I 

111TH CONGRESS 

1ST SESSION H. R. 1339 

To amend the Public Health Service Act, the Employee Retirement Income 

Security Act of 1974, and the Internal Revenue Code of 1986 to require 

that group and individual health insurance coverage and group health 

plans provide coverage for treatment of a minor child’s congenital or 

developmental deformity or disorder due to trauma, infection, tumor, 

or disease. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 5, 2009 

Mrs. MCCARTHY of New York (for herself, Mr. TIBERI, Mr. GORDON of Tennessee, Mr. MCDERMOTT, Mr. INSLEE, Mr. BARTLETT, Mr. BISHOP of 

Georgia, Mr. HINCHEY, Mr. ISRAEL, Ms. EDDIE BERNICE JOHNSON of 

Texas, Mr. KENNEDY, Mr. LEWIS of Georgia, Mr. MOORE of Kansas, Mr. 

MORAN of Virginia, Mr. PASCRELL, Mr. SMITH of New Jersey, Mr. 

TIERNEY, Mr. VAN HOLLEN, Mr. FILNER, Mr. MCHUGH, Mr. CARSON

of Indiana, Ms. SUTTON, Mr. CUMMINGS, Mr. WOLF, Mr. BISHOP of New 

York, Mr. GENE GREEN of Texas, Ms. HIRONO, Ms. SLAUGHTER, Mr. 

HOLT, Mr. LINCOLN DIAZ-BALART of Florida, Mr. GRIJALVA, Mr. 

MCGOVERN, Ms. SCHAKOWSKY, Ms. KAPTUR, Mr. NADLER of New York, 

Mr. WEXLER, Ms. LEE of California, Mr. SCOTT of Virginia, Mr. 

PIERLUISI, Ms. BERKLEY, Mrs. EMERSON, Mr. TAYLOR, and Mrs. 

MALONEY) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on 

Education and Labor 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 Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal 

Revenue Code of 1986 to require that group and indiVerDate Nov 24 2008 02:11 Mar 07, 2009 Jkt 079200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6652 E:\BILLS\H1339.IH H1339

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vidual health insurance coverage and group health plans 

provide coverage for treatment of a minor child’s congenital or developmental deformity or disorder due to 

trauma, infection, tumor, or disease. 

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 ‘‘Children’s Access to 

5 Reconstructive Evaluation & Surgery (CARES) Act of 

6 2009’’. 

7 SEC. 2. COVERAGE OF MINOR CHILD’S CONGENITAL OR DE8 VELOPMENTAL DEFORMITY OR DISORDER. 

9 (a) GROUP HEALTH PLANS.— 

10 (1) PUBLIC HEALTH SERVICE ACT AMEND11 MENTS.—(A) Subpart 2 of part A of title XXVII of 

12 the Public Health Service Act is amended by adding 

13 at the end the following new section: 

14 ‘‘SEC. 2708. STANDARDS RELATING TO BENEFITS FOR 

15 MINOR CHILD’S CONGENITAL OR DEVELOP16 MENTAL DEFORMITY OR DISORDER. 

17 ‘‘(a) REQUIREMENTS FOR RECONSTRUCTIVE SUR18 GERY.— 

19 ‘‘(1) IN GENERAL.—A group health plan, and a 

20 health insurance issuer offering group health insur21 ance coverage, that provides coverage for surgical 

22 benefits shall provide coverage for outpatient and inVerDate Nov 24 2008 02:11 Mar 07, 2009 Jkt 079200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1339.IH H1339

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1 patient diagnosis and treatment of a minor child’s 

2 congenital or developmental deformity, disease, or 

3 injury. A minor child shall include any individual 

4 through 21 years of age. 

5 ‘‘(2) REQUIREMENTS.—Any coverage provided 

6 under paragraph (1) shall be subject to pre-author7 ization or pre-certification as required by the plan or 

8 issuer, and such coverage shall include any surgical 

9 treatment which, in the opinion of the treating phy10 sician, is medically necessary to approximate a nor11 mal appearance. 

12 ‘‘(3) TREATMENT DEFINED.— 

13 ‘‘(A) IN GENERAL.—In this section, the 

14 term ‘treatment’ includes reconstructive sur15 gical procedures (procedures that are generally 

16 performed to improve function, but may also be 

17 performed to approximate a normal appear18 ance) that are performed on abnormal struc19 tures of the body caused by congenital defects, 

20 developmental abnormalities, trauma, infection, 

21 tumors, or disease, including— 

22 ‘‘(i) procedures that do not materially 

23 affect the function of the body part being 

24 treated; and 


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1 ‘‘(ii) procedures for secondary condi2 tions and follow-up treatment. 

3 ‘‘(B) EXCEPTION.—Such term does not in4 clude cosmetic surgery performed to reshape 

5 normal structures of the body to improve ap6 pearance or self-esteem. 

