I 

116TH CONGRESS 

2D SESSION H. R. 8573 

To prohibit group health plans, health insurance issuers offering group or 

individual health insurance coverage, State plans under title XIX of 

the Social Security Act, State child health plans under title XXI of 

such Act, and the TRICARE program from applying a deductible to 

outpatient pediatric services. 

IN THE HOUSE OF REPRESENTATIVES 

OCTOBER 9, 2020 

Ms. SCHRIER introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on 

Ways and Means, Education and Labor, and Armed Services, 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 prohibit group health plans, health insurance issuers offering group or individual health insurance coverage, 

State plans under title XIX of the Social Security Act, 

State child health plans under title XXI of such Act, 

and the TRICARE program from applying a deductible 

to outpatient pediatric 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 ‘‘Helping Families Ac3 cess Pediatric Care Act of 2020’’. 

4 SEC. 2. PROHIBITING CERTAIN HEALTH PLANS FROM AP5 PLYING A DEDUCTIBLE TO OUTPATIENT PE6 DIATRIC SERVICES. 

7 (a) ERISA.— 

8 (1) IN GENERAL.—Subpart B of part 7 of title 

9 I of the Employee Retirement Income Security Act 

10 of 1974 (29 U.S.C. 1185 et seq.) is amended by 

11 adding at the end the following new section: 

12 ‘‘SEC. 716. PROHIBITION ON APPLICATION OF DEDUCTIBLE 

13 TO OUTPATIENT PEDIATRIC SERVICES. 

14 ‘‘(a) IN GENERAL.—A group health plan and a health 

15 insurance issuer offering group health insurance coverage 

16 may not impose any deductible under such plan or cov17 erage (as applicable) with respect to outpatient pediatric 

18 services (as defined in subsection (b)) for which benefits 

19 are provided under such plan or coverage. 

20 ‘‘(b) OUTPATIENT PEDIATRIC SERVICES DEFINED.— 

21 For purposes of subsection (a), the term ‘outpatient pedi22 atric services’ means any item or service furnished to an 

23 individual under the age of 18 as an outpatient by a health 

24 care provider acting within the scope of such provider’s 

25 license, regardless of whether such service is furnished in26 person or through use of a telecommunications system.’’. 


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1 (2) CLERICAL AMENDMENT.—The table of con2 tents of the Employee Retirement Income Security 

3 Act of 1974 is amended by inserting after the item 

4 relating to section 714 the following: 

‘‘Sec. 715. Additional market reforms. 

‘‘Sec. 716. Prohibition on application of deductible to outpatient pediatric services.’’. 

5 (b) PHSA.—Subpart II of part A of title XXVII of 

6 the Public Health Service Act (42 U.S.C. 300gg–11 et 

7 seq.) is amended by adding at the end the following new 

8 section: 

9 ‘‘SEC. 2730. PROHIBITION ON APPLICATION OF DEDUCT10 IBLE TO OUTPATIENT PEDIATRIC SERVICES. 

11 ‘‘(a) IN GENERAL.—A group health plan and a health 

12 insurance issuer offering group or individual health insur13 ance coverage may not impose any deductible under such 

14 plan or coverage (as applicable) with respect to outpatient 

15 pediatric services (as defined in subsection (b)) for which 

16 benefits are provided under such plan or coverage. 

17 ‘‘(b) OUTPATIENT PEDIATRIC SERVICES DEFINED.— 

18 For purposes of subsection (a), the term ‘outpatient pedi19 atric services’ means any item or service furnished to an 

20 individual under the age of 18 as an outpatient by a health 

21 care provider acting within the scope of such provider’s 

22 license, regardless of whether such service is furnished in23 person or through use of a telecommunications system.’’. 

24 (c) IRC.— 


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

2 100 of the Internal Revenue Code of 1986 is amend3 ed by adding at the end the following new section: 

4 ‘‘SEC. 9816. PROHIBITION ON APPLICATION OF DEDUCT5 IBLE TO OUTPATIENT PEDIATRIC SERVICES. 

6 ‘‘(a) IN GENERAL.—A group health plan may not im7 pose any deductible under such plan with respect to out8 patient pediatric services (as defined in subsection (b)) for 

9 which benefits are provided under such plan. 

10 ‘‘(b) OUTPATIENT PEDIATRIC SERVICES DEFINED.— 

11 For purposes of subsection (a), the term ‘outpatient pedi12 atric services’ means any item or service furnished to an 

13 individual under the age of 18 as an outpatient by a health 

14 care provider acting within the scope of such provider’s 

15 license, regardless of whether such service is furnished in16 person or through use of a telecommunications system.’’. 

17 (2) CLERICAL AMENDMENT.—The table of sec18 tions for subchapter B of chapter 100 of the Inter19 nal Revenue Code of 1986 is amended by adding at 

20 the end the following new items: 

‘‘Sec. 9815. Additional market reforms. 

‘‘Sec. 9816. Prohibition on application of deductible to outpatient pediatric 

services.’’. 

