‘‘(b) REQUIREMENTS.—Coverage provided under 
subsection (a) shall include any service to functionally im-
prove, repair, or restore any body part that is medically 
necessary to achieve normal body functioning or appear-
ance, as determined by the treating physician (as defined 
in section 1861 of the Social Security Act). Any coverage 
provided under such subsection may be subject to coverage 
limits, such as pre-authorization or pre-certification, as re-
quired by the plan or issuer that are no more restrictive 
than the predominant treatment limitations applied to 
substantially all medical and surgical benefits covered by 
the plan (or coverage). 
‘‘(c) TREATMENT DEFINED.— 
‘‘(1) IN GENERAL.—Except as provided in para-
graph (2), in this section, the term ‘treatment’ in-
cludes patient and outpatient care and services per-
formed to improve or restore body function (or per-
formed to approximate a normal appearance), due to 
congenital anomaly or birth defect and shall include 
treatment to any and all missing or abnormal body 
parts, (including teeth, the oral cavity, and their as-
sociated structures) that would otherwise be pro-
vided under the plan or coverage for any other in-
jury and sickness, including— 
VerDate Sep 11 2014 
01:10 Mar 06, 2019
Jkt 089200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H1379.IH
H1379
kjohnson on DSK79L0C42 with BILLS
‘‘(A) inpatient and outpatient care, recon-
structive services and procedures, and complica-
tions thereof, including prosthetics and appli-
ances; 
‘‘(B) adjunctive dental, orthodontic or 
prosthodontic support from birth until the med-
ical 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; 
‘‘(C) procedures that do not materially re-
store or improve the function of the body part 
being treated; and 
‘‘(D) procedures for secondary conditions 
and follow-up treatment. 
‘‘(2) EXCEPTION.—The term ‘treatment’ shall 
not include cosmetic surgery performed to reshape 
normal structures of the body to improve appearance 
or self-esteem.’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions for such subchapter is amended by adding at 
the end the following new items: 
‘‘Sec. 9815. Additional market reforms. 
‘‘Sec. 9816. Standards relating to benefits for congenital anomaly or birth de-
fect.’’. 
(d) CLARIFYING AMENDMENT REGARDING APPLICA-
TION
TO
GRANDFATHERED
PLANS.—Section 
VerDate Sep 11 2014 
01:10 Mar 06, 2019
Jkt 089200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H1379.IH
H1379
kjohnson on DSK79L0C42 with BILLS
1251(a)(4)(A) of the Patient Protection and Affordable 
Care Act (42 U.S.C. 18011(a)(4)(A)), is amended by add-
ing at the end the following: 
‘‘(v) Section 2729 (relating to stand-
ards relating to benefits for congenital 
anomaly or birth defect), as added by sec-
tion 2(a) of the Ensuring Lasting Smiles 
Act.’’. 
(e) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to group health plans 
for plan years beginning on or after January 1, 2020, and 
with respect to health insurance coverage offered, sold, 
issued, renewed, in effect, or operated in the individual 
market on or after such date. 
(f) COORDINATED REGULATIONS.—Section 104(1) of 
the Health Insurance Portability and Accountability Act 
of 1996 is amended by striking ‘‘this subtitle (and the 
amendments made by this subtitle and section 401)’’ and 
inserting ‘‘the provisions of part 7 of subtitle B of title 
I of the Employee Retirement Income Security Act of 
1974, the provisions of parts A and C of title XXVII of 
the Public Health Service Act, and chapter 100 of the In-
ternal Revenue Code of 1986’’. 
Æ 
VerDate Sep 11 2014 
01:10 Mar 06, 2019
Jkt 089200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6301
E:\BILLS\H1379.IH
H1379
kjohnson on DSK79L0C42 with BILLS