II

106TH CONGRESS

1ST SESSION S. 265

Entitled the ‘‘Hospital Length of Stay Act of 1999’’.

IN THE SENATE OF THE UNITED STATES

JANUARY 20, 1999

Mrs. FEINSTEIN (for herself and Ms. SNOWE) introduced the following bill;

which was read twice and referred to the Committee on Finance

A BILL

Entitled the ‘‘Hospital Length of Stay Act of 1999’’.

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 ‘‘Hospital Length of

5 Stay Act of 1999’’.

6 SEC. 2. COVERAGE OF HOSPITAL LENGTH OF STAY.

7 (a) GROUP HEALTH PLANS.—

8 (1) PUBLIC HEALTH SERVICE ACT AMEND9 MENTS.—

10 (A) IN GENERAL.—Subpart 2 of part A of

11 title XXVII of the Public Health Service Act
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1 (42 U.S.C. 300gg–4 et seq.) is amended by

2 adding at the end the following new section:

3 ‘‘SEC. 2707. STANDARDS RELATING TO COVERAGE OF HOS4 PITAL LENGTHS OF STAY.

5 ‘‘(a) REQUIREMENT.—A group health plan and a

6 health insurance issuer offering group health insurance

7 coverage in connection with a group health plan (including

8 a self-insured issuer) that provides coverage for inpatient

9 hospital services—

10 ‘‘(1) shall provide coverage for the length of an

11 inpatient hospital stay as determined by the attend12 ing physician (or other attending health care pro13 vider to the extent permitted under State law) in

14 consultation with the patient to be medically appro15 priate; and

16 ‘‘(2) may not require that a provider obtain au17 thorization from the plan or the issuer for prescrib18 ing any length of stay required under paragraph (1).

19 ‘‘(b) PROHIBITIONS.—A group health plan and a

20 health insurance issuer offering group health insurance

21 coverage in connection with a group health plan (including

22 a self-insured issuer) may not—

23 ‘‘(1) deny to an individual eligibility, or contin24 ued eligibility, to enroll or to renew coverage under
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1 the terms of the plan, solely for the purpose of

2 avoiding the requirements of this section;

3 ‘‘(2) provide monetary payments or rebates to

4 an individual to encourage the individual to accept

5 less than the minimum protections available under

6 this section;

7 ‘‘(3) penalize or otherwise reduce or limit the

8 reimbursement of an attending provider because

9 such provider provided care to an individual partici10 pant or beneficiary in accordance with this section;

11 ‘‘(4) provide incentives (monetary or otherwise)

12 to an attending provider to induce such provider to

13 provide care to an individual participant or bene14 ficiary in a manner inconsistent with this section; or

15 ‘‘(5) subject to subsection (c)(4), restrict bene16 fits for any portion of a period within a hospital

17 length of stay required under subsection (a) in a

18 manner which is less favorable than the benefits pro19 vided for any preceding portion of such stay.

20 ‘‘(c) RULES OF CONSTRUCTION.—

21 ‘‘(1) NO REQUIREMENT TO STAY.—Nothing in

22 this section shall be construed to require an individ23 ual who is a participant or beneficiary to stay in the

24 hospital for a fixed period of time for any procedure.
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1 ‘‘(2) NO EFFECT ON REQUIREMENTS FOR MINI2 MUM HOSPITAL STAY FOLLOWING BIRTH.—Nothing

3 in this section shall be construed as modifying the

4 requirements of section 2704.

5 ‘‘(3) NONAPPLICABILITY.—This section shall

6 not apply with respect to any group health plan, or

7 any group health insurance coverage offered by a

8 health insurance issuer (including a self-insured

9 issuer), which does not provide benefits for hospital

10 lengths of stay.

11 ‘‘(4) COST-SHARING.—Nothing in this section

12 shall be construed as preventing a group health

13 plan, or a health insurance issuer offering group

14 health insurance coverage in connection with a group

15 health plan (including a self-insured issuer), from

16 imposing deductibles, coinsurance, or other cost17 sharing in relation to benefits for hospital lengths of

18 stay under the plan, health insurance coverage of19 fered in connection with a group health plan, or the

20 supplemental policy, except that such coinsurance or

21 other cost-sharing for any portion of a period within

22 a hospital length of stay required under subsection

23 (a) may not be greater than such coinsurance or

24 cost-sharing for any preceding portion of such stay.
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1 ‘‘(d) NOTICE.—A group health plan under this part

2 shall comply with the notice requirement under section

3 714(d) of the Employee Retirement Income Security Act

4 of 1974 with respect to the requirements of this section

5 as if such section applied to such plan.

