,i  #aaf? ,,congress  #a/ ,session  ,h4 
,r4 #ddeg  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,septemb] #bd1        
#bjai,ms4 ,und]wood introduc$ ! foll[+  
bill2 :i* 0 ref]r$ to ! ,committee on   
,en]gy & ,comm]ce1 & 9 addition to !    
,committees on ,education & ,labor1 &   
,ways & ,means1 = a p]iod to be         
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,a ,,bill  ,to am5d ! ,employee
 ,retirem5t ,income ,security ,act (    
#aigd1 title ,,xxvii ( ! ,public ,heal? 
,s]vice ,act1 & ! ,int]nal ,rev5ue ,code
 ( #aihf to require gr\p heal? plans &  
heal? insurance issu]s (f]+ gr\p or     
individual heal? insurance cov]age to   
provide cov]age = additional prev5tive  
c>e = individuals ) *ronic conditions   
)\t ! imposition ( co/ %>+ requirem5t1 &
 = o!r purposes4  #a4 ,%ort title ,?is  
,act may be cit$ z ! ,*ronic ,condition 
,copay ,elim9ation ,act4  #b4 ,cov]age (
 additional prev5tive c>e = individuals 

) *ronic conditions )\t imposition ( co/
 %>+ requirem5ts  7a7 ,,erisa  7#a7 ,9  
g5]al ,subp>t ,b ( "p #g ( subtitle ,b (
 title ,i ( ! ,employee ,retirem5t      
,income ,security ,act ( #aigd 7#bi     
,u4,s4,c4 #aahe et seq47 is am5d$ by    
add+ at ! end ! foll[+ new section3     
#gaf4 ,cov]age ( additional prev5tive   
c>e = individuals ) *ronic conditions   
)\t imposition ( co/ %>+ requirem5ts    
7a7 ,9 g5]al ,9 addition to any item or 
s]vice describ$ 9 section #bgac7;a7 ( ! 
,public ,heal? ,s]vice ,act1 a gr\p     
heal? plan & a heal? insurance issu]    
(f]+ gr\p heal? insurance cov]age %all1 
at a m9imum1 provide cov]age =1 & %all n
 impose any co/ %>+ requirem5ts =1 )    
respect to individuals ) *ronic         
conditions 7z def9$ 9 subsection 7b771  
su* additional prev5tive c>e & scre5+s n
 describ$ 9 p>agraph 7#a7 ( su* section 
#bgac7;a7 t are det]m9$ by ! ,secret>y  
to meet ! crit]ia specifi$ 9 subsection 
7c7 ) respect to ! *ronic condition     
involv$4  7b7 ,*ronic condition def9$ ,9

 ?is section1 ! t]m *ronic condition has
 ! mean+ giv5 su* t]m by ! ,secret>y &1 
at a m9imum1 includes ! foll[+          
conditions3  7#a7 ,he>t disease1 includ+
 conge/ive he>t failure & coron>y art]y 
disease4  7#b7 ,diabetes4  7#c7         
,o/eoporosis & o/eop5ia4  7#d7          
,hyp]t5sion4  7#e7 ,a/hma4  7#f7 ,liv]  
disease4  7#g7 ,ble$+ disord]s4  7#h7   
,depression4  7c7 ,crit]ia specifi$ ,=  
purposes ( subsection 7a71 ! crit]ia    
specifi$ 9 ?is subsection1 ) respect to 
an item or s]vice & a *ronic condition1 
are ! foll[+3  7#a7 ,! item or s]vice is
 l[-co/4  7#b7 ,!re is m$ical evid5ce   
support+ high-co/ effici5cy1 or a l>ge  
expect$ impact1 ( ! item or s]vice 9    
prev5t+ exac]bation ( ! *ronic condition
 or ! developm5t ( a second>y condition4
  7#c7 ,!re is a /rong likelihood1      
docum5t$ by cl9ical evid5ce1 t ! item or
 s]vice w prev5t ! exac]bation ( !      
*ronic condition or ! developm5t ( a    
second>y condition t requires           
significantly high]-co/ treatm5ts4  7d7 

