Insurance Fairness for Amputees Act - Amends the Employee Retirement Income Security Act of 1974 (ERISA) and the Public Health Service Act to require a group health plan that provides medical and surgical benefits and also provides benefits for prosthetics and custom orthotics to offer such prosthetics and custom orthotics in the same manner as applicable to medical and surgical benefits. Prohibits separate financial requirements or more restrictive treatment limitations. Requires a health plan that does not provide coverage for benefits outside of a network to ensure that such provider network is adequate to ensure enrollee access to prosthetic and custom orthotic devices and related services provided by appropriately credentialed practitioners and accredited suppliers.
Allows limitation of coverage for required benefits for prosthetics and custom orthotics to the most appropriate device or component that meets the medical requirements of the patient. Requires benefits to include repair and replacement due to normal wear and tear, irreparable damage, a change in the patient's condition, or as otherwise determined appropriate by the treating physician.
Prohibits any annual or lifetime dollar limitation on benefits for prosthetics and custom orthotics unless such limitation applies in the aggregate to all benefits.
[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3020 Introduced in House (IH)]
113th CONGRESS
1st Session
H. R. 3020
To amend the Employee Retirement Income Security Act of 1974, the
Public Health Service Act, and the Internal Revenue Code of 1986 to
provide parity under group and individual health plans and group and
individual health insurance coverage for the provision of benefits for
prosthetics and custom orthotics and benefits for other medical and
surgical services.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
August 2, 2013
Mr. Dent (for himself and Mr. Andrews) introduced the following bill;
which was referred to the Committee on Energy and Commerce, and in
addition to the Committees on Education and the Workforce and Ways and
Means, 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 Employee Retirement Income Security Act of 1974, the
Public Health Service Act, and the Internal Revenue Code of 1986 to
provide parity under group and individual health plans and group and
individual health insurance coverage for the provision of benefits for
prosthetics and custom orthotics and benefits for other medical and
surgical services.
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 ``Insurance Fairness for Amputees
Act''.
SEC. 2. FINDINGS AND PURPOSE.
(a) Findings.--Congress makes the following findings:
(1) There are more than 1,700,000 people in the United
States living with limb loss, many of whom are appropriate
candidates for prosthetic care. A comparable number experience
trauma, illness, or disability that results in musculoskeletal
or neuromuscular impairment of the limbs, back, and neck
requiring the use of orthotic care.
(2) Every year, there are more than 130,000 people in the
United States who undergo amputation procedures.
(3) In addition, United States military personnel serving
in Iraq and Afghanistan and around the world have sustained
traumatic injuries resulting in amputation and musculoskeletal
or neuromuscular injury.
(4) The number of amputations in the United States is
projected to increase in the years ahead due to the rising
incidence of diabetes and other chronic illness.
(5) Those experiencing limb loss and limb dysfunction can
and want to regain their lives as productive members of
society, and prosthetic and orthotic care often enables
amputees and others with orthopedic impairments to continue
working and living productive lives.
(6) Insurance companies often restrict coverage for
prosthetic and orthotic devices and related services over an
individual's lifetime, which shifts costs onto individuals and
consequently to the Medicare and Medicaid programs.
(7) Twenty States have addressed this problem and have
prosthetic or orthotic parity legislation, which also is being
considered actively in other States.
(8) The States in which prosthetic or orthotic fairness in
coverage laws have been enacted have found there to be minimal
or no increases in insurance premiums and have reduced Medicare
and Medicaid costs.
(9) Coverage of orthotic and prosthetic devices and related
services is only appropriate for individuals missing a limb or
having an orthopedic condition in need of treatment. Therefore,
a fixed population of individuals are candidates for these
devices and related services.
(10) Appropriate and timely treatment involving prosthetic
and orthotic devices and related services allow people to
regain health function, preexisting work, and independent
living.
(11) Prosthetic and orthotic devices and related services
are a distinct and separate benefit from the durable medical
equipment benefit, but this distinction often is not recognized
as insurers typically combine these benefits under a combined
limit.
(12) The Patient Protection and Affordable Care Act (Public
Law 111-148) and the Health Care and Education Reconciliation
Act (Public Law 111-152), include rehabilitative and
habilitative services as an essential health benefit, which
legislative history shows is intended to cover prosthetic and
orthotic devices and related services.
(13) The Institute of Medicine concluded that prosthetic
and orthotic devices and related services are covered under a
typical employer plan.
