I 
115TH CONGRESS 
2D SESSION 
H. R. 4978 
To amend the Internal Revenue Code of 1986 to permit high-deductible 
health plans to provide chronic disease prevention services to plan enroll-
ees prior to satisfying their plan deductible. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 8, 2018 
Mrs. BLACK (for herself and Mr. BLUMENAUER) introduced the following bill; 
which was referred to the Committee on Ways and Means 
A BILL 
To amend the Internal Revenue Code of 1986 to permit 
high-deductible health plans to provide chronic disease 
prevention services to plan enrollees prior to satisfying 
their plan deductible. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; FINDINGS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Chronic Disease Management Act of 2018’’. 
(b) FINDINGS.—Congress finds the following: 
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(1) A small number of chronic diseases account 
for the majority of health care spending in the 
United States. 
(2) Limited and targeted interventions for 
many chronic diseases prevent the need for addi-
tional, more costly therapies associated with un-
treated or unmanaged chronic diseases that lead to 
adverse effects on quality of life for patients. 
(3) These types of chronic care preventive serv-
ices should be encouraged to maximize the effective-
ness and positive outcomes of the care provided 
under high-deductible health plans. 
(4) Section 223(c)(2)(C) of the Internal Rev-
enue Code of 1986 explicitly grants the Secretary of 
the Treasury flexibility in defining the scope of pre-
ventive care for purposes of the preventive care safe 
harbor. As of the date of introduction of this Act, 
the Secretary of the Treasury has refrained from ex-
ercising existing authority under such section to ex-
pand the preventive care safe harbor to include 
chronic disease prevention. 
(5) In the absence of an expansion of the pre-
ventive care safe harbor by the Secretary of the 
Treasury, the Chronic Disease Management Act of 
2018 would expressly permit high-deductible health 
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plans to provide chronic disease prevention and 
treatment, subject to certain limitations, prior to a 
plan enrollee having met their plan deductible. 
(6) 
Allowing 
HSA-eligible 
high-deductible 
health plans to cover chronic disease prevention and 
treatment on a pre-deductible basis promotes the 
concept of Value-Based Insurance Design, which is 
an effective tool to improve the quality and reduce 
the cost of care for Americans with chronic diseases, 
with improved outcomes via increased medication ad-
herence, reduced complications, and decreased emer-
gency department visits. 
SEC. 2. CHRONIC DISEASE PREVENTION. 
(a) IN GENERAL.—Section 223(c)(2) of the Internal 
Revenue Code of 1986 is amended by redesignating sub-
paragraph (D) as subparagraph (E) and by inserting after 
subparagraph (C) the following new subparagraph: 
‘‘(D) SAFE HARBOR FOR ABSENCE OF DE-
DUCTIBLE
FOR
CARE
RELATED
TO
CHRONIC 
CONDITIONS.—A plan shall not fail to be treat-
ed as a high-deductible health plan by reason of 
failing to have a deductible for care and pre-
scription medicines related to the treatment of 
medically complex chronic conditions which— 
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‘‘(i) are substantially disabling or life 
threatening, 
‘‘(ii) have a high risk of hospitaliza-
tion or other significant adverse health 
outcomes, and 
‘‘(iii) require specialized delivery sys-
tems across domains of care.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall apply to coverage for months beginning 
after the date of the enactment of this Act. 
Æ 
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