S 1588 ISCommentsClose CommentsPermalink

To amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to require that group and individual health insurance coverage and group health plans provide coverage for treatment of a minor child's congenital or developmental deformity or disorder due to trauma, infection, tumor, or disease.CommentsClose CommentsPermalink

June 11, 2007

Ms. LANDRIEU (for herself, Mr. COLEMAN, Ms. SNOWE, Mr. BAYH, Ms. STABENOW, Mr. LUGAR, and Mr. COCHRAN) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and PensionsCommentsClose CommentsPermalink

To amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to require that group and individual health insurance coverage and group health plans provide coverage for treatment of a minor child's congenital or developmental deformity or disorder due to trauma, infection, tumor, or disease.CommentsClose CommentsPermalink

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

SECTION 1. SHORT TITLE.

This Act may be cited as the `Children's Access to Reconstructive Evaluation and Surgery Act' or the `CARES Act'.CommentsClose CommentsPermalink

SEC. 2. COVERAGE OF MINOR CHILD'S CONGENITAL OR DEVELOPMENTAL DEFORMITY OR DISORDER.

(a) Group Health Plans-CommentsClose CommentsPermalink





(1) PUBLIC HEALTH SERVICE ACT AMENDMENTS-CommentsClose CommentsPermalink





(A) IN GENERAL- Subpart 2 of part A of title XXVII of the Public Health Service Act (42 U.S.C. 300gg-4 et seq.) is amended by adding at the end the following:CommentsClose CommentsPermalink

`SEC. 2707. STANDARDS RELATING TO BENEFITS FOR MINOR CHILD'S CONGENITAL OR DEVELOPMENTAL DEFORMITY OR DISORDER.

`(a) Requirements for Reconstructive Surgery-CommentsClose CommentsPermalink





`(1) IN GENERAL- A group health plan, and a health insurance issuer offering group health insurance coverage, that provides coverage for surgical benefits shall provide coverage for outpatient and inpatient diagnosis and treatment of a minor child's congenital or developmental deformity, disease, or injury. A minor child shall include any individual through 21 years of age.CommentsClose CommentsPermalink





`(2) REQUIREMENTS- Any coverage provided under paragraph (1) shall be subject to pre-authorization or pre-certification as required by the plan or issuer, and such coverage shall include any surgical treatment which, in the opinion of the treating physician, is medically necessary to approximate a normal appearance.CommentsClose CommentsPermalink





`(3) TREATMENT DEFINED-CommentsClose CommentsPermalink





`(A) IN GENERAL- In this section, the term `treatment' includes reconstructive surgical procedures (procedures that are generally performed to improve function, but may also be performed to approximate a normal appearance) that are performed on abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease, including--CommentsClose CommentsPermalink





`(i) procedures that do not materially affect the function of the body part being treated; andCommentsClose CommentsPermalink





`(ii) procedures for secondary conditions and follow-up treatment.CommentsClose CommentsPermalink





`(B) EXCEPTION- Such term does not include cosmetic surgery performed to reshape normal structures of the body to improve appearance or self-esteem.CommentsClose CommentsPermalink





`(b) Notice- A group health plan under this part shall comply with the notice requirement under section 714(b) of the Employee Retirement Income Security Act of 1974 with respect to the requirements of this section as if such section applied to such plan.'.CommentsClose CommentsPermalink





(B) CONFORMING AMENDMENT- Section 2723(c) of the Public Health Service Act (42 U.S.C. 300gg-23(c)) is amended by striking `section 2704' and inserting `sections 2704 and 2707'.CommentsClose CommentsPermalink





(2) ERISA AMENDMENTS-CommentsClose CommentsPermalink





(A) 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:CommentsClose CommentsPermalink

`SEC. 714. STANDARDS RELATING TO BENEFITS FOR MINOR CHILD'S CONGENITAL OR DEVELOPMENTAL DEFORMITY OR DISORDER.