(14) However, while lifetime and annual dollar limitations
on essential health benefits are prohibited under the Patient
Protection and Affordable Care Act (Public Law 111-148) and the
Health Care and Education Reconciliation Act (Public Law 111-
152), other techniques to minimize or eliminate coverage
continue to be used across the country and are denying
individuals access to medically necessary prosthetic and
orthotic devices and related services.
(b) Purpose.--It is the purpose of this Act to require that each
group and individual health plan and individual and group health
insurance coverage that provides medical and surgical benefits and also
provides coverage for prosthetics or custom orthotics (or both),
provide such coverage under terms and conditions that are no less
favorable than the terms and conditions under which medical and
surgical benefits are provided under such plan.
SEC. 3. PROSTHETICS AND CUSTOM ORTHOTICS FAIRNESS IN COVERAGE.
(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:
``SEC. 716. PROSTHETICS AND CUSTOM ORTHOTICS FAIRNESS IN COVERAGE.
``(a) In General.--In the case of a group health plan (or health
insurance coverage offered in connection with a group health plan) that
provides medical and surgical benefits and also provides benefits for
prosthetics or custom orthotics (as defined under paragraphs (1) and
(2) of subsection (e)) (or both)--
``(1) such benefits for prosthetics or custom orthotics (or
both) under the plan (or coverage) shall be provided under
terms and conditions that are no less favorable than the terms
and conditions applicable to substantially all medical and
surgical benefits provided under the plan (or coverage);
``(2) such benefits for prosthetics or custom orthotics (or
both) under the plan (or coverage) may not be subject to
separate financial requirements (as defined in subsection
(d)(3)) that are applicable only with respect to such benefits,
and any financial requirements applicable to such benefits
shall be no more restrictive than the financial requirements
applicable to substantially all medical and surgical benefits
provided under the plan (or coverage); and
``(3) any treatment limitations (as defined in subsection
(d)(4)) applicable to such benefits for prosthetics or custom
orthotics (or both) under the plan (or coverage) may not be
more restrictive than the treatment limitations applicable to
substantially all medical and surgical benefits provided under
the plan (or coverage).
``(b) Patient Access.--A group health plan (or health insurance
coverage offered in connection with a group health plan) described in
subsection (a) that does not provide coverage for benefits outside of a
network shall ensure that such provider network is adequate to ensure
enrollee access to prosthetic and custom orthotic devices and related
services provided by appropriately credentialed practitioners and
accredited suppliers of prosthetics and custom orthotics.
``(c) Additional Requirements.--
``(1) Prior authorization.--In the case of a group health
plan (or health insurance coverage offered in connection with a
group health plan) that requires, as a condition of coverage or
payment for prosthetics or custom orthotics (or both) under the
plan (or coverage), prior authorization, such prior
authorization must be required in the same manner as prior
authorization is required by the plan (or coverage) as a
condition of coverage or payment for all similar medical and
surgical benefits provided under the plan (or coverage).
``(2) Limitation on benefits.--Coverage for required
benefits for prosthetics and custom orthotics under this
section may be limited to coverage of the most appropriate
device or component model that meets the medical requirements
of the patient, as determined by the treating physician of the
patient involved.
``(3) Coverage for repair or replacement.--Benefits for
prosthetics and custom orthotics required under this section
shall include coverage for the repair or replacement of
prosthetics and custom orthotics, if the repair or replacement
is due to normal wear and tear, irreparable damage, a change in
the condition of the patient as determined by the treating
physician, or otherwise determined appropriate by the treating
physician of the patient involved.
``(d) Definitions.--In this section:
``(1) Prosthetics.--The term `prosthetics' means those
devices and components that may be used to replace, in whole or
in part, an arm or leg, as well as the services required to do
so and includes external breast prostheses incident to
mastectomy resulting from breast cancer.
``(2) Custom orthotics.--The term `custom orthotics' means
the following:
``(A) Custom-fabricated orthotics and related
services, which include custom-fabricated devices that
are individually made for a specific patient, as well
as all services and supplies that are medically
necessary for the effective use of the orthotic device
and instructing the patient in the use of the device.
No other patient would be able to use this particular
orthosis. A custom-fabricated orthosis is a device
which is fabricated based on clinically derived and
rectified castings, tracings, measurements, or other
images (such as x-rays) of the body part. The
fabrication may involve using calculations, templates
and component parts. This process requires the use of
basic materials and involves substantial work such as
vacuum forming, cutting, bending, molding, sewing,
drilling and finishing prior to fitting on the patient.
