Sec. 301. Coverage for treatment for eating disorders under group health plans, individual health insurance coverage, and FEHBP
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Title XXVII of the Public Health Service Act is amended by inserting after section 2728 ( 42 U.S.C. 300gg–28 ), as redesignated by section 1001(2) of the Patient Protection and Affordable Care Act ( Public Law 111–148 ), the following new section: A group health plan, and a health insurance issuer offering group or individual health insurance coverage, that provides medical and surgical benefits shall provide coverage for treatment for eating disorders consistent with the provisions of this section.
A group health plan, and a health insurance issuer offering group or individual health insurance coverage, shall not— deny to an individual eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the plan, solely for the purpose of avoiding the requirement of this section; deny coverage for treatment of eating disorders, including coverage for residential treatment of eating disorders, if such treatment is medically necessary in accordance with the Practice Guidelines for the Treatment of Patients with Eating Disorders, as most recently published by the American Psychiatric Association; provide monetary payments, rebates, or other benefits to individuals to encourage such individuals to accept less than the minimum protections available under this section; penalize or otherwise reduce or limit the reimbursement of a provider because such provider provided care to an individual participant or beneficiary in accordance with this section; provide incentives (monetary or otherwise) to a provider to induce such provider to provide care to an individual participant or beneficiary in a manner inconsistent with this section; or deny to an individual participant or beneficiary continued eligibility to enroll or to renew coverage under the terms of the plan, solely because the individual was previously found to have an eating disorder or to have received treatment for an eating disorder.
In the case of a group health plan, or health insurance issuer offering group or individual health insurance coverage, that provides both medical and surgical benefits and coverage for treatment for eating disorders, if the plan or coverage provides coverage for medical or surgical benefits provided by out-of-network providers, the plan or coverage shall provide coverage for treatment for eating disorders provided by out-of-network providers in a manner that is consistent with the requirements of this section.
Nothing in this section shall be construed as preventing a group health plan or issuer from imposing deductibles, coinsurance, or other cost-sharing in relation to treatment for eating disorders, except that such deductibles, coinsurance, or other cost-sharing may not be greater than the deductibles, coinsurance, or other cost-sharing imposed on other comparable medical or surgical services covered under the plan. Nothing in this section shall be construed to preempt any State law in effect on the date of enactment of this section with respect to health insurance coverage that requires coverage of at least the coverage for treatment for eating disorders otherwise required under this section.
For purposes of this section, the term eating disorder includes anorexia nervosa, bulimia nervosa, binge eating disorder, and eating disorders not otherwise specified (EDNOS), as defined in the fifth edition of Diagnostic and Statistical Manual of Mental Disorders or, if applicable, the most recent successor edition. . For purposes of applying section 2729 of the Public Health Service Act, as inserted by paragraph (1), to individual health insurance coverage before 2014, the provisions of such section shall be treated as also included under part B of title XXVII of the Public Health Service 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: A group health plan, and a health insurance issuer offering group health insurance coverage in connection with a group health plan, that provides medical and surgical benefits shall provide coverage for treatment for eating disorders consistent with the provisions of this section. A group health plan, and a health insurance issuer offering group health insurance coverage in connection with a group health plan, shall not— deny to an individual eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the plan, solely for the purpose of avoiding the requirement of this section; deny coverage for treatment of eating disorders, including coverage for residential treatment of eating disorders, if such treatment is medically necessary in accordance with the Practice Guidelines for the Treatment of Patients with Eating Disorders, as most recently published by the American Psychiatric Association; provide monetary payments, rebates, or other benefits to individuals to encourage such individuals to accept less than the minimum protections available under this section; penalize or otherwise reduce or limit the reimbursement of a provider because such provider provided care to an individual participant or beneficiary in accordance with this section; provide incentives (monetary or otherwise) to a provider to induce such provider to provide care to an individual participant or beneficiary in a manner inconsistent with this section; or deny to an individual participant or beneficiary continued eligibility to enroll or to renew coverage under the terms of the plan, solely because the individual was previously found to have an eating disorder or to have received treatment for an eating disorder.
In the case of a group health plan, or health insurance issuer offering group health insurance coverage in connection with a group health plan, that provides both medical and surgical benefits and coverage for treatment for eating disorders, if the plan or coverage provides coverage for medical or surgical benefits provided by out-of-network providers, the plan or coverage shall provide coverage for treatment for eating disorders provided by out-of-network providers in a manner that is consistent with the requirements of this section.
