I 

111TH CONGRESS 

2D SESSION H. R. 4794 

To prohibit the use of any recommendation of the Preventive Services Task 

Force (or any successor task force) to deny or restrict coverage of 

an item or service under a Federal health care program, a group health 

plan, or a health insurance issuer, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 9, 2010 

Mr. LANCE (for himself, Mrs. EMERSON, Mr. PAULSEN, and Mrs. MCMORRIS

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

Ways and Means and Education and Labor, 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 the use of any recommendation of the Preventive 

Services Task Force (or any successor task force) to 

deny or restrict coverage of an item or service under 

a Federal health care program, a group health plan, 

or a health insurance issuer, 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 the ‘‘Safeguarding Access 

5 to Preventative Services Act of 2010’’. 


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1 SEC. 2. NO DENIAL OR RESTRICTION OF COVERAGE BASED 

2 ON TASK FORCE RECOMMENDATIONS. 

3 (a) FEDERAL HEALTH CARE PROGRAM.— 

4 (1) IN GENERAL.—Notwithstanding any other 

5 provision of law, the Secretary of Health and 

6 Human Services shall not, directly or as a condition 

7 on the receipt of Federal funds, use any rec8 ommendation of the Preventive Services Task Force 

9 convened under section 915(a) of the Public Health 

10 Service Act (42 U.S.C. 299b–4) (or any successor 

11 task force) to deny or restrict coverage of an item 

12 or service under a Federal health care program (in13 cluding the Medicare program under title XVIII of 

14 the Social Security Act (42 U.S.C. 1395 et seq.), the 

15 Medicaid program under title XIX of the Social Se16 curity Act (42 U.S.C. 1396–1 et seq.), and the Na17 tional Breast and Cervical Cancer Early Detection 

18 Program under title XV of the Public Health Service 

19 Act (42 U.S.C. 300k et seq.). 

20 (2) DEFINITIONS.—In this subsection: 

21 (A) The terms ‘‘group health plan’’, 

22 ‘‘health insurance coverage’’, and ‘‘health insur23 ance issuer’’ have the meanings given to those 

24 terms in section 2791 of the Public Health 

25 Service Act (42 U.S.C. 300gg–91). 


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1 (B) The term ‘‘Federal health care pro2 gram’’ has the meaning given to such term in 

3 section 1128B(f) of the Social Security Act (42 

4 U.S.C. 1320a–7b(f)). 

5 (b) GROUP HEALTH PLANS AND HEALTH INSUR6 ANCE.— 

7 (1) AMENDMENTS TO PUBLIC HEALTH SERVICE

8 ACT.— 

9 (A) GROUP MARKET.—Subpart 2 of part A 

10 of title XXVII of the Public Health Service Act 

11 (42 U.S.C. 300gg et seq.) is amended by add12 ing at the end the following: 

13 ‘‘SEC. 2708. NO DENIAL OR RESTRICTION OF COVERAGE 

14 BASED ON TASK FORCE RECOMMENDATIONS. 

15 ‘‘A group health plan, and a health insurance issuer 

16 offering group health insurance coverage, shall not use any 

17 recommendation of the Preventive Services Task Force 

18 convened under section 915(a) (or any successor task 

19 force) to deny or restrict coverage of an item or service.’’. 

20 (B) INDIVIDUAL MARKET.—Subpart 1 of 

21 part B of title XXVII of the Public Health 

22 Service Act (42 U.S.C. 300gg–41 et seq.) is 

23 amended by adding at the end the following: 


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1 ‘‘SEC. 2746. NO DENIAL OR RESTRICTION OF COVERAGE 

2 BASED ON TASK FORCE RECOMMENDATIONS. 

3 ‘‘The provisions of section 2708 shall apply to health 

4 insurance coverage offered by a health insurance issuer 

5 in the individual market in the same manner as such pro6 visions apply to health insurance coverage offered by a 

7 health insurance issuer in connection with a group health 

8 plan in the small or large group market.’’. 

