Ally's Act
Bill: S.41 | Sponsor: Sen. Capito, Shelley Moore (R-WV)
Policy area: Health

Summary:
Ally's Act  This bill requires private health insurance plans to cover certain hearing devices and systems (e.g., bone-anchored auditory implants) and related items and services. The bill also imposes limits on cost sharing.

To amend the Public Health Service Act, the Employee Retirement Income 
   Security Act of 1974, the Internal Revenue Code of 1986, and the 
   Patient Protection and Affordable Care Act to require coverage of 
hearing devices and systems in certain private health insurance plans, 
                        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 ``Ally's Act''.

SEC. 2. COVERAGE OF HEARING DEVICES AND SYSTEMS IN CERTAIN PRIVATE 
              HEALTH INSURANCE PLANS.

    (a) PHSA.--Part A of the Public Health Service Act (42 U.S.C. 300gg 
et seq.) is amended by inserting after section 2713 the following new 
section:

``SEC. 2713A. COVERAGE OF HEARING DEVICES AND SYSTEMS.

    ``(a) In General.--Beginning with plan years beginning on or after 
January 1, 2022, a group health plan and a health insurance issuer 
offering group or individual health insurance coverage shall, at a 
minimum provide coverage for and may impose cost-sharing requirements 
in accordance with subsection (b) for an individual that a physician 
(as defined in section 1861(r) of the Social Security Act) or qualified 
audiologist (as defined in section 1861(ll)(4)(B) of such Act) 
determines meets an indication (including unilateral or bilateral 
hearing loss) for an auditory device as approved by the Food and Drug 
Administration for--
            ``(1) auditory implant devices (including auditory 
        osseointegrated (bone conduction) implants and cochlear 
        implants) and external sound processors;
            ``(2) the maintenance of auditory implant devices and 
        external sound processors described in paragraph (1);
            ``(3) every 5 years, the upgrade (or replacement if an 
        upgrade is not available) of auditory implant devices and 
        external sound processors described in paragraph (1);
            ``(4) adhesive adapters and softband headbands;
            ``(5) the repair of auditory implant devices and external 
        sound processors described in paragraph (1);
            ``(6) a comprehensive hearing assessment;
            ``(7) a preoperative medical assessment;
            ``(8) surgery (as appropriate);
            ``(9) postoperative medical appointments for purposes of 
        ensuring appropriate recovery from surgery;
            ``(10) postoperative audiological appointments for 
        activation and fitting of the implant device and external sound 
        processor; and
            ``(11) aural rehabilitation and treatment services (as 
        appropriate).
    ``(b) Cost-Sharing.--Beginning with plan years beginning on or 
after January 1, 2022, the cost-sharing incurred under a plan or 
coverage described in subsection (a)--
            ``(1) for an auditory implant device and external sound 
        processors under this section, shall not exceed a dollar amount 
        that is the highest cost-sharing requirement for the amount of 
        the charges imposed for such device that is provided by a 
        physician or qualified audiologist that has a contractual 
        relationship with such plan or coverage for the providing of 
        such device;
            ``(2) for an item or service under this section, shall not 
        exceed a dollar amount that is imposed for similar items and 
        services under that plan that are provided by a physician or 
        qualified audiologist; and
            ``(3) that has a contractual relationship with such plan or 
        coverage for the providing of such items and services.''.
    (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 (29 
        U.S.C. 1185 et seq.) by adding at the end the following new 
        section:

``SEC. 726. COVERAGE OF HEARING DEVICES AND SYSTEMS.

