Chronic Condition Copay Elimination Act
Bill: H.R.4371 | Sponsor: Rep. Underwood, Lauren (D-IL)
Policy area: Health

Summary:
Chronic Condition Copay Elimination Act  This bill requires health insurers to cover, without cost sharing, preventive items and services for certain chronic conditions, such as heart disease, diabetes, and asthma.

To amend the Employee Retirement Income Security Act of 1974, title 
 XXVII of the Public Health Service Act, 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 additional preventive care for individuals with chronic 
conditions without the imposition of cost sharing requirement, 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 ``Chronic Condition Copay Elimination 
Act''.

SEC. 2. COVERAGE OF ADDITIONAL PREVENTIVE CARE FOR INDIVIDUALS WITH 
              CHRONIC CONDITIONS WITHOUT IMPOSITION OF COST SHARING 
              REQUIREMENTS.

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

``SEC. 726. COVERAGE OF ADDITIONAL PREVENTIVE CARE FOR INDIVIDUALS WITH 
              CHRONIC CONDITIONS WITHOUT IMPOSITION OF COST SHARING 
              REQUIREMENTS.

    ``(a) In General.--In addition to any item or service described in 
section 2713(a) of the Public Health Service Act, a group health plan 
and a health insurance issuer offering group health insurance coverage 
shall, at a minimum, 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 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 section, 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 subsection (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 prevent 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 requirement 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 contents in section 1 
        of such Act is amended by inserting after the item relating to 
        section 725 the following new items:

``726. Coverage of additional preventive care for individuals with 
                            chronic conditions without imposition of 
                            cost sharing requirements.''.
    (b) PHSA.--Part D 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. 2799A-11. COVERAGE OF ADDITIONAL PREVENTIVE CARE FOR INDIVIDUALS 
              WITH CHRONIC CONDITIONS WITHOUT IMPOSITION OF COST 
              SHARING REQUIREMENTS.

    ``(a) In General.--In addition to any item or service 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 
requirements 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 Secretary to meet the criteria specified in 
subsection (c) with respect to the chronic condition involved.
    ``(b) Chronic Condition Defined.--In this section, 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 subsection (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 prevent 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 requirement 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 the 
        Internal Revenue Code of 1986 is amended by adding at the end 
        the following new section:

``SEC. 9826. COVERAGE OF ADDITIONAL PREVENTIVE CARE FOR INDIVIDUALS 
              WITH CHRONIC CONDITIONS WITHOUT IMPOSITION OF COST 
              SHARING REQUIREMENTS.

    ``(a) In General.--In addition to any item or service described in 
section 2713(a) of the Public Health Service Act, a group health plan 
shall, at a minimum, 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 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 section, 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 subsection (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 prevent 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 requirement 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 contents for 
        subchapter B of chapter 100 of such Code is amended by adding 
        at the end the following new item:

``9826. Coverage of additional preventive care for individuals with 
                            chronic conditions without imposition of 
                            cost sharing requirements.''.
            (3) High deductible health plans.--Section 223(c)(2)(C) of 
        the Internal Revenue Code of 1986 is amended by inserting ``or 
        for additional preventive care for individuals with chronic 
        conditions described in section 9826'' before the period.
    (d) Effective Date.--The amendments made by this section shall 
apply with respect to plan years beginning on or after the date that is 
one year after the date of the enactment of this Act.
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