7 ‘‘(b) NOTICE.—A group health plan under this part 

8 shall comply with the notice requirement under section 

9 714(b) of the Employee Retirement Income Security Act 

10 of 1974 with respect to the requirements of this section 

11 as if such section applied to such plan.’’. 

12 (B) Section 2723(c) of such Act (42 U.S.C. 

13 300gg–23(c)) is amended by striking ‘‘section 2704’’ 

14 and inserting ‘‘sections 2704 and 2708’’. 

15 (2) ERISA AMENDMENTS.—(A) Subpart B of 

16 part 7 of subtitle B of title I of the Employee Re17 tirement Income Security Act of 1974 is amended by 

18 adding at the end the following new section: 

19 ‘‘SEC. 715. STANDARDS RELATING TO BENEFITS FOR MINOR 

20 CHILD’S CONGENITAL OR DEVELOPMENTAL 

21 DEFORMITY OR DISORDER. 

22 ‘‘(a) REQUIREMENTS FOR RECONSTRUCTIVE SUR23 GERY.— 

24 ‘‘(1) IN GENERAL.—A group health plan, and a 

25 health insurance issuer offering group health insurVerDate Nov 24 2008 02:11 Mar 07, 2009 Jkt 079200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1339.IH H1339

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1 ance coverage, that provides coverage for surgical 

2 benefits shall provide coverage for outpatient and in3 patient diagnosis and treatment of a minor child’s 

4 congenital or developmental deformity, disease, or 

5 injury. A minor child shall include any individual 

6 who has not attained age 22. 

7 ‘‘(2) REQUIREMENTS.—Any coverage provided 

8 under paragraph (1) shall be subject to pre-author9 ization or pre-certification as required by the plan or 

10 issuer, and such coverage shall include any surgical 

11 treatment which, in the opinion of the treating phy12 sician, is medically necessary to approximate a nor13 mal appearance. 

14 ‘‘(3) TREATMENT DEFINED.— 

15 ‘‘(A) IN GENERAL.—For purposes of this 

16 section, the term ‘treatment’ includes recon17 structive surgical procedures (procedures that 

18 are generally performed to improve function, 

19 but may also be performed to approximate a 

20 normal appearance) that are performed on ab21 normal structures of the body caused by con22 genital defects, developmental abnormalities, 

23 trauma, infection, tumors, or disease, includ24 ing— 


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1 ‘‘(i) procedures that do not materially 

2 affect the function of the body part being 

3 treated; and 

4 ‘‘(ii) procedures for secondary condi5 tions and follow-up treatment. 

6 ‘‘(B) EXCEPTION.—Such term does not in7 clude cosmetic surgery performed to reshape 

8 normal structures of the body to improve ap9 pearance or self-esteem. 

10 ‘‘(b) NOTICE UNDER GROUP HEALTH PLAN.—The 

11 imposition of the requirements of this section shall be 

12 treated as a material modification in the terms of the plan 

13 described in the last sentence of section 102(a), for pur14 poses of assuring notice of such requirements under the 

15 plan; except that the summary description required to be 

16 provided under the fourth sentence of section 104(b)(1) 

17 with respect to such modification shall be provided by not 

18 later than 60 days after the first day of the first plan 

19 year in which such requirements apply.’’. 

20 (B) Section 731(c) of such Act (29 U.S.C. 

21 1191(c)) is amended by striking ‘‘section 711’’ and 

22 inserting ‘‘sections 711 and 715’’. 

23 (C) Section 732(a) of such Act (29 U.S.C. 

24 1191a(a)) is amended by striking ‘‘section 711’’ and 

25 inserting ‘‘sections 711 and 715’’. 


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1 (D) The table of contents in section 1 of such 

2 Act is amended by inserting after the item relating 

3 to section 714 the following new item: 

‘‘Sec. 715. Standards relating to benefits for minor child’s congenital or developmental deformity or disorder.’’. 

4 (3) INTERNAL REVENUE CODE AMEND5 MENTS.— 

6 (A) IN GENERAL.—Subchapter B of chap7 ter 100 of the Internal Revenue Code of 1986 

8 is amended by adding at the end the following 

9 new section: 

10 ‘‘SEC. 9813. STANDARDS RELATING TO BENEFITS FOR 

11 MINOR CHILD’S CONGENITAL OR DEVELOP12 MENTAL DEFORMITY OR DISORDER. 

13 ‘‘(a) REQUIREMENTS FOR RECONSTRUCTIVE SUR14 GERY.— 

15 ‘‘(1) IN GENERAL.—A group health plan, and a 

16 health insurance issuer offering group health insur17 ance coverage, that provides coverage for surgical 

18 benefits shall provide coverage for outpatient and in19 patient diagnosis and treatment of a minor child’s 

20 congenital or developmental deformity, disease, or 

21 injury. A minor child shall include any individual 

22 who has not attained age 22. 

