II 

117TH CONGRESS 

1ST SESSION S. 41 

To amend the Public Health Service Act, the Employee Retirement Income 

Security Act of 1974, the Internal Revenue Code of 1986, and the 

Patient Protection and Affordable Care Act to require coverage of hearing devices and systems in certain private health insurance plans, and 

for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JANUARY 25, 2021 

Mrs. CAPITO (for herself and Ms. WARREN) introduced the following bill; 

which was read twice and referred to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, the Internal Revenue Code of 1986, and the Patient Protection and Affordable Care Act to require coverage of hearing devices 

and systems in certain private health insurance plans, 

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 ‘‘Ally’s Act’’. 


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1 SEC. 2. COVERAGE OF HEARING DEVICES AND SYSTEMS IN 

2 CERTAIN PRIVATE HEALTH INSURANCE 

3 PLANS. 

4 (a) PHSA.—Part A of the Public Health Service Act 

5 (42 U.S.C. 300gg et seq.) is amended by inserting after 

6 section 2713 the following new section: 

7 ‘‘SEC. 2713A. COVERAGE OF HEARING DEVICES AND SYS8 TEMS. 

9 ‘‘(a) IN GENERAL.—Beginning with plan years begin10 ning on or after January 1, 2022, a group health plan 

11 and a health insurance issuer offering group or individual 

12 health insurance coverage shall, at a minimum provide 

13 coverage for and may impose cost-sharing requirements 

14 in accordance with subsection (b) for an individual that 

15 a physician (as defined in section 1861(r) of the Social 

16 Security Act) or qualified audiologist (as defined in section 

17 1861(ll)(4)(B) of such Act) determines meets an indica18 tion (including unilateral or bilateral hearing loss) for an 

19 auditory device as approved by the Food and Drug Admin20 istration for— 

21 ‘‘(1) auditory implant devices (including audi22 tory osseointegrated (bone conduction) implants and 

23 cochlear implants) and external sound processors; 

24 ‘‘(2) the maintenance of auditory implant de25 vices and external sound processors described in 

26 paragraph (1); 


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1 ‘‘(3) every 5 years, the upgrade (or replacement 

2 if an upgrade is not available) of auditory implant 

3 devices and external sound processors described in 

4 paragraph (1); 

5 ‘‘(4) adhesive adapters and softband headbands; 

6 ‘‘(5) the repair of auditory implant devices and 

7 external sound processors described in paragraph 

8 (1); 

9 ‘‘(6) a comprehensive hearing assessment; 

10 ‘‘(7) a preoperative medical assessment; 

11 ‘‘(8) surgery (as appropriate); 

12 ‘‘(9) postoperative medical appointments for 

13 purposes of ensuring appropriate recovery from sur14 gery; 

15 ‘‘(10) postoperative audiological appointments 

16 for activation and fitting of the implant device and 

17 external sound processor; and 

18 ‘‘(11) aural rehabilitation and treatment serv19 ices (as appropriate). 

20 ‘‘(b) COST-SHARING.—Beginning with plan years be21 ginning on or after January 1, 2022, the cost-sharing in22 curred under a plan or coverage described in subsection 

23 (a)— 

24 ‘‘(1) for an auditory implant device and exter25 nal sound processors under this section, shall not exVerDate Sep 11 2014 04:10 Feb 06, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S41.IS S41

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1 ceed a dollar amount that is the highest cost-sharing 

2 requirement for the amount of the charges imposed 

3 for such device that is provided by a physician or 

4 qualified audiologist that has a contractual relation5 ship with such plan or coverage for the providing of 

6 such device; 

7 ‘‘(2) for an item or service under this section, 

8 shall not exceed a dollar amount that is imposed for 

9 similar items and services under that plan that are 

10 provided by a physician or qualified audiologist; and 

11 ‘‘(3) that has a contractual relationship with 

12 such plan or coverage for the providing of such 

13 items and services.’’. 

14 (b) ERISA.— 

15 (1) IN GENERAL.—Subpart B of part 7 of sub16 title B of title I of the Employee Retirement Income 

17 Security Act of 1974 (29 U.S.C. 1185 et seq.) by 

18 adding at the end the following new section: 

19 ‘‘SEC. 726. COVERAGE OF HEARING DEVICES AND SYSTEMS. 

20 ‘‘(a) IN GENERAL.—Beginning with plan years begin21 ning on or after January 1, 2022, a group health plan 

22 and a health insurance issuer offering group health insur23 ance coverage shall, at a minimum provide coverage for 

24 and may impose cost-sharing requirements in accordance 

25 with subsection (b) for an individual that a physician (as 


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•S 41 IS

1 defined in section 1861(r) of the Social Security Act) or 

2 qualified audiologist (as defined in section 1861(ll)(4)(B) 

3 of such Act) determines meets an indication (including 

4 unilateral or bilateral hearing loss) for an auditory device 

5 as approved by the Food and Drug Administration for— 

6 ‘‘(1) auditory implant devices (including audi7 tory osseointegrated (bone conduction) implants and 

8 cochlear implants) and external sound processors; 

9 ‘‘(2) the maintenance of auditory implant de10 vices and external sound processors described in 

11 paragraph (1); 

12 ‘‘(3) every 5 years, the upgrade (or replacement 

13 if an upgrade is not available) of auditory implant 

14 devices and external sound processors described in 

15 paragraph (1); 

16 ‘‘(4) adhesive adapters and softband headbands; 

17 ‘‘(5) the repair of auditory implant devices and 

18 external sound processors described in paragraph 

19 (1); 

20 ‘‘(6) a comprehensive hearing assessment; 

21 ‘‘(7) a preoperative medical assessment; 

22 ‘‘(8) surgery (as appropriate); 

23 ‘‘(9) postoperative medical appointments for 

24 purposes of ensuring appropriate recovery from sur25 gery; 


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1 ‘‘(10) postoperative audiological appointments 

2 for activation and fitting of the implant device and 

3 external sound processor; and 

4 ‘‘(11) aural rehabilitation and treatment serv5 ices (as appropriate). 