Custom-fabricated devices may be furnished only by an
appropriately credentialed (certified or licensed)
practitioner and accredited supplier in Orthotics or
Prosthetics. Such devices and related services are
represented by the set of L-codes under the Healthcare
Common Procedure Coding System describing this care
listed on the date of enactment of this section in
Centers for Medicare & Medicaid Services Transmittal
656.
``(B) Custom-fitted high orthotics and related
services, which include prefabricated devices that are
manufactured with no specific patient in mind, but that
are appropriately sized, adapted, modified, and
configured (with the required tools and equipment) to a
specific patient in accordance with a prescription, and
which no other patient would be able to use, as well as
all services and supplies that are medically necessary
for the effective use of the orthotic device and
instructing the patient in the use of the device.
Custom-fitted high devices may be furnished only by an
appropriately credentialed (certified or licensed)
practitioner and accredited supplier in Orthotics or
Prosthetics. Such devices and related services are
represented by the existing set of L-codes under the
Healthcare Common Procedure Coding System describing
this care listed on the date of enactment of this
section in Centers for Medicare & Medicaid Services
Transmittal 656.
For purposes of subparagraphs (A) and (B), Centers for Medicare
& Medicaid Services Transmittal 656, upon modification or
reissuance by the Centers for Medicare & Medicaid Services to
reflect new code additions and coding changes for prosthetics
and custom orthotics, shall be the version of the Transmittal
used for purposes of such subparagraphs.
``(3) Financial requirements.--The term `financial
requirements' includes deductibles, coinsurance, co-payments,
other cost sharing, and limitations on the total amount that
may be paid by a participant or beneficiary with respect to
benefits under the plan or health insurance coverage.
``(4) Treatment limitations.--The term `treatment
limitations' includes limits on the frequency of treatment,
number of visits, specific prescribed components, limits that
are more broadly applicable to durable medical equipment, or
other similar limits on the amount, duration, or scope of
treatment.
``(e) Differentiation From Durable Medical Equipment.--For purposes
of this section, prosthetics and custom orthotics shall be treated as
distinct from durable medical equipment.''.
(2) Clerical amendment.--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 714 the
following:
``Sec. 715. Additional market reforms.
``Sec. 716. Prosthetics and custom orthotics parity.''.
(b) PHSA.--
(1) In general.--Title XXVII of the Public Health Service
Act is amended by inserting after section 2728 of such Act (42
U.S.C. 300gg-28), as redesignated by section 1001(2) of the
Patient Protection and Affordable Care Act (Public Law 111-
148), the following:
``SEC. 2729. PROSTHETICS AND CUSTOM ORTHOTICS PARITY.
``(a) In General.--In the case of a group health plan, or a health
insurance issuer offering group or individual health insurance
coverage, that provides medical and surgical benefits and also provides
benefits for prosthetics or custom orthotics (as defined under
paragraphs (1) and (2) of subsection (e)) (or both)--
``(1) such benefits for prosthetics or custom orthotics (or
both) under the plan or coverage shall be provided under terms
and conditions that are no less favorable than the terms and
conditions applicable to substantially all medical and surgical
benefits provided under the plan or coverage;
``(2) such benefits for prosthetics or custom orthotics (or
both) under the plan or coverage may not be subject to separate
financial requirements (as defined in subsection (e)(2)) that
are applicable only with respect to such benefits, and any
financial requirements applicable to such benefits shall be no
more restrictive than the financial requirements applicable to
substantially all medical and surgical benefits provided under
the plan or coverage; and
``(3) any treatment limitations (as defined in subsection
(e)(3)) applicable to such benefits for prosthetics or custom
orthotics (or both) under the plan or coverage may not be more
restrictive than the treatment limitations applicable to
substantially all medical and surgical benefits provided under
the plan or coverage.
``(b) Patient Access.--A group health plan, or health insurance
issuer offering group or individual health insurance coverage,
described in subsection (a) that does not provide coverage for benefits
outside of a network shall ensure that such provider network is
adequate to ensure enrollee access to prosthetic and custom orthotic
devices and related services provided by appropriately credentialed
practitioners and accredited suppliers of prosthetics and custom
orthotics.