23 ‘‘(2) REQUIREMENTS.—Any coverage provided 

24 under paragraph (1) shall be subject to pre-authorVerDate Nov 24 2008 02:11 Mar 07, 2009 Jkt 079200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1339.IH H1339

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1 ization or pre-certification as required by the plan or 

2 issuer, and such coverage shall include any surgical 

3 treatment which, in the opinion of the treating phy4 sician, is medically necessary to approximate a nor5 mal appearance. 

6 ‘‘(3) TREATMENT DEFINED.— 

7 ‘‘(A) IN GENERAL.—For purposes of this 

8 section, the term ‘treatment’ includes recon9 structive surgical procedures (procedures that 

10 are generally performed to improve function, 

11 but may also be performed to approximate a 

12 normal appearance) that are performed on ab13 normal structures of the body caused by con14 genital defects, developmental abnormalities, 

15 trauma, infection, tumors, or disease, includ16 ing— 

17 ‘‘(i) procedures that do not materially 

18 affect the function of the body part being 

19 treated; and 

20 ‘‘(ii) procedures for secondary condi21 tions and follow-up treatment. 

22 ‘‘(B) EXCEPTION.—Such term does not in23 clude cosmetic surgery performed to reshape 

24 normal structures of the body to improve ap25 pearance or self-esteem.’’. 


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1 (B) CLERICAL AMENDMENT.—The table of 

2 sections for such subchapter is amended by 

3 adding at the end the following new item: 

‘‘Sec. 9813. Standards relating to benefits for minor child’s congenital or developmental deformity or disorder.’’. 

4 (b) INDIVIDUAL HEALTH INSURANCE.—(1) Part B 

5 of title XXVII of the Public Health Service Act is amend6 ed by inserting after section 2752 the following new sec7 tion: 

8 ‘‘SEC. 2754. STANDARDS RELATING TO BENEFITS FOR 

9 MINOR CHILD’S CONGENITAL OR DEVELOP10 MENTAL DEFORMITY OR DISORDER. 

11 ‘‘(a) REQUIREMENTS FOR RECONSTRUCTIVE SUR12 GERY.— 

13 ‘‘(1) IN GENERAL.—A group health plan, and a 

14 health insurance issuer offering group health insur15 ance coverage, that provides coverage for surgical 

16 benefits shall provide coverage for outpatient and in17 patient diagnosis and treatment of a minor child’s 

18 congenital or developmental deformity, disease, or 

19 injury. A minor child shall include any individual 

20 through 21 years of age. 

21 ‘‘(2) REQUIREMENTS.—Any coverage provided 

22 under paragraph (1) shall be subject to pre-author23 ization or pre-certification as required by the plan or 

24 issuer, and such coverage shall include any surgical 


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1 treatment which, in the opinion of the treating phy2 sician, is medically necessary to approximate a nor3 mal appearance. 

4 ‘‘(3) TREATMENT DEFINED.— 

5 ‘‘(A) IN GENERAL.—In this section, the 

6 term ‘treatment’ includes reconstructive sur7 gical procedures (procedures that are generally 

8 performed to improve function, but may also be 

9 performed to approximate a normal appear10 ance) that are performed on abnormal struc11 tures of the body caused by congenital defects, 

12 developmental abnormalities, trauma, infection, 

13 tumors, or disease, including— 

14 ‘‘(i) procedures that do not materially 

15 affect the function of the body part being 

16 treated; and 

17 ‘‘(ii) procedures for secondary condi18 tions and follow-up treatment. 

19 ‘‘(B) EXCEPTION.—Such term does not in20 clude cosmetic surgery performed to reshape 

21 normal structures of the body to improve ap22 pearance or self-esteem. 

23 ‘‘(b) NOTICE.—A health insurance issuer under this 

24 part shall comply with the notice requirement under sec25 tion 714(b) of the Employee Retirement Income Security 


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1 Act of 1974 with respect to the requirements referred to 

2 in subsection (a) as if such section applied to such issuer 

3 and such issuer were a group health plan.’’. 

4 (2) Section 2762(b)(2) of such Act (42 U.S.C. 

5 300gg–62(b)(2)) is amended by striking ‘‘section 2751’’ 

6 and inserting ‘‘sections 2751 and 2754’’. 

7 (c) EFFECTIVE DATES.—(1) The amendments made 

8 by subsection (a) shall apply with respect to group health 

9 plans for plan years beginning on or after January 1, 

10 2010. 

11 (2) The amendment made by subsection (b) shall 

12 apply with respect to health insurance coverage offered, 

13 sold, issued, renewed, in effect, or operated in the indi14 vidual market on or after such date. 

15 (d) COORDINATED REGULATIONS.—Section 104(1) 

16 of the Health Insurance Portability and Accountability 

17 Act of 1996 is amended by striking ‘‘this subtitle (and 

18 the amendments made by this subtitle and section 401)’’ 

19 and inserting ‘‘the provisions of part 7 of subtitle B of 

20 title I of the Employee Retirement Income Security Act 

21 of 1974, the provisions of parts A and C of title XXVII 

22 of the Public Health Service Act, and chapter 100 of the 

23 Internal Revenue Code of 1986’’. 

Æ 


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