,,ii  #aai? ,,congress  #a/ ,session    
,s4 #afgg  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,may #h1 #bjbe ,ms4    
,baldw9 7= h]self1 ,ms4 ,ern/1 ,ms4     
,klobu*>1 ,ms4 ,murk[ski1 ,mr4 ,lujn1   
,mr4 ,tillis1 ,mr4 ,k+1 ,mr4 ,m>%all1   
,mr4 ,re$1 ,mr4 ,grassley1 ,mr4         
,blum5?al1 ,mr4 ,book]1 & ,mr4 ,m]kley7 
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,heal?1 ,education1 ,labor1 & ,p5sions  
,a ,,bill  ,to provide heal? insurance  
b5efits = outpati5t & inpati5t items &  
s]vices relat$ to ! diagnosis & treatm5t
 ( a cong5ital anomaly or bir? defect4  
#a4  ,%ort title  ,?is ,act may be cit$ 
z ! ,ensur+ ,la/+ ,smiles ,act4  #b4    
,cov]age ( cong5ital anomaly or bir?    
defect  7a7  ,public ,heal? ,s]vice ,act
 ,am5dm5ts  ,"p ,d ( title ,,xxvii ( !  
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #cjj;gg-#aaa et seq47 is am5d$
 by add+ at ! end ! foll[+ new section3 
#bgii;,a-#aa4  ,cov]age ( cong5ital     
anomaly or bir? defect  7a7             

,requirem5ts = c>e & recon/ructive      
treatm5t  7#a7  ,9 g5]al  ,a gr\p heal? 
plan1 & a heal? insurance issu] (f]+    
gr\p or individual heal? insurance      
cov]age1 %all provide cov]age =         
outpati5t & inpati5t items & s]vices    
relat$ to ! diagnosis & treatm5t ( a    
cong5ital anomaly or bir? defect t      
prim>ily impacts ! appe>ance or function
 ( ! eyes1 e>s1 tee?1 m\?1 or jaw1      
consi/5t ) p>agraphs 7#b7 & 7#c74  7#b7 
,f9ancial requirem5ts  ,any cov]age     
provid$ "u p>agraph 7#a7 "u a gr\p heal?
 plan or gr\p or individual heal?       
insurance cov]age may be subject to     
co/-%>+ requirem5ts 7su* z co9surance1  
copaym5ts1 & d$uctibles71 z requir$ by !
 plan or issu] (f]+ su* cov]age1 t are  
no m re/rictive ?an ! pr$om9ant co/-%>+ 
requirem5ts appli$ to sub/antially all  
o!r m$ical & surgical b5efits cov]$ by !
 plan or cov]age4  7#c7  ,applicable    
items & s]vices  7,a7  ,9 g5]al  ,except
 z provid$ 9 subp>agraph 7,b71 ! items &
 s]vices requir$ "u p>agraph 7#a7 to be 

cov]$ by a gr\p heal? plan or gr\p or   
individual heal? insurance cov]age (f]$ 
by a heal? insurance issu] include--    
7i7 any item or s]vice to improve1      
repair1 or re/ore any body "p to a*ieve 
normal body function+ or appe>ance1 or  
p]=m$ to approximate a normal appe>ance1
 z det]m9$ m$ically necess>y by ! treat+
 physician 7z def9$ 9 section #ahfa7r7 (
 ! ,social ,security ,act71 on acc\nt ( 
a cong5ital anomaly or bir? defect t    
prim>ily impacts ! appe>ance or function
 ( ! eyes1 e>s1 tee?1 m\?1 or jaw2 &    
7ii7 any treatm5t or diagno/ic s]vice ) 
respect to any & all miss+ or abnormal  
body p>ts 7includ+ tee?1 ! oral cavity1 
& _! associat$ /ructures71 z det]m9$    
m$ically necess>y by ! treat+ physician 
7z def9$ 9 section #ahfa7r7 ( ! ,social 
,security ,act71 includ+--  7,i7        
recon/ructive s]vices & proc$ures1 &    
items & s]vices relat$ to any           
complications aris+ f su* s]vices &     
proc$ures2  7,,ii7 adjunctive d5tal1    
or?odontic1 or pro/hodontic support f   