`(a) Requirements for Reconstructive Surgery-CommentsClose CommentsPermalink





`(1) IN GENERAL- A group health plan, and a health insurance issuer offering group health insurance coverage, that provides coverage for surgical benefits shall provide coverage for outpatient and inpatient diagnosis and treatment of a minor child's congenital or developmental deformity, disease, or injury. A minor child shall include any individual through 21 years of age.CommentsClose CommentsPermalink





`(2) REQUIREMENTS- Any coverage provided under paragraph (1) shall be subject to pre-authorization or pre-certification as required by the plan or issuer, and such coverage shall include any surgical treatment which, in the opinion of the treating physician, is medically necessary to approximate a normal appearance.CommentsClose CommentsPermalink





`(3) TREATMENT DEFINED-CommentsClose CommentsPermalink





`(A) IN GENERAL- In this section, the term `treatment' includes reconstructive surgical procedures (procedures that are generally performed to improve function, but may also be performed to approximate a normal appearance) that are performed on abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease, including--CommentsClose CommentsPermalink





`(i) procedures that do not materially affect the function of the body part being treated; andCommentsClose CommentsPermalink





`(ii) procedures for secondary conditions and follow-up treatment.CommentsClose CommentsPermalink





`(B) EXCEPTION- Such term does not include cosmetic surgery performed to reshape normal structures of the body to improve appearance or self-esteem.CommentsClose CommentsPermalink





`(b) Notice Under Group Health Plan- The imposition of the requirements of this section shall be treated as a material modification in the terms of the plan described in section 102(a)(1), for purposes of assuring notice of such requirements under the plan; except that the summary description required to be provided under the last sentence of section 104(b)(1) with respect to such modification shall be provided by not later than 60 days after the first day of the first plan year in which such requirements apply.'.CommentsClose CommentsPermalink





(B) CONFORMING AMENDMENTS-CommentsClose CommentsPermalink





(i) Section 731(c) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1191(c)) is amended by striking `section 711' and inserting `sections 711 and 714'.CommentsClose CommentsPermalink





(ii) Section 732(a) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1191a(a)) is amended by striking `section 711' and inserting `sections 711 and 714'.CommentsClose CommentsPermalink





(iii) The table of contents in section 1 of the Employee Retirement Income Security Act of 1974 is amended by inserting after the item relating to section 713 the following:CommentsClose CommentsPermalink





`Sec. 714. Standards relating to benefits for minor child's congenital or developmental deformity or disorder.'.CommentsClose CommentsPermalink





(3) INTERNAL REVENUE CODE AMENDMENTS- Subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended--CommentsClose CommentsPermalink





(A) in the table of sections, by inserting after the item relating to section 9812 the following:CommentsClose CommentsPermalink





`Sec. 9813. Standards relating to benefits for minor child's congenital or developmental deformity or disorder.';CommentsClose CommentsPermalink





andCommentsClose CommentsPermalink





(B) by inserting after section 9812 the following:CommentsClose CommentsPermalink

`SEC. 9813. STANDARDS RELATING TO BENEFITS FOR MINOR CHILD'S CONGENITAL OR DEVELOPMENTAL DEFORMITY OR DISORDER.

`(a) Requirements for Reconstructive Surgery-CommentsClose CommentsPermalink





`(1) IN GENERAL- A group health plan, and a health insurance issuer offering group health insurance coverage, that provides coverage for surgical benefits shall provide coverage for outpatient and inpatient diagnosis and treatment of a minor child's congenital or developmental deformity, disease, or injury. A minor child shall include any individual through 21 years of age.CommentsClose CommentsPermalink





`(2) REQUIREMENTS- Any coverage provided under paragraph (1) shall be subject to pre-authorization or pre-certification as required by the plan or issuer, and such coverage shall include any surgical treatment which, in the opinion of the treating physician, is medically necessary to approximate a normal appearance.CommentsClose CommentsPermalink





