I 

110TH CONGRESS 

1ST SESSION H. R. 1655 

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

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

that group and individual health insurance coverage and group health 

plans provide coverage for treatment of a minor child’s congenital or 

developmental deformity or disorder due to trauma, infection, tumor, 

or disease. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 22, 2007 

Mrs. MCCARTHY of New York (for herself, Mr. TIBERI, Mrs. MALONEY of 

New York, Mr. GORDON of Tennessee, Mr. MCDERMOTT, Mr. INSLEE, 

Mr. COBLE, and Ms. HOOLEY) introduced the following bill; which was 

referred to the Committee on Energy and Commerce, and in addition to 

the Committees on Education and Labor and Ways and Means, 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 amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal 

Revenue Code of 1986 to require that group and individual health insurance coverage and group health plans 

provide coverage for treatment of a minor child’s congenital or developmental deformity or disorder due to 

trauma, infection, tumor, or disease. 


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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 ‘‘Children’s Access to 

5 Reconstructive Evaluation & Surgery (CARES) Act of 

6 2007’’. 

7 SEC. 2. COVERAGE OF MINOR CHILD’S CONGENITAL OR DE8 VELOPMENTAL DEFORMITY OR DISORDER. 

9 (a) GROUP HEALTH PLANS.— 

10 (1) PUBLIC HEALTH SERVICE ACT AMEND11 MENTS.—(A) Subpart 2 of part A of title XXVII of 

12 the Public Health Service Act is amended by adding 

13 at the end the following new section: 

14 ‘‘SEC. 2707. STANDARDS RELATING TO BENEFITS FOR 

15 MINOR CHILD’S CONGENITAL OR DEVELOP16 MENTAL DEFORMITY OR DISORDER. 

17 ‘‘(a) REQUIREMENTS FOR RECONSTRUCTIVE SUR18 GERY.— 

19 ‘‘(1) IN GENERAL.—A group health plan, and a 

20 health insurance issuer offering group health insur21 ance coverage, that provides coverage for surgical 

22 benefits shall provide coverage for outpatient and in23 patient diagnosis and treatment of a minor child’s 

24 congenital or developmental deformity, disease, or 


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1 injury. A minor child shall include any individual 

2 through 21 years of age. 

3 ‘‘(2) REQUIREMENTS.—Any coverage provided 

4 under paragraph (1) shall be subject to pre-author5 ization or pre-certification as required by the plan or 

6 issuer, and such coverage shall include any surgical 

7 treatment which, in the opinion of the treating phy8 sician, is medically necessary to approximate a nor9 mal appearance. 

10 ‘‘(3) TREATMENT DEFINED.— 

11 ‘‘(A) IN GENERAL.—In this section, the 

12 term ‘treatment’ includes reconstructive sur13 gical procedures (procedures that are generally 

14 performed to improve function, but may also be 

15 performed to approximate a normal appear16 ance) that are performed on abnormal struc17 tures of the body caused by congenital defects, 

18 developmental abnormalities, trauma, infection, 

19 tumors, or disease, including— 

20 ‘‘(i) procedures that do not materially 

21 affect the function of the body part being 

22 treated; and 

23 ‘‘(ii) procedures for secondary condi24 tions and follow-up treatment. 


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1 ‘‘(B) EXCEPTION.—Such term does not in2 clude cosmetic surgery performed to reshape 

3 normal structures of the body to improve ap4 pearance or self-esteem. 

5 ‘‘(b) NOTICE.—A group health plan under this part 

6 shall comply with the notice requirement under section 

7 714(b) of the Employee Retirement Income Security Act 

8 of 1974 with respect to the requirements of this section 

9 as if such section applied to such plan.’’. 

10 (B) Section 2723(c) of such Act (42 U.S.C. 

11 300gg–23(c)) is amended by striking ‘‘section 2704’’ 

12 and inserting ‘‘sections 2704 and 2707’’. 

13 (2) ERISA AMENDMENTS.—(A) Subpart B of 

14 part 7 of subtitle B of title I of the Employee Re15 tirement Income Security Act of 1974 is amended by 

16 adding at the end the following new section: 

17 ‘‘SEC. 714. STANDARDS RELATING TO BENEFITS FOR MINOR 

18 CHILD’S CONGENITAL OR DEVELOPMENTAL 

19 DEFORMITY OR DISORDER. 

20 ‘‘(a) REQUIREMENTS FOR RECONSTRUCTIVE SUR21 GERY.— 

22 ‘‘(1) IN GENERAL.—A group health plan, and a 

23 health insurance issuer offering group health insur24 ance coverage, that provides coverage for surgical 

25 benefits shall provide coverage for outpatient and inVerDate Aug 31 2005 02:26 Mar 27, 2007 Jkt 059200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1655.IH H1655

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1 patient diagnosis and treatment of a minor child’s 

2 congenital or developmental deformity, disease, or 

3 injury. A minor child shall include any individual 

4 who has not attained age 22. 

