I 
119TH CONGRESS 
1ST SESSION H. R. 3277 
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 
MAY 8, 2025 
Mr. DUNN of Florida (for himself, Ms. SCHRIER, Mr. ADERHOLT, Mr. BABIN, 
Ms. SALAZAR, Mr. GOSAR, Mr. NEHLS, Mr. YAKYM, Ms. MOORE of Wis-
consin, Mrs. DINGELL, Ms. NORTON, Ms. TLAIB, Mr. LANDSMAN, Mr. 
FIELDS, Ms. BONAMICI, Mr. MRVAN, Mr. QUIGLEY, Mr. MANNION, Mr. 
LYNCH, Ms. OMAR, Ms. HOULAHAN, Ms. TOKUDA, and Mr. NEGUSE) in-
troduced the following bill; which was referred to the Committee on En-
ergy and Commerce, and in addition to the Committees on Education and 
Workforce, and Ways and Means, for a period to be subsequently deter-
mined by the Speaker, in each case for consideration of such provisions 
as fall within the jurisdiction of the committee 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’’. 
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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. COVERAGE OF CONGENITAL 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 items and services related 
to the diagnosis and treatment of a congenital 
anomaly or birth defect that primarily impacts the 
appearance or function of the eyes, ears, teeth, 
mouth, or jaw, consistent with paragraphs (2) and 
(3). 
‘‘(2) FINANCIAL
REQUIREMENTS.—Any cov-
erage provided under paragraph (1) under a group 
health plan or group or individual health insurance 
coverage may be subject to cost-sharing require-
ments (such as coinsurance, copayments, and 
deductibles), as required by the plan or issuer offer-
ing such coverage, that are no more restrictive than 
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the predominant cost-sharing requirements applied 
to substantially all other medical and surgical bene-
fits covered by the plan or coverage. 
‘‘(3) APPLICABLE ITEMS AND SERVICES.— 
‘‘(A) IN GENERAL.—Except as provided in 
subparagraph (B), the items and services re-
quired under paragraph (1) to be covered by a 
group health plan or group or individual health 
insurance coverage offered by a health insur-
ance issuer include— 
‘‘(i) any item or service to improve, 
repair, or restore any body part to achieve 
normal body functioning or appearance, or 
performed to approximate a normal ap-
pearance, as determined medically nec-
essary by the treating physician (as de-
fined in section 1861(r) of the Social Secu-
rity Act), on account of a congenital anom-
aly or birth defect that primarily impacts 
the appearance or function of the eyes, 
ears, teeth, mouth, or jaw; and 
‘‘(ii) any treatment or diagnostic serv-
ice with respect to any and all missing or 
abnormal body parts (including teeth, the 
oral cavity, and their associated struc-
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tures), as determined medically necessary 
by the treating physician (as defined in 
section 1861(r) of the Social Security Act), 
including— 
‘‘(I) reconstructive services and 
procedures, and items and services re-
lated to any complications arising 
from such services and procedures; 
‘‘(II) adjunctive dental, ortho-
dontic, 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 
normal appearance, notwithstanding 
any exclusions, limitations, or restric-
tions under the plan or health insur-
ance coverage on coverage of dental, 
orthodontic, or prosthodontic items 
and services arising from other inju-
ries or sicknesses; and 
‘‘(III) items and services related 
to secondary conditions and follow-up 
treatment associated with the under-
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