I 
117TH CONGRESS 
1ST SESSION H. R. 1916 
To provide health insurance benefits for outpatient and inpatient items and 
services related to the diagnosis and treatment of a congenital anomaly 
or birth defect. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 16, 2021 
Ms. ESHOO (for herself, Mr. FERGUSON, Ms. MCCOLLUM, Mrs. AXNE, Ms. 
DEGETTE, Mr. MCEACHIN, Mrs. LURIA, Mr. STANTON, Ms. STEVENS, 
Mr. HUFFMAN, Mr. GOTTHEIMER, Mrs. TRAHAN, Ms. BARRAGA´N, Mr. 
GRIJALVA, Mr. WITTMAN, Mr. GALLEGO, Mr. CARBAJAL, Ms. WILD, Mr. 
SUOZZI, Mr. DEUTCH, Ms. NORTON, Mr. FITZPATRICK, Ms. BROWNLEY, 
Mrs. HAYES, Mr. TAKANO, Ms. BLUNT ROCHESTER, Mr. HASTINGS, Mr. 
KIM of New Jersey, Mr. PERLMUTTER, Mr. CROW, Miss RICE of New 
York, Mr. STAUBER, Mr. RODNEY DAVIS of Illinois, Mr. PAYNE, Mr. 
RUPPERSBERGER, Ms. TLAIB, Mr. MOULTON, Mr. PASCRELL, Mrs. WAT-
SON COLEMAN, Mrs. BEATTY, Mr. VELA, Mr. COOPER, Ms. UNDERWOOD, 
Mr. TRONE, Mr. YOUNG, Ms. MENG, Ms. PORTER, Ms. SCANLON, Mr. 
RESCHENTHALER, Mr. VAN DREW, Mr. TIMMONS, Ms. CRAIG, Mr. 
NEGUSE, Ms. PINGREE, Mr. LYNCH, Mr. POSEY, Mr. LAMB, Mr. COLE, 
Mr. JOYCE of Pennsylvania, Mr. SIRES, Mr. PALAZZO, Mr. GRAVES of 
Louisiana, Mr. YARMUTH, Mr. BISHOP of Georgia, Mrs. RADEWAGEN, 
Mr. KILDEE, Mr. BUTTERFIELD, Mr. TONKO, Mr. STIVERS, Ms. ROSS, 
Mr. LEVIN of Michigan, Ms. HOULAHAN, Mrs. NAPOLITANO, Mr. 
RASKIN, Mr. MCNERNEY, Mr. MCGOVERN, Mr. MORELLE, Ms. BASS, 
Ms. BONAMICI, Ms. CLARKE of New York, Ms. SALAZAR, Mr. MRVAN, 
Ms. LEE of California, Mr. RUTHERFORD, Ms. SA´NCHEZ, Mr. CON-
NOLLY, Mrs. LAWRENCE, Mr. MCKINLEY, Mr. PRICE of North Carolina, 
Mr. GARAMENDI, Ms. VELA´ZQUEZ, Mr. ADERHOLT, Ms. KELLY of Illi-
nois, Mr. JONES, Mr. PHILLIPS, Ms. OMAR, Mr. ALLEN, Mr. GARBARINO, 
Mr. GOSAR, Mr. LAWSON of Florida, Mr. RUSH, Mr. CARTER of Georgia, 
Mr. BACON, Mr. GROTHMAN, Mr. HARDER of California, Mr. VICENTE 
GONZALEZ
of Texas, Mr. MANN, Mr. UPTON, Mr. COHEN, Mr. 
CICILLINE, Mr. KHANNA, Mrs. HARTZLER, Ms. BUSH, Mr. BOST, Ms. 
STRICKLAND, Ms. MANNING, Mr. BRENDAN F. BOYLE of Pennsylvania, 
Mr. GUEST, Mr. SIMPSON, Mr. O’HALLERAN, Ms. MOORE of Wisconsin, 
Mr. BABIN, Ms. TITUS, Ms. JOHNSON of Texas, Mr. POCAN, Mr. 
