SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Chronic Condition 
Copay Elimination Act’’. 
SEC. 2. COVERAGE OF ADDITIONAL PREVENTIVE CARE FOR 
INDIVIDUALS WITH CHRONIC CONDITIONS 
WITHOUT IMPOSITION OF COST SHARING RE-
QUIREMENTS. 
(a) ERISA.— 
(1) IN GENERAL.—Subpart B of part 7 of sub-
title B of title I of the Employee Retirement Income 
Security Act of 1974 (29 U.S.C. 1185 et seq.) is 
amended by adding at the end the following new sec-
tion: 
‘‘SEC. 716. COVERAGE OF ADDITIONAL PREVENTIVE CARE 
FOR INDIVIDUALS WITH CHRONIC CONDI-
TIONS WITHOUT IMPOSITION OF COST SHAR-
ING REQUIREMENTS. 
‘‘(a) IN GENERAL.—In addition to any item or serv-
ice described in section 2713(a) of the Public Health Serv-
ice Act, a group health plan and a health insurance issuer 
offering group health insurance coverage shall, at a min-
imum, provide coverage for, and shall not impose any cost 
sharing requirements for, with respect to individuals with 
chronic conditions (as defined in subsection (b)), such ad-
ditional preventive care and screenings not described in 
paragraph (1) of such section 2713(a) that are determined 
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by the Secretary to meet the criteria specified in sub-
section (c) with respect to the chronic condition involved. 
‘‘(b) CHRONIC CONDITION DEFINED.—In this sec-
tion, the term ‘chronic condition’ has the meaning given 
such term by the Secretary and, at a minimum, includes 
the following conditions: 
‘‘(1) Heart disease, including congestive heart 
failure and coronary artery disease. 
‘‘(2) Diabetes. 
‘‘(3) Osteoporosis and osteopenia. 
‘‘(4) Hypertension. 
‘‘(5) Asthma. 
‘‘(6) Liver disease. 
‘‘(7) Bleeding disorders. 
‘‘(8) Depression. 
‘‘(c) CRITERIA SPECIFIED.—For purposes of sub-
section (a), the criteria specified in this subsection, with 
respect to an item or service and a chronic condition, are 
the following: 
‘‘(1) The item or service is low-cost. 
‘‘(2) There is medical evidence supporting high- 
cost efficiency, or a large expected impact, of the 
item or service in preventing exacerbation of the 
chronic condition or the development of a secondary 
condition. 
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‘‘(3) There is a strong likelihood, documented 
by clinical evidence, that the item or service will pre-
vent the exacerbation of the chronic condition or the 
development of a secondary condition that requires 
significantly higher-cost treatments. 
‘‘(d) UPDATES.— 
‘‘(1) IN GENERAL.—Once every three years, the 
Secretary shall review and update— 
‘‘(A) the list of conditions included within 
the meaning of the term ‘chronic condition’ 
under subsection (b); and 
‘‘(B) the items and services determined to 
meet the criteria specified in subsection (c) for 
purposes of subsection (a). 
‘‘(2) APPLICATION OF UPDATES.—The require-
ment under subsection (a) shall apply with respect 
to an update made under paragraph (1) beginning 
with the first plan year beginning after the date of 
such update.’’. 
(2) CLERICAL AMENDMENT.—The table of con-
tents in section 1 of such Act is amended by insert-
ing after the item relating to section 714 the fol-
lowing new items: 
‘‘715. Additional market reforms. 
‘‘716. Coverage of additional preventive care for individuals with chronic condi-
tions without imposition of cost sharing requirements.’’. 
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(b) PHSA.—Subpart II of part A of title XXVII of 
the Public Health Service Act (42 U.S.C. 300gg–11 et 
seq.) is amended by adding at the end the following new 
section: 
‘‘SEC. 2730. COVERAGE OF ADDITIONAL PREVENTIVE CARE 
FOR INDIVIDUALS WITH CHRONIC CONDI-
TIONS WITHOUT IMPOSITION OF COST SHAR-
ING REQUIREMENTS. 
‘‘(a) IN GENERAL.—In addition to any item or serv-
ice described in section 2713(a), a group health plan and 
a health insurance issuer offering group or individual 
health insurance coverage shall, at a minimum, provide 
coverage for, and shall not impose any cost sharing re-
quirements for, with respect to individuals with chronic 
conditions (as defined in subsection (b)), such additional 
preventive care and screenings not described in paragraph 
(1) of section 2713(a) that are determined by the Sec-
retary to meet the criteria specified in subsection (c) with 
respect to the chronic condition involved. 
‘‘(b) CHRONIC CONDITION DEFINED.—In this sec-
tion, the term ‘chronic condition’ has the meaning given 
such term by the Secretary and, at a minimum, includes 
the following conditions: 
‘‘(1) Heart disease, including congestive heart 
failure and coronary artery disease. 
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‘‘(2) Diabetes. 
