Chronic Condition Copay Elimination Act

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.) is amended by adding at the end the following new section:

In addition to any item or service described in section 2713(a) of the Public Health Service Act, a group health plan and a health insurance issuer offering group health insurance coverage shall, at a minimum, provide coverage for, and shall not impose any cost sharing requirements for, with respect to individuals with chronic conditions (as defined in subsection (b)), such additional preventive care and screenings not described in paragraph (1) of such section 2713(a) that are determined by the Secretary to meet the criteria specified in subsection (c) with respect to the chronic condition involved.

In this section, the term chronic condition has the meaning given such term by the Secretary and, at a minimum, includes the following conditions:

(1) Heart disease, including congestive heart failure and coronary artery disease.

(2) Diabetes.

(3) Osteoporosis and osteopenia.

(4) Hypertension.

(5) Asthma.

(6) Liver disease.

(7) Bleeding disorders.

(8) Depression.

For purposes of subsection (a), the criteria specified in this subsection, with respect to an item or service and a chronic condition, are the following:

(1) The item or service is low-cost.

(2) There is medical evidence supporting high-cost efficiency, or a large expected impact, of the item or service in preventing exacerbation of the chronic condition or the development of a secondary condition.

(3) There is a strong likelihood, documented by clinical evidence, that the item or service will prevent the exacerbation of the chronic condition or the development of a secondary condition that requires significantly higher-cost treatments.

Once every three years, the Secretary shall review and update—

(A) the list of conditions included within the meaning of the term chronic condition under subsection (b); and

(B) the items and services determined to meet the criteria specified in subsection (c) for purposes of subsection (a).

The requirement under subsection (a) shall apply with respect to an update made under paragraph (1) beginning with the first plan year beginning after the date of such update.

The table of contents in section 1 of such Act is amended by inserting after the item relating to section 725 the following new items:

Part D of title XXVII of the Public Health Service Act (42 U.S.C. 300gg–11 et seq.), is amended by adding at the end the following new section:

In addition to any item or service described in section 2713(a), a group health plan and a health insurance issuer offering group or individual health insurance coverage shall, at a minimum, provide coverage for, and shall not impose any cost sharing requirements for, with respect to individuals with chronic conditions (as defined in subsection (b)), such additional preventive care and screenings not described in paragraph (1) of section 2713(a) that are determined by the Secretary to meet the criteria specified in subsection (c) with respect to the chronic condition involved.

In this section, the term chronic condition has the meaning given such term by the Secretary and, at a minimum, includes the following conditions:

(1) Heart disease, including congestive heart failure and coronary artery disease.

(2) Diabetes.

(3) Osteoporosis and osteopenia.

(4) Hypertension.

(5) Asthma.

(6) Liver disease.

(7) Bleeding disorders.

(8) Depression.

For purposes of subsection (a), the criteria specified in this subsection, with respect to an item or service and a chronic condition, are the following:

(1) The item or service is low-cost.

(2) There is medical evidence supporting high-cost efficiency, or a large expected impact, of the item or service in preventing exacerbation of the chronic condition or the development of a secondary condition.

(3) There is a strong likelihood, documented by clinical evidence, that the item or service will prevent the exacerbation of the chronic condition or the development of a secondary condition that requires significantly higher-cost treatments.

Once every three years, the Secretary shall review and update—

(A) the list of conditions included within the meaning of the term chronic condition under subsection (b); and

(B) the items and services determined to meet the criteria specified in subsection (c) for purposes of subsection (a).

The requirement under subsection (a) shall apply with respect to an update made under paragraph (1) beginning with the first plan year beginning after the date of such update.

Subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following new section:

In addition to any item or service described in section 2713(a) of the Public Health Service Act, a group health plan shall, at a minimum, provide coverage for, and shall not impose any cost sharing requirements for, with respect to individuals with chronic conditions (as defined in subsection (b)), such additional preventive care and screenings not described in paragraph (1) of such section 2713(a) that are determined by the Secretary to meet the criteria specified in subsection (c) with respect to the chronic condition involved.

In this section, the term chronic condition has the meaning given such term by the Secretary and, at a minimum, includes the following conditions:

(1) Heart disease, including congestive heart failure and coronary artery disease.

(2) Diabetes.

(3) Osteoporosis and osteopenia.

(4) Hypertension.

(5) Asthma.

(6) Liver disease.

(7) Bleeding disorders.

(8) Depression.

For purposes of subsection (a), the criteria specified in this subsection, with respect to an item or service and a chronic condition, are the following:

(1) The item or service is low-cost.

(2) There is medical evidence supporting high-cost efficiency, or a large expected impact, of the item or service in preventing exacerbation of the chronic condition or the development of a secondary condition.

(3) There is a strong likelihood, documented by clinical evidence, that the item or service will prevent the exacerbation of the chronic condition or the development of a secondary condition that requires significantly higher-cost treatments.

Once every three years, the Secretary shall review and update—

(A) the list of conditions included within the meaning of the term chronic condition under subsection (b); and

(B) the items and services determined to meet the criteria specified in subsection (c) for purposes of subsection (a).

The requirement under subsection (a) shall apply with respect to an update made under paragraph (1) beginning with the first plan year beginning after the date of such update.

The table of contents for subchapter B of chapter 100 of such Code is amended by adding at the end the following new item:

Section 223(c)(2)(C) of the Internal Revenue Code of 1986 is amended by inserting or for additional preventive care for individuals with chronic conditions described in section 9826 before the period.

The amendments made by this section shall apply with respect to plan years beginning on or after the date that is one year after the date of the enactment of this Act.