No Surprises for Survivors Act of 2022
Bill: H.R.8891 | Sponsor: Rep. Sánchez, Linda T. (D-CA)
Policy area: Health

Summary:
No Surprises for Survivors Act of 2022
This bill requires health insurance plans to cover, with no cost sharing, medical forensic examinations for sexual assault patients.

To amend the Public Health Service Act, the Employee Retirement Income 
Security Act of 1974, and the Internal Revenue Code of 1986 to require 
   group health plans and health insurance issuers offering group or 
 individual health insurance coverage to provide coverage for forensic 
      medical exams with no cost sharing, and for other purposes.

    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 ``No Surprises for Survivors Act of 
2022''.

SEC. 2. REQUIRING COVERAGE OF FORENSIC MEDICAL EXAMS WITH NO COST 
              SHARING.

    (a) PHSA.--Part D of title XXVII of the Public Health Service Act 
(42 U.S.C. 300gg-111 et seq.) is amended--
            (1) in section 2799A-1(a)(3)(C)(ii), by inserting 
        ``forensic medical exams (as defined in section 2799A-11(d)) 
        furnished on or after January 1, 2025 and'' after ``shall 
        include''; and
            (2) by adding at the end the following new section:

``SEC. 2799A-11. REQUIRED COVERAGE OF FORENSIC MEDICAL EXAMS WITH NO 
              COST SHARING.

    ``(a) In General.--Except as provided in subsection (b), a group 
health plan and a health insurance issuer offering group or individual 
health insurance coverage shall provide coverage for and shall not 
impose any cost sharing requirements for a forensic medical exam (as 
defined in subsection (d)) furnished by a sexual assault forensic 
examiner (as defined for purposes of section 304 of the DNA Sexual 
Assault Justice Act of 2004), a sexual assault nurse examiner (as so 
defined), or any other provider specified by the Secretary, regardless 
of whether such forensic examiner, nurse examiner, or other provider 
has in effect a contractual relationship with such plan or coverage for 
the furnishing of such exam or item or service.
    ``(b) Nonapplication to Certain Forensic Medical Exams Otherwise 
Covered.--
            ``(1) In general.--The provisions of subsection (a) shall 
        not apply with respect to a forensic medical exam furnished in 
        a State for which such State is responsible for incurring the 
        full out-of-pocket costs under section 2010 of the Omnibus 
        Crime Control and Safe Streets Act of 1968.
            ``(2) Notification.--In the case that a group health plan 
        or health insurance issuer offering group or individual health 
        insurance coverage receives a claim for a forensic medical exam 
        to which the provisions of subsection (a) would apply but for 
        application of paragraph (1) and such plan or issuer denies 
        such claim or imposes cost sharing on such claim, such plan or 
        issuer shall--
                    ``(A) at the time of such denial or imposition, 
                notify the individual with respect to whom such exam 
                was furnished of the manner in which such individual 
                may seek reimbursement for such exam (or for the amount 
                of such cost sharing so imposed, as applicable) from 
                the State in which such exam was furnished; and
                    ``(B) after receiving authorization from such 
                individual, notify the appropriate State agency of the 
                State in which such exam was furnished of such claim.
    ``(c) Application of Surprise Billing Provisions.--
            ``(1) In general.--The provisions of sections 2799A-1 and 
        2799B-1, 716 of the Employee Retirement Income Security Act of 
        1974, and 9816 of the Internal Revenue Code of 1986 shall apply 
        to a forensic medical exam for which a group health plan or 
        health insurance issuer offering group or individual health 
        insurance coverage is responsible for providing coverage at no 
        cost sharing under this section furnished to an enrollee of 
        such plan or group or individual health insurance coverage by a 
        provider that does not have in effect a contractual 
        relationship described in subsection (a) with such plan or 
        coverage (as applicable) for furnishing such exam as if such 
        exam was an emergency service furnished by a nonparticipating 
        provider in an emergency department of a hospital.
            ``(2) Definitions.--In this subsection, the terms 
        `emergency service' and `nonparticipating provider' have the 
        meanings given such terms in subparagraphs (C)(i) and (G), 
        respectively, of sections 2799A-1(a)(3), 716(a)(3) of the 
        Employee Retirement Income Security Act of 1974, and section 
        9816(a)(3) of the Internal Revenue Code of 1986.
    ``(d) Definition.--For purposes of this section, the term `forensic 
medical exam' means, with respect to an individual--
            ``(1) an examination for physical trauma;
            ``(2) a determination of penetration or force;
            ``(3) an interview of such individual; and
            ``(4) the collection and evaluation of evidence from such 
        individual.''.
    (b) ERISA.--
            (1) In general.--Subpart B of part 7 of subtitle B of title 
        I of the Employee Retirement Income Security Act of 1974 is 
        amended--
                    (A) in section 716(a)(3)(C)(ii), by inserting 
                ``forensic medical exams (as defined in section 726(d)) 
                furnished on or after January 1, 2025 and'' after 
                ``shall include''; and
                    (B) by adding at the end the following new section:

``SEC. 726. REQUIRED COVERAGE OF FORENSIC MEDICAL EXAMS WITH NO COST 
              SHARING.

    ``(a) In General.--Except as provided in subsection (b), a group 
health plan and a health insurance issuer offering group health 
insurance coverage shall provide coverage for and shall not impose any 
cost sharing requirements for a forensic medical exam (as defined in 
subsection (d)) furnished by a sexual assault forensic examiner (as 
defined for purposes of section 304 of the DNA Sexual Assault Justice 
Act of 2004), a sexual assault nurse examiner (as so defined), or any 
other provider specified by the Secretary, regardless of whether such 
forensic examiner, nurse examiner, or other provider has in effect a 
contractual relationship with such plan or coverage for the furnishing 
of such exam or item or service.
    ``(b) Nonapplication to Certain Forensic Medical Exams Otherwise 
Covered.--
            ``(1) In general.--The provisions of subsection (a) shall 
        not apply with respect to a forensic medical exam furnished in 
        a State for which such State is responsible for incurring the 
        full out-of-pocket costs under section 2010 of the Omnibus 
        Crime Control and Safe Streets Act of 1968.
            ``(2) Notification.--In the case that a group health plan 
        or health insurance issuer offering group health insurance 
        coverage receives a claim for a forensic medical exam to which 
        the provisions of subsection (a) would apply but for 
        application of paragraph (1) and such plan or issuer denies 
        such claim or imposes cost sharing on such claim, such plan or 
        issuer shall--
                    ``(A) at the time of such denial or imposition, 
                notify the individual with respect to whom such exam 
                was furnished of the manner in which such individual 
                may seek reimbursement for such exam (or for the amount 
                of such cost sharing so imposed, as applicable) from 
                the State in which such exam was furnished; and
                    ``(B) after receiving authorization from such 
                individual, notify the appropriate State agency of the 
                State in which such exam was furnished of such claim.
    ``(c) Application of Surprise Billing Provisions.--
            ``(1) In general.--The provisions of sections 2799A-1 and 
        2799B-1 of the Public Health Service Act, 716, and 9816 of the 
        Internal Revenue Code of 1986 shall apply to a forensic medical 
        exam for which a group health plan or health insurance issuer 
        offering group health insurance coverage is responsible for 
        providing coverage at no cost sharing under this section 
        furnished to a participant or beneficiary of such plan or group 
        health insurance coverage by a provider that does not have in 
        effect a contractual relationship described in subsection (a) 
        with such plan or coverage (as applicable) for furnishing such 
        exam as if such exam was an emergency services furnished by a 
        nonparticipating provider in an emergency department of a 
        hospital.
            ``(2) Definitions.--In this subsection, the terms 
        `emergency service' and `nonparticipating provider' have the 
        meanings given such terms in subparagraphs (C)(i) and (G), 
        respectively, of sections 2799A-1(a)(3) of the Public Health 
        Service Act, 716(a)(3), and section 9816(a)(3) of the Internal 
        Revenue Code of 1986.
    ``(d) Definition.--For purposes of this section, the term `forensic 
medical exam' means, with respect to an individual--
            ``(1) an examination for physical trauma;
            ``(2) a determination of penetration or force;
            ``(3) an interview of such individual; and
            ``(4) the collection and evaluation of evidence from such 
        individual.''.
            (2) Technical amendment.--The table of contents in section 
        1 of such Act is amended by inserting after the item relating 
        to section 725 the following new item:

``Sec. 726. Required coverage of forensic medical exams with no cost 
                            sharing.''.
    (c) IRC.--
            (1) In general.--Subchapter B of chapter 100 of the 
        Internal Revenue Code of 1986 is amended--
                    (A) in section 9816(a)(3)(C)(ii), by inserting 
                ``forensic medical exams (as defined in section 
                9826(d)) furnished on or after January 1, 2025 and'' 
                after ``shall include''; and
                    (B) by adding at the end the following new section:

``SEC. 9826. REQUIRED COVERAGE OF FORENSIC MEDICAL EXAMS WITH NO COST 
              SHARING.

