I 

111TH CONGRESS 

2D SESSION H. R. 4926 

To provide for the coverage of medically necessary food under Federal health 

programs and private health insurance. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 24, 2010 

Ms. BALDWIN (for herself, Mr. EDWARDS of Texas, Mr. POLIS of Colorado, 

Mr. SARBANES, and Mr. JOHNSON of Georgia) 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 provide for the coverage of medically necessary food under 

Federal health programs and private health insurance. 

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 ‘‘Medical Foods Equity 

5 Act of 2010’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 


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1 (1) Newborns are screened for inborn errors of 

2 metabolism, but treatment for such conditions is not 

3 uniformly covered by insurance. 

4 (2) Each year approximately 2,550 children in 

5 the United States are diagnosed with an inborn 

6 error of metabolism disorder, requiring foods modi7 fied to be void of the nutrient or nutrients the 

8 child’s body is incapable of processing, or requiring 

9 supplementation with vitamins or amino acids. 

10 (3) More than 30 States have passed laws to at 

11 least partially address the inequity in coverage for 

12 medically necessary foods, critical treatment for such 

13 disorders. 

14 (4) The cost associated with providing medically 

15 necessary foods presents a large financial burden for 

16 many families. 

17 (5) There is no current cure for inborn errors 

18 of metabolism disorders and treatment is necessary 

19 during the entire lifespan of the individual. 

20 SEC. 3. COVERAGE IN FEDERAL HEALTH PROGRAMS OF 

21 MEDICALLY NECESSARY FOOD AND FOOD 

22 MODIFIED TO BE LOW PROTEIN. 

23 (a) COVERAGE UNDER THE MEDICARE PROGRAM.— 


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1 (1) COVERAGE OF MEDICALLY NECESSARY

2 FOOD UNDER THE ORIGINAL MEDICARE FEE-FOR3 SERVICE PROGRAM.— 

4 (A) IN GENERAL.—Section 1861(s)(2) of 

5 the Social Security Act (42 U.S.C. 1395x(s)(2)) 

6 is amended— 

7 (i) in subparagraph (DD), by striking 

8 ‘‘and’’ at the end; 

9 (ii) in subparagraph (EE), by insert10 ing ‘‘and’’ at the end; and 

11 (iii) by adding at the end the fol12 lowing new subparagraph: 

13 ‘‘(FF) medically necessary food (as defined 

14 in subsection (hhh)) and food modified to be 

15 low protein that is formulated to be consumed 

16 or administered under the supervision of a 

17 qualified medical provider, for the treatment of 

18 conditions as recommended by the Advisory 

19 Committee on Heritable Disorders in Newborns 

20 and Children, and the medical equipment and 

21 supplies necessary to administer such food.’’. 

22 (B) DEFINITION.—Section 1861 of such 

23 Act (42 U.S.C. 1395x) is amended by adding at 

24 the end the following new subsection: 

25 ‘‘(hhh)(1) The term ‘medically necessary food’— 


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1 ‘‘(A) means a food which is formulated to be 

2 consumed or administered enterally under the super3 vision of a qualified medical provider and which is 

4 intended for the specific dietary management of a 

5 disease or condition for which distinctive nutritional 

6 requirements, based on recognized scientific prin7 ciples, are established by medical evaluation; and 

8 ‘‘(B) includes nutritionally modified counter9 parts of traditional foods and other forms of foods 

10 such as formulas, pills, capsules and bars, so long as 

11 consumed or administered enterally. 

12 ‘‘(2) For purposes of paragraph (1), the term 

13 ‘enterally’ refers to consumption or administration 

14 through the gastrointestinal tract, whether orally or by 

15 tube.’’. 

16 (C) PAYMENT.—Section 1833(a)(1) of the 

17 Social Security Act (42 U.S.C. 1395l(a)(1)) is 

18 amended— 

19 (i) by striking ‘‘and’’ before ‘‘(W)’’; 

20 and 

21 (ii) by inserting before the semicolon 

22 at the end the following: ‘‘, and (X) with 

23 respect to medically necessary food and 

24 pharmacological doses of vitamins and 

25 amino acids under section 1861(s)(2)(FF), 


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1 the amounts paid shall be 80 percent of 

2 the lesser of the actual charge for the serv3 ices or 85 percent of the amount deter4 mined under the fee schedule established 

5 under section 1848(b) for the same serv6 ices if furnished by a physician’’. 

