II 

111TH CONGRESS 

1ST SESSION S. 2766 

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

programs and private health insurance. 

IN THE SENATE OF THE UNITED STATES 

NOVEMBER 10, 2009 

Mr. KERRY (for himself and Mr. CASEY) introduced the following bill; which 

was read twice and referred to the Committee on Finance 

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 2009’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 

8 (1) Newborns are screened for inborn errors of 

9 metabolism, but treatment for such conditions is not 

10 uniformly covered by insurance. 


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

2 the United States are diagnosed with an inborn 

3 error of metabolism disorder, requiring foods modi4 fied to be void of the nutrient or nutrients the 

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

6 supplementation with vitamins or amino acids. 

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

8 least partially address the inequity in coverage for 

9 medically necessary foods, critical treatment for such 

10 disorders. 

11 (4) The cost associated with providing medically 

12 necessary foods presents a large financial burden for 

13 many families. 

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

15 of metabolism disorders and treatment is necessary 

16 during the entire lifespan of the individual. 

17 SEC. 3. COVERAGE IN FEDERAL HEALTH PROGRAMS OF 

18 MEDICALLY NECESSARY FOOD AND FOOD 

19 MODIFIED TO BE LOW PROTEIN. 

20 (a) COVERAGE UNDER THE MEDICARE PROGRAM.— 

21 (1) COVERAGE OF MEDICALLY NECESSARY

22 FOOD UNDER THE ORIGINAL MEDICARE FEE-FOR23 SERVICE PROGRAM.— 


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

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

3 is amended— 

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

5 ‘‘and’’ at the end; 

6 (ii) in subparagraph (EE), by insert7 ing ‘‘and’’ at the end; and 

8 (iii) by adding at the end the fol9 lowing new subparagraph: 

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

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

12 low protein that is formulated to be consumed 

13 or administered under the supervision of a 

14 qualified medical provider, for the treatment of 

15 conditions as recommended by the Advisory 

16 Committee on Heritable Disorders in Newborns 

17 and Children, and the medical equipment and 

18 supplies necessary to administer such food.’’. 

19 (B) DEFINITION.—Section 1861 of such 

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

21 the end the following new subsection: 

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

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

24 consumed or administered enterally under the super25 vision of a qualified medical provider and which is 


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1 intended for the specific dietary management of a 

2 disease or condition for which distinctive nutritional 

3 requirements, based on recognized scientific prin4 ciples, are established by medical evaluation; and 

5 ‘‘(B) includes nutritionally modified counter6 parts of traditional foods and other forms of foods 

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

8 consumed or administered enterally. 

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

10 ‘enterally’ refers to consumption or administration 

11 through the gastrointestinal tract, whether orally or by 

12 tube.’’. 

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

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

15 amended— 

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

17 and 

18 (ii) by inserting before the semicolon 

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

20 respect to medically necessary food and 

21 pharmacological doses of vitamins and 

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

23 the amounts paid shall be 80 percent of 

24 the lesser of the actual charge for the serv25 ices or 85 percent of the amount deterVerDate Nov 24 2008 00:59 Nov 11, 2009 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S2766.IS S2766

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1 mined under the fee schedule established 

2 under section 1848(b) for the same serv3 ices if furnished by a physician’’. 

4 (2) INCLUSION OF PHARMACOLOGICAL DOSES

5 OF VITAMINS AND AMINO ACIDS AS A COVERED PART

6 D DRUG.— 

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

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

9 102(e)(1)) is amended— 

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

11 ‘‘or’’; 

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

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

14 and 

15 (iii) by adding at the end the fol16 lowing new subparagraph: 

17 ‘‘(C) pharmacological doses of vitamins 

18 and amino acids used for the treatment of in19 born errors of metabolism, for the treatment of 

20 conditions as recommended by the Advisory 

21 Committee on Heritable Disorders in Newborns 

22 and Children and as prescribed by a qualified 

23 medical provider,’’. 

24 (B) EFFECTIVE DATE.—The amendments 

25 made by subparagraph (A) shall apply to plan 


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1 years beginning on or after the date that is 6 

2 months after date of enactment of this Act. 

