I 
116TH CONGRESS 
1ST SESSION H. R. 1379 
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 congenital anomaly or birth 
defect. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 26, 2019 
Mr. PETERSON (for himself, Mr. RIGGLEMAN, Mrs. AXNE, Miss RICE of New 
York, Mr. SIMPSON, Mr. VISCLOSKY, Mr. RODNEY DAVIS of Illinois, and 
Mr. STIVERS) introduced the following bill; which was referred to the 
Committee on Energy and Commerce, and in addition to the Committees 
on Ways and Means, and Education and Labor, for a period to be subse-
quently 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 Re-
tirement Income Security Act of 1974, and the Internal 
Revenue Code of 1986 to require that group and indi-
vidual health insurance coverage and group health plans 
provide coverage for treatment of a congenital anomaly 
or birth defect. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Ensuring Lasting 
Smiles Act’’. 
SEC. 2. COVERAGE OF CONGENITAL ANOMALY OR BIRTH 
DEFECT. 
(a) PUBLIC HEALTH SERVICE ACT AMENDMENTS.— 
(1) IN GENERAL.—Title XXVII of the Public 
Health Service Act is amended by inserting after 
section 2729 (42 U.S.C. 300gg–28), the following: 
‘‘SEC. 2730. STANDARDS RELATING TO BENEFITS FOR CON-
GENITAL ANOMALY OR BIRTH DEFECT. 
‘‘(a) REQUIREMENTS FOR CARE AND RECONSTRUC-
TIVE TREATMENT.— 
‘‘(1) IN GENERAL.—A group health plan, and a 
health insurance issuer offering group or individual 
health insurance coverage, shall provide coverage for 
outpatient and inpatient services related to the diag-
nosis and treatment of a congenital anomaly or birth 
defect. 
‘‘(2) 
REQUIREMENTS.—Coverage 
provided 
under paragraph (1) shall include any service to 
functionally improve, repair, or restore any body 
part that is medically necessary to achieve normal 
body functioning or appearance, as determined by 
the treating physician (as defined in section 1861 of 
the Social Security Act). Any coverage provided 
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under such paragraph may be subject to coverage 
limits, such as pre-authorization or pre-certification, 
as required by the plan or issuer that are no more 
restrictive than the predominant treatment limita-
tions applied to substantially all medical and sur-
gical benefits covered by the plan (or coverage). 
‘‘(3) TREATMENT DEFINED.— 
‘‘(A) IN GENERAL.—Except as provided in 
subparagraph (B), in this section, the term 
‘treatment’ includes patient and outpatient care 
and services performed to improve or restore 
body function (or performed to approximate a 
normal appearance), due to congenital anomaly 
or birth defect and shall include treatment to 
any and all missing or abnormal body parts, 
(including teeth, the oral cavity, and their asso-
ciated structures) that would otherwise be pro-
vided under the plan or coverage for any other 
injury and sickness, including— 
‘‘(i) inpatient and outpatient care, re-
constructive services and procedures, and 
complications thereof, including prosthetics 
and appliances; 
‘‘(ii) adjunctive dental, orthodontic or 
prosthodontic support from birth until the 
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