KRISHNAMOORTHI, Mr. SEAN PATRICK MALONEY of New York, Ms. 
DELBENE, Mr. RYAN, Mr. STEWART, Mr. HAGEDORN, Ms. JAYAPAL, Mr. 
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EMMER, and Mr. MOORE of Utah) 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 subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
A BILL 
To provide health insurance benefits for outpatient and inpa-
tient items and services related to the diagnosis and 
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, 
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.— 
Part D of title XXVII of the Public Health Service Act 
(42 U.S.C. 300gg–111 et seq.) is amended by adding at 
the end the following new section: 
‘‘SEC. 2799A–11. STANDARDS RELATING TO BENEFITS FOR 
CONGENITAL ANOMALY OR BIRTH DEFECT. 
‘‘(a) REQUIREMENTS FOR CARE AND RECONSTRUC-
TIVE TREATMENT.— 
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‘‘(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 items and services related 
to the diagnosis and treatment of a congenital 
anomaly or birth defect. 
‘‘(2) REQUIREMENTS.— 
‘‘(A) IN
GENERAL.—Coverage provided 
under paragraph (1) shall include any medically 
necessary item or service to functionally im-
prove, repair, or restore any body part to 
achieve normal body functioning or appearance, 
as determined by the treating physician (as de-
fined in section 1861(r) of the Social Security 
Act), due to congenital anomaly or birth defect. 
‘‘(B) 
FINANCIAL
REQUIREMENTS
AND 
TREATMENT
REQUIREMENTS.—Any coverage 
provided under paragraph (1) under a group 
health plan or individual or group health insur-
ance coverage offered by a health insurance 
issuer may be subject to coverage limits (such 
as medical necessity, pre-authorization, or pre- 
certification) and cost-sharing requirements 
(such 
as 
coinsurance, 
copayments, 
and 
deductibles), as required by the plan or issuer, 
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that are no more restrictive than the predomi-
nant coverage limits and cost-sharing require-
ments, respectively, applied to substantially all 
medical and surgical benefits covered by the 
plan (or coverage). 
‘‘(3) TREATMENT DEFINED.—In this section: 
‘‘(A) IN GENERAL.—Except as provided in 
subparagraph (B), the term ‘treatment’ in-
cludes, with respect to a group health plan or 
group or individual health insurance coverage 
offered by a health insurance issuer, inpatient 
and outpatient items and services performed to 
improve, repair, or restore bodily function (or 
performed to approximate a normal appear-
ance), due to a congenital anomaly or birth de-
fect, and includes treatment to any and all 
missing or abnormal body parts (including 
teeth, the oral cavity, and their associated 
structures) that would otherwise be provided 
under the plan or coverage for any other injury 
or sickness, including— 
‘‘(i) any items or services, including 
inpatient and outpatient care, reconstruc-
tive services and procedures, and complica-
tions thereof; 
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‘‘(ii) adjunctive dental, orthodontic, or 
prosthodontic support from birth until the 
medical or surgical treatment of the defect 
or anomaly has been completed, including 
ongoing or subsequent treatment required 
to maintain function or approximate a nor-
mal appearance; 
‘‘(iii) procedures that materially im-
prove, repair, or restore bodily function; 
and 
‘‘(iv) procedures for secondary condi-
tions and follow-up treatment associated 
with the underlying congenital anomaly or 
birth defect. 
‘‘(B) EXCEPTION.—The term ‘treatment’ 
shall not include cosmetic surgery performed to 
reshape normal structures of the body to im-
prove appearance or self-esteem. 
‘‘(b) NOTICE.—A group health plan under this part 
shall comply with the notice requirement under section 
714(c) of the Employee Retirement Income Security Act 
of 1974 with respect to the requirements of this section 
as if such section applied to such plan.’’. 
(b) ERISA AMENDMENTS.— 
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