3 (b) COVERAGE UNDER THE MEDICAID PROGRAM.— 

4 (1) DEFINITION OF MEDICAL ASSISTANCE.— 

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

6 1396d) is amended— 

7 (A) in subsection (a)— 

8 (i) by redesignating paragraph (28) as 

9 paragraph (30); 

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

11 the end ‘‘and’’; and 

12 (iii) by inserting after paragraph (27) 

13 the following new paragraphs: 

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

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

16 that is formulated to be consumed or administered 

17 under the supervision of a qualified medical pro18 vider, for the treatment of conditions as rec19 ommended by the Advisory Committee on Heritable 

20 Disorders in Newborns and Children, and the med21 ical equipment and supplies necessary to administer 

22 such food; 

23 ‘‘(29) pharmacological doses of vitamins and 

24 amino acids used for the treatment of inborn errors 

25 of metabolism, for the treatment of conditions as 


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1 recommended by the Advisory Committee on Heri2 table Disorders in Newborns and Children and as 

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

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

5 subsection: 

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

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

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

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

10 be consumed or administered enterally under 

11 the supervision of a qualified medical provider 

12 and which is intended for the specific dietary 

13 management of a disease or condition for which 

14 distinctive nutritional requirements, based on 

15 recognized scientific principles, are established 

16 by medical evaluation; and 

17 ‘‘(B) includes nutritionally modified coun18 terparts of traditional foods and other forms of 

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

20 so long as consumed or administered enterally. 

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

22 (1), the term ‘enterally’ refers to consumption or ad23 ministration through the gastrointestinal tract, 

24 whether orally or by tube.’’. 


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1 (2) MANDATORY BENEFITS.—Section 

2 1902(a)(10)(A) of the Social Security Act (42 

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

4 preceding clause (i), by striking ‘‘and (21)’’ and in5 serting ‘‘, (21), (28), and (29)’’. 

6 (3) CONFORMING AMENDMENTS.— 

7 (A) MEDICALLY NEEDY.—Section 

8 1902(a)(10)(C)(iv) of such Act (42 U.S.C. 

9 1396a(a)(10)(C)(iv)) is amended by striking 

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

11 services listed in any 7 of the paragraphs num12 bered (1) through (24)’’ and inserting ‘‘(17), 

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

14 and services listed in any 7 of the paragraphs 

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

16 (B) EXCEPTION TO REBATE EXCLUSION.— 

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

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

19 by inserting ‘‘, pharmacological doses of vita20 mins and amino acids used for the treatment of 

21 inborn errors of metabolism, for the treatment 

22 of conditions as recommended by the Advisory 

23 Committee on Heritable Disorders in Newborns 

24 and Children and as prescribed by a qualified 

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


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1 (4) EXCEPTION TO EFFECTIVE DATE IF STATE

2 LEGISLATION REQUIRED.—In the case of a State 

3 plan for medical assistance under title XIX of the 

4 Social Security Act which the Secretary of Health 

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

6 ‘‘Secretary’’) determines requires State legislation 

7 (other than legislation appropriating funds) in order 

8 for the plan to meet the additional requirement im9 posed by the amendments made by this subsection, 

10 the State plan shall not be regarded as failing to 

11 comply with the requirements of such title solely on 

12 the basis of its failure to meet this additional re13 quirement before the first day of the first calendar 

14 quarter beginning after the close of the first regular 

15 session of the State legislature that begins after the 

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

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

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

19 shall be deemed to be a separate regular session of 

20 the State legislature. 

21 (c) COVERAGE UNDER CHIP.— 

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

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

24 amended by inserting after paragraph (8) the fol25 lowing: 


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1 ‘‘(9) MEDICALLY NECESSARY FOOD.— 

2 ‘‘(A) IN GENERAL.—The child health as3 sistance provided to a targeted low-income child 

4 under the plan shall include coverage of medi5 cally necessary food and food modified to be low 

6 protein that is formulated to be consumed or 

7 administered under the supervision of a quali8 fied medical provider, for the treatment of con9 ditions as recommended by the Advisory Com10 mittee on Heritable Disorders in Newborns and 

11 Children, and the medical equipment and sup12 plies necessary to administer such food. 

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

14 ‘‘(i) the term ‘medically necessary 

15 food’— 

16 ‘‘(I) means a food which is for17 mulated to be consumed or adminis18 tered enterally under the supervision 

19 of a qualified medical provider and 

20 which is intended for the specific die21 tary management of a disease or con22 dition for which distinctive nutritional 

23 requirements, based on recognized sci24 entific principles, are established by 

25 medical evaluation; and 


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1 ‘‘(II) includes nutritionally modi2 fied counterparts of traditional foods 

3 and other forms of foods such as for4 mulas, pills, capsules and bars, so 

5 long as consumed or administered 

6 enterally; and 

7 ‘‘(ii) the term ‘enterally’ refers to con8 sumption or administration through the 

9 gastrointestinal tract, whether orally or by 

10 tube. 