9 (2) AMENDMENTS TO ERISA.— 

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

11 title I of the Employee Retirement Income Se12 curity Act of 1974 (29 U.S.C. 1185 et seq.) is 

13 amended by adding at the end the following: 

14 ‘‘SEC. 715. NO DENIAL OR RESTRICTION OF COVERAGE 

15 BASED ON TASK FORCE RECOMMENDATIONS. 

16 ‘‘A group health plan, and a health insurance issuer 

17 offering group health insurance coverage, shall not use any 

18 recommendation of the Preventive Services Task Force 

19 convened under section 915(a) (or any successor task 

20 force) to deny or restrict coverage of an item or service.’’. 

21 (B) CLERICAL AMENDMENT.—The table of 

22 contents in section 1 of such Act is amended by 

23 inserting after the item relating to section 714 

24 the following new item: 

‘‘Sec. 715. No denial or restriction of coverage based on Task Force recommendations.’’. 


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1 (3) AMENDMENTS TO INTERNAL REVENUE

2 CODE.— 

3 (A) IN GENERAL.—Subchapter B of chap4 ter 100 of the Internal Revenue Code of 1986 

5 (relating to group health plan requirements) is 

6 amended by adding at the end the following: 

7 ‘‘SEC. 9814. NO DENIAL OR RESTRICTION OF COVERAGE 

8 BASED ON TASK FORCE RECOMMENDATIONS. 

9 ‘‘A group health plan shall not use any recommenda10 tion of the Preventive Services Task Force convened under 

11 section 915(a) (or any successor task force) to deny or 

12 restrict coverage of an item or service.’’. 

13 (B) CLERICAL AMENDMENT.—The table of 

14 sections for subchapter B of chapter 100 of 

15 such Code is amended by inserting after the 

16 item relating to section 9813 the following new 

17 item: 

‘‘Sec. 9814. No denial or restriction of coverage based on Task Force recommendations.’’. 

18 (4) EFFECTIVE DATE.—The amendments made 

19 by paragraphs (1)(A), (2), and (3) of this subsection 

20 shall apply with respect to plan years beginning on 

21 or after the date of the enactment of this Act. The 

22 amendment made by paragraph (1)(B) of this sub23 section applies with respect to health insurance cov24 erage offered, sold, issued, renewed, in effect, or opVerDate Nov 24 2008 22:47 Mar 10, 2010 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H4794.IH H4794

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1 erated in the individual market on or after such 

2 date. 

3 SEC. 3. DETERMINATIONS OF COVERAGE OF PREVENTIVE 

4 ITEMS AND SERVICES. 

5 (a) AMENDMENTS TO PUBLIC HEALTH SERVICE

6 ACT.— 

7 (1) GROUP MARKET.—Subpart 2 of part A of 

8 title XXVII of the Public Health Service Act (42 

9 U.S.C. 300gg et seq.), as amended by section 2 of 

10 this Act, is amended by adding at the end the fol11 lowing: 

12 ‘‘SEC. 2709. DETERMINATIONS OF COVERAGE OF PREVEN13 TIVE ITEMS AND SERVICES. 

14 ‘‘The plan sponsor of a group health plan and a 

15 health insurance issuer offering group health insurance 

16 coverage shall, in determining which preventive items and 

17 services to provide coverage for under the plan or cov18 erage, consult the medical guidelines and recommenda19 tions of relevant professional medical organizations of rel20 evant medical practice areas (such as the American Soci21 ety of Clinical Oncology, the American College of Sur22 geons, the American College of Radiology, the Society of 

23 Breast Imaging, the American College of Radiation Oncol24 ogy, the American College of Obstetricians and Gyne25 cologists, and other similar organizations), including 


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1 guidelines and recommendations relating to the coverage 

2 of women’s preventive services (such as mammograms and 

3 cervical cancer screenings). The plan administrator shall 

4 disclose such guidelines and recommendations to enrollees 

5 as part of a summary of benefits and coverage provided 

6 to enrollees.’’. 

7 (2) INDIVIDUAL MARKET.—Subpart 1 of part B 

8 of title XXVII of the Public Health Service Act (42 

9 U.S.C. 300gg–41 et seq.) is amended by adding at 

10 the end the following: 

11 ‘‘SEC. 2747. DETERMINATIONS OF COVERAGE OF PREVEN12 TIVE ITEMS AND SERVICES. 

