,i #aaith ,,congress #ast ,session ,h4 ,r4 #dfjf ,,in ,,the ,,house ,,of ,,representatives ,july #bb1 #bjbe,mr4 ,neguse 7for himself1 ,mr4 ,fitzpatrick1 ,mr4 ,pocan1 and ,mr4 ,rutherford7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committees on ,education and ,workforce1 and ,ways and ,means1 for a period to be subsequently determined by the ,speaker1 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 ,act1 the ,employee ,retirement ,income ,security ,act of #aigd1 the ,internal ,revenue ,code of #aihf1 and the ,patient ,protection and ,affordable ,care ,act to require coverage of hearing devices and systems in certain private health insurance plans1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,ally's ,act4 #b4 ,coverage of hearing devices and systems in certain private health insurance plans 7a7 ,,phsa ,part ,d of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#aaa et seq47 is amended by adding at the end the following new section3 #bgii;,a-#aa4 ,coverage of hearing devices and systems 7a7 ,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 7as defined in subsection 7d773 7#a7 ,auditory implant devices 7including auditory osseointegrated 7bone conduction7 implants and cochlear implants7 and external sound processors4 7#b7 ,the maintenance of auditory implant devices and external sound processors described in paragraph 7#a74 7#c7 ,every #e years1 the upgrade 7or replacement if an upgrade is not available7 of auditory implant devices and external sound processors described in paragraph 7#a74 7#d7 ,adhesive adapters and softband headbands4 7#e7 ,the repair of auditory implant devices and external sound processors described in paragraph 7#a74 7#f7 ,a comprehensive hearing assessment4 7#g7 ,a preoperative medical assessment4 7#h7 ,surgery relating to the furnishing of such devices and processors 7as determined necessary by a physician or qualified audiologist 7as such terms are defined for purposes of subsection 7d77 treating such individual74 7#i7 ,postoperative medical visits for purposes of ensuring appropriate recovery from such surgery4 7#aj7 ,postoperative audiological visits for activation and fitting of such devices and processors4 7#aa7 ,aural rehabilitation and treatment services 7as so determined necessary74 7b7 ,coverage requirements ,in the case of an item or service described in subsection 7a7 furnished to a qualifying individual under a group health plan or group or individual health insurance coverage1 such plan or coverage shall ensure that-- 7#a7 the financial requirements 7as defined in section #bgbf7;a77#c77 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 7as applicable71 and that there are no separate cost sharing requirements that are applicable only with respect to such item or service2 and 7#b7 the treatment limitations 7as defined in such section7 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 7as applicable71 and that there are no separate treatment limitations that are applicable only with respect to such item or service4 7c7 ,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 7a7 where such item or service has been determined to be medically necessary by a physician or qualified audiologist 7as such terms are defined in subsection 7d774 7d7 ,qualifying individual defined ,for purposes of this section1 the term qualifying individual means an individual that a physician 7as defined in section #ahfa7r7 of the ,social ,security ,act7 or qualified audiologist 7as defined in section #ahfa7ll77#d77;,b7 of such ,act7 determines meets an indication 7including unilateral or bilateral hearing loss7 for an auditory implant device and external sound processor described in subsection 7a77#a74 4 7b7 ,,erisa 7#a7 ,in general ,subpart ,b of part #g of subtitle ,b of title ,i of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aahe et seq47 by adding at the end the following new section3 #gbf4 ,coverage of hearing devices and systems 7a7 ,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 7as defined in subsection 7d773 7#a7 ,auditory implant devices 7including auditory osseointegrated 7bone conduction7 implants and cochlear implants7 and external sound processors4 7#b7 ,the maintenance of auditory implant devices and external sound processors described in paragraph 7#a74 7#c7 ,every #e years1 the upgrade 7or replacement if an upgrade is not available7 of auditory implant devices and external sound processors described in paragraph 7#a74 7#d7 ,adhesive adapters and softband headbands4 7#e7 ,the repair of auditory implant devices and external sound processors described in paragraph 7#a74 7#f7 ,a comprehensive hearing assessment4 7#g7 ,a preoperative medical assessment4 7#h7 ,surgery relating to the furnishing of such devices and processors 7as determined necessary by a physician or qualified audiologist 7as such terms are defined for purposes of subsection 7d77 treating such individual74 7#i7 ,postoperative medical visits for purposes of ensuring appropriate recovery from such surgery4 7#aj7 ,postoperative audiological visits for activation and fitting of such devices and processors4 7#aa7 ,aural rehabilitation and treatment services 7as so determined necessary74 7b7 ,coverage requirements ,in the case of an item or service described in subsection 7a7 furnished to a qualifying individual