II 

118TH CONGRESS 

1ST SESSION S. 1135 

To amend title XXVII of the Public Health Service Act, the Employee 

Retirement Income Security Act of 1974, the Internal Revenue Code 

of 1986, and the Patient Protection and Affordable Care Act to require 

coverage of hearing devices and systems in certain private health insurance plans, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MARCH 30, 2023 

Mrs. CAPITO (for herself, Ms. WARREN, and Mr. HICKENLOOPER) introduced 

the following bill; which was read twice and referred to the Committee 

on Health, Education, Labor, and Pensions 

A BILL 

To amend title XXVII of the Public Health Service Act, 

the Employee Retirement Income Security Act of 1974, 

the Internal Revenue Code of 1986, and the Patient 

Protection and Affordable Care Act to require coverage 

of hearing devices and systems in certain private health 

insurance plans, and for other purposes. 

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 ‘‘Ally’s Act’’. 


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1 SEC. 2. COVERAGE OF HEARING DEVICES AND SYSTEMS IN 

2 CERTAIN PRIVATE HEALTH INSURANCE 

3 PLANS. 

4 (a) PHSA.—Part D of the Public Health Service Act 

5 (42 U.S.C. 300gg–111 et seq.) is amended by adding at 

6 the end the following new section: 

7 ‘‘SEC. 2799A–11. COVERAGE OF HEARING DEVICES AND SYS8 TEMS. 

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

10 insurance issuer offering group or individual health insur11 ance coverage shall at a minimum provide coverage for 

12 the following items and services furnished to a qualifying 

13 individual: 

14 ‘‘(1) Auditory implant devices (including audi15 tory osseointegrated (bone conduction) implants and 

16 cochlear implants) and external sound processors. 

17 ‘‘(2) The maintenance of auditory implant de18 vices and external sound processors described in 

19 paragraph (1). 

20 ‘‘(3) Every 5 years, the upgrade (or replace21 ment if an upgrade is not available) of auditory im22 plant devices and external sound processors de23 scribed in paragraph (1). 

24 ‘‘(4) Adhesive adapters and softband head25 bands. 


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1 ‘‘(5) The repair of auditory implant devices and 

2 external sound processors described in paragraph 

3 (1). 

4 ‘‘(6) A comprehensive hearing assessment. 

5 ‘‘(7) A preoperative medical assessment. 

6 ‘‘(8) Surgery relating to the furnishing of such 

7 devices and processors (as determined necessary by 

8 a physician or qualified audiologist (as such terms 

9 are defined for purposes of subsection (d)) treating 

10 such individual). 

11 ‘‘(9) Postoperative medical visits for purposes 

12 of ensuring appropriate recovery from such surgery. 

13 ‘‘(10) Postoperative audiological visits for acti14 vation and fitting of such devices and processors. 

15 ‘‘(11) Aural rehabilitation and treatment serv16 ices (as so determined necessary). 

17 ‘‘(b) COVERAGE REQUIREMENTS.—In the case of an 

18 item or service described in subsection (a) furnished to 

19 a qualifying individual under a group health plan or group 

20 or individual health insurance coverage, such plan or cov21 erage shall ensure that— 

22 ‘‘(1) the financial requirements (as defined in 

23 section 2726(a)(3)) applicable to such item or serv24 ice are no more restrictive than the predominant fi25 nancial requirements applied to substantially all 


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1 medical and surgical benefits covered by the plan or 

2 coverage (as applicable), and that there are no sepa3 rate cost sharing requirements that are applicable 

4 only with respect to such item or service; and 

5 ‘‘(2) the treatment limitations (as defined in 

6 such section) applicable to such item or service are 

7 no more restrictive than the predominant treatment 

8 limitations applied to substantially all medical and 

9 surgical benefits covered by the plan or coverage (as 

10 applicable), and that there are no separate treat11 ment limitations that are applicable only with re12 spect to such item or service. 

13 ‘‘(c) PROHIBITION ON REVIEW OF MEDICAL NECES14 SITY.—A group health plan and a health insurance issuer 

15 offering group or individual health insurance coverage 

16 may not deny or otherwise limit coverage of any item or 

17 service described in subsection (a) furnished to a quali18 fying individual on the basis of a review of the medical 

19 necessity of such item or service by such plan or issuer. 

20 ‘‘(d) QUALIFYING INDIVIDUAL DEFINED.—For pur21 poses of this section, the term ‘qualifying individual’ 

22 means an individual that a physician (as defined in section 

23 1861(r) of the Social Security Act) or qualified audiologist 

24 (as defined in section 1861(ll)(4)(B) of such Act) deter25 mines meets an indication (including unilateral or bilateral 


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1 hearing loss) for an auditory implant device and external 

2 sound processor described in subsection (a)(1).’’. 