``(c) Additional Requirements.--
``(1) Prior authorization.--In the case of a group health
plan, or health insurance issuer offering group or individual
health insurance coverage, that requires, as a condition of
coverage or payment for prosthetics or custom orthotics (or
both) under the plan or coverage, prior authorization, such
prior authorization must be required in the same manner as
prior authorization is required by the plan or coverage as a
condition of coverage or payment for all similar medical and
surgical benefits provided under the plan or coverage.
``(2) Limitation on benefits.--Coverage for required
benefits for prosthetics and custom orthotics under this
section may be limited to coverage of the most appropriate
device or component model that adequately meets the medical
requirements of the patient, as determined by the treating
physician of the patient involved.
``(3) Coverage for repair or replacement.--Benefits for
prosthetics and custom orthotics required under this section
shall include coverage for the repair or replacement of
prosthetics and custom orthotics, if the repair or replacement
is due to normal wear and tear, irreparable damage, a change in
the condition of the patient as determined by the treating
physician, or otherwise determined appropriate by the treating
physician of the patient involved.
``(d) Definitions.--In this section:
``(1) Prosthetics.--The term `prosthetics' means those
devices and components that may be used to replace, in whole or
in part, an arm or leg, as well as the services required to do
so and includes external breast prostheses incident to
mastectomy resulting from breast cancer.
``(2) Custom orthotics.--The term `custom orthotics' means
the following:
``(A) Custom-fabricated orthotics and related
services, which include custom-fabricated devices that
are individually made for a specific patient, as well
as all services and supplies that are medically
necessary for the effective use of the orthotic device
and instructing the patient in the use of the device.
No other patient would be able to use this particular
orthosis. A custom-fabricated orthosis is a device
which is fabricated based on clinically derived and
rectified castings, tracings, measurements, or other
images (such as x-rays) of the body part. The
fabrication may involve using calculations, templates
and component parts. This process requires the use of
basic materials and involves substantial work such as
vacuum forming, cutting, bending, molding, sewing,
drilling and finishing prior to fitting on the patient.
Custom-fabricated devices may be furnished only by an
appropriately credentialed (certified or licensed)
practitioner and accredited supplier in Orthotics or
Prosthetics. Such devices and related services are
represented by the set of L-codes under the Healthcare
Common Procedure Coding System describing this care
listed on the date of enactment of this section in
Centers for Medicare & Medicaid Services Transmittal
656.
``(B) Custom-fitted high orthotics and related
services, which include prefabricated devices that are
manufactured with no specific patient in mind, but that
are appropriately sized, adapted, modified, and
configured (with the required tools and equipment) to a
specific patient in accordance with a prescription, and
which no other patient would be able to use, as well as
all services and supplies that are medically necessary
for the effective use of the orthotic device and
instructing the patient in the use of the device.
Custom-fitted high devices may be furnished only by an
appropriately credentialed (certified or licensed)
practitioner and accredited supplier in Orthotics or
Prosthetics. Such devices and related services are
represented by the existing set of L-codes under the
Healthcare Common Procedure Coding System describing
this care listed on the date of enactment of this
section in Centers for Medicare & Medicaid Services
Transmittal 656.
For purposes of subparagraphs (A) and (B), Centers for Medicare
& Medicaid Services Transmittal 656, upon modification or
reissuance by the Centers for Medicare & Medicaid Services to
reflect new code additions and coding changes for prosthetics
and custom orthotics, shall be the version of the Transmittal
used for purposes of such subparagraphs.
``(3) Financial requirements.--The term `financial
requirements' includes deductibles, coinsurance, co-payments,
other cost sharing, and limitations on the total amount that
may be paid by a participant or beneficiary with respect to
benefits under the plan or health insurance coverage.
``(4) Treatment limitations.--The term `treatment
limitations' includes limits on the frequency of treatment,
number of visits, specific prescribed components, and limits
that are more broadly applicable to durable medical equipment,
or other similar limits on the amount, duration, or scope of
treatment.
``(e) Differentiation From Durable Medical Equipment.--For purposes
of this section, prosthetics and custom orthotics shall be treated as
distinct from durable medical equipment.''.
(2) Application to individual health insurance coverage
before 2014.--For purposes of applying section 2729 of the
Public Health Service Act, as inserted by paragraph (1), to
individual health insurance coverage before 2014, the
provisions of such section shall be treated as also included
under part B of title XXVII of the Public Health Service Act.