bir? until ! m$ical or surgical treatm5t
 ( ! defect or anomaly has be5 complet$1
 includ+ ongo+ or subsequ5t treatm5t    
requir$ to ma9ta9 function or           
approximate a normal appe>ance1 not)/&+ 
any exclusions1 limitations1 or         
re/rictions "u ! plan or heal? insurance
 cov]age on cov]age ( d5tal1 or?odontic1
 or pro/hodontic items & s]vices aris+ f
 o!r injuries or sicknesses2 &  7,,iii7 
items & s]vices relat$ to second>y      
conditions & foll[-up treatm5t associat$
 ) ! und]ly+ cong5ital anomaly or bir?  
defect4  7,b7  ,exception  ,! items &   
s]vices requir$ "u ?is subsection to be 
cov]$ by a gr\p heal? plan or heal?     
insurance issu] (f]+ gr\p or individual 
heal? insurance cov]age %all n include  
cosmetic surg]y p]=m$ to re%ape normal  
/ructures ( ! body to improve appe>ance 
or self-e/eem1 if su* items & s]vices   
are n furni%$ z a result ( a m$ical     
det]m9ation ( a cong5ital anomaly or    
bir? defect4  7b7  ,notice  ,beg9n+ n   
lat] ,janu>y #a1 #bjbf1 a gr\p heal?    

plan or heal? insurance issu] (f]+ gr\p 
or individual heal? insurance cov]age   
%all provide notice to ea* p>ticipant & 
b5efici>y "u su* plan or cov]age reg>d+ 
! cov]age requir$ by ?is section 9 any  
docum5ts describ+ s]vices1 9 accordance 
) any regulations promulgat$ by !       
,secret>y4  7c7  ,def9ition  ,9 ?is     
section1 ! t]m cong5ital anomaly or bir?
 defect means a /ructural or functional 
anomaly t occurs dur+ intraut]9e life1  
develops pr5atally1 & may be id5tifi$   
be=e bir?1 at bir?1 or lat] 9 life1 &   
:i* may--  7#a7 be caus$ by g5etic or   
*romosomal disord]s1 embryotoxic or     
t]atog5ic environm5tal factors1 nutri5t 
defici5cy1 multifactorial inh]itance1 or
 be ( an unkn[n cause2  7#b7 manife/ z  
abnormal anatomical /ructures2  7#c7    
manife/ z physical1 s5sory1 or cognitive
 functional disabilities2  7#d7 manife/ 
z syndromes1 diseases1 or o!r heal?     
problems2 &  7#e7 manife/ z s+ul>       
anomalies or 9 comb9ation pr5atally1 at 
bir?1 or lat] 9 life4  4  7b7  ,,erisa  

am5dm5ts  7#a7  ,9 g5]al  ,subp>t ,b (  
"p #g ( subtitle ,b ( title ,i ( !      
,employee ,retirem5t ,income ,security  
,act ( #aigd is am5d$ by add+ at ! end !
 foll[+3  #gbf4  ,cov]age ( cong5ital   
anomaly or bir? defect  7a7             
,requirem5ts = c>e & recon/ructive      
treatm5t  7#a7  ,9 g5]al  ,a gr\p heal? 
plan1 & a heal? insurance issu] (f]+    
gr\p heal? insurance cov]age1 %all      
provide cov]age = outpati5t & inpati5t  
items & s]vices relat$ to ! diagnosis & 
treatm5t ( a cong5ital anomaly or bir?  
defect t prim>ily impacts ! appe>ance or
 function ( ! eyes1 e>s1 tee?1 m\?1 or  
jaw1 consi/5t ) p>agraphs 7#b7 & 7#c74  
7#b7  ,f9ancial requirem5ts  ,any       
cov]age provid$ "u p>agraph 7#a7 "u a   
gr\p heal? plan or gr\p heal? insurance 
cov]age (f]$ by a heal? insurance issu] 
may be subject to co/-%>+ requirem5ts   
7su* z co9surance1 copaym5ts1 &         
d$uctibles71 z requir$ by ! plan or     
issu] (f]+ su* cov]age1 t are no m      
re/rictive ?an ! pr$om9ant co/-%>+      

