I 

116TH CONGRESS 

1ST SESSION H. R. 4457 

To amend the Employee Retirement Income Security Act of 1974, title 

XXVII of the Public Health Service Act, and the Internal Revenue 

Code of 1986 to require group health plans and health insurance issuers 

offering group or individual health insurance coverage to provide coverage 

for additional preventive care for individuals with chronic conditions 

without the imposition of cost sharing requirement, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 24, 2019 

Ms. UNDERWOOD 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 Employee Retirement Income Security Act 

of 1974, title XXVII of the Public Health Service Act, 

and the Internal Revenue Code of 1986 to require group 

health plans and health insurance issuers offering group 

or individual health insurance coverage to provide coverage for additional preventive care for individuals with 

chronic conditions without the imposition of cost sharing 

requirement, 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, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Chronic Condition 

3 Copay Elimination Act’’. 

4 SEC. 2. COVERAGE OF ADDITIONAL PREVENTIVE CARE FOR 

5 INDIVIDUALS WITH CHRONIC CONDITIONS 

6 WITHOUT IMPOSITION OF COST SHARING RE7 QUIREMENTS. 

8 (a) ERISA.— 

9 (1) IN GENERAL.—Subpart B of part 7 of sub10 title B of title I of the Employee Retirement Income 

11 Security Act of 1974 (29 U.S.C. 1185 et seq.) is 

12 amended by adding at the end the following new sec13 tion: 

14 ‘‘SEC. 716. COVERAGE OF ADDITIONAL PREVENTIVE CARE 

15 FOR INDIVIDUALS WITH CHRONIC CONDI16 TIONS WITHOUT IMPOSITION OF COST SHAR17 ING REQUIREMENTS. 

18 ‘‘(a) IN GENERAL.—In addition to any item or serv19 ice described in section 2713(a) of the Public Health Serv20 ice Act, a group health plan and a health insurance issuer 

21 offering group health insurance coverage shall, at a min22 imum, provide coverage for, and shall not impose any cost 

23 sharing requirements for, with respect to individuals with 

24 chronic conditions (as defined in subsection (b)), such ad25 ditional preventive care and screenings not described in 

26 paragraph (1) of such section 2713(a) that are determined 


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1 by the Secretary to meet the criteria specified in sub2 section (c) with respect to the chronic condition involved. 

3 ‘‘(b) CHRONIC CONDITION DEFINED.—In this sec4 tion, the term ‘chronic condition’ has the meaning given 

5 such term by the Secretary and, at a minimum, includes 

6 the following conditions: 

7 ‘‘(1) Heart disease, including congestive heart 

8 failure and coronary artery disease. 

9 ‘‘(2) Diabetes. 

10 ‘‘(3) Osteoporosis and osteopenia. 

11 ‘‘(4) Hypertension. 

12 ‘‘(5) Asthma. 

13 ‘‘(6) Liver disease. 

14 ‘‘(7) Bleeding disorders. 

15 ‘‘(8) Depression. 

16 ‘‘(c) CRITERIA SPECIFIED.—For purposes of sub17 section (a), the criteria specified in this subsection, with 

18 respect to an item or service and a chronic condition, are 

19 the following: 

20 ‘‘(1) The item or service is low-cost. 

21 ‘‘(2) There is medical evidence supporting high22 cost efficiency, or a large expected impact, of the 

23 item or service in preventing exacerbation of the 

24 chronic condition or the development of a secondary 

25 condition. 


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1 ‘‘(3) There is a strong likelihood, documented 

2 by clinical evidence, that the item or service will pre3 vent the exacerbation of the chronic condition or the 

4 development of a secondary condition that requires 

5 significantly higher-cost treatments. 

6 ‘‘(d) UPDATES.— 

7 ‘‘(1) IN GENERAL.—Once every three years, the 

8 Secretary shall review and update— 

9 ‘‘(A) the list of conditions included within 

10 the meaning of the term ‘chronic condition’ 

11 under subsection (b); and 

12 ‘‘(B) the items and services determined to 

13 meet the criteria specified in subsection (c) for 

14 purposes of subsection (a). 

15 ‘‘(2) APPLICATION OF UPDATES.—The require16 ment under subsection (a) shall apply with respect 

17 to an update made under paragraph (1) beginning 

18 with the first plan year beginning after the date of 

19 such update.’’. 

20 (2) CLERICAL AMENDMENT.—The table of con21 tents in section 1 of such Act is amended by insert22 ing after the item relating to section 714 the fol23 lowing new items: 

‘‘715. Additional market reforms. 

‘‘716. Coverage of additional preventive care for individuals with chronic conditions without imposition of cost sharing requirements.’’. 


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

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

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

4 section: 

5 ‘‘SEC. 2730. COVERAGE OF ADDITIONAL PREVENTIVE CARE 

6 FOR INDIVIDUALS WITH CHRONIC CONDI7 TIONS WITHOUT IMPOSITION OF COST SHAR8 ING REQUIREMENTS. 

9 ‘‘(a) IN GENERAL.—In addition to any item or serv10 ice described in section 2713(a), a group health plan and 

11 a health insurance issuer offering group or individual 

12 health insurance coverage shall, at a minimum, provide 

13 coverage for, and shall not impose any cost sharing re14 quirements for, with respect to individuals with chronic 

15 conditions (as defined in subsection (b)), such additional 

16 preventive care and screenings not described in paragraph 

17 (1) of section 2713(a) that are determined by the Sec18 retary to meet the criteria specified in subsection (c) with 

19 respect to the chronic condition involved. 

