I 
116TH CONGRESS 
1ST SESSION H. R. 5485 
To amend title XXVII of the Public Health Service Act 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 HOUSE OF REPRESENTATIVES 
DECEMBER 18, 2019 
Mr. NEGUSE (for himself, Mr. THOMPSON of California, and Mr. MCKINLEY) 
introduced the following bill; which was referred to the Committee on En-
ergy and Commerce 
A BILL 
To amend title XXVII of the Public Health Service Act 
and the Patient Protection and Affordable Care Act to 
require coverage of hearing devices and systems in cer-
tain private health insurance plans, and for other pur-
poses. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as ‘‘Ally’s Act’’. 
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SEC. 2. COVERAGE OF HEARING DEVICES AND SYSTEMS IN 
CERTAIN 
PRIVATE 
HEALTH 
INSURANCE 
PLANS. 
(a) IN GENERAL.—Part A of the Public Health Serv-
ice Act (42 U.S.C. 300gg et seq.) is amended by inserting 
after section 2713 the following new section: 
‘‘SEC. 2713A. COVERAGE OF HEARING DEVICES AND SYS-
TEMS. 
‘‘(a) IN GENERAL.—Beginning with plan years begin-
ning on or after January 1, 2021, a group health plan 
and a health insurance issuer offering group or individual 
health insurance coverage shall, at a minimum provide 
coverage for and may impose cost-sharing requirements 
in accordance with subsection (b) for an individual that 
a physician (as defined in section 1861(r) of the Social 
Security Act) or qualified audiologist (as defined in section 
1861(ll)(4)(B) of such Act) determines meets an indica-
tion (including unilateral or bilateral hearing loss) for an 
auditory device as approved by the Food and Drug Admin-
istration for— 
‘‘(1) auditory implant devices (including audi-
tory osseointegrated (bone conduction) implants and 
cochlear implants) and external sound processors; 
‘‘(2) the maintenance of auditory implant de-
vices and external sound processors described in 
paragraph (1); 
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‘‘(3) every 5 years, the upgrade (or replacement 
if an upgrade is not available) of auditory implant 
devices and external sound processors described in 
paragraph (1); 
‘‘(4) adhesive adapters and softband headbands; 
‘‘(5) the repair of auditory implant devices and 
external sound processors described in paragraph 
(1); 
‘‘(6) a comprehensive hearing assessment; 
‘‘(7) a preoperative medical assessment; 
‘‘(8) surgery (as appropriate); 
‘‘(9) postoperative medical appointments for 
purposes of ensuring appropriate recovery from sur-
gery; 
‘‘(10) postoperative audiological appointments 
for activation and fitting of the implant device and 
external sound processor; and 
‘‘(11) aural rehabilitation and treatment serv-
ices (as appropriate). 
‘‘(b) COST-SHARING.—Beginning with plan years be-
ginning on or after January 1, 2021, the cost-sharing in-
curred under a plan or coverage described in subsection 
(a)— 
‘‘(1) for an auditory implant device and exter-
nal sound processors under this section, shall not ex-
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ceed a dollar amount that is the highest cost-sharing 
requirement for the amount of the charges imposed 
for such device that is provided by a physician or 
qualified audiologist that has a contractual relation-
ship with such plan or coverage for the providing of 
such device; 
‘‘(2) for an item or service under this section, 
shall not exceed a dollar amount that is imposed for 
similar items and services under that plan that are 
provided by a physician or qualified audiologist; and 
‘‘(3) that has a contractual relationship with 
such plan or coverage for the providing of such 
items and services.’’. 
(b) APPLICATION
TO GRANDFATHERED HEALTH 
PLANS.—Section 1251(a)(4)(A) of the Patient Protection 
and Affordable Care Act (42 U.S.C. 18011(a)(4)(A)) is 
amended— 
(1) by striking ‘‘title’’ and inserting ‘‘title, or as 
added after the date of the enactment of this Act)’’; 
and 
(2) by adding at the end the following new 
clause: 
‘‘(v) Section 2713A (relating to hear-
ing devices and systems).’’. 
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(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply with respect to plan 
years beginning on or after January 1, 2021. 
Æ 
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