7 (2) INCLUSION OF PHARMACOLOGICAL DOSES

8 OF VITAMINS AND AMINO ACIDS AS A COVERED PART

9 D DRUG.— 

10 (A) IN GENERAL.—Section 1860D–2(e)(1) 

11 of the Social Security Act (42 U.S.C. 1395w– 

12 102(e)(1)) is amended— 

13 (i) in subparagraph (A), by striking 

14 ‘‘or’’; 

15 (ii) in subparagraph (B), by striking 

16 the comma at the end and inserting ‘‘, or’’; 

17 and 

18 (iii) by adding at the end the fol19 lowing new subparagraph: 

20 ‘‘(C) pharmacological doses of vitamins 

21 and amino acids used for the treatment of in22 born errors of metabolism, for the treatment of 

23 conditions as recommended by the Advisory 

24 Committee on Heritable Disorders in Newborns 


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1 and Children and as prescribed by a qualified 

2 medical provider,’’. 

3 (B) EFFECTIVE DATE.—The amendments 

4 made by subparagraph (A) shall apply to plan 

5 years beginning on or after the date that is 6 

6 months after date of enactment of this Act. 

7 (b) COVERAGE UNDER THE MEDICAID PROGRAM.— 

8 (1) DEFINITION OF MEDICAL ASSISTANCE.— 

9 Section 1905 of the Social Security Act (42 U.S.C. 

10 1396d) is amended— 

11 (A) in subsection (a)— 

12 (i) by redesignating paragraph (28) as 

13 paragraph (30); 

14 (ii) in paragraph (27), by striking at 

15 the end ‘‘and’’; and 

16 (iii) by inserting after paragraph (27) 

17 the following new paragraphs: 

18 ‘‘(28) medically necessary food (as defined in 

19 subsection (y)) and food modified to be low protein 

20 that is formulated to be consumed or administered 

21 under the supervision of a qualified medical pro22 vider, for the treatment of conditions as rec23 ommended by the Advisory Committee on Heritable 

24 Disorders in Newborns and Children, and the medVerDate Nov 24 2008 01:18 Mar 25, 2010 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H4926.IH H4926

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1 ical equipment and supplies necessary to administer 

2 such food; 

3 ‘‘(29) pharmacological doses of vitamins and 

4 amino acids used for the treatment of inborn errors 

5 of metabolism, for the treatment of conditions as 

6 recommended by the Advisory Committee on Heri7 table Disorders in Newborns and Children and as 

8 prescribed by a qualified medical provider; and’’; and 

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

10 subsection: 

11 ‘‘(y) MEDICALLY NECESSARY FOOD DEFINED.— 

12 ‘‘(1) IN GENERAL.—For purposes of subsection 

13 (a)(28), the term ‘medically necessary food’— 

14 ‘‘(A) means a food which is formulated to 

15 be consumed or administered enterally under 

16 the supervision of a qualified medical provider 

17 and which is intended for the specific dietary 

18 management of a disease or condition for which 

19 distinctive nutritional requirements, based on 

20 recognized scientific principles, are established 

21 by medical evaluation; and 

22 ‘‘(B) includes nutritionally modified coun23 terparts of traditional foods and other forms of 

24 foods such as formulas, pills, capsules and bars, 

25 so long as consumed or administered enterally. 


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1 ‘‘(2) ENTERALLY.—For purposes of paragraph 

2 (1), the term ‘enterally’ refers to consumption or ad3 ministration through the gastrointestinal tract, 

4 whether orally or by tube.’’. 

5 (2) MANDATORY BENEFITS.—Section 

6 1902(a)(10)(A) of the Social Security Act (42 

7 U.S.C. 1396a(a)(10)(A)) is amended, in the matter 

8 preceding clause (i), by striking ‘‘and (21)’’ and in9 serting ‘‘, (21), (28), and (29)’’. 

10 (3) CONFORMING AMENDMENTS.— 

11 (A) MEDICALLY NEEDY.—Section 

12 1902(a)(10)(C)(iv) of such Act (42 U.S.C. 

