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 financial requirements and treatment limitations applicable to such coverage may be no more restrictive than the requirements and limitations for other medical and surgical benefits covered under the plan. Further, a plan may not deny or limit coverage based on the plan's review of the medical necessity of such items or services.
[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2439 Introduced in House (IH)]
<DOC>
118th CONGRESS
1st Session
H. R. 2439
To amend title XXVII of 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.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 30, 2023
Mr. Neguse (for himself, Mr. Fitzpatrick, and Mr. Thompson of
California) 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 title XXVII of 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 D of the Public Health Service Act (42 U.S.C.
300gg-111 et seq.) is amended by adding at the end the following new
section:
``SEC. 2799A-11. COVERAGE OF HEARING DEVICES AND SYSTEMS.
``(a) In General.--A group health plan and a health insurance
issuer offering group or individual health insurance coverage shall at
a minimum provide coverage for the following items and services
furnished to a qualifying individual (as defined in subsection (d)):
``(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 relating to the furnishing of such devices
and processors (as determined necessary by a physician or
qualified audiologist (as such terms are defined for purposes
of subsection (d)) treating such individual).
``(9) Postoperative medical visits for purposes of ensuring
appropriate recovery from such surgery.
``(10) Postoperative audiological visits for activation and
fitting of such devices and processors.
``(11) Aural rehabilitation and treatment services (as so
determined necessary).
``(b) Coverage Requirements.--In the case of an item or service
described in subsection (a) furnished to a qualifying individual under
a group health plan or group or individual health insurance coverage,
such plan or coverage shall ensure that--
``(1) the financial requirements (as defined in section
2726(a)(3)) applicable to such item or service are no more
restrictive than the predominant financial requirements applied
to substantially all medical and surgical benefits covered by
the plan or coverage (as applicable), and that there are no
separate cost sharing requirements that are applicable only
with respect to such item or service; and
``(2) the treatment limitations (as defined in such
section) applicable to such item or service are no more
restrictive than the predominant treatment limitations applied
to substantially all medical and surgical benefits covered by
the plan or coverage (as applicable), and that there are no
separate treatment limitations that are applicable only with
respect to such item or service.
``(c) Prohibition on Review of Medical Necessity.--A group health
plan and a health insurance issuer offering group or individual health
insurance coverage may not deny or otherwise limit coverage of any item
or service described in subsection (a) furnished to a qualifying
individual on the basis of a review of the medical necessity of such
item or service by such plan or issuer.
``(d) Qualifying Individual Defined.--For purposes of this section,
the term `qualifying individual' means 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 implant device and external sound
processor described in subsection (a)(1).''.
(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.--A group health plan and a health insurance
issuer offering group health insurance coverage shall at a minimum
provide coverage for the following items and services furnished to a
qualifying individual (as defined in subsection (d)):
``(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 relating to the furnishing of such devices
and processors (as determined necessary by a physician or
qualified audiologist (as such terms are defined for purposes
of subsection (d)) treating such individual).
``(9) Postoperative medical visits for purposes of ensuring
appropriate recovery from such surgery.
``(10) Postoperative audiological visits for activation and
fitting of such devices and processors.
``(11) Aural rehabilitation and treatment services (as so
determined necessary).
``(b) Coverage Requirements.--In the case of an item or service
described in subsection (a) furnished to a qualifying individual under
a group health plan or group health insurance coverage, such plan or
coverage shall ensure that--
``(1) the financial requirements (as defined in section
2726(a)(3) of the Public Health Service Act) applicable to such
item or service are no more restrictive than the predominant
financial requirements applied to substantially all medical and
surgical benefits covered by the plan or coverage (as
applicable), and that there are no separate cost sharing
requirements that are applicable only with respect to such item
or service; and
``(2) the treatment limitations (as defined in such
section) applicable to such item or service are no more
restrictive than the predominant treatment limitations applied
to substantially all medical and surgical benefits covered by
the plan or coverage (as applicable), and that there are no
separate treatment limitations that are applicable only with
respect to such item or service.
``(c) Prohibition on Review of Medical Necessity.--A group health
plan and a health insurance issuer offering group health insurance
coverage may not deny or otherwise limit coverage of any item or
service described in subsection (a) furnished to a qualifying
individual on the basis of a review of the medical necessity of such
item or service by such plan or issuer.
``(d) Qualifying Individual Defined.--For purposes of this section,
the term `qualifying individual' means 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 implant device and external sound
processor described in subsection (a)(1).''.
(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.--A group health plan shall at a minimum provide
coverage for the following items and services furnished to a qualifying
individual (as defined in subsection (d)):
``(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 relating to the furnishing of such devices
and processors (as determined necessary by a physician or
qualified audiologist (as such terms are defined for purposes
of subsection (d)) treating such individual).
``(9) Postoperative medical visits for purposes of ensuring
appropriate recovery from such surgery.
``(10) Postoperative audiological visits for activation and
fitting of such devices and processors.
``(11) Aural rehabilitation and treatment services (as so
determined necessary).
``(b) Coverage Requirements.--In the case of an item or service
described in subsection (a) furnished to a qualifying individual under
a group health plan, such plan shall ensure that--
``(1) the financial requirements (as defined in section
2726(a)(3) of the Public Health Service Act) applicable to such
item or service are no more restrictive than the predominant
financial requirements applied to substantially all medical and
surgical benefits covered by the plan, and that there are no
separate cost sharing requirements that are applicable only
with respect to such item or service; and
``(2) the treatment limitations (as defined in such
section) applicable to such item or service are no more
restrictive than the predominant treatment limitations applied
to substantially all medical and surgical benefits covered by
the plan, and that there are no separate treatment limitations
that are applicable only with respect to such item or service.
``(c) Prohibition on Review of Medical Necessity.--A group health
plan may not deny or otherwise limit coverage of any item or service
described in subsection (a) furnished to a qualifying individual on the
basis of a review of the medical necessity of such item or service by
such plan or issuer.
``(d) Qualifying Individual Defined.--For purposes of this section,
the term `qualifying individual' means 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 implant device and external sound
processor described in subsection (a)(1).''.
(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. 9286. 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 2799A-11 (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, 2025.
<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.
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