    ``(a) In General.--Beginning with plan years beginning on or after 
January 1, 2022, a group health plan and a health insurance issuer 
offering group health insurance coverage shall, at a minimum provide 
coverage for and may impose cost-sharing requirements in accordance 
with subsection (b) for an individual that a physician (as defined in 
section 1861(r) of the Social Security Act) or qualified audiologist 
(as defined in section 1861(ll)(4)(B) of such Act) determines meets an 
indication (including unilateral or bilateral hearing loss) for an 
auditory device as approved by the Food and Drug Administration for--
            ``(1) auditory implant devices (including auditory 
        osseointegrated (bone conduction) implants and cochlear 
        implants) and external sound processors;
            ``(2) the maintenance of auditory implant devices and 
        external sound processors described in paragraph (1);
            ``(3) every 5 years, the upgrade (or replacement if an 
        upgrade is not available) of auditory implant devices and 
        external sound processors described in paragraph (1);
            ``(4) adhesive adapters and softband headbands;
            ``(5) the repair of auditory implant devices and external 
        sound processors described in paragraph (1);
            ``(6) a comprehensive hearing assessment;
            ``(7) a preoperative medical assessment;
            ``(8) surgery (as appropriate);
            ``(9) postoperative medical appointments for purposes of 
        ensuring appropriate recovery from surgery;
            ``(10) postoperative audiological appointments for 
        activation and fitting of the implant device and external sound 
        processor; and
            ``(11) aural rehabilitation and treatment services (as 
        appropriate).
    ``(b) Cost-Sharing.--Beginning with plan years beginning on or 
after January 1, 2022, the cost-sharing incurred under a plan or 
coverage described in subsection (a)--
            ``(1) for an auditory implant device and external sound 
        processors under this section, shall not exceed a dollar amount 
        that is the highest cost-sharing requirement for the amount of 
        the charges imposed for such device that is provided by a 
        physician or qualified audiologist that has a contractual 
        relationship with such plan or coverage for the providing of 
        such device;
            ``(2) for an item or service under this section, shall not 
        exceed a dollar amount that is imposed for similar items and 
        services under that plan that are provided by a physician or 
        qualified audiologist; and
            ``(3) that has a contractual relationship with such plan or 
        coverage for the providing of such items and services.''.
            (2) Clerical amendment.--The table of contents in section 1 
        of the Employee Retirement Income Security Act of 1974 (29 
        U.S.C. 1001 et seq.) is amended by inserting after the item 
        relating to section 725 the following new item:

``Sec. 726. Coverage of hearing devices and systems.''.
    (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 HEARING DEVICES AND SYSTEMS.

    ``(a) In General.--Beginning with plan years beginning on or after 
January 1, 2022, a group health plan shall, at a minimum provide 
coverage for and may impose cost-sharing requirements in accordance 
with subsection (b) for an individual that a physician (as defined in 
section 1861(r) of the Social Security Act) or qualified audiologist 
(as defined in section 1861(ll)(4)(B) of such Act) determines meets an 
indication (including unilateral or bilateral hearing loss) for an 
auditory device as approved by the Food and Drug Administration for--
            ``(1) auditory implant devices (including auditory 
        osseointegrated (bone conduction) implants and cochlear 
        implants) and external sound processors;
            ``(2) the maintenance of auditory implant devices and 
        external sound processors described in paragraph (1);
            ``(3) every 5 years, the upgrade (or replacement if an 
        upgrade is not available) of auditory implant devices and 
        external sound processors described in paragraph (1);
            ``(4) adhesive adapters and softband headbands;
            ``(5) the repair of auditory implant devices and external 
        sound processors described in paragraph (1);
            ``(6) a comprehensive hearing assessment;
            ``(7) a preoperative medical assessment;
            ``(8) surgery (as appropriate);
            ``(9) postoperative medical appointments for purposes of 
        ensuring appropriate recovery from surgery;
            ``(10) postoperative audiological appointments for 
        activation and fitting of the implant device and external sound 
        processor; and
            ``(11) aural rehabilitation and treatment services (as 
        appropriate).
    ``(b) Cost-Sharing.--Beginning with plan years beginning on or 
after January 1, 2022, the cost-sharing incurred under a plan described 
in subsection (a)--
            ``(1) for an auditory implant device and external sound 
        processors under this section, shall not exceed a dollar amount 
        that is the highest cost-sharing requirement for the amount of 
        the charges imposed for such device that is provided by a 
        physician or qualified audiologist that has a contractual 
        relationship with such plan for the providing of such device;
            ``(2) for an item or service under this section, shall not 
        exceed a dollar amount that is imposed for similar items and 
        services under that plan that are provided by a physician or 
        qualified audiologist; and
            ``(3) that has a contractual relationship with such plan 
        for the providing of such items and services.''.
            (2) Clerical amendment.--The table of sections for 
        subchapter B of chapter 100 of the Internal Revenue Code of 
        1986 is amended by inserting after the item relating to section 
        9825 the following new item:

``Sec. 9826. Coverage of hearing devices and systems.''.
    (d) Application to Grandfathered Health Plans.--Section 
1251(a)(4)(A) of the Patient Protection and Affordable Care Act (42 
U.S.C. 18011(a)(4)(A)) is amended--
            (1) by striking ``title'' and inserting ``title, or as 
        added after the date of the enactment of this Act)''; and
            (2) by adding at the end the following new clause:
                            ``(v) Section 2713A (relating to hearing 
                        devices and systems).''.
            (3) Effective date.--The amendments made by this subsection 
        shall apply with respect to plan years beginning on or after 
        January 1, 2022.
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