II 

116TH CONGRESS 

1ST SESSION S. 1948 

To amend the Internal Revenue Code of 1986 to permit high-deductible 

health plans to provide chronic disease prevention services to plan enrollees prior to satisfying their plan deductible. 

IN THE SENATE OF THE UNITED STATES 

JUNE 24, 2019 

Mr. THUNE (for himself and Mr. CARPER) introduced the following bill; which 

was read twice and referred to the Committee on Finance 

A BILL 

To amend the Internal Revenue Code of 1986 to permit 

high-deductible health plans to provide chronic disease 

prevention services to plan enrollees prior to satisfying 

their plan deductible. 

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; FINDINGS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Chronic Disease Management Act of 2019’’. 

6 (b) FINDINGS.—Congress finds the following: 


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•S 1948 IS

1 (1) A small number of chronic diseases account 

2 for the majority of health care spending in the 

3 United States. 

4 (2) The Office of the Assistant Secretary for 

5 Health of the Department of Health and Human 

6 Services used a deliberative process involving the 

7 Multiple Chronic Conditions working group subject 

8 matter experts in clinical medicine, epidemiology, 

9 and public health to develop a list of 20 chronic con10 ditions that are prevalent and potentially amenable 

11 to public health or clinical interventions, or a com12 bination of both. 

13 (3) Limited and targeted interventions for 

14 many chronic diseases prevent the need for addi15 tional, more costly therapies associated with un16 treated or unmanaged chronic diseases that lead to 

17 adverse effects on quality of life for patients. 

18 (4) These types of chronic care preventive serv19 ices should be encouraged to maximize the effective20 ness and positive outcomes of the care provided 

21 under high-deductible health plans. 

22 (5) Section 223(c)(2)(C) of the Internal Rev23 enue Code of 1986 explicitly grants the Secretary of 

24 the Treasury flexibility in defining the scope of pre25 ventive care for purposes of the preventive care safe 


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1 harbor. As of the date of introduction of this Act, 

2 the Secretary of the Treasury has refrained from ex3 ercising existing authority under such section to ex4 pand the preventive care safe harbor to include 

5 chronic disease prevention. 

6 (6) In the absence of an expansion of the pre7 ventive care safe harbor by the Secretary of the 

8 Treasury, the Chronic Disease Management Act of 

9 2019 would expressly permit high-deductible health 

10 plans to provide chronic disease prevention and 

11 treatment, subject to certain limitations, prior to a 

12 plan enrollee having met their plan deductible. 

13 (7) Allowing health savings account-eligible 

14 high-deductible health plans to cover chronic disease 

15 prevention and treatment on a pre-deductible basis 

16 promotes the concept of Value-Based Insurance De17 sign, which is an effective tool to improve the quality 

18 and reduce the cost of care for Americans with 

19 chronic diseases, with improved outcomes via in20 creased medication adherence, reduced complica21 tions, and decreased emergency department visits. 

22 SEC. 2. CHRONIC DISEASE PREVENTION. 

23 (a) IN GENERAL.—Section 223(c)(2) of the Internal 

24 Revenue Code of 1986 is amended by redesignating subVerDate Sep 11 2014 04:00 Jun 27, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1948.IS S1948

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1 paragraph (D) as subparagraph (E) and by inserting after 

2 subparagraph (C) the following new subparagraph: 

3 ‘‘(D) SAFE HARBOR FOR ABSENCE OF DE4 DUCTIBLE FOR CARE RELATED TO CHRONIC

5 CONDITIONS.—A plan shall not fail to be treat6 ed as a high-deductible health plan by reason of 

7 failing to have a deductible for care related to 

8 the treatment of any chronic condition, as de9 termined by the Assistant Secretary for Health 

10 of the Department of Health and Human Serv11 ices.’’. 

12 (b) EFFECTIVE DATE.—The amendments made by 

13 this section shall apply to coverage for months beginning 

14 after the date of the enactment of this Act. 

Æ 


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