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

12 health assistance provided to a targeted low-income 

13 child under the plan shall include coverage of phar14 macological doses of vitamins and amino acids used 

15 for the treatment of inborn errors of metabolism, for 

16 the treatment of conditions as recommended by the 

17 Advisory Committee on Heritable Disorders in 

18 Newborns and Children and as prescribed by a 

19 qualified medical provider.’’. 

20 (2) CONFORMING AMENDMENTS.— 

21 (A) MANDATORY BENEFITS.—Section 

22 2103(a) of the Social Security Act (42 U.S.C. 

23 1397cc(a)) is amended, in the matter preceding 

24 paragraph (1), by striking ‘‘, and (7)’’ and in25 serting ‘‘, (7), (9), and (10)’’. 


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1 (B) DEFINITION OF CHILD HEALTH AS2 SISTANCE.—Section 2110(a) of such Act (42 

3 U.S.C. 1397jj) is amended— 

4 (i) by redesignating paragraph (28) as 

5 paragraph (30); and 

6 (ii) by inserting after paragraph (27) 

7 the following: 

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

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

10 low protein that is formulated to be consumed or ad11 ministered under the supervision of a qualified med12 ical provider, for the treatment of conditions as rec13 ommended by the Advisory Committee on Heritable 

14 Disorders in Newborns and Children, and the med15 ical equipment and supplies necessary to administer 

16 such food. 

17 ‘‘(29) Pharmacological doses of vitamins and 

18 amino acids used for the treatment of inborn errors 

19 of metabolism, for the treatment of conditions as 

20 recommended by the Advisory Committee on Heri21 table Disorders in Newborns and Children and as 

22 prescribed by a qualified medical provider.’’. 

23 (d) AVAILABILITY OF MEDICALLY NECESSARY FOOD, 

24 FOOD MODIFIED TO BE LOW PROTEIN, AND RELATED

25 ITEMS UNDER THE TRICARE PROGRAM.—Section 


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1 1077(a)(8) of title 10, United States Code, is amended 

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

3 ‘‘including the following: 

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

5 screening of an infant for the level of lead in 

6 the blood of the infant. 

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

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

9 and food modified to be low protein that is for10 mulated to be consumed or administered under 

11 the supervision of a qualified medical provider, 

12 for the treatment of conditions as recommended 

13 by the Advisory Committee on Heritable Dis14 orders in Newborns and Children, and the med15 ical equipment and supplies necessary to admin16 ister such food. 

17 ‘‘(C) Pharmacological doses of vitamins 

18 and amino acids used for the treatment of in19 born errors of metabolism and other conditions 

20 as recommended by the Advisory Committee on 

21 Heritable Disorders in Newborns and Chil22 dren.’’. 


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1 SEC. 4. COVERAGE IN THE PRIVATE INSURANCE MARKET 

2 OF MEDICALLY NECESSARY FOOD AND FOOD 

3 MODIFIED TO BE LOW PROTEIN. 

4 (a) GROUP HEALTH PLANS.— 

5 (1) AMENDMENTS TO ERISA.— 

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

7 title I of the Employee Retirement Income Se8 curity Act of 1974 (29 U.S.C. 1185 et seq.) is 

9 amended by adding at the end the following: 

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

11 AND FOOD MODIFIED TO BE LOW PROTEIN. 

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

13 ‘‘(1) 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) the term ‘enterally’ refers to consumption 

2 or administration through the gastrointestinal tract, 

3 whether orally or by tube. 

4 ‘‘(b) COVERAGE.— 

5 ‘‘(1) MEDICALLY NECESSARY FOOD AND FOOD

6 MODIFIED TO BE LOW PROTEIN.—A group health 

7 plan, or a health insurance issuer that provides 

8 health insurance coverage in connection with a group 

9 health plan, shall provide coverage for medically nec10 essary food and food modified to be low protein that 

11 is formulated to be consumed or administered under 

12 the supervision of a qualified medical provider, for 

13 the treatment of conditions as recommended by the 

14 Advisory Committee on Heritable Disorders in 

15 Newborns and Children, and the medical equipment 

16 and supplies necessary to administer such food. 

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

18 health plan, or a health insurance issuer that pro19 vides health insurance coverage in connection with a 

20 group health plan, that provides prescription drug 

21 coverage shall provide coverage for pharmacological 

22 doses of vitamins and amino acids used for the 

23 treatment of inborn errors of metabolism, for the 

24 treatment of conditions as recommended by the Ad25 visory Committee on Heritable Disorders in 


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1 Newborns and Children and as prescribed by a 

2 qualified medical provider, to the same extent as 

3 other prescription drug coverage under such plan or 

4 coverage.’’. 

