Helping Families Access Pediatric Care Act of 2022

To prohibit group health plans, health insurance issuers offering group or individual health insurance coverage, State plans under title XIX of the Social Security Act, State child health plans under title XXI of such Act, and the TRICARE program from applying a deductible to outpatient pediatric services. 1. Short title This Act may be cited as the Helping Families Access Pediatric Care Act of 2022 2. Prohibiting certain health plans from applying a deductible to outpatient pediatric services (a) ERISA (1) In general Subpart B of part 7 of title I of the Employee Retirement Income Security Act of 1974 ( 29 U.S.C. 1185 et seq. 716. Prohibition on application of deductible to outpatient pediatric services (a) In general A group health plan and a health insurance issuer offering group health insurance coverage may not impose any deductible under such plan or coverage (as applicable) with respect to outpatient pediatric services (as defined in subsection (b)) for which benefits are provided under such plan or coverage. (b) Outpatient pediatric services defined For purposes of subsection (a), the term outpatient pediatric services . (2) Clerical amendment The table of contents of the Employee Retirement Income Security Act of 1974 is amended by inserting after the item relating to section 714 the following: Sec. 715. Additional market reforms. Sec. 716. Prohibition on application of deductible to outpatient pediatric services. . (b) PHSA Subpart II of part A of title XXVII of the Public Health Service Act ( 42 U.S.C. 300gg–11 et seq. 2730. Prohibition on application of deductible to outpatient pediatric services (a) In general A group health plan and a health insurance issuer offering group or individual health insurance coverage may not impose any deductible under such plan or coverage (as applicable) with respect to outpatient pediatric services (as defined in subsection (b)) for which benefits are provided under such plan or coverage. (b) Outpatient pediatric services defined For purposes of subsection (a), the term outpatient pediatric services . (c) IRC (1) In general Subchapter B of chapter 100 9816. Prohibition on application of deductible to outpatient pediatric services (a) In general A group health plan may not impose any deductible under such plan with respect to outpatient pediatric services (as defined in subsection (b)) for which benefits are provided under such plan. (b) Outpatient pediatric services defined For purposes of subsection (a), the term outpatient pediatric services . (2) Clerical amendment The table of sections for subchapter B of chapter 100 Sec. 9815. Additional market reforms. Sec. 9816. Prohibition on application of deductible to outpatient pediatric services. . (d) Medicaid Section 1916A of the Social Security Act ( 42 U.S.C. 1396o–1 (1) in subsection (a)— (A) in paragraph (1), by striking paragraph (2) paragraphs (2) and (4) (B) by adding at the end the following new paragraph: (4) Prohibition on application of deduction to outpatient pediatric services A State may not impose a deduction under the plan with respect to outpatient pediatric services (as defined in subsection (f)). ; and (2) by adding at the end the following new subsection: (f) Outpatient pediatric services defined For purposes of this section, the term outpatient pediatric services . (e) CHIP Section 2103(e) of the Social Security Act ( 42 U.S.C. 1397cc (5) Prohibition on application of deduction to outpatient pediatric services (A) In general The State child health plan may not impose a deductible with respect to outpatient pediatric services (as defined in subparagraph (B)). (B) Outpatient pediatric services defined For purposes of this paragraph, the term outpatient pediatric services . (f) First-Dollar coverage allowance for outpatient pediatric services for high deductible plans Section 223(c)(2) (G) Safe harbor for absence of deductible for outpatient pediatric services A plan shall not fail to be treated as a high deductible health plan by reason of failing to have a deductible for outpatient pediatric services (as defined in section 9816(b)). . (g) TRICARE program (1) In general Section 1095d of title 10, United States Code, is amended— (A) in the section heading, by inserting prohibition on and waiver (B) by redesignating subsections (a) and (b) as subsections (b) and (c), respectively; (C) by inserting before subsection (b), as so redesignated, the following new subsection (a): (a) Prohibition on application of deductible to outpatient pediatric services The Secretary of Defense may not impose any deductible under the TRICARE program for medical care provided to a covered beneficiary who is under the age of 18 as an outpatient, regardless of whether such care is furnished in-person or through use of a telecommunications system. ; and (D) in subsection (b), as so redesignated, by striking The Secretary In addition to the requirement under subsection (a), the Secretary (2) Clerical amendment The table of sections at the beginning of chapter 55 1095d. TRICARE program: prohibition on and waiver of certain deductibles. . (3) Conforming amendment Section 1075(d) of such title is amended by adding at the end the following new paragraph: (5) The Secretary may not impose any deductible amounts for outpatient pediatric services pursuant to section 1095d of this title. . (h) GAO study Not later than 4 years after the date of the enactment of this Act, the Comptroller General of the United States shall conduct a study and submit to Congress a report on the effects of the amendments made by this Act on premiums, deductibles, and copayment and coinsurance requirements with respect to group health plans and group and individual health insurance coverage (as such terms are defined in section 2791 of the Public Health Service Act ( 42 U.S.C. 300gg–91 (i) Effective date The amendment (or amendments) made by— (1) subsections (a) through (c) and subsections (f) and (g) shall apply with respect to plan years beginning on or after the date that is 2 years after the date of the enactment of this Act; (2) subsection (d) shall apply with respect to medical assistance furnished in calendar quarters beginning on or after the date that is 2 years after the date of the enactment of this Act; and (3) subsection (c) shall apply with respect to child health assistance furnished calendar quarters described in paragraph (2).

Summary: Helping Families Access Pediatric Care Act of 2022 This bill prohibits deductibles for outpatient pediatric services under private health insurance, Medicaid, the Children's Health Insurance Program (CHIP), and TRICARE.