,i #aah? ,,congress #a/ ,session ,h4 ,r4 #efdg ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,septemb] #ba1 #bjbc,mr4 ,mc,caul 7= himself1 ,mr4 ,b]a1 & ,mr4 ,kelly ( ,p5nsylvania7 introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,en]gy & ,comm]ce1 & 9 addition to ! ,committee on ,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 title ,,xxvii ( ! ,public ,heal? ,s]vice ,act to require out-(-network cov]age = qualifi$ individuals diagnos$ ) a r>e p$iatric disease p>ticipat+ 9 approv$ cl9ical trials1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,*ildhood ,canc] ,cl9ical ,trials ,act4 #b4 ,am5dm5ts relat+ to cov]age 9 individual & gr\p m>ket & "u ,m$ic>e program = qualifi$ individuals diagnos$ ) a r>e p$iatric disease p>ticipat+ 9 approv$ cl9ical trials 7a7 ,individual & gr\p m>ket 7#a7 ,requir+ out-(-network cov]age ( r\t9e pati5t co/s ,section #bgji ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#h7 is am5d$-- 7,a7 9 subsection 7a77#b7-- 7i7 9 subp>agraph 7,a71 by ins]t+ & subsection 7c77#b7 aft] 7#a77;,b72 & 7ii7 9 subp>agraph 7,b71 by ins]t+ & subsection 7c77#b7 aft] 7#a77;,b72 7,b7 by am5d+ subsection 7c7 to read z foll[s3 7c7 ,treatm5t ( non-,p>ticipat+ provid]s 7#a7 ,9 g5]al ,subject to p>agraph 7#b71 ?is section %all n be con/ru$ to require a gr\p heal? plan1 or a heal? insurance issu] (f]+ gr\p or individual heal? insurance cov]age1 to provide b5efits = r\t9e pati5t c>e s]vices provid$ outside ( ! plan's 7or cov]age's7 heal? c>e provid] network unless out-(-network b5efits are o!rwise provid$ "u ! plan 7or cov]age74 7#b7 ,qualifi$ individuals diagnos$ ) a r>e p$iatric disease ,9 ! case ( a qualifi$ individual diagnos$ ) a r>e p$iatric disease1 ) respect to r\t9e pati5t co/s = items & s]vices furni%$ to su* individual 9 connection ) p>ticipation 9 an approv$ cl9ical trial by a nonp>ticipat+ provid]1 a gr\p heal? plan or heal? insurance issu] (f]+ gr\p or individual heal? insurance cov]age t provides cov]age to su* individual-- 7,a7 %all impose ! same co/-%>+ requirem5t 7express$ z a copaym5t am\nt or co9surance rate7 t w\ld apply if su* item or s]vice 0 furni%$ by a p>ticipat+ provid]2 & 7,b7 %all pay to su* nonp>ticipat+ provid] ! am\nt by :i* ! recogniz$ am\nt = su* item or s]vice exce$s ! co/-%>+ am\nt = su* item or s]vice 7z det]m9$ 9 accordance ) subp>agraph 7,a774 2 & 7,c7 by add+ at ! end ! foll[+ new subsection3 7i7 ,o!r def9itions 7#a7 ,nonp>ticipat+ provid]2 p>ticipat+ provid]2 recogniz$ am\nt ,= purposes ( ?is section1 ! t]ms nonp>ticipat+ provid]1 p>ticipat+ provid]1 & recogniz$ am\nt h ! mean+ giv5 su* t]ms 9 section #bgii;,a-#a7;a77#c74 7#b7 ,r>e p$iatric disease ,! t]m r>e p$iatric disease has ! mean+ giv5 su* t]m 9 section #ebi7;a77#c7 ( ! ,f$]al ,food1 ,drug1 & ,cosmetic ,act4 4 7#b7 ,am5dm5t relat+ to def9ition ( r\t9e pati5t co/s ,section #bgji7;a77#b77;,a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#h7;a77#b77;,a77 is am5d$-- 7,a7 by /rik+ include all items & s]vices & ins]t+ include-- 7i7 all items & s]vices 2 & 7,b7 by /rik+ ! p]iod at ! end & ins]t+ 2 & 7ii7 consultation & ref]ral s]vices relat+ to approv$ cl9ical trials furni%$ to qualifi$ individuals4 4 7#c7 ,am5dm5t