21 (d) MEDICAID.—Section 1916A of the Social Security 

22 Act (42 U.S.C. 1396o–1) is amended— 

23 (1) in subsection (a)— 


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1 (A) in paragraph (1), by striking ‘‘para2 graph (2)’’ and inserting ‘‘paragraphs (2) and 

3 (4)’’; and 

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

5 paragraph: 

6 ‘‘(4) PROHIBITION ON APPLICATION OF DEDUC7 TION TO OUTPATIENT PEDIATRIC SERVICES.—A 

8 State may not impose a deduction under the plan 

9 with respect to outpatient pediatric services (as de10 fined in subsection (f)).’’; and 

11 (2) by adding at the end the following new sub12 section: 

13 ‘‘(f) OUTPATIENT PEDIATRIC SERVICES DEFINED.— 

14 For purposes of this section, the term ‘outpatient pediatric 

15 services’ means any item or service furnished to an indi16 vidual under the age of 18 as an outpatient by a health 

17 care provider acting within the scope of such provider’s 

18 license, regardless of whether such service is furnished in19 person or through use of a telecommunications system.’’. 

20 (e) CHIP.—Section 2103(e) of the Social Security 

21 Act (42 U.S.C. 1397cc) is amended by adding at the end 

22 the following new paragraph: 

23 ‘‘(5) PROHIBITION ON APPLICATION OF DEDUC24 TION TO OUTPATIENT PEDIATRIC SERVICES.— 


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1 ‘‘(A) IN GENERAL.—The State child health 

2 plan may not impose a deductible with respect 

3 to outpatient pediatric services (as defined in 

4 subparagraph (B)). 

5 ‘‘(B) OUTPATIENT PEDIATRIC SERVICES

6 DEFINED.—For purposes of this paragraph, the 

7 term ‘outpatient pediatric services’ means any 

8 item or service furnished to an individual under 

9 the age of 18 as an outpatient by a health care 

10 provider acting within the scope of such pro11 vider’s license, regardless of whether such serv12 ice is furnished in-person or through use of a 

13 telecommunications system.’’. 

14 (f) FIRST-DOLLAR COVERAGE ALLOWANCE FOR

15 OUTPATIENT PEDIATRIC SERVICES FOR HIGH DEDUCT16 IBLE PLANS.—Section 226(c)(2) of the Internal Revenue 

17 Code of 1986 is amended by adding at the end the fol18 lowing new subparagraph: 

19 ‘‘(F) SAFE HARBOR FOR ABSENCE OF DE20 DUCTIBLE FOR OUTPATIENT PEDIATRIC SERV21 ICES.—A plan shall not fail to be treated as a 

22 high deductible health plan by reason of failing 

23 to have a deductible for outpatient pediatric 

24 services (as defined in section 9816(b)).’’. 

25 (g) TRICARE PROGRAM.— 


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1 (1) IN GENERAL.—Section 1095d of title 10, 

2 United States Code, is amended— 

3 (A) in the section heading, by inserting 

4 ‘‘prohibition on and’’ before ‘‘waiver’’; 

5 (B) by redesignating subsections (a) and 

6 (b) as subsections (b) and (c), respectively; 

7 (C) by inserting before subsection (b), as 

8 so redesignated, the following new subsection 

9 (a): 

10 ‘‘(a) PROHIBITION ON APPLICATION OF DEDUCTIBLE

11 TO OUTPATIENT PEDIATRIC SERVICES.—The Secretary of 

12 Defense may not impose any deductible under the 

13 TRICARE program for medical care provided to a covered 

14 beneficiary who is under the age of 18 as an outpatient, 

15 regardless of whether such care is furnished in-person or 

16 through use of a telecommunications system.’’; and 

17 (D) in subsection (b), as so redesignated, 

18 by striking ‘‘The Secretary’’ and inserting ‘‘In 

19 addition to the requirement under subsection 

20 (a), the Secretary’’. 

21 (2) CLERICAL AMENDMENT.—The table of sec22 tions at the beginning of chapter 55 of title 10, 

23 United States Code, is amended by striking the item 

24 relating to section 1095d and inserting the following 

25 new item: 

‘‘1095d. TRICARE program: prohibition on and waiver of certain deductibles.’’. 


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1 (3) CONFORMING AMENDMENT.—Section 

2 1075(d) of such title is amended by adding at the 

3 end the following new paragraph: 

4 ‘‘(5) The Secretary may not impose any deductible 

5 amounts for outpatient pediatric services pursuant to sec6 tion 1095d of this title.’’. 

7 (h) GAO STUDY.—Not later than 4 years after the 

8 date of the enactment of this Act, the Comptroller General 

9 of the United States shall conduct a study and submit to 

10 Congress a report on the effects of the amendments made 

11 by this Act on premiums, deductibles, and copayment and 

12 coinsurance requirements with respect to group health 

13 plans and group and individual health insurance coverage 

14 (as such terms are defined in section 2791 of the Public 

15 Health Service Act (42 U.S.C. 300gg–91)). 

16 (i) EFFECTIVE DATE.—The amendment (or amend17 ments) made by— 

18 (1) subsections (a) through (c) and subsections 

19 (f) and (g) shall apply with respect to plan years be20 ginning on or after the date that is 2 years after the 

21 date of the enactment of this Act; 

22 (2) subsection (d) shall apply with respect to 

23 medical assistance furnished in calendar quarters be24 ginning on or after the date that is 2 years after the 

25 date of the enactment of this Act; and 


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1 (3) subsection (c) shall apply with respect to 

2 child health assistance furnished calendar quarters 

3 described in paragraph (2). 

Æ 


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