13 1396a(a)(10)(C)(iv)) is amended by striking 

14 ‘‘and (17) of section 1905(a) or the care and 

15 services listed in any 7 of the paragraphs num16 bered (1) through (24)’’ and inserting ‘‘(17), 

17 (28), and (29) of section 1905(a) or the care 

18 and services listed in any 7 of the paragraphs 

19 numbered (1) through (24) or (28) or (29)’’. 

20 (B) EXCEPTION TO REBATE EXCLUSION.— 

21 Section 1927(d)(2)(F) of the Social Security 

22 Act (42 U.S.C. 1396r–8(d)(2)(F)) is amended 

23 by inserting ‘‘, pharmacological doses of vita24 mins and amino acids used for the treatment of 

25 inborn errors of metabolism, for the treatment 


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1 of conditions as recommended by the Advisory 

2 Committee on Heritable Disorders in Newborns 

3 and Children and as prescribed by a qualified 

4 medical provider,’’ after ‘‘prenatal vitamins’’. 

5 (4) EXCEPTION TO EFFECTIVE DATE IF STATE

6 LEGISLATION REQUIRED.—In the case of a State 

7 plan for medical assistance under title XIX of the 

8 Social Security Act which the Secretary of Health 

9 and Human Services (referred to in this Act as the 

10 ‘‘Secretary’’) determines requires State legislation 

11 (other than legislation appropriating funds) in order 

12 for the plan to meet the additional requirement im13 posed by the amendments made by this subsection, 

14 the State plan shall not be regarded as failing to 

15 comply with the requirements of such title solely on 

16 the basis of its failure to meet this additional re17 quirement before the first day of the first calendar 

18 quarter beginning after the close of the first regular 

19 session of the State legislature that begins after the 

20 date of the enactment of this Act. For purposes of 

21 the previous sentence, in the case of a State that has 

22 a 2-year legislative session, each year of such session 

23 shall be deemed to be a separate regular session of 

24 the State legislature. 

25 (c) COVERAGE UNDER CHIP.— 


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1 (1) REQUIRED COVERAGE.—Section 2103(c) of 

2 the Social Security Act (42 U.S.C. 1397cc(c)) is 

3 amended by inserting after paragraph (8) the fol4 lowing: 

5 ‘‘(9) MEDICALLY NECESSARY FOOD.— 

6 ‘‘(A) IN GENERAL.—The child health as7 sistance provided to a targeted low-income child 

8 under the plan shall include coverage of medi9 cally necessary food and food modified to be low 

10 protein that is formulated to be consumed or 

11 administered under the supervision of a quali12 fied medical provider, for the treatment of con13 ditions as recommended by the Advisory Com14 mittee on Heritable Disorders in Newborns and 

15 Children, and the medical equipment and sup16 plies necessary to administer such food. 

17 ‘‘(B) DEFINITIONS.—In this paragraph— 

18 ‘‘(i) the term ‘medically necessary 

19 food’— 

20 ‘‘(I) means a food which is for21 mulated to be consumed or adminis22 tered enterally under the supervision 

23 of a qualified medical provider and 

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1 dition for which distinctive nutritional 

2 requirements, based on recognized sci3 entific principles, are established by 

4 medical evaluation; and 

5 ‘‘(II) includes nutritionally modi6 fied counterparts of traditional foods 

7 and other forms of foods such as for8 mulas, pills, capsules and bars, so 

9 long as consumed or administered 

10 enterally; and 

11 ‘‘(ii) the term ‘enterally’ refers to con12 sumption or administration through the 

13 gastrointestinal tract, whether orally or by 

14 tube. 

15 ‘‘(10) VITAMINS AND AMINO ACIDS.—The child 

16 health assistance provided to a targeted low-income 

17 child under the plan shall include coverage of phar18 macological doses of vitamins and amino acids used 

19 for the treatment of inborn errors of metabolism, for 

20 the treatment of conditions as recommended by the 

21 Advisory Committee on Heritable Disorders in 

22 Newborns and Children and as prescribed by a 

23 qualified medical provider.’’. 

24 (2) CONFORMING AMENDMENTS.— 


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1 (A) MANDATORY BENEFITS.—Section 

2 2103(a) of the Social Security Act (42 U.S.C. 

