I 
112TH CONGRESS 
1ST SESSION H. R. 1955 
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, burns, infection, 
tumor, or disease. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 24, 2011 
Mr. TIBERI (for himself, Mrs. MCCARTHY of New York, Ms. SCHAKOWSKY, 
Ms. LEE of California, and Mrs. MALONEY) 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 Speaker, 
in each case for consideration of such provisions as fall within the juris-
diction 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, burns, infection, tumor, or disease. 
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 ‘‘Children’s Access to 
Reconstructive Evaluation & Surgery (CARES) Act of 
2011’’. 
SEC. 2. COVERAGE OF MINOR CHILD’S CONGENITAL OR DE-
VELOPMENTAL DEFORMITY OR DISORDER. 
(a) PUBLIC HEALTH SERVICE ACT AMENDMENTS.— 
(1) Title XXVII of the Public Health Service Act is 
amended by inserting after section 2728 (42 U.S.C. 
300gg–28), as redesignated by section 1001(2) of the Pa-
tient Protection and Affordable Care Act (Public Law 
111–148), the following new section: 
‘‘SEC. 2729. 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 or individual 
health insurance coverage, that provides coverage for 
surgical benefits shall provide coverage for out-
patient and inpatient 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. 
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‘‘(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, burns, in-
fection, 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. 
‘‘(B) EXCEPTION.—Such term does not in-
clude cosmetic surgery performed to reshape 
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