requirem5ts appli$ to sub/antially all  
o!r m$ical & surgical b5efits cov]$ by !
 plan or cov]age4  7#c7  ,applicable    
items & s]vices  7,a7  ,9 g5]al  ,except
 z provid$ 9 subp>agraph 7,b71 ! items &
 s]vices requir$ "u p>agraph 7#a7 to be 
cov]$ by a gr\p heal? plan or gr\p heal?
 insurance cov]age (f]$ by a heal?      
insurance issu] include--  7i7 any item 
or s]vice to improve1 repair1 or re/ore 
any body "p to a*ieve normal body       
function+ or appe>ance1 or p]=m$ to     
approximate a normal appe>ance1 z       
det]m9$ m$ically necess>y by ! treat+   
physician 7z def9$ 9 section #ahfa7r7 ( 
! ,social ,security ,act71 on acc\nt ( a
 cong5ital anomaly or bir? defect t     
prim>ily impacts ! appe>ance or function
 ( ! eyes1 e>s1 tee?1 m\?1 or jaw2 &    
7ii7 any treatm5t or diagno/ic s]vice ) 
respect to any & all miss+ or abnormal  
body p>ts 7includ+ tee?1 ! oral cavity1 
& _! associat$ /ructures71 z det]m9$    
m$ically necess>y by ! treat+ physician 
7z def9$ 9 section #ahfa7r7 ( ! ,social 

,security ,act71 includ+--  7,i7        
recon/ructive s]vices & proc$ures1 &    
items & s]vices relat$ to any           
complications aris+ f su* s]vices &     
proc$ures2  7,,ii7 adjunctive d5tal1    
or?odontic1 or pro/hodontic support f   
bir? until ! m$ical or surgical treatm5t
 ( ! defect or anomaly has be5 complet$1
 includ+ ongo+ or subsequ5t treatm5t    
requir$ to ma9ta9 function or           
approximate a normal appe>ance1 not)/&+ 
any exclusions1 limitations1 or         
re/rictions "u ! plan or heal? insurance
 cov]age on cov]age ( d5tal1 or?odontic1
 or pro/hodontic items & s]vices aris+ f
 o!r injuries or sicknesses2 &  7,,iii7 
items & s]vices relat$ to second>y      
conditions & foll[-up treatm5t associat$
 ) ! und]ly+ cong5ital anomaly or bir?  
defect4  7,b7  ,exception  ,! items &   
s]vices requir$ "u ?is subsection to be 
cov]$ by a gr\p heal? plan or heal?     
insurance issu] (f]+ gr\p heal?         
insurance cov]age %all n include        
cosmetic surg]y p]=m$ to re%ape normal  

/ructures ( ! body to improve appe>ance 
or self-e/eem1 if su* items & s]vices   
are n furni%$ z a result ( a m$ical     
det]m9ation ( a cong5ital anomaly or    
bir? defect4  7b7  ,notice  ,beg9n+ n   
lat] ?an ,janu>y #a1 #bjbf1 a gr\p heal?
 plan or heal? insurance issu] (f]+ gr\p
 heal? insurance cov]age %all provide   
notice to ea* p>ticipant & b5efici>y "u 
su* plan or cov]age reg>d+ ! cov]age    
requir$ by ?is section1 9 any docum5ts  
describ+ s]vices1 9 accordance ) any    
regulations promulgat$ by ! ,secret>y4  
7c7  ,def9ition  ,9 ?is section1 ! t]m  
cong5ital anomaly or bir? defect means a
 /ructural or functional anomaly t      
occurs dur+ intraut]9e life1 develops   
pr5atally1 & may be id5tifi$ be=e bir?1 
at bir?1 or lat] 9 life1 & :i* may--    
7#a7 be caus$ by g5etic or *romosomal   
disord]s1 embryotoxic or t]atog5ic      
environm5tal factors1 nutri5t defici5cy1
 multifactorial inh]itance1 or be ( an  
unkn[n cause2  7#b7 manife/ z abnormal  
anatomical /ructures2  7#c7 manife/ z   