3 1397cc(a)) is amended, in the matter preceding 

4 paragraph (1), by striking ‘‘, and (7)’’ and in5 serting ‘‘, (7), (9), and (10)’’. 

6 (B) DEFINITION OF CHILD HEALTH AS7 SISTANCE.—Section 2110(a) of such Act (42 

8 U.S.C. 1397jj) is amended— 

9 (i) by redesignating paragraph (28) as 

10 paragraph (30); and 

11 (ii) by inserting after paragraph (27) 

12 the following: 

13 ‘‘(28) Medically necessary food (as defined in 

14 section 2103(c)(9)(B)(i)) and food modified to be 

15 low protein that is formulated to be consumed or ad16 ministered under the supervision of a qualified med17 ical provider, for the treatment of conditions as rec18 ommended by the Advisory Committee on Heritable 

19 Disorders in Newborns and Children, and the med20 ical equipment and supplies necessary to administer 

21 such food. 

22 ‘‘(29) Pharmacological doses of vitamins and 

23 amino acids used for the treatment of inborn errors 

24 of metabolism, for the treatment of conditions as 

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1 table Disorders in Newborns and Children and as 

2 prescribed by a qualified medical provider.’’. 

3 (d) AVAILABILITY OF MEDICALLY NECESSARY FOOD, 

4 FOOD MODIFIED TO BE LOW PROTEIN, AND RELATED

5 ITEMS UNDER THE TRICARE PROGRAM.—Section 

6 1077(a)(8) of title 10, United States Code, is amended 

7 by striking ‘‘including’’ and all that follows and inserting 

8 ‘‘including the following: 

9 ‘‘(A) Well-baby care that includes one 

10 screening of an infant for the level of lead in 

11 the blood of the infant. 

12 ‘‘(B) Medically necessary food (as defined 

13 in section 1861(hhh) of the Social Security Act) 

14 and food modified to be low protein that is for15 mulated to be consumed or administered under 

16 the supervision of a qualified medical provider, 

17 for the treatment of conditions as recommended 

18 by the Advisory Committee on Heritable Dis19 orders in Newborns and Children, and the med20 ical equipment and supplies necessary to admin21 ister such food. 

22 ‘‘(C) Pharmacological doses of vitamins 

23 and amino acids used for the treatment of in24 born errors of metabolism and other conditions 

25 as recommended by the Advisory Committee on 


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1 Heritable Disorders in Newborns and Chil2 dren.’’. 

3 SEC. 4. COVERAGE IN THE PRIVATE INSURANCE MARKET 

4 OF MEDICALLY NECESSARY FOOD AND FOOD 

5 MODIFIED TO BE LOW PROTEIN. 

6 (a) GROUP HEALTH PLANS.— 

7 (1) AMENDMENTS TO ERISA.— 

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

9 title I of the Employee Retirement Income Se10 curity Act of 1974 (29 U.S.C. 1185 et seq.) is 

11 amended by adding at the end the following: 

12 ‘‘SEC. 715. COVERAGE OF MEDICALLY NECESSARY FOOD 

13 AND FOOD MODIFIED TO BE LOW PROTEIN. 

14 ‘‘(a) DEFINITION.—In this section— 

15 ‘‘(1) the term ‘medically necessary food’— 

16 ‘‘(A) means a food which is formulated to 

17 be consumed or administered enterally under 

18 the supervision of a qualified medical provider 

19 and which is intended for the specific dietary 

20 management of a disease or condition for which 

21 distinctive nutritional requirements, based on 

22 recognized scientific principles, are established 

23 by medical evaluation; and 

24 ‘‘(B) includes nutritionally modified coun25 terparts of traditional foods and other forms of 


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1 foods such as formulas, pills, capsules and bars, 

2 so long as consumed or administered enterally. 

3 ‘‘(2) the term ‘enterally’ refers to consumption 

4 or administration through the gastrointestinal tract, 

5 whether orally or by tube. 

6 ‘‘(b) COVERAGE.— 

7 ‘‘(1) MEDICALLY NECESSARY FOOD AND FOOD

8 MODIFIED TO BE LOW PROTEIN.—A group health 

9 plan, or a health insurance issuer that provides 

10 health insurance coverage in connection with a group 

11 health plan, shall provide coverage for medically nec12 essary food and food modified to be low protein that 

13 is formulated to be consumed or administered under 

14 the supervision of a qualified medical provider, for 

15 the treatment of conditions as recommended by the 

16 Advisory Committee on Heritable Disorders in 

17 Newborns and Children, and the medical equipment 

18 and supplies necessary to administer such food. 