under a group health plan or group health insurance coverage1 such plan or coverage shall ensure that-- 7#a7 the financial requirements 7as defined in section #bgbf7;a77#c7 of the ,public ,health ,service ,act7 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 7as applicable71 and that there are no separate cost sharing requirements that are applicable only with respect to such item or service2 and 7#b7 the treatment limitations 7as defined in such section7 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 7as applicable71 and that there are no separate treatment limitations that are applicable only with respect to such item or service4 7c7 ,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 7a7 where such item or service has been determined to be medically necessary by a physician or qualified audiologist 7as such terms are defined in subsection 7d774 7d7 ,qualifying individual defined ,for purposes of this section1 the term qualifying individual means an individual that a physician 7as defined in section #ahfa7r7 of the ,social ,security ,act7 or qualified audiologist 7as defined in section #ahfa7ll77#d77;,b7 of such ,act7 determines meets an indication 7including unilateral or bilateral hearing loss7 for an auditory implant device and external sound processor described in subsection 7a77#a74 4 7#b7 ,clerical amendment ,the table of contents in section #a of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #ajja et seq47 is amended by inserting after the item relating to section #gbe the following new item3 ,sec4 #gbf4 ,coverage of hearing devices and systems4 4 7c7 ,,irc 7#a7 ,in general ,subchapter ,b of chapter #ajj of the ,internal ,revenue ,code of #aihf is amended by adding at the end the following new section3 #ihbf4 ,coverage of hearing devices and systems 7a7 ,in general ,a group health plan shall at a minimum provide coverage for the following items and services furnished to a qualifying individual 7as defined in subsection 7d773 7#a7 ,auditory implant devices 7including auditory osseointegrated 7bone conduction7 implants and cochlear implants7 and external sound processors4 7#b7 ,the maintenance of auditory implant devices and external sound processors described in paragraph 7#a74 7#c7 ,every #e years1 the upgrade 7or replacement if an upgrade is not available7 of auditory implant devices and external sound processors described in paragraph 7#a74 7#d7 ,adhesive adapters and softband headbands4 7#e7 ,the repair of auditory implant devices and external sound processors described in paragraph 7#a74 7#f7 ,a comprehensive hearing assessment4 7#g7 ,a preoperative medical assessment4 7#h7 ,surgery relating to the furnishing of such devices and processors 7as determined necessary by a physician or qualified audiologist 7as such terms are defined for purposes of subsection 7d77 treating such individual74 7#i7 ,postoperative medical visits for purposes of ensuring appropriate recovery from such surgery4 7#aj7 ,postoperative audiological visits for activation and fitting of such devices and processors4 7#aa7 ,aural rehabilitation and treatment services 7as so determined necessary74 7b7 ,coverage requirements ,in the case of an item or service described in subsection 7a7 furnished to a qualifying individual under a group health plan1 such plan shall ensure that-- 7#a7 the financial requirements 7as defined in section #bgbf7;a77#c7 of the ,public ,health ,service ,act7 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 plan1 and that there are no separate cost sharing requirements that are applicable only with respect to such item or service2 and 7#b7 the treatment limitations 7as defined in such section7 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 plan1 and that there are no separate treatment limitations that are applicable only with respect to such item or service4 7c7 ,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 7a7 where such item or service has been determined to be medically necessary by a physician or qualified audiologist 7as such terms are defined in subsection 7d774 7d7 ,qualifying individual defined ,for purposes of this section1 the term qualifying individual means an individual that a physician 7as defined in section #ahfa7r7 of the ,social ,security ,act7 or qualified audiologist 7as defined in section #ahfa7ll77#d77;,b7 of such ,act7 determines meets an indication 7including unilateral or bilateral hearing loss7 for an auditory implant device and external sound processor described in subsection 7a77#a74 4 7#b7 ,clerical amendment ,the table of sections for subchapter ,b of chapter #ajj of the ,internal ,revenue ,code of #aihf is amended by inserting after the item relating to section #ihbe the following new item3 ,sec4 #ibhf4 ,coverage of hearing devices and systems4 4 7d7 ,application to grandfathered health plans ,section #abea7;a77#d77;,a7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjaa7;a77#d77;,a77 is amended-- 7#a7 by striking title and inserting title1 or as added after the date of the enactment of this ,act72 and 7#b7 by adding at the end the following new clause3 7v7 ,section #bgii;,a-#aa 7relating to hearing devices and systems74 4 7#c7 ,effective date ,the amendments made by this subsection shall apply with respect to plan years beginning on or after ,january #a1 #bjbf4