Helping Families Access Pediatric Care Act of 2022
Bill: H.R.8792 | Sponsor: Rep. Schrier, Kim (D-WA)
Policy area: Health

Summary:
Helping Families Access Pediatric Care Act of 2022
This bill prohibits deductibles for outpatient pediatric services under private health insurance, Medicaid, the Children's Health Insurance Program (CHIP), and TRICARE.

To prohibit group health plans, health insurance issuers offering group 
or individual health insurance coverage, State plans under title XIX of 
 the Social Security Act, State child health plans under title XXI of 
    such Act, and the TRICARE program from applying a deductible to 
                     outpatient pediatric services.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Helping Families Access Pediatric 
Care Act of 2022''.

SEC. 2. PROHIBITING CERTAIN HEALTH PLANS FROM APPLYING A DEDUCTIBLE TO 
              OUTPATIENT PEDIATRIC SERVICES.

    (a) ERISA.--
            (1) In general.--Subpart B of part 7 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 
        section:

``SEC. 716. PROHIBITION ON APPLICATION OF DEDUCTIBLE TO OUTPATIENT 
              PEDIATRIC SERVICES.

    ``(a) In General.--A group health plan and a health insurance 
issuer offering group health insurance coverage may not impose any 
deductible under such plan or coverage (as applicable) with respect to 
outpatient pediatric services (as defined in subsection (b)) for which 
benefits are provided under such plan or coverage.
    ``(b) Outpatient Pediatric Services Defined.--For purposes of 
subsection (a), the term `outpatient pediatric services' means any item 
or service furnished to an individual under the age of 18 as an 
outpatient by a health care provider acting within the scope of such 
provider's license, regardless of whether such service is furnished in-
person or through use of a telecommunications system.''.
            (2) Clerical amendment.--The table of contents of the 
        Employee Retirement Income Security Act of 1974 is amended by 
        inserting after the item relating to section 714 the following:

``Sec. 715. Additional market reforms.
``Sec. 716. Prohibition on application of deductible to outpatient 
                            pediatric services.''.
    (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. PROHIBITION ON APPLICATION OF DEDUCTIBLE TO OUTPATIENT 
              PEDIATRIC SERVICES.

    ``(a) In General.--A group health plan and a health insurance 
issuer offering group or individual health insurance coverage may not 
impose any deductible under such plan or coverage (as applicable) with 
respect to outpatient pediatric services (as defined in subsection (b)) 
for which benefits are provided under such plan or coverage.
    ``(b) Outpatient Pediatric Services Defined.--For purposes of 
subsection (a), the term `outpatient pediatric services' means any item 
or service furnished to an individual under the age of 18 as an 
outpatient by a health care provider acting within the scope of such 
provider's license, regardless of whether such service is furnished in-
person or through use of a telecommunications system.''.
    (c) IRC.--
            (1) In general.--Subchapter B of chapter 100 of the 
        Internal Revenue Code of 1986 is amended by adding at the end 
        the following new section:

``SEC. 9816. PROHIBITION ON APPLICATION OF DEDUCTIBLE TO OUTPATIENT 
              PEDIATRIC SERVICES.

    ``(a) In General.--A group health plan may not impose any 
deductible under such plan with respect to outpatient pediatric 
services (as defined in subsection (b)) for which benefits are provided 
under such plan.
    ``(b) Outpatient Pediatric Services Defined.--For purposes of 
subsection (a), the term `outpatient pediatric services' means any item 
or service furnished to an individual under the age of 18 as an 
outpatient by a health care provider acting within the scope of such 
provider's license, regardless of whether such service is furnished in-
person or through use of a telecommunications system.''.
            (2) Clerical amendment.--The table of sections for 
        subchapter B of chapter 100 of the Internal Revenue Code of 
        1986 is amended by adding at the end the following new items:

``Sec. 9815. Additional market reforms.
``Sec. 9816. Prohibition on application of deductible to outpatient 
                            pediatric services.''.
    (d) Medicaid.--Section 1916A of the Social Security Act (42 U.S.C. 
1396o-1) is amended--
            (1) in subsection (a)--
                    (A) in paragraph (1), by striking ``paragraph (2)'' 
                and inserting ``paragraphs (2) and (4)''; and
                    (B) by adding at the end the following new 
                paragraph:
            ``(4) Prohibition on application of deduction to outpatient 
        pediatric services.--A State may not impose a deduction under 
        the plan with respect to outpatient pediatric services (as 
        defined in subsection (f)).''; and
            (2) by adding at the end the following new subsection:
    ``(f) Outpatient Pediatric Services Defined.--For purposes of this 
section, the term `outpatient pediatric services' means any item or 
service furnished to an individual under the age of 18 as an outpatient 
by a health care provider acting within the scope of such provider's 
license, regardless of whether such service is furnished in-person or 
through use of a telecommunications system.''.
    (e) CHIP.--Section 2103(e) of the Social Security Act (42 U.S.C. 
1397cc) is amended by adding at the end the following new paragraph:
            ``(5) Prohibition on application of deduction to outpatient 
        pediatric services.--
                    ``(A) In general.--The State child health plan may 
                not impose a deductible with respect to outpatient 
                pediatric services (as defined in subparagraph (B)).
                    ``(B) Outpatient pediatric services defined.--For 
                purposes of this paragraph, the term `outpatient 
                pediatric services' means any item or service furnished 
                to an individual under the age of 18 as an outpatient 
                by a health care provider acting within the scope of 
                such provider's license, regardless of whether such 
                service is furnished in-person or through use of a 
                telecommunications system.''.
    (f) First-Dollar Coverage Allowance for Outpatient Pediatric 
Services for High Deductible Plans.--Section 223(c)(2) of the Internal 
Revenue Code of 1986 is amended by adding at the end the following new 
subparagraph:
                    ``(G) Safe harbor for absence of deductible for 
                outpatient pediatric services.--A plan shall not fail 
                to be treated as a high deductible health plan by 
                reason of failing to have a deductible for outpatient 
                pediatric services (as defined in section 9816(b)).''.
    (g) TRICARE Program.--
            (1) In general.--Section 1095d of title 10, United States 
        Code, is amended--
                    (A) in the section heading, by inserting 
                ``prohibition on and'' before ``waiver'';
                    (B) by redesignating subsections (a) and (b) as 
                subsections (b) and (c), respectively;
                    (C) by inserting before subsection (b), as so 
                redesignated, the following new subsection (a):
    ``(a) Prohibition on Application of Deductible to Outpatient 
Pediatric Services.--The Secretary of Defense may not impose any 
deductible under the TRICARE program for medical care provided to a 
covered beneficiary who is under the age of 18 as an outpatient, 
regardless of whether such care is furnished in-person or through use 
of a telecommunications system.''; and
                    (D) in subsection (b), as so redesignated, by 
                striking ``The Secretary'' and inserting ``In addition 
                to the requirement under subsection (a), the 
                Secretary''.
            (2) Clerical amendment.--The table of sections at the 
        beginning of chapter 55 of title 10, United States Code, is 
        amended by striking the item relating to section 1095d and 
        inserting the following new item:

``1095d. TRICARE program: prohibition on and waiver of certain 
                            deductibles.''.
            (3) Conforming amendment.--Section 1075(d) of such title is 
        amended by adding at the end the following new paragraph:
    ``(5) The Secretary may not impose any deductible amounts for 
outpatient pediatric services pursuant to section 1095d of this 
title.''.
    (h) GAO Study.--Not later than 4 years after the date of the 
enactment of this Act, the Comptroller General of the United States 
shall conduct a study and submit to Congress a report on the effects of 
the amendments made by this Act on premiums, deductibles, and copayment 
and coinsurance requirements with respect to group health plans and 
group and individual health insurance coverage (as such terms are 
defined in section 2791 of the Public Health Service Act (42 U.S.C. 
300gg-91)).
    (i) Effective Date.--The amendment (or amendments) made by--
            (1) subsections (a) through (c) and subsections (f) and (g) 
        shall apply with respect to plan years beginning on or after 
        the date that is 2 years after the date of the enactment of 
        this Act;
            (2) subsection (d) shall apply with respect to medical 
        assistance furnished in calendar quarters beginning on or after 
        the date that is 2 years after the date of the enactment of 
        this Act; and
            (3) subsection (c) shall apply with respect to child health 
        assistance furnished calendar quarters described in paragraph 
        (2).
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