19 ‘‘(2) VITAMINS AND AMINO ACIDS.—A group 

20 health plan, or a health insurance issuer that pro21 vides health insurance coverage in connection with a 

22 group health plan, that provides prescription drug 

23 coverage shall provide coverage for pharmacological 

24 doses of vitamins and amino acids used for the 

25 treatment of inborn errors of metabolism, for the 


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1 treatment of conditions as recommended by the Ad2 visory Committee on Heritable Disorders in 

3 Newborns and Children and as prescribed by a 

4 qualified medical provider, to the same extent as 

5 other prescription drug coverage under such plan or 

6 coverage.’’. 

7 (B) CONFORMING AMENDMENT.—The 

8 table of contents in section 1 of such Act is 

9 amended by inserting after the item relating to 

10 section 714 the following new item: 

‘‘Sec. 715. Coverage of medically necessary food and food modified to be low 

protein.’’. 

11 (2) AMENDMENTS TO THE PUBLIC HEALTH

12 SERVICE ACT.—Subpart 2 of part A of title XXVII 

13 of the Public Health Service Act (42 U.S.C. 300gg– 

14 4 et seq.) is amended by adding at the end the fol15 lowing new section: 

16 ‘‘SEC. 2708. COVERAGE OF MEDICALLY NECESSARY FOOD 

17 AND FOOD MODIFIED TO BE LOW PROTEIN. 

18 ‘‘(a) DEFINITIONS.—In this section— 

19 ‘‘(1) the term ‘medically necessary food’— 

20 ‘‘(A) means a food which is formulated to 

21 be consumed or administered enterally under 

22 the supervision of a qualified medical provider 

23 and which is intended for the specific dietary 

24 management of a disease or condition for which 


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1 distinctive nutritional requirements, based on 

2 recognized scientific principles, are established 

3 by medical evaluation; and 

4 ‘‘(B) includes nutritionally modified coun5 terparts of traditional foods and other forms of 

6 foods such as formulas, pills, capsules and bars, 

7 so long as consumed or administered enterally. 

8 ‘‘(2) the term ‘enterally’ refers to consumption 

9 or administration through the gastrointestinal tract, 

10 whether orally or by tube. 

11 ‘‘(b) COVERAGE.— 

12 ‘‘(1) MEDICALLY NECESSARY FOOD AND FOOD

13 MODIFIED TO BE LOW PROTEIN.—A group health 

14 plan, or a health insurance issuer that provides 

15 health insurance coverage in connection with a group 

16 health plan, shall provide coverage for medically nec17 essary food and food modified to be low protein that 

18 is formulated to be consumed or administered under 

19 the supervision of a qualified medical provider, for 

20 the treatment of conditions as recommended by the 

21 Advisory Committee on Heritable Disorders in 

22 Newborns and Children, and the medical equipment 

23 and supplies necessary to administer such food. 

24 ‘‘(2) VITAMINS AND AMINO ACIDS.—A group 

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1 vides health insurance coverage in connection with a 

2 group health plan, that provides prescription drug 

3 coverage, shall provide coverage for pharmacological 

4 doses of vitamins and amino acids used for the 

5 treatment of inborn errors of metabolism, for the 

6 treatment of conditions as recommended by the Ad7 visory Committee on Heritable Disorders in 

8 Newborns and Children and as prescribed by a 

9 qualified medical provider, to the same extent as 

10 other prescription drug coverage under such plan or 

11 coverage.’’. 