6 ‘‘(e) LEVEL AND TYPE OF REIMBURSEMENTS.—

7 Nothing in this section shall be construed to prevent a

8 group health plan or a health insurance issuer offering

9 group health insurance coverage in connection with a

10 group health plan (including a self-insured issuer) from

11 negotiating the level and type of reimbursement with a

12 provider for care provided in accordance with this section.

13 ‘‘(f) PREEMPTION; EXCEPTION FOR HEALTH INSUR14 ANCE COVERAGE IN CERTAIN STATES.—

15 ‘‘(1) IN GENERAL.—The requirements of this

16 section shall not apply with respect to health insur17 ance coverage if there is a State law (as defined in

18 section 2723(d)(1)) for a State that regulates such

19 coverage and provides greater protections to patients

20 than those provided under this section.

21 ‘‘(2) CONSTRUCTION.—Section 2723(a)(1) shall

22 not be construed as superseding a State law de23 scribed in paragraph (1).’’.

24 (B) CONFORMING AMENDMENT.—Section

25 2723(c) of the Public Health Service Act (42
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1 U.S.C. 300gg–23(c)) is amended by striking

2 ‘‘section 2704’’ and inserting ‘‘sections 2704

3 and 2707’’.

4 (2) ERISA AMENDMENTS.—

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

6 subtitle B of title I of the Employee Retirement

7 Income Security Act of 1974 (29 U.S.C. 1185

8 et seq.) is amended by adding at the end the

9 following new section:

10 ‘‘SEC. 714. STANDARDS RELATING TO COVERAGE OF HOS11 PITAL LENGTHS OF STAY.

12 ‘‘(a) REQUIREMENT.—A group health plan and a

13 health insurance issuer offering group health insurance

14 coverage in connection with a group health plan (including

15 a self-insured issuer), that provides coverage for inpatient

16 hospital services—

17 ‘‘(1) shall provide coverage for the length of an

18 inpatient hospital stay as determined by the attend19 ing physician (or other attending health care pro20 vider to the extent permitted under State law) in

21 consultation with the patient to be medically appro22 priate; and

23 ‘‘(2) may not require that a provider obtain au24 thorization from the plan or the issuer for prescrib25 ing any length of stay required under paragraph (1).
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1 ‘‘(b) PROHIBITIONS.—A group health plan and a

2 health insurance issuer offering group health insurance

3 coverage in connection with a group health plan (including

4 a self-insured issuer), may not—

5 ‘‘(1) deny to an individual eligibility, or contin6 ued eligibility, to enroll or to renew coverage under

7 the terms of the plan, solely for the purpose of

8 avoiding the requirements of this section;

9 ‘‘(2) provide monetary payments or rebates to

10 an individual to encourage the individual to accept

11 less than the minimum protections available under

12 this section;

13 ‘‘(3) penalize or otherwise reduce or limit the

14 reimbursement of an attending provider because

15 such provider provided care to an individual partici16 pant or beneficiary in accordance with this section;

17 ‘‘(4) provide incentives (monetary or otherwise)

18 to an attending provider to induce such provider to

19 provide care to an individual participant or bene20 ficiary in a manner inconsistent with this section; or

21 ‘‘(5) subject to subsection (c)(4), restrict bene22 fits for any portion of a period within a hospital

23 length of stay required under subsection (a) in a

24 manner which is less favorable than the benefits pro25 vided for any preceding portion of such stay.
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1 ‘‘(c) RULES OF CONSTRUCTION.—

2 ‘‘(1) NO REQUIREMENT TO STAY.—Nothing in

3 this section shall be construed to require an individ4 ual who is a participant or beneficiary to stay in the

5 hospital for a fixed period of time for any procedure.

6 ‘‘(2) NO EFFECT ON REQUIREMENTS FOR MINI7 MUM HOSPITAL STAY FOLLOWING BIRTH.—Nothing

8 in this section shall be construed as modifying the

9 requirements of section 711.