,updates  7#a7 ,9 g5]al ,once e ?ree    
ye>s1 ! ,secret>y %all review & update--
 7,a7 ! li/ ( conditions includ$ )9 !   
mean+ ( ! t]m *ronic condition "u       
subsection 7b72 &  7,b7 ! items &       
s]vices det]m9$ to meet ! crit]ia       
specifi$ 9 subsection 7c7 = purposes (  
subsection 7a74  7#b7 ,application (    
updates ,! requirem5t "u subsection 7a7 
%all apply ) respect to an update made  
"u p>agraph 7#a7 beg9n+ ) ! fir/ plan   
ye> beg9n+ aft] ! date ( su* update4  4 
7#b7 ,cl]ical am5dm5t ,! table ( cont5ts
 9 section #a ( su* ,act is am5d$ by    
ins]t+ aft] ! item relat+ to section    
#gad ! foll[+ new items3  #gae4         
,additional m>ket re=ms4 #gaf4 ,cov]age 
( additional prev5tive c>e = individuals
 ) *ronic conditions )\t imposition (   
co/ %>+ requirem5ts4  4  7b7 ,,phsa     
,subp>t ,,ii ( "p ,a ( title ,,xxvii ( !
 ,public ,heal? ,s]vice ,act 7#db       
,u4,s4,c4 #cjj;gg-#aa et seq47 is am5d$ 
by add+ at ! end ! foll[+ new section3  
#bgcj4 ,cov]age ( additional prev5tive  

c>e = individuals ) *ronic conditions   
)\t imposition ( co/ %>+ requirem5ts    
7a7 ,9 g5]al ,9 addition to any item or 
s]vice describ$ 9 section #bgac7;a71 a  
gr\p heal? plan & a heal? insurance     
issu] (f]+ gr\p or individual heal?     
insurance cov]age %all1 at a m9imum1    
provide cov]age =1 & %all n impose any  
co/ %>+ requirem5ts =1 ) respect to     
individuals ) *ronic conditions 7z def9$
 9 subsection 7b771 su* additional      
prev5tive c>e & scre5+s n describ$ 9    
p>agraph 7#a7 ( section #bgac7;a7 t are 
det]m9$ by ! ,secret>y to meet ! crit]ia
 specifi$ 9 subsection 7c7 ) respect to 
! *ronic condition involv$4  7b7 ,*ronic
 condition def9$ ,9 ?is section1 ! t]m  
*ronic condition has ! mean+ giv5 su*   
t]m by ! ,secret>y &1 at a m9imum1      
includes ! foll[+ conditions3  7#a7     
,he>t disease1 includ+ conge/ive he>t   
failure & coron>y art]y disease4  7#b7  
,diabetes4  7#c7 ,o/eoporosis &         
o/eop5ia4  7#d7 ,hyp]t5sion4  7#e7      
,a/hma4  7#f7 ,liv] disease4  7#g7      

,ble$+ disord]s4  7#h7 ,depression4  7c7
 ,crit]ia specifi$ ,= purposes (        
subsection 7a71 ! crit]ia specifi$ 9 ?is
 subsection1 ) respect to an item or    
s]vice & a *ronic condition1 are !      
foll[+3  7#a7 ,! item or s]vice is      
l[-co/4  7#b7 ,!re is m$ical evid5ce    
support+ high-co/ effici5cy1 or a l>ge  
expect$ impact1 ( ! item or s]vice 9    
prev5t+ exac]bation ( ! *ronic condition
 or ! developm5t ( a second>y condition4
  7#c7 ,!re is a /rong likelihood1      
docum5t$ by cl9ical evid5ce1 t ! item or
 s]vice w prev5t ! exac]bation ( !      
*ronic condition or ! developm5t ( a    
second>y condition t requires           
significantly high]-co/ treatm5ts4  7d7 
,updates  7#a7 ,9 g5]al ,once e ?ree    
ye>s1 ! ,secret>y %all review & update--
 7,a7 ! li/ ( conditions includ$ )9 !   
mean+ ( ! t]m *ronic condition "u       
subsection 7b72 &  7,b7 ! items &       
s]vices det]m9$ to meet ! crit]ia       
specifi$ 9 subsection 7c7 = purposes (  
subsection 7a74  7#b7 ,application (    

