(2) CLERICAL AMENDMENT.—The table of con-
tents 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 serv-
ices.’’. 
(b) PHSA.—Subpart II of part A of title XXVII of 
the Public Health Service Act (42 U.S.C. 300gg–11 et 
seq.) is amended by adding at the end the following new 
section: 
‘‘SEC. 2730. PROHIBITION ON APPLICATION OF DEDUCT-
IBLE TO OUTPATIENT PEDIATRIC SERVICES. 
‘‘(a) IN GENERAL.—A group health plan and a health 
insurance issuer offering group or individual health insur-
ance 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 pedi-
atric services’ means any item or service furnished to an 
individual under the age of 18 as an outpatient by a health 
care provider acting within the scope of such provider’s 
license, regardless of whether such service is furnished in- 
person or through use of a telecommunications system.’’. 
(c) IRC.— 
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(1) IN
GENERAL.—Subchapter B of chapter 
100 of the Internal Revenue Code of 1986 is amend-
ed by adding at the end the following new section: 
‘‘SEC. 9816. PROHIBITION ON APPLICATION OF DEDUCT-
IBLE TO OUTPATIENT PEDIATRIC SERVICES. 
‘‘(a) IN GENERAL.—A group health plan may not im-
pose any deductible under such plan with respect to out-
patient 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 pedi-
atric services’ means any item or service furnished to an 
individual under the age of 18 as an outpatient by a health 
care provider acting within the scope of such provider’s 
license, regardless of whether such service is furnished in- 
person or through use of a telecommunications system.’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions for subchapter B of chapter 100 of the Inter-
nal Revenue Code of 1986 is amended by adding at 
the end the following new items: 
‘‘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) is amended— 
(1) in subsection (a)— 
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(A) in paragraph (1), by striking ‘‘para-
graph (2)’’ and inserting ‘‘paragraphs (2) and 
(4)’’; and 
(B) by adding at the end the following new 
paragraph: 
‘‘(4) PROHIBITION ON APPLICATION OF DEDUC-
TION
TO
OUTPATIENT
PEDIATRIC
SERVICES.—A 
State may not impose a deduction under the plan 
with respect to outpatient pediatric services (as de-
fined in subsection (f)).’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(f) OUTPATIENT PEDIATRIC SERVICES DEFINED.— 
For purposes of this section, the term ‘outpatient pediatric 
services’ means any item or service furnished to an indi-
vidual under the age of 18 as an outpatient by a health 
care provider acting within the scope of such provider’s 
license, regardless of whether such service is furnished in- 
person or through use of a telecommunications system.’’. 
(e) CHIP.—Section 2103(e) of the Social Security 
Act (42 U.S.C. 1397cc) is amended by adding at the end 
the following new paragraph: 
‘‘(5) PROHIBITION ON APPLICATION OF DEDUC-
TION TO OUTPATIENT PEDIATRIC SERVICES.— 
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‘‘(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’ means any 
item or service furnished to an individual under 
the age of 18 as an outpatient by a health care 
provider acting within the scope of such pro-
vider’s license, regardless of whether such serv-
ice is furnished in-person or through use of a 
telecommunications system.’’. 
(f) FIRST-DOLLAR
COVERAGE
ALLOWANCE
FOR 
OUTPATIENT PEDIATRIC SERVICES FOR HIGH DEDUCT-
IBLE PLANS.—Section 226(c)(2) of the Internal Revenue 
Code of 1986 is amended by adding at the end the fol-
lowing new subparagraph: 
‘‘(F) SAFE HARBOR FOR ABSENCE OF DE-
DUCTIBLE FOR OUTPATIENT PEDIATRIC SERV-
ICES.—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.— 
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(1) IN GENERAL.—Section 1095d of title 10, 
United States Code, is amended— 
(A) in the section heading, by inserting 
‘‘prohibition on and’’ before ‘‘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’’ and inserting ‘‘In 
addition to the requirement under subsection 
(a), the Secretary’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions at the beginning of chapter 55 of title 10, 
United States Code, is amended by striking the item 
relating to section 1095d and inserting the following 
new item: 
‘‘1095d. TRICARE program: prohibition on and waiver of certain deductibles.’’. 
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(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 sec-
tion 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 amend-
ments) made by— 
(1) subsections (a) through (c) and subsections 
(f) and (g) shall apply with respect to plan years be-
ginning 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 be-
ginning on or after the date that is 2 years after the 
date of the enactment of this Act; and 
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(3) subsection (c) shall apply with respect to 
child health assistance furnished calendar quarters 
described in paragraph (2). 
Æ 
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