12 (3) AMENDMENTS TO THE INTERNAL REVENUE

13 CODE.— 

14 (A) IN GENERAL.—Subchapter B of chap15 ter 100 of the Internal Revenue Code of 1986 

16 (relating to other group health plan require17 ments) is amended by inserting after section 

18 9813 the following new section: 

19 ‘‘SEC. 9814. COVERAGE OF MEDICALLY NECESSARY FOOD 

20 AND FOOD MODIFIED TO BE LOW PROTEIN. 

21 ‘‘(a) DEFINITIONS.—In this section— 

22 ‘‘(1) the term ‘medically necessary food’— 

23 ‘‘(A) means a food which is formulated to 

24 be consumed or administered enterally under 

25 the supervision of a qualified medical provider 


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1 and which is intended for the specific dietary 

2 management of a disease or condition for which 

3 distinctive nutritional requirements, based on 

4 recognized scientific principles, are established 

5 by medical evaluation; and 

6 ‘‘(B) includes nutritionally modified coun7 terparts of traditional foods and other forms of 

8 foods such as formulas, pills, capsules and bars, 

9 so long as consumed or administered enterally. 

10 ‘‘(2) the term ‘enterally’ refers to consumption 

11 or administration through the gastrointestinal tract, 

12 whether orally or by tube. 

13 ‘‘(b) COVERAGE.— 

14 ‘‘(1) MEDICALLY NECESSARY FOOD AND FOOD

15 MODIFIED TO BE LOW PROTEIN.—A group health 

16 plan, or a health insurance issuer that provides 

17 health insurance coverage in connection with a group 

18 health plan, shall provide coverage for necessary 

19 medically necessary food and food modified to be low 

20 protein that is formulated to be consumed or admin21 istered under the supervision of a qualified medical 

22 provider, for the treatment of conditions as rec23 ommended by the Advisory Committee on Heritable 

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1 ical equipment and supplies necessary to administer 

2 such food. 

3 ‘‘(2) VITAMINS AND AMINO ACIDS.—A group 

4 health plan, or a health insurance issuer that pro5 vides health insurance coverage in connection with a 

6 group health plan, that provides prescription drug 

7 coverage, shall provide coverage for pharmacological 

8 doses of vitamins and amino acids used for the 

9 treatment of inborn errors of metabolism, for the 

10 treatment of conditions as recommended by the Ad11 visory Committee on Heritable Disorders in 

12 Newborns and Children and as prescribed by a 

13 qualified medical provider, to the same extent as 

14 other prescription drug coverage under such plan or 

15 coverage.’’. 

16 (B) CONFORMING AMENDMENT.—The 

17 table of sections for subchapter B of chapter 

18 100 of such Code is amended by inserting after 

19 the item relating to section 9813 the following 

20 new item: 

‘‘Sec. 9814. Coverage of medically necessary food and food modified to be low 

protein.’’. 

21 (b) INDIVIDUAL MARKET.—Subpart 3 of part B of 

22 title XXVII of the Public Health Service Act (42 U.S.C. 

23 300gg–51 et seq.) is amended by adding at the end the 

24 following new section: 


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1 ‘‘SEC. 2754. COVERAGE OF MEDICALLY NECESSARY FOOD 

2 AND FOOD MODIFIED TO BE LOW PROTEIN. 

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 they apply 

6 to health insurance coverage offered by a health insurance 

7 issuer in connection with a group health plan in the small 

8 or large group market.’’. 

9 SEC. 5. EFFECTIVE DATE; DETERMINATION OF MINIMUM 

10 YEARLY COVERAGE. 

11 (a) EFFECTIVE DATE.—The amendments made by 

12 sections 3 and 4 shall apply to plan years beginning after 

13 the date that is 180 days after the date of enactment of 

14 this Act. 

15 (b) DETERMINATION BY SECRETARY.— 

16 (1) IN GENERAL.—Prior to the date described 

17 under subsection (a), the Secretary of Health and 

18 Human Services (referred to in this Act as the ‘‘Sec19 retary’’) shall determine the minimum yearly cov20 erage for all health insurance plans pursuant to the 

21 amendments made by this Act. Such minimum year22 ly coverage shall apply to an individual during any 

23 period when the individual is covered under the plan 

24 and for as long as deemed medically necessary. The 

25 Secretary may establish age-specific minimum levels 

26 of coverage and periodically update these levels 


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1 based on a standard cost of living index, the actual 

2 cost of treatment, and other appropriate measures 

3 as determined by the Secretary. 

4 (2) NO PREEMPTION.—The minimum yearly 

5 coverage determined by the Secretary under para6 graph (1) shall not preempt any State standards 

7 that require a higher minimum yearly coverage level 

8 for the same services and benefits. 

Æ 


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