relat+ to def9ition ( approv$ cl9ical trial ,section #bgji7;d77#a77;,a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#h7;d77#a77;,a77 is am5d$ by add+ at ! end ! foll[+ new clause3 7viii7 ,! ,pati5t-,c5t]$ ,outcomes ,rese>* ,in/itute4 4 7#d7 ,te*nical & con=m+ am5dm5ts ,section #bgji ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#h71 z am5d$ by ! prec$+ p>agraphs1 is fur!r am5d$-- 7,a7 9 subsection 7a7-- 7i7 9 p>agraph 7#a77;,a71 by ins]t+ be=e cl9ical trial ref]r$ to 9 subsection 7b77#b7 ! foll[+3 approv$2 7ii7 9 p>agraph 7#b77;,a71 by /rik+ a cl9ical trial & ins]t+ an approv$ cl9ical trial2 7iii7 9 p>agraph 7#c7-- 7,i7 by /rik+ 9-network provid]s & ins]t+ p>ticipat+ provid]s2 & 7,,ii7 by /rik+ a cl9ical trial & ins]t+ an approv$ cl9ical trial2 & 7iv7 9 p>agraph 7#d71 by /rik+ out-(-network & ins]t+ nonp>ticipat+ provid]s2 7,b7 9 subsection 7b77#b77;,a71 by /rik+ p>ticipat+ heal? c>e provid] & ins]t+ p>ticipat+ provid]2 & 7,c7 9 subsection 7d77#a77;,a77v71 by /rik+ coop]ative gr\p & ins]t+ ,a coop]ative gr\p4 7#e7 ,effective date ,! am5dm5ts made by ?is subsection %all apply ) respect to plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjbd4 7b7 ,m$ic>e 7#a7 ,am5dm5t relat+ to def9ition ( r\t9e co/s ( c>e ,section #ahfb7m7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciey7m77 is am5d$-- 7,a7 9 p>agraph 7#a71 by ins]t+ be=e z def9$ by ! ,secret>y ! foll[+3 subject to p>agraph 7#c712 & 7,b7 by add+ at ! end ! foll[+ new p>agraph3 7#c7 ,r\t9e co/s ( c>e ,9 def9+ r\t9e co/s ( c>e = purposes ( p>agraph 7#a71 ! ,secret>y %all def9e su* t]m 9 a mann] t provides = cov]age ( consultation & ref]ral s]vices furni%$ to an individual 9 ! c\rse ( p>ticipation 9 a category ,a cl9ical trial4 4 7#b7 ,am5dm5t relat+ to def9ition ( category ,a cl9ical trial ,section #ahfb7m77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciey7m77#b77 is am5d$ by ins]t+ aft] means a trial ! foll[+3 7includ+ a trial fund$ by ! ,pati5t-,c5t]$ ,outcomes ,rese>* ,in/itute74 7#c7 ,effective date ,! am5dm5ts made by ?is subsection %all apply ) respect to items & s]vices furni%$ on or aft] ,janu>y #a1 #bjbd4 #c4 ,volunt>y network ( p>ticipat+ provid]s 7a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices may issue a reque/ = in=mation f gr\p heal? plans1 & heal? insurance issu]s (f]+ gr\p or individual heal? cov]age to id5tify an int]e/ 9 e/abli%+ a volunt>y network ( p>ticipat+ provid]s adm9i/]$ by a ?ird-p>ty adm9i/rator 7z designat$ by ! ,secret>y7 = purposes ( comply+ ) cov]age requirem5ts = cl9ical trials "u section #bgji ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#h74 7b7 ,def9itions ,9 ?is section3 7#a7 ,gr\p heal? plan ,! t]m gr\p heal? plan has ! mean+ giv5 su* t]m 9 section #fjg7a7 ( ! ,employee ,retirem5t ,income ,security ,act ( #aigd 7#bi ,u4,s4,c4 #aafg7a774 7#b7 ,heal? insurance issu] ,! t]m heal? insurance issu] has ! mean+ giv5 su* t]m 9 section #bgia7;b77#a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#ia7;b77#a774 7#c7 ,p>ticipat+ provid] ,! t]m p>ticipat+ provid] has ! mean+ giv5 su* t]m 9 section #bgii;,a-#a7;a77#c77;,g77ii7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#aaa7;a77#c77;,g77ii774