10 ‘‘(3) NONAPPLICABILITY.—This section shall

11 not apply with respect to any group health plan or

12 any group health insurance coverage offered by a

13 health insurance issuer (including a self-insured

14 issuer), which does not provide benefits for hospital

15 lengths of stay.

16 ‘‘(4) COST-SHARING.—Nothing in this section

17 shall be construed as preventing a group health plan

18 or a health insurance issuer offering group health

19 insurance coverage in connection with a group health

20 plan (including a self-insured issuer), from imposing

21 deductibles, coinsurance, or other cost-sharing in re22 lation to benefits for hospital lengths of stay under

23 the plan or health insurance coverage offered in con24 nection with a group health plan, except that such

25 coinsurance or other cost-sharing for any portion of
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1 a period within a hospital length of stay required

2 under subsection (a) may not be greater than such

3 coinsurance or cost-sharing for any preceding por4 tion of such stay.

5 ‘‘(d) NOTICE UNDER GROUP HEALTH PLAN.—The

6 imposition of the requirements of this section shall be

7 treated as a material modification in the terms of the plan

8 described in section 102(a)(1), for purposes of assuring

9 notice of such requirements under the plan; except that

10 the summary description required to be provided under the

11 last sentence of section 104(b)(1) with respect to such

12 modification shall be provided by not later than 60 days

13 after the first day of the first plan year in which such

14 requirements apply.

15 ‘‘(e) LEVEL AND TYPE OF REIMBURSEMENTS.—

16 Nothing in this section shall be construed to prevent a

17 group health plan or a health insurance issuer offering

18 group health insurance coverage in connection with a

19 group health plan (including a self-insured issuer), from

20 negotiating the level and type of reimbursement with a

21 provider for care provided in accordance with this section.

22 ‘‘(f) PREEMPTION; EXCEPTION FOR HEALTH INSUR23 ANCE COVERAGE IN CERTAIN STATES.—

24 ‘‘(1) IN GENERAL.—The requirements of this

25 section shall not apply with respect to health insur-
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1 ance coverage if there is a State law (as defined in

2 section 731(d)(1)) for a State that regulates such

3 coverage and provides greater protections to patients

4 than those provided under this section.

5 ‘‘(2) CONSTRUCTION.—Section 731(a)(1) shall

6 not be construed as superseding a State law de7 scribed in paragraph (1).’’.

8 (B) CONFORMING AMENDMENTS.—

9 (i) Section 731(c) of the Employee

10 Retirement Income Security Act of 1974

11 (29 U.S.C. 1191(c)) is amended by strik12 ing ‘‘section 711’’ and inserting ‘‘sections

13 711 and 714’’.

14 (ii) Section 732(a) of the Employee

15 Retirement Income Security Act of 1974

16 (29 U.S.C. 1191a(a)), as amended by sec17 tion 603(b)(2) of Public Law 104–204, is

18 amended by striking ‘‘section 711’’ and in19 serting ‘‘sections 711 and 714’’.

20 (iii) The table of contents in section 1

21 of the Employee Retirement Income Secu22 rity Act of 1974 is amended by inserting

23 after the item relating to section 713 the

24 following new item:

‘‘Sec. 714. Standards relating to coverage of hospital lengths of stay.’’.
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1 (b) INDIVIDUAL MARKET.—Subpart 3 of part B of

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

3 300gg–51 et seq.) is amended by adding at the end the

4 following new section:

5 ‘‘SEC. 2753. STANDARDS RELATING TO COVERAGE OF HOS6 PITAL LENGTHS OF STAY.

7 ‘‘The provisions of section 2707 shall apply to health

8 insurance coverage offered by a health insurance issuer

9 in the individual market in the same manner as they apply

10 to health insurance coverage offered by a health insurance

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

12 or large group market.’’.

13 (c) EFFECTIVE DATES.—

14 (1) GROUP HEALTH PLANS.—Subject to para15 graph (3), the amendments made by subsection (a)

16 shall apply with respect to group health plans for

17 plan years beginning on or after January 1, 2000.

18 (2) HEALTH INSURANCE COVERAGE.—The

19 amendment made by subsection (b) shall apply with

20 respect to health insurance coverage offered, sold,

21 issued, renewed, in effect, or operated in the individ22 ual market on or after such date.

