[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 296 Introduced in House (IH)]
108th CONGRESS
1st Session
H. R. 296
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.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
January 8, 2003
Mrs. Kelly introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committees on
Ways and Means and Education and the Workforce, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
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.
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 ``Treatment of Children's Deformities
Act of 2003''.
SEC. 2. COVERAGE OF MINOR CHILD'S CONGENITAL OR DEVELOPMENTAL DEFORMITY
OR DISORDER.
(a) Group Health Plans.--
(1) Public health service act amendments.--(A) Subpart 2 of
part A of title XXVII of the Public Health Service Act is
amended by adding at the end the following new section:
``SEC. 2707. STANDARDS RELATING TO BENEFITS FOR MINOR CHILD'S
CONGENITAL OR DEVELOPMENTAL DEFORMITY OR DISORDER.
``(a) Requirements for Reconstructive Surgery.--
``(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.
``(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.
``(3) Treatment defined.--
``(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--
``(i) procedures that do not materially
affect the function of the body part being
treated; and
``(ii) procedures for secondary conditions
and follow-up treatment.
``(B) Exception.--Such term does not include
cosmetic surgery performed to reshape normal structures
of the body to improve appearance or self-esteem.
``(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.''.
(B) Section 2723(c) of such Act (42 U.S.C. 300gg-23(c)) is
amended by striking ``section 2704'' and inserting ``sections
2704 and 2707''.
(2) ERISA amendments.--(A) Subpart B of part 7 of subtitle
B of title I of the Employee Retirement Income Security Act of
1974 is amended by adding at the end the following new section:
``SEC. 714. STANDARDS RELATING TO BENEFITS FOR MINOR CHILD'S CONGENITAL
OR DEVELOPMENTAL DEFORMITY OR DISORDER.
``(a) Requirements for Reconstructive Surgery.--
``(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.
``(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.
``(3) Treatment defined.--
``(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--
``(i) procedures that do not materially
affect the function of the body part being
treated; and
``(ii) procedures for secondary conditions
and follow-up treatment.
``(B) Exception.--Such term does not include
cosmetic surgery performed to reshape normal structures
of the body to improve appearance or self-esteem.
``(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.''.
(B) Section 731(c) of such Act (29 U.S.C. 1191(c)) is
amended by striking ``section 711'' and inserting ``sections
711 and 714''.
(C) Section 732(a) of such Act (29 U.S.C. 1191a(a)) is
amended by striking ``section 711'' and inserting ``sections
711 and 714''.
(D) The table of contents in section 1 of such Act is
amended by inserting after the item relating to section 712 the
following new item:
``Sec. 714. Standards relating to benefits for minor child's congenital
or developmental deformity or disorder.''.
(3) Internal revenue code amendments.--Subchapter B of
chapter 100 of the Internal Revenue Code of 1986 is amended--
(A) in the table of sections, by inserting after
the item relating to section 9812 the following new
item:
``Sec. 9813. Standards relating to
benefits for minor child's
congenital or developmental
deformity or disorder.'';
and
(B) by inserting after section 9812 the following:
``SEC. 9813. STANDARDS RELATING TO BENEFITS FOR MINOR CHILD'S
CONGENITAL OR DEVELOPMENTAL DEFORMITY OR DISORDER.
``(a) Requirements for Reconstructive Surgery.--
``(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.
``(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.
``(3) Treatment defined.--
``(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--
``(i) procedures that do not materially
affect the function of the body part being
treated; and
``(ii) procedures for secondary conditions
and follow-up treatment.
``(B) Exception.--Such term does not include
cosmetic surgery performed to reshape normal structures
of the body to improve appearance or self-esteem.''.
(b) Individual Health Insurance.--(1) Part B of title XXVII of the
Public Health Service Act is amended by inserting after section 2752
the following new section:
``SEC. 2753. STANDARDS RELATING TO BENEFITS FOR MINOR CHILD'S
CONGENITAL OR DEVELOPMENTAL DEFORMITY OR DISORDER.
``(a) Requirements for Reconstructive Surgery.--
``(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.
``(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.
``(3) Treatment defined.--
``(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--
``(i) procedures that do not materially
affect the function of the body part being
treated; and
``(ii) procedures for secondary conditions
and follow-up treatment.
``(B) Exception.--Such term does not include
cosmetic surgery performed to reshape normal structures
of the body to improve appearance or self-esteem.
``(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.''.
(2) Section 2762(b)(2) of such Act (42 U.S.C. 300gg-62(b)(2)) is
amended by striking ``section 2751'' and inserting ``sections 2751 and
2753''.
(c) Effective Dates.--(1) The amendments made by subsection (a)
shall apply with respect to group health plans for plan years beginning
on or after January 1, 2004.
(2) 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.
(d) Coordinated Regulations.--Section 104(1) of Health Insurance
Portability and Accountability Act of 1996 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''.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and the Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and the Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and the Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and the Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Employer-Employee Relations.
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