I
107TH CONGRESS
1ST SESSION
H. R. 792
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 minor child’s congenital or
developmental deformity or disorder due to trauma, infection, tumor,
or disease.
IN THE HOUSE OF REPRESENTATIVES
FEBRUARY 28, 2001
Mrs. KELLY (for herself, Mr. GANSKE, Mr. MOORE, Mrs. MALONEY of New
York, Mr. BACHUS, Mr. HILLIARD, Mr. FROST, Mr. BOUCHER, Mr.
KING, Mr. BALDACCI, Mr. MCNULTY, Mr. PRICE of North Carolina, Mr.
DOYLE, Mr. COOKSEY, Mr. LUTHER, Mr. WHITFIELD, Mr. FRANK, Mr.
ENGLISH, Mr. STRICKLAND, Mr. PALLONE, Mr. MATSUI, Ms. ROYBAL-
ALLARD, Mrs. MORELLA, Mr. FOLEY, Mr. COYNE, Ms. DUNN, Mr. ACK-
ERMAN, Mr. OXLEY, Mr. GILMAN, Ms. BERKLEY, Mr. WOLF, Mr.
WALSH, Mr. HINCHEY, Mr. MCINTYRE, Mr. PAYNE, Mr. FATTAH, Mrs.
CHRISTENSEN, Mr. BONIOR, Mr. WEINER, Mr. OWENS, Mrs. THURMAN,
Mrs. ROUKEMA, Mr. VISCLOSKY, Mr. KILDEE, Mr. LEACH, Mr.
KUCINICH, Mr. CLEMENT, and Mr. MCGOVERN) 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
the Workforce, for a period to be subsequently determined by the Speak-
er, in each case for consideration of such provisions as fall within the ju-
risdiction 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 minor child’s con-
genital or developmental deformity or disorder due to
trauma, infection, tumor, or disease.
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 the ‘‘Treatment of Chil-
dren’s Deformities Act of 2001’’.
SEC. 2. COVERAGE OF MINOR CHILD’S CONGENITAL OR DE-
VELOPMENTAL DEFORMITY OR DISORDER.
(a) GROUP HEALTH PLANS.—
(1) PUBLIC
HEALTH
SERVICE
ACT
AMEND-
MENTS.—(A) Subpart 2 of part A of title XXVII of
the Public Health Service Act is amended by adding
at the end the following new section:
‘‘SEC. 2707. STANDARDS RELATING TO BENEFITS FOR
MINOR CHILD’S CONGENITAL OR DEVELOP-
MENTAL DEFORMITY OR DISORDER.
‘‘(a) REQUIREMENTS
FOR RECONSTRUCTIVE SUR-
GERY.—
‘‘(1) IN GENERAL.—A group health plan, and a
health insurance issuer offering group health insur-
ance coverage, that provides coverage for surgical
benefits shall provide coverage for outpatient and in-
patient diagnosis and treatment of a minor child’s
congenital or developmental deformity, disease, or
injury. A minor child shall include any individual
through 21 years of age.
‘‘(2) REQUIREMENTS.—Any coverage provided
under paragraph (1) shall be subject to pre-author-
ization or pre-certification as required by the plan or
issuer, and such coverage shall include any surgical
treatment which, in the opinion of the treating phy-
sician, is medically necessary to approximate a nor-
mal appearance.
‘‘(3) TREATMENT DEFINED.—
‘‘(A) IN
GENERAL.—In this section, the
term ‘treatment’ includes reconstructive sur-
gical procedures (procedures that are generally
performed to improve function, but may also be
performed to approximate a normal appear-
ance) that are performed on abnormal struc-
tures of the body caused by congenital defects,
developmental abnormalities, trauma, infection,
tumors, or disease, including—
‘‘(i) procedures that do not materially
affect the function of the body part being
treated; and
‘‘(ii) procedures for secondary condi-
tions and follow-up treatment.