23 (3) COLLECTIVE BARGAINING AGREEMENTS.—

24 In the case of a group health plan maintained pur25 suant to 1 or more collective bargaining agreements
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1 between employee representatives and 1 or more em2 ployers ratified before the date of enactment of this

3 Act, the amendments made by subsection (a) shall

4 not apply to plan years beginning before the later

5 of—

6 (A) the date on which the last collective

7 bargaining agreements relating to the plan ter8 minates (determined without regard to any ex9 tension thereof agreed to after the date of en10 actment of this Act), or

11 (B) January 1, 2000.

12 For purposes of subparagraph (A), any plan amend13 ment made pursuant to a collective bargaining

14 agreement relating to the plan which amends the

15 plan solely to conform to any requirement added by

16 subsection (a) shall not be treated as a termination

17 of such collective bargaining agreement.

18 SEC. 3. APPLICATION TO MEDICARE AND MEDICAID BENE19 FICIARIES.

20 (a) MEDICARE.—

21 (1) IN GENERAL.—Title XVIII of the Social Se22 curity Act (42 U.S.C. 1395 et seq.) is amended by

23 adding at the end the following:
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1 ‘‘STANDARDS RELATING TO COVERAGE OF HOSPITAL

2 LENGTHS OF STAY

3 ‘‘SEC. 1897. (a) APPLICATION TO MEDICARE.—Not4 withstanding the limitation on benefits described in sec5 tion 1812, or any other limitation on benefits imposed

6 under this title, the provisions of section 2707 of the Pub7 lic Health Service Act shall apply to the provision of items

8 and services under this title.

9 ‘‘(b) MEDICARE+CHOICE AND ELIGIBLE ORGANIZA10 TIONS.—The Secretary may not enter into a contract with

11 a Medicare+Choice organization under part C, or with an

12 eligible organization with a risk-sharing contract under

13 section 1876, unless the organization meets the require14 ments of section 2707 of the Public Health Service Act

15 with respect to individuals enrolled with the organiza16 tion.’’.

17 (2) MEDICARE SUPPLEMENTAL POLICIES.—

18 (A) IN GENERAL.—Section 1882(c) of the

19 Social Security Act (42 U.S.C. 1395ss(c)) is

20 amended—

21 (i) in paragraph (4), by striking

22 ‘‘and’’ at the end;

23 (ii) in paragraph (5), by striking the

24 period and inserting ‘‘, and’’; and
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1 (iii) by adding at the end the follow2 ing:

3 ‘‘(6) meets the requirements of section 2707 of

4 the Public Health Service Act with respect to indi5 viduals enrolled under the policy.’’.

6 (B) CONFORMING AMENDMENT.—Section

7 1882(b)(1)(B) of the Social Security Act (42

8 U.S.C. 1395ss(b)(1)(B)) is amended by striking

9 ‘‘(5)’’ and inserting ‘‘(6)’’.

10 (3) COST SHARING.—Nothing in this subsection

11 or section 2707(c) of the Public Health Service Act

12 shall be construed as authorizing the imposition of

13 cost sharing with respect to the coverage or benefits

14 required to be provided under the amendments to

15 the Social Security Act made by paragraphs (1) and

16 (2) that is inconsistent with the cost sharing that is

17 otherwise permitted under title XVIII of the Social

18 Security Act.

19 (b) MEDICAID.—Title XIX of the Social Security Act

20 (42 U.S.C. 1396 et seq.) is amended by redesignating sec21 tion 1935 as section 1936 and by inserting after section

22 1934 the following:

23 ‘‘STANDARDS RELATING TO COVERAGE OF HOSPITAL

24 LENGTHS OF STAY

25 ‘‘SEC. 1935. (a) IN GENERAL.—A State plan may

26 not be approved under this title unless the plan requires
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1 each health insurance issuer or other entity with a con2 tract with such plan to provide coverage or benefits to in3 dividuals eligible for medical assistance under the plan, in4 cluding a managed care entity, as defined in section

5 1932(a)(1)(B), to comply with the provisions of section

6 2707 of the Public Health Service Act with respect to such

7 coverage or benefits.

8 ‘‘(b) COST SHARING.—Nothing in this section or sec9 tion 2707(c) of the Public Health Service Act shall be con10 strued as authorizing a health insurance issuer or entity

11 to impose cost sharing with respect to the coverage or ben12 efits required to be provided under section 2707 of the

13 Public Health Service Act that is inconsistent with the

14 cost sharing that is otherwise permitted under this title.

