan, that provides prescription drug 

12 coverage, shall provide coverage for pharmacological 

13 doses of vitamins and amino acids used for the 

14 treatment of inborn errors of metabolism, for the 

15 treatment of conditions as recommended by the Ad16 visory Committee on Heritable Disorders in 

17 Newborns and Children and as prescribed by a 

18 qualified medical provider, to the same extent as 

19 other prescription drug coverage under such plan or 

20 coverage.’’. 

21 (3) AMENDMENTS TO THE INTERNAL REVENUE

22 CODE.— 

23 (A) IN GENERAL.—Subchapter B of chap24 ter 100 of the Internal Revenue Code of 1986 

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1 ments) is amended by inserting after section 

2 9813 the following new section: 

3 ‘‘SEC. 9814. COVERAGE OF MEDICALLY NECESSARY FOOD 

4 AND FOOD MODIFIED TO BE LOW PROTEIN. 

5 ‘‘(a) DEFINITIONS.—In this section— 

6 ‘‘(1) the term ‘medically necessary food’— 

7 ‘‘(A) means a food which is formulated to 

8 be consumed or administered enterally under 

9 the supervision of a physician and which is in10 tended for the specific dietary management of 

11 a disease or condition for which distinctive nu12 tritional requirements, based on recognized sci13 entific principles, are established by medical 

14 evaluation; and 

15 ‘‘(B) includes nutritionally modified coun16 terparts of traditional foods and other forms of 

17 foods such as formulas, pills, capsules, and 

18 bars, so long as consumed or administered 

19 enterally; and 

20 ‘‘(2) the term ‘enterally’ refers to consumption 

21 or administration through the gastrointestinal tract, 

22 whether orally or by tube. 

23 ‘‘(b) COVERAGE.— 

24 ‘‘(1) MEDICALLY NECESSARY FOOD AND FOOD

25 MODIFIED TO BE LOW PROTEIN.—A group health 


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1 plan, or a health insurance issuer that provides 

2 health insurance coverage in connection with a group 

3 health plan, shall provide coverage for necessary 

4 medically necessary food and food modified to be low 

5 protein that is formulated to be consumed or admin6 istered under the supervision of a qualified medical 

7 provider, for the treatment of conditions as rec8 ommended by the Advisory Committee on Heritable 

9 Disorders in Newborns and Children, and the med10 ical equipment and supplies necessary to administer 

11 such food. 

12 ‘‘(2) VITAMINS AND AMINO ACIDS.—A group 

13 health plan, or a health insurance issuer that pro14 vides health insurance coverage in connection with a 

15 group health plan, that provides prescription drug 

16 coverage, shall provide coverage for pharmacological 

17 doses of vitamins and amino acids used for the 

18 treatment of inborn errors of metabolism, for the 

19 treatment of conditions as recommended by the Ad20 visory Committee on Heritable Disorders in 

21 Newborns and Children and as prescribed by a 

22 qualified medical provider, to the same extent as 

23 other prescription drug coverage under such plan or 

24 coverage.’’. 


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1 (B) CONFORMING AMENDMENT.—The 

2 table of sections for subchapter B of chapter 

3 100 of such Code is amended by inserting after 

4 the item relating to section 9813 the following 

5 new item: 

‘‘Sec. 9814. Coverage of medically necessary food and food modified to be low 

protein.’’. 

6 (b) INDIVIDUAL MARKET.—Subpart 2 of part B of 

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

8 300gg–51 et seq.) is amended by adding at the end the 

9 following new section: 

10 ‘‘SEC. 2754. COVERAGE OF MEDICALLY NECESSARY FOOD 

11 AND FOOD MODIFIED TO BE LOW PROTEIN. 

12 ‘‘The provisions of section 2729 shall apply to health 

13 insurance coverage offered by a health insurance issuer 

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

15 to health insurance coverage offered by a health insurance 

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

17 or large group market.’’. 

18 (c) AMENDMENT TO PPACA.—Section 1302(b)(1) of 

19 the Patient Protection and Affordable Care Act (42 

20 U.S.C. 18022(b)(1)) is amended by adding at the end the 

21 following: 

22 ‘‘(K) Medically necessary food, as defined 

23 in section 2729 of the Public Health Service 

24 Act.’’. 


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1 SEC. 5. EFFECTIVE DATE; DETERMINATION OF MINIMUM 

2 YEARLY COVERAGE. 

3 (a) EFFECTIVE DATE.—The amendments made by 

4 sections 3 and 4 shall apply to plan years beginning after 

5 the date that is 180 days after the date of enactment of 

6 this Act. 

7 (b) DETERMINATION BY SECRETARY.— 

8 (1) IN GENERAL.—Prior to the date described 

9 under subsection (a), the Secretary of Health and 

10 Human Services (referred to in this Act as the ‘‘Sec11 retary’’) shall determine the minimum yearly cov12 erage for all health insurance plans pursuant to the 

13 amendments made by this Act. Such minimum year14 ly coverage shall apply to an individual during any 

15 period when the individual is covered under the plan 

16 and for as long as deemed medically necessary. The 

17 Secretary may establish age-specific minimum levels 

18 of coverage and periodically update these levels 

19 based on a standard cost of living index, the actual 

20 cost of treatment, and other appropriate measures 

21 as determined by the Secretary. 

22 (2) NO PREEMPTION.—The minimum yearly 

23 coverage determined by the Secretary under para24 graph (1) shall not preempt any State standards 


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1 that require a higher minimum yearly coverage level 

2 for the same services and benefits. 

Æ 


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