`(3) TREATMENT DEFINED-CommentsClose CommentsPermalink





`(A) IN GENERAL- In this section, the term `treatment' includes reconstructive surgical procedures (procedures that are generally performed to improve function, but may also be performed to approximate a normal appearance) that are performed on abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease, including--CommentsClose CommentsPermalink





`(i) procedures that do not materially affect the function of the body part being treated; andCommentsClose CommentsPermalink





`(ii) procedures for secondary conditions and follow-up treatment.CommentsClose CommentsPermalink





`(B) EXCEPTION- Such term does not include cosmetic surgery performed to reshape normal structures of the body to improve appearance or self-esteem.'.CommentsClose CommentsPermalink





(b) Individual Health Insurance-CommentsClose CommentsPermalink





(1) IN GENERAL- Part B of title XXVII of the Public Health Service Act is amended by inserting after section 2752 the following:CommentsClose CommentsPermalink

`SEC. 2753. STANDARDS RELATING TO BENEFITS FOR MINOR CHILD'S CONGENITAL OR DEVELOPMENTAL DEFORMITY OR DISORDER.

`(a) Requirements for Reconstructive Surgery-CommentsClose CommentsPermalink





`(1) IN GENERAL- A group health plan, and a health insurance issuer offering group health insurance coverage, that provides coverage for surgical benefits shall provide coverage for outpatient and inpatient diagnosis and treatment of a minor child's congenital or developmental deformity, disease, or injury. A minor child shall include any individual through 21 years of age.CommentsClose CommentsPermalink





`(2) REQUIREMENTS- Any coverage provided under paragraph (1) shall be subject to pre-authorization or pre-certification as required by the plan or issuer, and such coverage shall include any surgical treatment which, in the opinion of the treating physician, is medically necessary to approximate a normal appearance.CommentsClose CommentsPermalink





`(3) TREATMENT DEFINED-CommentsClose CommentsPermalink





`(A) IN GENERAL- In this section, the term `treatment' includes reconstructive surgical procedures (procedures that are generally performed to improve function, but may also be performed to approximate a normal appearance) that are performed on abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease, including--CommentsClose CommentsPermalink





`(i) procedures that do not materially affect the function of the body part being treated; andCommentsClose CommentsPermalink





`(ii) procedures for secondary conditions and follow-up treatment.CommentsClose CommentsPermalink





`(B) EXCEPTION- Such term does not include cosmetic surgery performed to reshape normal structures of the body to improve appearance or self-esteem.CommentsClose CommentsPermalink





`(b) Notice- A health insurance issuer under this part shall comply with the notice requirement under section 714(b) of the Employee Retirement Income Security Act of 1974 with respect to the requirements referred to in subsection (a) as if such section applied to such issuer and such issuer were a group health plan.'.CommentsClose CommentsPermalink





(2) CONFORMING AMENDMENT- Section 2762(b)(2) of the Public Health Service Act (42 U.S.C. 300gg-62(b)(2)) is amended by striking `section 2751' and inserting `sections 2751 and 2753'.CommentsClose CommentsPermalink





(c) Effective Dates-CommentsClose CommentsPermalink





(1) GROUP HEALTH COVERAGE- The amendments made by subsection (a) shall apply with respect to group health plans for plan years beginning on or after January 1, 2008.CommentsClose CommentsPermalink





(2) INDIVIDUAL HEALTH COVERAGE- The amendment made by subsection (b) shall apply with respect to health insurance coverage offered, sold, issued, renewed, in effect, or operated in the individual market on or after such date.CommentsClose CommentsPermalink





(d) Coordinated Regulations- Section 104(1) of Health Insurance Portability and Accountability Act of 1996 (42 U.S.C. 300gg-92 note) is amended by striking `this subtitle (and the amendments made by this subtitle and section 401)' and inserting `the provisions of part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974, the provisions of parts A and C of title XXVII of the Public Health Service Act, and chapter 100 of the Internal Revenue Code of 1986'.CommentsClose CommentsPermalink