(c) Internal Revenue Code.--Subchapter B of chapter 100 of subtitle
K of the Internal Revenue Code of 1986 is amended by adding after
section 9813 the following:
``SEC. 9814. PROSTHETICS AND CUSTOM ORTHOTICS FAIRNESS IN COVERAGE.
``(a) In General.--In the case of a group health plan (or health
insurance coverage offered in connection with a group health plan) that
provides medical and surgical benefits and also provides benefits for
prosthetics or custom orthotics (as defined under paragraphs (1) and
(2) of subsection (e)) (or both)--
``(1) such benefits for prosthetics or custom orthotics (or
both) under the plan (or coverage) shall be provided under
terms and conditions that are no less favorable than the terms
and conditions applicable to substantially all medical and
surgical benefits provided under the plan (or coverage);
``(2) such benefits for prosthetics or custom orthotics (or
both) under the plan (or coverage) may not be subject to
separate financial requirements (as defined in subsection
(e)(2)) that are applicable only with respect to such benefits,
and any financial requirements applicable to such benefits
shall be no more restrictive than the financial requirements
applicable to substantially all medical and surgical benefits
provided under the plan (or coverage); and
``(3) any treatment limitations (as defined in subsection
(e)(3)) applicable to such benefits for prosthetics or custom
orthotics (or both) under the plan (or coverage) may not be
more restrictive than the treatment limitations applicable to
substantially all medical and surgical benefits provided under
the plan (or coverage).
``(b) Patient Access.--A group health plan (or health insurance
coverage offered in connection with a group health plan) described in
subsection (a) that does not provide coverage for benefits outside of a
network shall ensure that such provider network is adequate to ensure
enrollee access to prosthetic and custom orthotic devices and related
services provided by appropriately credentialed practitioners and
accredited suppliers of prosthetics and custom orthotics.
``(c) Additional Requirements.--
``(1) Prior authorization.--In the case of a group health
plan (or health insurance coverage offered in connection with a
group health plan) that requires, as a condition of coverage or
payment for prosthetics or custom orthotics (or both) under the
plan (or coverage), prior authorization, such prior
authorization must be required in the same manner as prior
authorization is required by the plan (or coverage) as a
condition of coverage or payment for all similar medical and
surgical benefits provided under the plan (or coverage).
``(2) Limitation on benefits.--Coverage for required
benefits for prosthetics and custom orthotics under this
section may be limited to coverage of the most appropriate
device or component model that meets the medical requirements
of the patient, as determined by the treating physician of the
patient involved.
``(3) Coverage for repair or replacement.--Benefits for
prosthetics and custom orthotics required under this section
shall include coverage for the repair or replacement of
prosthetics and custom orthotics, if the repair or replacement
is due to normal wear and tear, irreparable damage, a change in
the condition of the patient as determined by the treating
physician, or otherwise determined appropriate by the treating
physician of the patient involved.
``(4) Assistance to enrollees.--The Secretary of the
Treasury, in consultation with the Secretary of Health and
Human Services, shall provide assistance to enrollees under
plans or coverage to which the amendment made by section 3
apply with any questions or problems with respect to compliance
with the requirements of such amendment.
``(5) Audits.--The Secretary of the Treasury, in
consultation with the Secretary of Health and Human Services,
shall provide for the conduct of random audits of group health
plans (and health insurance coverage offered in connection with
such plans) to ensure that such plans (or coverage) are in
compliance with the amendments made by section (3).
``(d) Definitions.--In this section:
``(1) Prosthetics.--The term `prosthetics' means those
devices and components that may be used to replace, in whole or
in part, an arm or leg, as well as the services required to do
so and includes external breast prostheses incident to
mastectomy resulting from breast cancer.
``(2) Custom orthotics.--The term `custom orthotics' means
the following:
``(A) Custom-fabricated orthotics and related
services, which include custom-fabricated devices that
are individually made for a specific patient, as well
as all services and supplies that are medically
necessary for the effective use of the orthotic device
and instructing the patient in the use of the device.
No other patient would be able to use this particular
orthosis. A custom-fabricated orthosis is a device
which is fabricated based on clinically derived and
rectified castings, tracings, measurements, or other
images (such as x-rays) of the body part. The
fabrication may involve using calculations, templates
and component parts. This process requires the use of
basic materials and involves substantial work such as
vacuum forming, cutting, bending, molding, sewing,
drilling and finishing prior to fitting on the patient.