15 ‘‘(c) WAIVERS PROHIBITED.—The requirement of

16 subsection (a) may not be waived under section 1115 or

17 section 1915(b) of the Social Security Act.’’.

18 (c) EFFECTIVE DATE.—The amendments made by

19 this section apply to contract years under titles XVIII and

20 XIX of the Social Security Act beginning on or after Jan21 uary 1, 2000.

22 (d) MEDIGAP TRANSITION PROVISIONS.—

23 (1) IN GENERAL.—If the Secretary of Health

24 and Human Services identifies a State as requiring

25 a change to its statutes or regulations to conform its
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1 regulatory program to the changes made by sub2 section (a)(2), the State regulatory program shall

3 not be considered to be out of compliance with the

4 requirements of section 1882 of the Social Security

5 Act due solely to failure to make such change until

6 the date specified in paragraph (4).

7 (2) NAIC STANDARDS.—If, within 9 months

8 after the date of the enactment of this Act, the Na9 tional Association of Insurance Commissioners (in

10 this subsection referred to as the ‘‘NAIC’’) modifies

11 its NAIC Model Regulation relating to section 1882

12 of the Social Security Act (referred to in such sec13 tion as the 1991 NAIC Model Regulation, as modi14 fied pursuant to section 171(m)(2) of the Social Se15 curity Act Amendments of 1994 (Public Law 103–

16 432) and as modified pursuant to section

17 1882(d)(3)(A)(vi)(IV) of the Social Security Act, as

18 added by section 271(a) of the Health Insurance

19 Portability and Accountability Act of 1996 (Public

20 Law 104–191) to conform to the amendments made

21 by this section, such revised regulation incorporating

22 the modifications shall be considered to be the appli23 cable NAIC model regulation (including the revised

24 NAIC model regulation and the 1991 NAIC Model

25 Regulation) for the purposes of such section.
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1 (3) SECRETARY STANDARDS.—If the NAIC

2 does not make the modifications described in para3 graph (2) within the period specified in such para4 graph, the Secretary of Health and Human Services

5 shall make the modifications described in such para6 graph and such revised regulation incorporating the

7 modifications shall be considered to be the appro8 priate regulation for the purposes of such section.

9 (4) DATE SPECIFIED.—

10 (A) IN GENERAL.—Subject to subpara11 graph (B), the date specified in this paragraph

12 for a State is the earlier of—

13 (i) the date the State changes its stat14 utes or regulations to conform its regu15 latory program to the changes made by

16 this section, or

17 (ii) 1 year after the date the NAIC or

18 the Secretary first makes the modifications

19 under paragraph (2) or (3), respectively.

20 (B) ADDITIONAL LEGISLATIVE ACTION RE21 QUIRED.—In the case of a State which the Sec22 retary identifies as—

23 (i) requiring State legislation (other

24 than legislation appropriating funds) to
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1 conform its regulatory program to the

2 changes made in this section, but

3 (ii) having a legislature which is not

4 scheduled to meet in 2000 in a legislative

5 session in which such legislation may be

6 considered,

7 the date specified in this paragraph is the first

8 day of the first calendar quarter beginning after

9 the close of the first legislative session of the

10 State legislature that begins on or after July 1,

11 2000. For purposes of the previous sentence, in

12 the case of a State that has a 2-year legislative

13 session, each year of such session shall be

14 deemed to be a separate regular session of the

15 State legislature.

16 SEC. 4. APPLICATION TO OTHER HEALTH CARE COVERAGE.

17 (a) FEHBP.—Chapter 89 of title 5, United States

18 Code, is amended by adding at the end the following:

19 ‘‘§ 8915. Standards relating to coverage of hospital

20 lengths of stay

21 ‘‘(a) The provisions of section 2707 of the Public

22 Health Service Act shall apply to the provision of items

23 and services under this chapter.

24 ‘‘(b) Nothing in this section or section 2707(c) of the

25 Public Health Service Act shall be construed as authoriz-
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1 ing a health insurance issuer or entity to impose cost shar2 ing with respect to the coverage or benefits required to

3 be provided under section 2707 of the Public Health Serv4 ice Act that is inconsistent with the cost sharing that is

5 otherwise permitted under this chapter.’’.