5 ‘‘(2) REQUIREMENTS.—Any coverage provided 

6 under paragraph (1) shall be subject to pre-author7 ization or pre-certification as required by the plan or 

8 issuer, and such coverage shall include any surgical 

9 treatment which, in the opinion of the treating phy10 sician, is medically necessary to approximate a nor11 mal appearance. 

12 ‘‘(3) TREATMENT DEFINED.— 

13 ‘‘(A) IN GENERAL.—For purposes of this 

14 section, the term ‘treatment’ includes recon15 structive surgical procedures (procedures that 

16 are generally performed to improve function, 

17 but may also be performed to approximate a 

18 normal appearance) that are performed on ab19 normal structures of the body caused by con20 genital defects, developmental abnormalities, 

21 trauma, infection, tumors, or disease, includ22 ing— 

23 ‘‘(i) procedures that do not materially 

24 affect the function of the body part being 

25 treated; and 


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1 ‘‘(ii) procedures for secondary condi2 tions and follow-up treatment. 

3 ‘‘(B) EXCEPTION.—Such term does not in4 clude cosmetic surgery performed to reshape 

5 normal structures of the body to improve ap6 pearance or self-esteem. 

7 ‘‘(b) NOTICE UNDER GROUP HEALTH PLAN.—The 

8 imposition of the requirements of this section shall be 

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

10 described in the last sentence of section 102(a), for pur11 poses of assuring notice of such requirements under the 

12 plan; except that the summary description required to be 

13 provided under the fourth sentence of section 104(b)(1) 

14 with respect to such modification shall be provided by not 

15 later than 60 days after the first day of the first plan 

16 year in which such requirements apply.’’. 

17 (B) Section 731(c) of such Act (29 U.S.C. 

18 1191(c)) is amended by striking ‘‘section 711’’ and 

19 inserting ‘‘sections 711 and 714’’. 

20 (C) Section 732(a) of such Act (29 U.S.C. 

21 1191a(a)) is amended by striking ‘‘section 711’’ and 

22 inserting ‘‘sections 711 and 714’’. 

23 (D) The table of contents in section 1 of such 

24 Act is amended by inserting after the item relating 

25 to section 713 the following new item: 


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‘‘Sec. 714. Standards relating to benefits for minor child’s congenital or developmental deformity or disorder.’’. 

1 (3) INTERNAL REVENUE CODE AMEND2 MENTS.— 

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

5 is amended by adding at the end the following 

6 new section: 

7 ‘‘SEC. 9813. STANDARDS RELATING TO BENEFITS FOR 

8 MINOR CHILD’S CONGENITAL OR DEVELOP9 MENTAL DEFORMITY OR DISORDER. 

10 ‘‘(a) REQUIREMENTS FOR RECONSTRUCTIVE SUR11 GERY.— 

12 ‘‘(1) IN GENERAL.—A group health plan, and a 

13 health insurance issuer offering group health insur14 ance coverage, that provides coverage for surgical 

15 benefits shall provide coverage for outpatient and in16 patient diagnosis and treatment of a minor child’s 

17 congenital or developmental deformity, disease, or 

18 injury. A minor child shall include any individual 

19 who has not attained age 22. 

20 ‘‘(2) REQUIREMENTS.—Any coverage provided 

21 under paragraph (1) shall be subject to pre-author22 ization or pre-certification as required by the plan or 

23 issuer, and such coverage shall include any surgical 

24 treatment which, in the opinion of the treating phyVerDate Aug 31 2005 02:26 Mar 27, 2007 Jkt 059200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1655.IH H1655

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1 sician, is medically necessary to approximate a nor2 mal appearance. 