    ``(a) In General.--Except as provided in subsection (b), a group 
health plan shall provide coverage for and shall not impose any cost 
sharing requirements for a forensic medical exam (as defined in 
subsection (d)) furnished by a sexual assault forensic examiner (as 
defined for purposes of section 304 of the DNA Sexual Assault Justice 
Act of 2004), a sexual assault nurse examiner (as so defined), or any 
other provider specified by the Secretary, regardless of whether such 
forensic examiner, nurse examiner, or other provider has in effect a 
contractual relationship with such plan for the furnishing of such exam 
or item or service.
    ``(b) Nonapplication to Certain Forensic Medical Exams Otherwise 
Covered.--
            ``(1) In general.--The provisions of subsection (a) shall 
        not apply with respect to a forensic medical exam furnished in 
        a State for which such State is responsible for incurring the 
        full out-of-pocket costs under section 2010 of the Omnibus 
        Crime Control and Safe Streets Act of 1968.
            ``(2) Notification.--In the case that a group health plan 
        receives a claim for a forensic medical exam to which the 
        provisions of subsection (a) would apply but for application of 
        paragraph (1) and such plan denies such claim or imposes cost 
        sharing on such claim, such plan shall--
                    ``(A) at the time of such denial or imposition, 
                notify the individual with respect to whom such exam 
                was furnished of the manner in which such individual 
                may seek reimbursement for such exam (or for the amount 
                of such cost sharing so imposed, as applicable) from 
                the State in which such exam was furnished; and
                    ``(B) after receiving authorization from such 
                individual, notify the appropriate State agency of the 
                State in which such exam was furnished of such claim.
    ``(c) Application of Surprise Billing Provisions.--
            ``(1) In general.--The provisions of sections 2799A-1 and 
        2799B-1 of the Public Health Service Act, 716 of the Employee 
        Retirement Income Security Act of 1974, and 9816 shall apply to 
        a forensic medical exam for which a group health plan is 
        responsible for providing coverage at no cost sharing under 
        this section furnished to an enrollee, participant, or 
        beneficiary of such plan by a provider that does not have in 
        effect a contractual relationship described in subsection (a) 
        with such plan for furnishing such exam as if such exam was an 
        emergency service furnished by a nonparticipating provider in 
        an emergency department of a hospital.
            ``(2) Definitions.--In this subsection, the terms 
        `emergency service' and `nonparticipating provider' have the 
        meanings given such terms in subparagraphs (C)(i) and (G), 
        respectively, of sections 2799A-1(a)(3) of the Public Health 
        Service Act, 716(a)(3) of the Employee Retirement Income 
        Security Act of 1974, and section 9816(a)(3).
    ``(d) Definition.--For purposes of this section, the term `forensic 
medical exam' means, with respect to an individual--
            ``(1) an examination for physical trauma;
            ``(2) a determination of penetration or force;
            ``(3) an interview of such individual; and
            ``(4) the collection and evaluation of evidence from such 
        individual.''.
            (2) Technical amendment.--The table of sections for such 
        subchapter is amended by adding at the end the following new 
        item:

``Sec. 9826. Required coverage of forensic medical exams with no cost 
                            sharing.''.
    (d) Conforming Amendment.--Section 223(c)(2) of the Internal 
Revenue Code of 1986 is amended by adding at the end the following new 
subparagraph:
                    ``(H) Safe harbor for forensic medical exams.--A 
                plan shall not fail to be treated as a high deductible 
                health plan by reason of failing to have a deductible 
                for any item or service for which such plan is required 
                to provide coverage at no cost sharing under section 
                9826.''.
    (e) Implementation.--The Secretaries of Labor, Health and Human 
Services, and the Treasury may implement the amendments made by this 
section through interim final rules, subregulatory guidance, program 
instruction, or otherwise.
    (f) Effective Date.--The amendments made by subsections (a) through 
(d) shall apply with respect to plan years beginning on or after 
January 1, 2025.
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