‘‘(3) Osteoporosis and osteopenia. 
‘‘(4) Hypertension. 
‘‘(5) Asthma. 
‘‘(6) Liver disease. 
‘‘(7) Bleeding disorders. 
‘‘(8) Depression. 
‘‘(c) CRITERIA SPECIFIED.—For purposes of sub-
section (a), the criteria specified in this subsection, with 
respect to an item or service and a chronic condition, are 
the following: 
‘‘(1) The item or service is low-cost. 
‘‘(2) There is medical evidence supporting high- 
cost efficiency, or a large expected impact, of the 
item or service in preventing exacerbation of the 
chronic condition or the development of a secondary 
condition. 
‘‘(3) There is a strong likelihood, documented 
by clinical evidence, that the item or service will pre-
vent the exacerbation of the chronic condition or the 
development of a secondary condition that requires 
significantly higher-cost treatments. 
‘‘(d) UPDATES.— 
‘‘(1) IN GENERAL.—Once every three years, the 
Secretary shall review and update— 
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‘‘(A) the list of conditions included within 
the meaning of the term ‘chronic condition’ 
under subsection (b); and 
‘‘(B) the items and services determined to 
meet the criteria specified in subsection (c) for 
purposes of subsection (a). 
‘‘(2) APPLICATION OF UPDATES.—The require-
ment under subsection (a) shall apply with respect 
to an update made under paragraph (1) beginning 
with the first plan year beginning after the date of 
such update.’’. 
(c) IRC.— 
(1) IN
GENERAL.—Subchapter B of chapter 
100 of subtitle K of the Internal Revenue Code of 
1986 is amended by adding at the end the following 
new section: 
‘‘SEC. 9816. COVERAGE OF ADDITIONAL PREVENTIVE CARE 
FOR INDIVIDUALS WITH CHRONIC CONDI-
TIONS WITHOUT IMPOSITION OF COST SHAR-
ING REQUIREMENTS. 
‘‘(a) IN GENERAL.—In addition to any item or serv-
ice described in section 2713(a) of the Public Health Serv-
ice Act, a group health plan shall, at a minimum, provide 
coverage for, and shall not impose any cost sharing re-
quirements for, with respect to individuals with chronic 
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conditions (as defined in subsection (b)), such additional 
preventive care and screenings not described in paragraph 
(1) of such section 2713(a) that are determined by the 
Secretary to meet the criteria specified in subsection (c) 
with respect to the chronic condition involved. 
‘‘(b) CHRONIC CONDITION DEFINED.—In this sec-
tion, the term ‘chronic condition’ has the meaning given 
such term by the Secretary and, at a minimum, includes 
the following conditions: 
‘‘(1) Heart disease, including congestive heart 
failure and coronary artery disease. 
‘‘(2) Diabetes. 
‘‘(3) Osteoporosis and osteopenia. 
‘‘(4) Hypertension. 
‘‘(5) Asthma. 
‘‘(6) Liver disease. 
‘‘(7) Bleeding disorders. 
‘‘(8) Depression. 
‘‘(c) CRITERIA SPECIFIED.—For purposes of sub-
section (a), the criteria specified in this subsection, with 
respect to an item or service and a chronic condition, are 
the following: 
‘‘(1) The item or service is low-cost. 
‘‘(2) There is medical evidence supporting high- 
cost efficiency, or a large expected impact, of the 
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item or service in preventing exacerbation of the 
chronic condition or the development of a secondary 
condition. 
‘‘(3) There is a strong likelihood, documented 
by clinical evidence, that the item or service will pre-
vent the exacerbation of the chronic condition or the 
development of a secondary condition that requires 
significantly higher-cost treatments. 
‘‘(d) UPDATES.— 
‘‘(1) IN GENERAL.—Once every three years, the 
Secretary shall review and update— 
‘‘(A) the list of conditions included within 
the meaning of the term ‘chronic condition’ 
under subsection (b); and 
‘‘(B) the items and services determined to 
meet the criteria specified in subsection (c) for 
purposes of subsection (a). 
‘‘(2) APPLICATION OF UPDATES.—The require-
ment under subsection (a) shall apply with respect 
to an update made under paragraph (1) beginning 
with the first plan year beginning after the date of 
such update.’’. 
(2) CLERICAL AMENDMENT.—The table of con-
tents for subchapter B of chapter 100 of subtitle K 
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of such Code is amended by adding at the end the 
following new item: 
‘‘9816. Coverage of additional preventive care for individuals with chronic condi-
tions without imposition of cost sharing requirements.’’. 
(3) HIGH DEDUCTIBLE HEALTH PLANS.—Sec-
tion 223(c)(2)(C) of the Internal Revenue Code of 
1986 is amended by inserting ‘‘or for additional pre-
ventive care for individuals with chronic conditions 
described in section 9816’’ before the period. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to plan years begin-
ning on or after the date that is one year after the date 
of the enactment of this Act. 
Æ 
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