3 ‘‘(3) TREATMENT DEFINED.— 

4 ‘‘(A) IN GENERAL.—For purposes of this 

5 section, the term ‘treatment’ includes recon6 structive surgical procedures (procedures that 

7 are generally performed to improve function, 

8 but may also be performed to approximate a 

9 normal appearance) that are performed on ab10 normal structures of the body caused by con11 genital defects, developmental abnormalities, 

12 trauma, infection, tumors, or disease, includ13 ing— 

14 ‘‘(i) procedures that do not materially 

15 affect the function of the body part being 

16 treated; and 

17 ‘‘(ii) procedures for secondary condi18 tions and follow-up treatment. 

19 ‘‘(B) EXCEPTION.—Such term does not in20 clude cosmetic surgery performed to reshape 

21 normal structures of the body to improve ap22 pearance or self-esteem.’’. 

23 (B) CLERICAL AMENDMENT.—The table of 

24 sections for such subchapter is amended by 

25 adding at the end the following new item: 


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‘‘Sec. 9813. Standards relating to benefits for minor child’s congenital or developmental deformity or disorder.’’. 

1 (b) INDIVIDUAL HEALTH INSURANCE.—(1) Part B 

2 of title XXVII of the Public Health Service Act is amend3 ed by inserting after section 2752 the following new sec4 tion: 

5 ‘‘SEC. 2753. STANDARDS RELATING TO BENEFITS FOR 

6 MINOR CHILD’S CONGENITAL OR DEVELOP7 MENTAL DEFORMITY OR DISORDER. 

8 ‘‘(a) REQUIREMENTS FOR RECONSTRUCTIVE SUR9 GERY.— 

10 ‘‘(1) IN GENERAL.—A group health plan, and a 

11 health insurance issuer offering group health insur12 ance coverage, that provides coverage for surgical 

13 benefits shall provide coverage for outpatient and in14 patient diagnosis and treatment of a minor child’s 

15 congenital or developmental deformity, disease, or 

16 injury. A minor child shall include any individual 

17 through 21 years of age. 

18 ‘‘(2) REQUIREMENTS.—Any coverage provided 

19 under paragraph (1) shall be subject to pre-author20 ization or pre-certification as required by the plan or 

21 issuer, and such coverage shall include any surgical 

22 treatment which, in the opinion of the treating phy23 sician, is medically necessary to approximate a nor24 mal appearance. 


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1 ‘‘(3) TREATMENT DEFINED.— 

2 ‘‘(A) IN GENERAL.—In this section, the 

3 term ‘treatment’ includes reconstructive sur4 gical procedures (procedures that are generally 

5 performed to improve function, but may also be 

6 performed to approximate a normal appear7 ance) that are performed on abnormal struc8 tures of the body caused by congenital defects, 

9 developmental abnormalities, trauma, infection, 

10 tumors, or disease, including— 

11 ‘‘(i) procedures that do not materially 

12 affect the function of the body part being 

13 treated; and 

14 ‘‘(ii) procedures for secondary condi15 tions and follow-up treatment. 

16 ‘‘(B) EXCEPTION.—Such term does not in17 clude cosmetic surgery performed to reshape 

18 normal structures of the body to improve ap19 pearance or self-esteem. 

20 ‘‘(b) NOTICE.—A health insurance issuer under this 

21 part shall comply with the notice requirement under sec22 tion 714(b) of the Employee Retirement Income Security 

23 Act of 1974 with respect to the requirements referred to 

24 in subsection (a) as if such section applied to such issuer 

25 and such issuer were a group health plan.’’. 


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1 (2) Section 2762(b)(2) of such Act (42 U.S.C. 

2 300gg–62(b)(2)) is amended by striking ‘‘section 2751’’ 

3 and inserting ‘‘sections 2751 and 2753’’. 

4 (c) EFFECTIVE DATES.—(1) The amendments made 

5 by subsection (a) shall apply with respect to group health 

6 plans for plan years beginning on or after January 1, 

7 2008. 

8 (2) The amendment made by subsection (b) shall 

9 apply with respect to health insurance coverage offered, 

10 sold, issued, renewed, in effect, or operated in the indi11 vidual market on or after such date. 

12 (d) COORDINATED REGULATIONS.—Section 104(1) 

13 of Health Insurance Portability and Accountability Act of 

14 1996 is amended by striking ‘‘this subtitle (and the 

15 amendments made by this subtitle and section 401)’’ and 

16 inserting ‘‘the provisions of part 7 of subtitle B of title 

17 I of the Employee Retirement Income Security Act of 

18 1974, the provisions of parts A and C of title XXVII of 

19 the Public Health Service Act, and chapter 100 of the In20 ternal Revenue Code of 1986’’. 

Æ 


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