physical1 s5sory1 or cognitive          
functional disabilities2  7#d7 manife/ z
 syndromes1 diseases1 or o!r heal?      
problems2 &  7#e7 manife/ z s+ul>       
anomalies or 9 comb9ation pr5atally1 at 
bir?1 or lat] 9 life4  4  7#b7          
,te*nical am5dm5ts  7,a7 ,section       
#gcb7;a7 ( su* ,act 7#bi ,u4,s4,c4      
#aaia;a7a77 is am5d$ by /rik+ section   
#gaa & ins]t+ sections #gaa & #gbf4     
7,b7 ,! table ( cont5ts 9 section #a (  
su* ,act is am5d$ by ins]t+ aft] ! item 
relat+ to section #gbe ! foll[+ new     
item3  ,sec4 #gbf4 ,cov]age ( cong5ital 
anomaly or bir? defect4  4  7c7         
,int]nal ,rev5ue ,code am5dm5ts  7#a7   
,9 g5]al  ,sub*apt] ,b ( *apt] #ajj ( ! 
,int]nal ,rev5ue ,code ( #aihf is am5d$ 
by add+ at ! end ! foll[+3  #ihbf4      
,cov]age ( cong5ital anomaly or bir?    
defect  7a7  ,requirem5ts = c>e &       
recon/ructive treatm5t  7#a7  ,9 g5]al  
,a gr\p heal? plan %all provide cov]age 
= outpati5t & inpati5t items & s]vices  
relat$ to ! diagnosis & treatm5t ( a    

cong5ital anomaly or bir? defect t      
prim>ily impacts ! appe>ance or function
 ( ! eyes1 e>s1 tee?1 m\?1 or jaw1      
consi/5t ) p>agraphs 7#b7 & 7#c74  7#b7 
,f9ancial requirem5ts  ,any cov]age     
provid$ "u p>agraph 7#a7 "u a gr\p heal?
 plan may be subject to co/-%>+         
requirem5ts 7su* z co9surance1          
copaym5ts1 & d$uctibles71 z requir$ by !
 plan1 t are no m re/rictive ?an !      
pr$om9ant co/-%>+ requirem5ts appli$ to 
sub/antially all o!r m$ical & surgical  
b5efits cov]$ by ! plan4  7#c7          
,applicable items & s]vices  7,a7  ,9   
g5]al  ,except z provid$ 9 subp>agraph  
7,b71 ! items & s]vices requir$ "u      
p>agraph 7#a7 to be cov]$ by a gr\p     
heal? plan include--  7i7 any item or   
s]vice to improve1 repair1 or re/ore any
 body "p to a*ieve normal body function+
 or appe>ance1 or p]=m$ to approximate a
 normal appe>ance1 z det]m9$ m$ically   
necess>y by ! treat+ physician 7z def9$ 
9 section #ahfa7r7 ( ! ,social ,security
 ,act71 on acc\nt ( a cong5ital anomaly 

or bir? defect t prim>ily impacts !     
appe>ance or function ( ! eyes1 e>s1    
tee?1 m\?1 or jaw2 &  7ii7 any treatm5t 
or diagno/ic s]vice ) respect to any &  
all miss+ or abnormal body p>ts 7includ+
 tee?1 ! oral cavity1 & _! associat$    
/ructures71 z det]m9$ m$ically necess>y 
by ! treat+ physician 7z def9$ 9 section
 #ahfa7r7 ( ! ,social ,security ,act71  
includ+--  7,i7 recon/ructive s]vices & 
proc$ures1 & items & s]vices relat$ to  
any complications aris+ f su* s]vices & 
proc$ures2  7,,ii7 adjunctive d5tal1    
or?odontic1 or pro/hodontic support f   
bir? until ! m$ical or surgical treatm5t
 ( ! defect or anomaly has be5 complet$1
 includ+ ongo+ or subsequ5t treatm5t    
requir$ to ma9ta9 function or           
approximate a normal appe>ance1 not)/&+ 
any exclusions1 limitations1 or         
re/rictions "u ! plan on cov]age (      
d5tal1 or?odontic1 or pro/hodontic items
 & s]vices aris+ f o!r injuries or      
sicknesses2 &  7,,iii7 items & s]vices  
relat$ to second>y conditions & foll[-up