13 ‘‘The provisions of section 2708 shall apply to health 

14 insurance coverage offered by a health insurance issuer 

15 in the individual market in the same manner as such pro16 visions apply to health insurance coverage offered by a 

17 health insurance issuer in connection with a group health 

18 plan in the small or large group market.’’. 

19 (b) AMENDMENTS TO ERISA.— 

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

21 I of the Employee Retirement Income Security Act 

22 of 1974 (as amended by section 2) is amended by 

23 adding at the end the following: 


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1 ‘‘SEC. 716. DETERMINATIONS OF COVERAGE OF PREVEN2 TIVE ITEMS AND SERVICES. 

3 ‘‘The plan sponsor of a group health plan and a 

4 health insurance issuer offering group health insurance 

5 coverage shall, in determining which preventive items and 

6 services to provide coverage for under the plan or cov7 erage, consult the medical guidelines and recommenda8 tions of relevant professional medical organizations of rel9 evant medical practice areas (such as the American Soci10 ety of Clinical Oncology, the American College of Sur11 geons, the American College of Radiology, the Society of 

12 Breast Imaging, the American College of Radiation Oncol13 ogy, the American College of Obstetricians and Gyne14 cologists, and other similar organizations), including 

15 guidelines and recommendations relating to the coverage 

16 of women’s preventive services (such as mammograms and 

17 cervical cancer screenings). The plan administrator of the 

18 group health plan shall disclose such guidelines and rec19 ommendations to participants and beneficiaries as part of 

20 the summary plan description required to be provided 

21 under section 102, and any failure to so disclose such 

22 guidelines and recommendations shall be treated as a vio23 lation of section 102.’’. 

24 (2) CLERICAL AMENDMENT.—The table of con25 tents in section 1 of such Act (as amended by secVerDate Nov 24 2008 22:47 Mar 10, 2010 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H4794.IH H4794

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1 tion 2) is amended by inserting after the item relat2 ing to section 715 the following new item: 

‘‘Sec. 716. Determinations of coverage of preventive items and services.’’. 

3 (c) AMENDMENTS TO INTERNAL REVENUE CODE.— 

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

5 100 of the Internal Revenue Code of 1986 (as 

6 amended by section 2) is amended by adding at the 

7 end the following: 

8 ‘‘SEC. 9814. DETERMINATIONS OF COVERAGE OF PREVEN9 TIVE ITEMS AND SERVICES. 

10 ‘‘The plan sponsor of a group health plan shall, in 

11 determining which preventive items and services to provide 

12 coverage for under the plan, consult the medical guidelines 

13 and recommendations of relevant professional medical or14 ganizations of relevant medical practice areas (such as the 

15 American Society of Clinical Oncology, the American Col16 lege of Surgeons, the American College of Radiology, the 

17 Society of Breast Imaging, the American College of Radi18 ation Oncology, the American College of Obstetricians and 

19 Gynecologists, and other similar organizations), including 

20 guidelines and recommendations relating to the coverage 

21 of women’s preventive services (such as mammograms and 

22 cervical cancer screenings). The plan administrator shall 

23 disclose such guidelines and recommendations to partici24 pants and beneficiaries as part of a summary of benefits 

25 and coverage provided to participants and beneficiaries.’’. 


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1 (2) CLERICAL AMENDMENT.—The table of sec2 tions for subchapter B of chapter 100 of such Code 

3 is amended by inserting after the item relating to 

4 section 9813 the following new item: 

‘‘Sec. 9814. Determinations of coverage of preventive items and services.’’. 

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

6 subsections (a)(1), (b), and (c) of this section shall apply 

7 with respect to plan years beginning on or after the date 

8 of the enactment of this Act. The amendment made by 

9 subsection (a)(2) of this section applies with respect to 

10 health insurance coverage offered, sold, issued, renewed, 

11 in effect, or operated in the individual market on or after 

12 such date. 

Æ 


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