3 (b) ERISA.— 

4 (1) IN GENERAL.—Subpart B of part 7 of sub5 title B of title I of the Employee Retirement Income 

6 Security Act of 1974 (29 U.S.C. 1185 et seq.) by 

7 adding at the end the following new section: 

8 ‘‘SEC. 726. COVERAGE OF HEARING DEVICES AND SYSTEMS. 

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

10 insurance issuer offering group health insurance coverage 

11 shall at a minimum provide coverage for the following 

12 items and services furnished to a qualifying individual: 

13 ‘‘(1) Auditory implant devices (including audi14 tory osseointegrated (bone conduction) implants and 

15 cochlear implants) and external sound processors. 

16 ‘‘(2) The maintenance of auditory implant de17 vices and external sound processors described in 

18 paragraph (1). 

19 ‘‘(3) Every 5 years, the upgrade (or replace20 ment if an upgrade is not available) of auditory im21 plant devices and external sound processors de22 scribed in paragraph (1). 

23 ‘‘(4) Adhesive adapters and softband head24 bands. 


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1 ‘‘(5) The repair of auditory implant devices and 

2 external sound processors described in paragraph 

3 (1). 

4 ‘‘(6) A comprehensive hearing assessment. 

5 ‘‘(7) A preoperative medical assessment. 

6 ‘‘(8) Surgery relating to the furnishing of such 

7 devices and processors (as determined necessary by 

8 a physician or qualified audiologist (as such terms 

9 are defined for purposes of subsection (d)) treating 

10 such individual). 

11 ‘‘(9) Postoperative medical visits for purposes 

12 of ensuring appropriate recovery from such surgery. 

13 ‘‘(10) Postoperative audiological visits for acti14 vation and fitting of such devices and processors. 

15 ‘‘(11) Aural rehabilitation and treatment serv16 ices (as so determined necessary). 

17 ‘‘(b) COVERAGE REQUIREMENTS.—In the case of an 

18 item or service described in subsection (a) furnished to 

19 a qualifying individual under a group health plan or group 

20 health insurance coverage, such plan or coverage shall en21 sure that— 

22 ‘‘(1) the financial requirements (as defined in 

23 section 2726(a)(3) of the Public Health Service Act 

24 (42 U.S.C. 300gg–26(a)(3))) applicable to such item 

25 or service are no more restrictive than the predomiVerDate Sep 11 2014 22:00 Apr 13, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1135.IS S1135

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1 nant financial requirements applied to substantially 

2 all medical and surgical benefits covered by the plan 

3 or coverage (as applicable), and that there are no 

4 separate cost sharing requirements that are applica5 ble only with respect to such item or service; and 

6 ‘‘(2) the treatment limitations (as defined in 

7 such section) applicable to such item or service are 

8 no more restrictive than the predominant treatment 

9 limitations applied to substantially all medical and 

10 surgical benefits covered by the plan or coverage (as 

11 applicable), and that there are no separate treat12 ment limitations that are applicable only with re13 spect to such item or service. 

14 ‘‘(c) PROHIBITION ON REVIEW OF MEDICAL NECES15 SITY.—A group health plan and a health insurance issuer 

16 offering group health insurance coverage may not deny or 

17 otherwise limit coverage of any item or service described 

18 in subsection (a) furnished to a qualifying individual on 

19 the basis of a review of the medical necessity of such item 

20 or service by such plan or issuer. 

21 ‘‘(d) QUALIFYING INDIVIDUAL DEFINED.—For pur22 poses of this section, the term ‘qualifying individual’ 

23 means an individual that a physician (as defined in section 

24 1861(r) of the Social Security Act (42 U.S.C. 1395x(r))) 

25 or qualified audiologist (as defined in section 


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1 1861(ll)(4)(B) of such Act (42 U.S.C. 1395x(ll)(4)(B))) 

2 determines meets an indication (including unilateral or bi3 lateral hearing loss) for an auditory implant device and 

4 external sound processor described in subsection (a)(1).’’. 

5 (2) CLERICAL AMENDMENT.—The table of con6 tents in section 1 of the Employee Retirement In7 come Security Act of 1974 (29 U.S.C. 1001 et seq.) 

8 is amended by inserting after the item relating to 

9 section 725 the following new item: 

‘‘Sec. 726. Coverage of hearing devices and systems.’’. 