Custom-fabricated devices may be furnished only by an
appropriately credentialed (certified or licensed)
practitioner and accredited supplier in Orthotics or
Prosthetics. Such devices and related services are
represented by the set of L-codes under the Healthcare
Common Procedure Coding System describing this care
listed on the date of enactment of this section in
Centers for Medicare & Medicaid Services Transmittal
656.
``(B) Custom-fitted high orthotics and related
services, which include prefabricated devices that are
manufactured with no specific patient in mind, but that
are appropriately sized, adapted, modified, and
configured (with the required tools and equipment) to a
specific patient in accordance with a prescription, and
which no other patient would be able to use, as well as
all services and supplies that are medically necessary
for the effective use of the orthotic device and
instructing the patient in the use of the device.
Custom-fitted high devices may be furnished only by an
appropriately credentialed (certified or licensed)
practitioner and accredited supplier in Orthotics or
Prosthetics. Such devices and related services are
represented by the existing set of L-codes under the
Healthcare Common Procedure Coding System describing
this care listed on the date of enactment of this
section in Centers for Medicare & Medicaid Services
Transmittal 656.
For purposes of subparagraphs (A) and (B), Centers for Medicare
& Medicaid Services Transmittal 656, upon modification or
reissuance by the Centers for Medicare & Medicaid Services to
reflect new code additions and coding changes for prosthetics
and custom orthotics, shall be the version of the Transmittal
used for purposes of such subparagraphs.
``(3) Financial requirements.--The term `financial
requirements' includes deductibles, coinsurance, co-payments,
other cost sharing, and limitations on the total amount that
may be paid by a participant or beneficiary with respect to
benefits under the plan or health insurance coverage.
``(4) Treatment limitations.--The term `treatment
limitations' includes limits on the frequency of treatment,
number of visits, specific prescribed components, or other
similar limits on the scope or duration of treatment.
``(e) Differentiation From Durable Medical Equipment.--For purposes
of this section, prosthetics and custom orthotics shall be treated as
distinct from durable medical equipment.''.
(d) Effective Date.--The amendments made by this section shall
apply with respect to plan years beginning on or after the date of the
enactment of this section and with respect to health insurance coverage
issued on or after such date.
SEC. 4. UPDATING STANDARD DEFINITIONS TO INCLUDE PROSTHETICS AND CUSTOM
ORTHOTICS.
(a) In General.--Section 2715(g)(3) of the Public Health Service
Act (42 U.S.C. 300gg-15(g)(3)) is amended by inserting ``prosthetics,
custom orthotics,'' after ``emergency medical transportation,''.
(b) Prosthetics; Custom Orthotics.--In developing standards for the
definitions of the terms ``prosthetics'' and ``custom orthotics''
pursuant to the amendment made by subsection (a), the Secretary shall
ensure that such definitions are consistent with the definitions of
such terms in section 2729(d) of the Public Health Service Act (as
added by section 3(b) of this Act).
SEC. 5. FEDERAL ADMINISTRATIVE RESPONSIBILITIES.
(a) Assistance to Enrollees.--The Secretary of Labor, in
consultation with the Secretary of Health and Human Services, shall
provide assistance to enrollees under group health plans (and health
insurance coverage offered in connection with such plans) to which the
amendments made by section 3 apply with any questions or problems with
respect to compliance with the requirements of such amendments.
(b) Audits.--The Secretary of Labor, in consultation with the
Secretary of Health and Human Services, shall provide for the conduct
of random audits of group health plans (and health insurance coverage
offered in connection with such plans) to ensure that such plans (or
coverage) are in compliance with the amendments made by section 3.
(c) Regulations.--Not later than 1 year after the date of the
enactment of this Act, the Secretary of Labor, in consultation with the
Secretary of Health and Human Services, shall promulgate final
regulations to carry out this Act and the amendments made by this Act.
(d) Definitions.--In this section:
(1) Group health plan.--The term ``group health plan'' has
the meaning given such term in section 733(a) of the Employee
Retirement and Income Security Act of 1974 (29 U.S.C.
1191b(a)).
(2) Health insurance coverage.--The term ``health insurance
coverage'' has the meaning given such term in section 733(b)(1)
of such Act (29 U.S.C. 1191b(b)(1)).
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and the Workforce, and Ways and Means, 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 Education and the Workforce, and Ways and Means, 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 Education and the Workforce, and Ways and Means, 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, Employment, Labor, and Pensions.
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