6 (b) MEDICAL CARE FOR MEMBERS AND CERTAIN

7 FORMER MEMBERS OF THE UNIFORMED SERVICES AND

8 THEIR DEPENDENTS.—Chapter 55 of title 10, United

9 States Code, is amended by adding at the end the follow10 ing:

11 ‘‘§ 1110. Standards relating to coverage of hospital

12 lengths of stay

13 ‘‘(a) APPLICATION OF STANDARDS.—The provisions

14 of section 2707 of the Public Health Service Act shall

15 apply to the provision of items and services under this

16 chapter.

17 ‘‘(b) COST-SHARING.—Nothing in this section or sec18 tion 2707(c) of the Public Health Service Act shall be con19 strued as authorizing the imposition of cost sharing with

20 respect to the coverage or benefits required to be provided

21 under section 2707 of the Public Health Service Act that

22 is inconsistent with the cost sharing that is otherwise per23 mitted under this chapter.’’.
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1 (c) VETERANS.—Subchapter II of chapter 17 of title

2 38, United States Code, is amended by adding at the end

3 the following:

4 ‘‘§ 1720E. Standards relating to coverage of hospital

5 lengths of stay

6 ‘‘(a) The provisions of section 2707 of the Public

7 Health Service Act shall apply to the provision of items

8 and services under this chapter.

9 ‘‘(b) Nothing in this section or section 2707(c) of the

10 Public Health Service Act shall be construed as authoriz11 ing the imposition of cost sharing with respect to the cov12 erage or benefits required to be provided under section

13 2706 of the Public Health Service Act that is inconsistent

14 with the cost sharing that is otherwise permitted under

15 this chapter.’’.

16 (d) STATE CHILDREN’S HEALTH INSURANCE PRO17 GRAM.—Section 2109 of the Social Security Act (42

18 U.S.C. 1397ii) is amended by adding at the end the follow19 ing:

20 ‘‘(b) APPLICATION OF STANDARDS RELATING TO

21 COVERAGE OF HOSPITAL LENGTHS OF STAY.—

22 ‘‘(1) IN GENERAL.—The provisions of section

23 2707 of the Public Health Service Act shall apply to

24 the provision of items and services under this title.
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1 ‘‘(2) COST-SHARING.—Nothing in this section

2 or section 2707(c) of the Public Health Service Act

3 shall be construed as authorizing a health insurance

4 issuer or entity to impose cost sharing with respect

5 to the coverage or benefits required to be provided

6 under section 2707 of the Public Health Service Act

7 that is inconsistent with the cost sharing that is oth8 erwise permitted under this title.’’.

9 (e) INDIAN HEALTH SERVICE AND HEALTH CARE

10 PROVIDED BY TRIBAL ORGANIZATIONS.—Title VIII of the

11 Indian Health Care Improvement Act (25 U.S.C. 1671 et

12 seq.) is amended by adding at the end the following:

13 ‘‘STANDARDS RELATING TO COVERAGE OF HOSPITAL

14 LENGTHS OF STAY

15 ‘‘SEC. 826. (a) The provisions of section 2707 of the

16 Public Health Service Act shall apply to the provision of

17 items and services under this Act by the Service or a tribal

18 organization.

19 ‘‘(b) Nothing in this section or section 2707(c) of the

20 Public Health Service Act shall be construed as authoriz21 ing the imposition of cost sharing with respect to the cov22 erage or benefits required to be provided under section

23 2707 of the Public Health Service Act that is inconsistent

24 with the cost sharing that is otherwise permitted under

25 this Act.’’.
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1 (f) HEALTH CARE PROVIDED TO PEACE CORPS VOL2 UNTEERS.—Section 5(e) of the Peace Corps Act (22

3 U.S.C. 2504(e)) is amended by adding at the end the fol4 lowing: ‘‘The provisions of section 2707 of the Public

5 Health Service Act shall apply to the provision of items

6 and services under this section. Nothing in this section

7 or section 2707(c) of the Public Health Service Act shall

8 be construed as authorizing the imposition of cost sharing

9 with respect to the coverage or benefits required to be pro10 vided under section 2707 of the Public Health Service Act

11 that is inconsistent with the cost sharing that is otherwise

12 permitted under this section.’’.

Æ