10 (c) IRC.— 

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

12 100 of the Internal Revenue Code of 1986 is amend13 ed by adding at the end the following new section: 

14 ‘‘SEC. 9826. COVERAGE OF HEARING DEVICES AND SYS15 TEMS. 

16 ‘‘(a) IN GENERAL.—A group health plan shall at a 

17 minimum provide coverage for the following items and 

18 services furnished to a qualifying individual: 

19 ‘‘(1) Auditory implant devices (including audi20 tory osseointegrated (bone conduction) implants and 

21 cochlear implants) and external sound processors. 

22 ‘‘(2) The maintenance of auditory implant de23 vices and external sound processors described in 

24 paragraph (1). 


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1 ‘‘(3) Every 5 years, the upgrade (or replace2 ment if an upgrade is not available) of auditory im3 plant devices and external sound processors de4 scribed in paragraph (1). 

5 ‘‘(4) Adhesive adapters and softband head6 bands. 

7 ‘‘(5) The repair of auditory implant devices and 

8 external sound processors described in paragraph 

9 (1). 

10 ‘‘(6) A comprehensive hearing assessment. 

11 ‘‘(7) A preoperative medical assessment. 

12 ‘‘(8) Surgery relating to the furnishing of such 

13 devices and processors (as determined necessary by 

14 a physician or qualified audiologist (as such terms 

15 are defined for purposes of subsection (d)) treating 

16 such individual). 

17 ‘‘(9) Postoperative medical visits for purposes 

18 of ensuring appropriate recovery from such surgery. 

19 ‘‘(10) Postoperative audiological visits for acti20 vation and fitting of such devices and processors. 

21 ‘‘(11) Aural rehabilitation and treatment serv22 ices (as so determined necessary). 

23 ‘‘(b) COVERAGE REQUIREMENTS.—In the case of an 

24 item or service described in subsection (a) furnished to 


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•S 1135 IS

1 a qualifying individual under a group health plan, such 

2 plan shall ensure that— 

3 ‘‘(1) the financial requirements (as defined in 

4 section 2726(a)(3) of the Public Health Service Act 

5 (42 U.S.C. 300gg–26(a)(3))) applicable to such item 

6 or service are no more restrictive than the predomi7 nant financial requirements applied to substantially 

8 all medical and surgical benefits covered by the plan, 

9 and that there are no separate cost sharing require10 ments that are applicable only with respect to such 

11 item or service; and 

12 ‘‘(2) the treatment limitations (as defined in 

13 such section) applicable to such item or service are 

14 no more restrictive than the predominant treatment 

15 limitations applied to substantially all medical and 

16 surgical benefits covered by the plan, and that there 

17 are no separate treatment limitations that are appli18 cable only with respect to such item or service. 

19 ‘‘(c) PROHIBITION ON REVIEW OF MEDICAL NECES20 SITY.—A group health plan may not deny or otherwise 

21 limit coverage of any item or service described in sub22 section (a) furnished to a qualifying individual on the basis 

23 of a review of the medical necessity of such item or service 

24 by such plan or issuer. 


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1 ‘‘(d) QUALIFYING INDIVIDUAL DEFINED.—For pur2 poses of this section, the term ‘qualifying individual’ 

3 means an individual that a physician (as defined in section 

4 1861(r) of the Social Security Act (42 U.S.C. 1395x(r))) 

5 or qualified audiologist (as defined in section 

6 1861(ll)(4)(B) of such Act (42 U.S.C. 1395x(ll)(4)(B))) 

7 determines meets an indication (including unilateral or bi8 lateral hearing loss) for an auditory implant device and 

9 external sound processor described in subsection (a)(1).’’. 

10 (2) CLERICAL AMENDMENT.—The table of sec11 tions for subchapter B of chapter 100 of the Inter12 nal Revenue Code of 1986 is amended by inserting 

13 after the item relating to section 9825 the following 

14 new item: 

‘‘Sec. 9826. Coverage of hearing devices and systems.’’. 

15 (d) APPLICATION TO GRANDFATHERED HEALTH

16 PLANS.—Section 1251(a)(4)(A) of the Patient Protection 

17 and Affordable Care Act (42 U.S.C. 18011(a)(4)(A)) is 

18 amended— 

19 (1) by striking ‘‘title’’ and inserting ‘‘title, or as 

20 added after the date of the enactment of this Act)’’; 

21 and 

22 (2) by adding at the end the following new 

23 clause: 

24 ‘‘(v) Section 2799A–11 (relating to 

25 hearing devices and systems).’’. 


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1 (3) EFFECTIVE DATE.—The amendments made 

2 by this subsection shall apply with respect to plan 

3 years beginning on or after January 1, 2025. 

Æ 


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