Nothing in this section shall be construed as preventing a group health plan or issuer from imposing deductibles, coinsurance, or other cost-sharing in relation to treatment for eating disorders, except that such deductibles, coinsurance, or other cost-sharing may not be greater than the deductibles, coinsurance, or other cost-sharing imposed on other comparable medical or surgical services covered under the plan. Nothing in this section shall be construed to preempt any State law in effect on the date of enactment of this section with respect to health insurance coverage that requires coverage of at least the coverage for treatment for eating disorders otherwise required under this section.
For purposes of this section, the term eating disorder includes anorexia nervosa, bulimia nervosa, binge eating disorder, and eating disorders not otherwise specified (EDNOS), as defined in the fifth edition of Diagnostic and Statistical Manual of Mental Disorders or, if applicable, the most recent successor edition. . Section 732(a) of such Act ( 29 U.S.C. 1191a(a) ) is amended by striking section 711 and inserting sections 711 and 716 . The table of contents in section 1 of such Act is amended by inserting after the item relating to section 714 the following new items:
Sec. 715. Additional market reforms. Sec. 716. Coverage for treatment for eating disorders. . Subchapter B of chapter 100 of the Internal Revenue Code of 1986, as amended by subsection
(f)of section 1563 (relating to conforming amendments) of the Patient Protection and Affordable Care Act ( Public Law 111–148 ), is amended by inserting after section 9815 the following: A group health plan that provides medical and surgical benefits shall provide coverage for treatment for eating disorders consistent with the provisions of this section. A group health plan shall not— deny to an individual eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the plan, solely for the purpose of avoiding the requirement of this section; deny coverage for treatment of eating disorders, including coverage for residential treatment of eating disorders, if such treatment is medically necessary in accordance with the Practice Guidelines for the Treatment of Patients with Eating Disorders, as most recently published by the American Psychiatric Association; provide monetary payments, rebates, or other benefits to individuals to encourage such individuals to accept less than the minimum protections available under this section; penalize or otherwise reduce or limit the reimbursement of a provider because such provider provided care to an individual participant or beneficiary in accordance with this section; provide incentives (monetary or otherwise) to a provider to induce such provider to provide care to an individual participant or beneficiary in a manner inconsistent with this section; or deny to an individual participant or beneficiary continued eligibility to enroll or to renew coverage under the terms of the plan, solely because the individual was previously found to have an eating disorder or to have received treatment for an eating disorder. In the case of a group health plan that provides both medical and surgical benefits and coverage for treatment for eating disorders, if the plan provides coverage for medical or surgical benefits provided by out-of-network providers, the plan or coverage shall provide coverage for treatment for eating disorders provided by out-of-network providers in a manner that is consistent with the requirements of this section. Nothing in this section shall be construed as preventing a group health plan or issuer from imposing deductibles, coinsurance, or other cost-sharing in relation to treatment for eating disorders, except that such deductibles, coinsurance, or other cost-sharing may not be greater than the deductibles, coinsurance, or other cost-sharing imposed on other comparable medical or surgical services covered under the plan. For purposes of this section, the term eating disorder includes anorexia nervosa, bulimia nervosa, binge eating disorder, and eating disorders not otherwise specified (EDNOS), as defined in the fifth edition of Diagnostic and Statistical Manual of Mental Disorders or, if applicable, the most recent successor edition. . The table of sections of such subchapter is amended by adding at the end the following new items: Sec. 9815. Additional market reforms. Sec. 9816. Coverage for treatment for eating disorders. . Section 4980D(d)(1) of the Internal Revenue Code of 1986 is amended by striking section 9811 and inserting sections 9811 and 9816 . Section 8902 of title 5, United States Code, is amended by adding at the end the following new subsection: A contract may not be made or a plan approved which does not comply with the requirements of section 2729 of the Public Health Service Act. . The amendments made by this section shall apply with respect to group health plans and health benefit plans for plan years beginning on or after the date that is 6 months after the date of the enactment of this Act, and with respect to health insurance coverage offered, sold, issued, renewed, in effect, or operated in the individual market on or after such date that is 6 months after such date of enactment. The Secretary of Labor, the Secretary of Health and Human Services, and the Secretary of the Treasury shall ensure, through the execution of an interagency memorandum of understanding among such Secretaries, that— regulations, rulings, and interpretations issued by such Secretaries relating to the same matter over which two or more such Secretaries have responsibility under the provisions of this section (and the amendments made thereby) are administered so as to have the same effect at all times; and coordination of policies relating to enforcing the same requirements through such Secretaries in order to have a coordinated enforcement strategy that avoids duplication of enforcement efforts and assigns priorities in enforcement.
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- 42 USC 300gg–28
- Pub. L. 111-148
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Sec. 301
Coverage for treatment for eating disorders under group health plans, individual health insurance coverage, and FEHBP
Cite42 USC 300gg–28
Pub. L.Pub. L. 111-148
Cites 4Cited by 0 across 0 sources