 treatm5t associat$ ) ! und]ly+         
cong5ital anomaly or bir? defect4  7,b7 
,exception  ,! items & s]vices requir$  
"u ?is subsection to be cov]$ by a gr\p 
heal? plan %all n include cosmetic      
surg]y p]=m$ to re%ape normal /ructures 
( ! body to improve appe>ance or        
self-e/eem1 if su* items & s]vices are n
 furni%$ z a result ( a m$ical          
det]m9ation ( a cong5ital anomaly or    
bir? defect4  7b7  ,notice  ,beg9n+ n   
lat] ,janu>y #a1 #bjbf1 a gr\p heal?    
plan %all provide notice to ea*         
p>ticipant & b5efici>y "u su* plan or   
cov]age reg>d+ ! cov]age requir$ by ?is 
section 9 any docum5ts describ+ s]vices1
 9 accordance ) any regulations         
promulgat$ by ! ,secret>y4  7c7         
,def9ition  ,9 ?is section1 ! t]m       
cong5ital anomaly or bir? defect means a
 /ructural or functional anomaly t      
occurs dur+ intraut]9e life1 develops   
pr5atally1 & may be id5tifi$ be=e bir?1 
at bir?1 or lat] 9 life1 & :i* may--    
7#a7 be caus$ by g5etic or *romosomal   

disord]s1 embryotoxic or t]atog5ic      
environm5tal factors1 nutri5t defici5cy1
 multifactorial inh]itance1 or be ( an  
unkn[n cause2  7#b7 manife/ z abnormal  
anatomical /ructures2  7#c7 manife/ z   
physical1 s5sory1 or cognitive          
functional disabilities2  7#d7 manife/ z
 syndromes1 diseases1 or o!r heal?      
problems2 &  7#e7 manife/ z s+ul>       
anomalies or 9 comb9ation pr5atally1 at 
bir?1 or lat] 9 life4  4  7#b7  ,cl]ical
 am5dm5t  ,! table ( sections = su*     
sub*apt] is am5d$ by add+ at ! end !    
foll[+ new item3  ,sec4 #ihbf4 ,cov]age 
( cong5ital anomaly or bir? defect4  4  
7d7  ,/udy & report on network adequacy 
,! ,secret>y ( ,heal? & ,human ,s]vices 
%all conduct a /udy1 & n lat] ?an       
,decemb] #ca1 #bjbg1 submit a report to 
,congress1 on ! matt]s relat+ to access 
( s]vices = cov]age ( outpati5t &       
inpati5t items & s]vices relat$ to !    
diagnosis & treatm5t ( a cong5ital      
anomaly or bir? defect t prim>ily       
impacts ! appe>ance or function ( !     

eyes1 e>s1 tee?1 m\?1 or jaw4 ,su* /udy 
& report %all--  7#a7 evaluate !        
suffici5cy & accessibility ( networks ( 
provid]s t p]=m s]vices relat$ to !     
diagnosis & treatm5t ( su* cong5ital    
anomalies & bir? defects "u gr\p heal?  
plans & gr\p & individual heal?         
insurance cov]age 7z su* t]ms are def9$ 
9 section #bgia ( ! ,public ,heal?      
,s]vice ,act 7#db ,u4,s4,c4             
#cjj;gg-#ia772 &  7#b7 assess any *ange 
9 out-(-pocket co/s = pati5ts1 by       
proc$ure type1 result+ f ! cov]age      
requirem5ts "u sections #bgii;,a-#aa ( !
 ,public ,heal? ,s]vice ,act1 #gbf ( !  
,employee ,retirem5t ,income ,security  
,act ( #aigd1 & #ihbf ( ! ,int]nal      
,rev5ue ,code ( #aihf1 z add$ by ?is    
section1 & any *ange 9 ! ov]all proc$ure
 co/ = su* s]vices4  7e7  ,effective    
date  ,! am5dm5ts made by subsections   
7a71 7b71 & 7c7 %all apply ) respect to 
plan ye>s beg9n+ on or aft] ,janu>y #a1 
#bjbf4