updates ,! requirem5t "u subsection 7a7 
%all apply ) respect to an update made  
"u p>agraph 7#a7 beg9n+ ) ! fir/ plan   
ye> beg9n+ aft] ! date ( su* update4  4 
7c7 ,,irc  7#a7 ,9 g5]al ,sub*apt] ,b ( 
*apt] #ajj ( subtitle ,k ( ! ,int]nal   
,rev5ue ,code ( #aihf is am5d$ by add+  
at ! end ! foll[+ new section3  #ihaf4  
,cov]age ( additional prev5tive c>e =   
individuals ) *ronic conditions )\t     
imposition ( co/ %>+ requirem5ts  7a7 ,9
 g5]al ,9 addition to any item or s]vice
 describ$ 9 section #bgac7;a7 ( !       
,public ,heal? ,s]vice ,act1 a gr\p     
heal? plan %all1 at a m9imum1 provide   
cov]age =1 & %all n impose any co/ %>+  
requirem5ts =1 ) respect to individuals 
) *ronic conditions 7z def9$ 9          
subsection 7b771 su* additional         
prev5tive c>e & scre5+s n describ$ 9    
p>agraph 7#a7 ( su* section #bgac7;a7 t 
are det]m9$ by ! ,secret>y to meet !    
crit]ia specifi$ 9 subsection 7c7 )     
respect to ! *ronic condition involv$4  
7b7 ,*ronic condition def9$ ,9 ?is      

section1 ! t]m *ronic condition has !   
mean+ giv5 su* t]m by ! ,secret>y &1 at 
a m9imum1 includes ! foll[+ conditions3 
7#a7 ,he>t disease1 includ+ conge/ive   
he>t failure & coron>y art]y disease4   
7#b7 ,diabetes4  7#c7 ,o/eoporosis &    
o/eop5ia4  7#d7 ,hyp]t5sion4  7#e7      
,a/hma4  7#f7 ,liv] disease4  7#g7      
,ble$+ disord]s4  7#h7 ,depression4  7c7
 ,crit]ia specifi$ ,= purposes (        
subsection 7a71 ! crit]ia specifi$ 9 ?is
 subsection1 ) respect to an item or    
s]vice & a *ronic condition1 are !      
foll[+3  7#a7 ,! item or s]vice is      
l[-co/4  7#b7 ,!re is m$ical evid5ce    
support+ high-co/ effici5cy1 or a l>ge  
expect$ impact1 ( ! item or s]vice 9    
prev5t+ exac]bation ( ! *ronic condition
 or ! developm5t ( a second>y condition4
  7#c7 ,!re is a /rong likelihood1      
docum5t$ by cl9ical evid5ce1 t ! item or
 s]vice w prev5t ! exac]bation ( !      
*ronic condition or ! developm5t ( a    
second>y condition t requires           
significantly high]-co/ treatm5ts4  7d7 

,updates  7#a7 ,9 g5]al ,once e ?ree    
ye>s1 ! ,secret>y %all review & update--
 7,a7 ! li/ ( conditions includ$ )9 !   
mean+ ( ! t]m *ronic condition "u       
subsection 7b72 &  7,b7 ! items &       
s]vices det]m9$ to meet ! crit]ia       
specifi$ 9 subsection 7c7 = purposes (  
subsection 7a74  7#b7 ,application (    
updates ,! requirem5t "u subsection 7a7 
%all apply ) respect to an update made  
"u p>agraph 7#a7 beg9n+ ) ! fir/ plan   
ye> beg9n+ aft] ! date ( su* update4  4 
7#b7 ,cl]ical am5dm5t ,! table ( cont5ts
 = sub*apt] ,b ( *apt] #ajj ( subtitle  
,k ( su* ,code is am5d$ by add+ at ! end
 ! foll[+ new item3  #ihaf4 ,cov]age (  
additional prev5tive c>e = individuals )
 *ronic conditions )\t imposition ( co/ 
%>+ requirem5ts4  4  7#c7 ,high         
d$uctible heal? plans ,section          
#bbc7;c77#b77;,c7 ( ! ,int]nal ,rev5ue  
,code ( #aihf is am5d$ by ins]t+ or =   
additional prev5tive c>e = individuals )
 *ronic conditions describ$ 9 section   
#ihaf be=e ! p]iod4  7d7 ,effective date

 ,! am5dm5ts made by ?is section %all   
apply ) respect to plan ye>s beg9n+ on  
or aft] ! date t is "o ye> aft] ! date (
 ! enactm5t ( ?is ,act4