20 ‘‘(b) CHRONIC CONDITION DEFINED.—In this sec21 tion, the term ‘chronic condition’ has the meaning given 

22 such term by the Secretary and, at a minimum, includes 

23 the following conditions: 

24 ‘‘(1) Heart disease, including congestive heart 

25 failure and coronary artery disease. 


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1 ‘‘(2) Diabetes. 

2 ‘‘(3) Osteoporosis and osteopenia. 

3 ‘‘(4) Hypertension. 

4 ‘‘(5) Asthma. 

5 ‘‘(6) Liver disease. 

6 ‘‘(7) Bleeding disorders. 

7 ‘‘(8) Depression. 

8 ‘‘(c) CRITERIA SPECIFIED.—For purposes of sub9 section (a), the criteria specified in this subsection, with 

10 respect to an item or service and a chronic condition, are 

11 the following: 

12 ‘‘(1) The item or service is low-cost. 

13 ‘‘(2) There is medical evidence supporting high14 cost efficiency, or a large expected impact, of the 

15 item or service in preventing exacerbation of the 

16 chronic condition or the development of a secondary 

17 condition. 

18 ‘‘(3) There is a strong likelihood, documented 

19 by clinical evidence, that the item or service will pre20 vent the exacerbation of the chronic condition or the 

21 development of a secondary condition that requires 

22 significantly higher-cost treatments. 

23 ‘‘(d) UPDATES.— 

24 ‘‘(1) IN GENERAL.—Once every three years, the 

25 Secretary shall review and update— 


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1 ‘‘(A) the list of conditions included within 

2 the meaning of the term ‘chronic condition’ 

3 under subsection (b); and 

4 ‘‘(B) the items and services determined to 

5 meet the criteria specified in subsection (c) for 

6 purposes of subsection (a). 

7 ‘‘(2) APPLICATION OF UPDATES.—The require8 ment under subsection (a) shall apply with respect 

9 to an update made under paragraph (1) beginning 

10 with the first plan year beginning after the date of 

11 such update.’’. 

12 (c) IRC.— 

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

14 100 of subtitle K of the Internal Revenue Code of 

15 1986 is amended by adding at the end the following 

16 new section: 

17 ‘‘SEC. 9816. COVERAGE OF ADDITIONAL PREVENTIVE CARE 

18 FOR INDIVIDUALS WITH CHRONIC CONDI19 TIONS WITHOUT IMPOSITION OF COST SHAR20 ING REQUIREMENTS. 

21 ‘‘(a) IN GENERAL.—In addition to any item or serv22 ice described in section 2713(a) of the Public Health Serv23 ice Act, a group health plan shall, at a minimum, provide 

24 coverage for, and shall not impose any cost sharing re25 quirements for, with respect to individuals with chronic 


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1 conditions (as defined in subsection (b)), such additional 

2 preventive care and screenings not described in paragraph 

3 (1) of such section 2713(a) that are determined by the 

4 Secretary to meet the criteria specified in subsection (c) 

5 with respect to the chronic condition involved. 

6 ‘‘(b) CHRONIC CONDITION DEFINED.—In this sec7 tion, the term ‘chronic condition’ has the meaning given 

8 such term by the Secretary and, at a minimum, includes 

9 the following conditions: 

10 ‘‘(1) Heart disease, including congestive heart 

11 failure and coronary artery disease. 

12 ‘‘(2) Diabetes. 

13 ‘‘(3) Osteoporosis and osteopenia. 

14 ‘‘(4) Hypertension. 

15 ‘‘(5) Asthma. 

16 ‘‘(6) Liver disease. 

17 ‘‘(7) Bleeding disorders. 

18 ‘‘(8) Depression. 

19 ‘‘(c) CRITERIA SPECIFIED.—For purposes of sub20 section (a), the criteria specified in this subsection, with 

21 respect to an item or service and a chronic condition, are 

22 the following: 

23 ‘‘(1) The item or service is low-cost. 

24 ‘‘(2) There is medical evidence supporting high25 cost efficiency, or a large expected impact, of the 


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1 item or service in preventing exacerbation of the 

2 chronic condition or the development of a secondary 

3 condition. 

4 ‘‘(3) There is a strong likelihood, documented 

5 by clinical evidence, that the item or service will pre6 vent the exacerbation of the chronic condition or the 

7 development of a secondary condition that requires 

8 significantly higher-cost treatments. 

9 ‘‘(d) UPDATES.— 

10 ‘‘(1) IN GENERAL.—Once every three years, the 

11 Secretary shall review and update— 

12 ‘‘(A) the list of conditions included within 

13 the meaning of the term ‘chronic condition’ 

14 under subsection (b); and 

15 ‘‘(B) the items and services determined to 

16 meet the criteria specified in subsection (c) for 

17 purposes of subsection (a). 

18 ‘‘(2) APPLICATION OF UPDATES.—The require19 ment under subsection (a) shall apply with respect 

20 to an update made under paragraph (1) beginning 

21 with the first plan year beginning after the date of 

22 such update.’’. 

23 (2) CLERICAL AMENDMENT.—The table of con24 tents for subchapter B of chapter 100 of subtitle K 


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1 of such Code is amended by adding at the end the 

2 following new item: 

‘‘9816. Coverage of additional preventive care for individuals with chronic conditions without imposition of cost sharing requirements.’’. 

3 (3) HIGH DEDUCTIBLE HEALTH PLANS.—Sec4 tion 223(c)(2)(C) of the Internal Revenue Code of 

5 1986 is amended by inserting ‘‘or for additional pre6 ventive care for individuals with chronic conditions 

7 described in section 9816’’ before the period. 

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

9 this section shall apply with respect to plan years begin10 ning on or after the date that is one year after the date 

11 of the enactment of this Act. 

Æ 


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