6 ‘‘(b) COST-SHARING.—Beginning with plan years be7 ginning on or after January 1, 2022, the cost-sharing in8 curred under a plan or coverage described in subsection 

9 (a)— 

10 ‘‘(1) for an auditory implant device and exter11 nal sound processors under this section, shall not ex12 ceed a dollar amount that is the highest cost-sharing 

13 requirement for the amount of the charges imposed 

14 for such device that is provided by a physician or 

15 qualified audiologist that has a contractual relation16 ship with such plan or coverage for the providing of 

17 such device; 

18 ‘‘(2) for an item or service under this section, 

19 shall not exceed a dollar amount that is imposed for 

20 similar items and services under that plan that are 

21 provided by a physician or qualified audiologist; and 

22 ‘‘(3) that has a contractual relationship with 

23 such plan or coverage for the providing of such 

24 items and services.’’. 


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1 (2) CLERICAL AMENDMENT.—The table of con2 tents in section 1 of the Employee Retirement In3 come Security Act of 1974 (29 U.S.C. 1001 et seq.) 

4 is amended by inserting after the item relating to 

5 section 725 the following new item: 

‘‘Sec. 726. Coverage of hearing devices and systems.’’. 

6 (c) IRC.— 

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

8 100 of the Internal Revenue Code of 1986, is 

9 amended by adding at the end the following new sec10 tion: 

11 ‘‘SEC. 9826. COVERAGE OF HEARING DEVICES AND SYS12 TEMS. 

13 ‘‘(a) IN GENERAL.—Beginning with plan years begin14 ning on or after January 1, 2022, a group health plan 

15 shall, at a minimum provide coverage for and may impose 

16 cost-sharing requirements in accordance with subsection 

17 (b) for an individual that a physician (as defined in section 

18 1861(r) of the Social Security Act) or qualified audiologist 

19 (as defined in section 1861(ll)(4)(B) of such Act) deter20 mines meets an indication (including unilateral or bilateral 

21 hearing loss) for an auditory device as approved by the 

22 Food and Drug Administration for— 

23 ‘‘(1) auditory implant devices (including audi24 tory osseointegrated (bone conduction) implants and 

25 cochlear implants) and external sound processors; 


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1 ‘‘(2) the maintenance of auditory implant de2 vices and external sound processors described in 

3 paragraph (1); 

4 ‘‘(3) every 5 years, the upgrade (or replacement 

5 if an upgrade is not available) of auditory implant 

6 devices and external sound processors described in 

7 paragraph (1); 

8 ‘‘(4) adhesive adapters and softband headbands; 

9 ‘‘(5) the repair of auditory implant devices and 

10 external sound processors described in paragraph 

11 (1); 

12 ‘‘(6) a comprehensive hearing assessment; 

13 ‘‘(7) a preoperative medical assessment; 

14 ‘‘(8) surgery (as appropriate); 

15 ‘‘(9) postoperative medical appointments for 

16 purposes of ensuring appropriate recovery from sur17 gery; 

18 ‘‘(10) postoperative audiological appointments 

19 for activation and fitting of the implant device and 

20 external sound processor; and 

21 ‘‘(11) aural rehabilitation and treatment serv22 ices (as appropriate). 

23 ‘‘(b) COST-SHARING.—Beginning with plan years be24 ginning on or after January 1, 2022, the cost-sharing in25 curred under a plan described in subsection (a)— 


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1 ‘‘(1) for an auditory implant device and exter2 nal sound processors under this section, shall not ex3 ceed a dollar amount that is the highest cost-sharing 

4 requirement for the amount of the charges imposed 

5 for such device that is provided by a physician or 

6 qualified audiologist that has a contractual relation7 ship with such plan for the providing of such device; 

8 ‘‘(2) for an item or service under this section, 

9 shall not exceed a dollar amount that is imposed for 

10 similar items and services under that plan that are 

11 provided by a physician or qualified audiologist; and 

12 ‘‘(3) that has a contractual relationship with 

13 such plan for the providing of such items and serv14 ices.’’. 

15 (2) CLERICAL AMENDMENT.—The table of sec16 tions for subchapter B of chapter 100 of the Inter17 nal Revenue Code of 1986 is amended by inserting 

18 after the item relating to section 9825 the following 

19 new item: 

‘‘Sec. 9826. Coverage of hearing devices and systems.’’. 

20 (d) APPLICATION TO GRANDFATHERED HEALTH

21 PLANS.—Section 1251(a)(4)(A) of the Patient Protection 

22 and Affordable Care Act (42 U.S.C. 18011(a)(4)(A)) is 

23 amended— 


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1 (1) by striking ‘‘title’’ and inserting ‘‘title, or as 

2 added after the date of the enactment of this Act)’’; 

3 and 

4 (2) by adding at the end the following new 

5 clause: 

6 ‘‘(v) Section 2713A (relating to hear7 ing devices and systems).’’. 

8 (3) EFFECTIVE DATE.—The amendments made 

9 by this subsection shall apply with respect to plan 

10 years beginning on or after January 1, 2022. 

Æ 


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