5 (B) CONFORMING AMENDMENT.—The 

6 table of contents in section 1 of such Act is 

7 amended by inserting after the item relating to 

8 section 714 the following new item: 

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

protein.’’. 

9 (2) AMENDMENTS TO THE PUBLIC HEALTH

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

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

12 4 et seq.) is amended by adding at the end the fol13 lowing new section: 

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

15 AND FOOD MODIFIED TO BE LOW PROTEIN. 

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

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

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

19 be consumed or administered enterally under 

20 the supervision of a qualified medical provider 

21 and which is intended for the specific dietary 

22 management of a disease or condition for which 

23 distinctive nutritional requirements, based on 


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1 recognized scientific principles, are established 

2 by medical evaluation; and 

3 ‘‘(B) includes nutritionally modified coun4 terparts of traditional foods and other forms of 

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

6 so long as consumed or administered enterally. 

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

8 or administration through the gastrointestinal tract, 

9 whether orally or by tube. 

10 ‘‘(b) COVERAGE.— 

11 ‘‘(1) MEDICALLY NECESSARY FOOD AND FOOD

12 MODIFIED TO BE LOW PROTEIN.—A group health 

13 plan, or a health insurance issuer that provides 

14 health insurance coverage in connection with a group 

15 health plan, shall provide coverage for medically nec16 essary food and food modified to be low protein that 

17 is formulated to be consumed or administered under 

18 the supervision of a qualified medical provider, for 

19 the treatment of conditions as recommended by the 

20 Advisory Committee on Heritable Disorders in 

21 Newborns and Children, and the medical equipment 

22 and supplies necessary to administer such food. 

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

24 health plan, or a health insurance issuer that pro25 vides health insurance coverage in connection with a 


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1 group health plan, that provides prescription drug 

2 coverage, shall provide coverage for pharmacological 

3 doses of vitamins and amino acids used for the 

4 treatment of inborn errors of metabolism, for the 

5 treatment of conditions as recommended by the Ad6 visory Committee on Heritable Disorders in 

7 Newborns and Children and as prescribed by a 

8 qualified medical provider, to the same extent as 

9 other prescription drug coverage under such plan or 

10 coverage.’’. 

11 (3) AMENDMENTS TO THE INTERNAL REVENUE

12 CODE.— 

13 (A) IN GENERAL.—Subchapter B of chap14 ter 100 of the Internal Revenue Code of 1986 

15 (relating to other group health plan require16 ments) is amended by inserting after section 

17 9813 the following new section: 

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

19 AND FOOD MODIFIED TO BE LOW PROTEIN. 

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

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

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

23 be consumed or administered enterally under 

24 the supervision of a qualified medical provider 

25 and which is intended for the specific dietary 


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1 management of a disease or condition for which 

2 distinctive nutritional requirements, based on 

3 recognized scientific principles, are established 

4 by medical evaluation; and 

5 ‘‘(B) includes nutritionally modified coun6 terparts of traditional foods and other forms of 

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

8 so long as consumed or administered enterally. 

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

10 or administration through the gastrointestinal tract, 

11 whether orally or by tube. 

12 ‘‘(b) COVERAGE.— 

13 ‘‘(1) MEDICALLY NECESSARY FOOD AND FOOD

14 MODIFIED TO BE LOW PROTEIN.—A group health 

15 plan, or a health insurance issuer that provides 

16 health insurance coverage in connection with a group 

17 health plan, shall provide coverage for necessary 

18 medically necessary food and food modified to be low 

19 protein that is formulated to be consumed or admin20 istered under the supervision of a qualified medical 

21 provider, for the treatment of conditions as rec22 ommended by the Advisory Committee on Heritable 

23 Disorders in Newborns and Children, and the med24 ical equipment and supplies necessary to administer 

25 such food. 


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

2 health plan, or a health insurance issuer that pro3 vides health insurance coverage in connection with a 

4 group health plan, that provides prescription drug 

5 coverage, shall provide coverage for pharmacological 

6 doses of vitamins and amino acids used for the 

7 treatment of inborn errors of metabolism, for the 

8 treatment of conditions as recommended by the Ad9 visory Committee on Heritable Disorders in 

10 Newborns and Children and as prescribed by a 

11 qualified medical provider, to the same extent as 

12 other prescription drug coverage under such plan or 

13 coverage.’’. 

14 (B) CONFORMING AMENDMENT.—The 

15 table of sections for subchapter B of chapter 

16 100 of such Code is amended by inserting after 

17 the item relating to section 9813 the following 

18 new item: 

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

protein.’’. 

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

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

21 300gg–51 et seq.) is amended by adding at the end the 

22 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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