H.R. 3277: Ensuring Lasting Smiles Act
This bill, titled the Ensuring Lasting Smiles Act
, aims to improve healthcare coverage for those affected by congenital anomalies or birth defects. Here are the main points of the bill:
Health Insurance Requirements
The bill requires that group health plans and health insurance issuers provide coverage for both outpatient and inpatient services related to diagnosing and treating congenital anomalies or birth defects that primarily affect the eyes, ears, teeth, mouth, or jaw. This includes the following:
- Items and services necessary to improve, repair, or restore function or appearance, determined to be medically necessary by a treating physician.
- Treatment for any missing or abnormal body parts, including services that address complications from prior treatments.
- Supportive dental, orthodontic, or prosthetic services from birth until the medical or surgical intervention has been completed, including any follow-up treatments needed.
Financial Requirements
The coverage for these services may involve cost-sharing, such as copayments and deductibles, although these must not be more restrictive than those applied to other medical or surgical benefits in the plan.
Exclusions
The required coverage does not include cosmetic surgery that is not linked to a medically determined congenital anomaly or birth defect. This means any procedures undertaken solely for aesthetic purposes unrelated to medical necessity are excluded from coverage.
Notice Requirements
By January 1, 2026, group health plans and insurance issuers must inform all participants and beneficiaries about this coverage in their documents detailing available services.
Definitions
The bill defines a congenital anomaly or birth defect
as any structural or functional anomaly that occurs during pregnancy, which can be caused by a range of genetic and environmental factors and can affect individuals in various ways such as:
- Being evident at birth or developing later in life.
- Manifesting as abnormal anatomical structures.
- Causing physical, sensory, or cognitive disabilities.
- Leading to syndromes, diseases, or other health problems.
Studies and Reports
The Secretary of Health and Human Services is tasked with conducting a study by December 31, 2027, to evaluate how accessible the necessary healthcare services are under these coverage requirements. The study will assess:
- The adequacy of networks of providers for these services.
- Changes in patients' out-of-pocket costs for affected procedures and overall costs for services associated with congenital anomalies or birth defects.
Implementation Timeline
The provisions of this bill will take effect for plan years beginning on or after January 1, 2026.
Relevant Companies
- UNH (UnitedHealth Group): As a major health insurer, UnitedHealth Group will need to adjust its coverage policies to comply with the new requirements, potentially affecting its cost structures and service offerings.
- ANTM (Anthem Inc.): Similar to UnitedHealth, Anthem will have to implement changes in its health plans to provide the mandated coverage, which could involve increased administrative processes and modifications in claims handling.
- CNC (Centene Corporation): Centene, which provides managed care services, will need to adapt its health plans to ensure coverage for congenital anomalies and might face financial implications based on the new coverage requirements.
This is an AI-generated summary of the bill text. There may be mistakes.
Sponsors
110 bill sponsors
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TrackNeal P. Dunn
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TrackRobert B. Aderholt
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TrackGabe Amo
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TrackJake Auchincloss
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TrackBrian Babin
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TrackBecca Balint
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TrackAndy Barr
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TrackMichael Baumgartner
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TrackNicholas Begich
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TrackAmi Bera
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TrackJack Bergman
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TrackDonald S. Beyer, Jr.
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TrackGus M. Bilirakis
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TrackSuzanne Bonamici
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TrackMike Bost
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TrackRobert Bresnahan
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TrackJulia Brownley
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TrackJanelle Bynum
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TrackKathy Castor
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TrackJoaquin Castro
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TrackSheila Cherfilus-McCormick
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TrackJudy Chu
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TrackEmanuel Cleaver
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TrackAngie Craig
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TrackSharice Davids
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TrackDonald G. Davis
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TrackRosa L. DeLauro
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TrackSuzan K. DelBene
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TrackDebbie Dingell
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TrackSarah Elfreth
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TrackCleo Fields
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TrackRandy Fine
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TrackScott Fitzgerald
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TrackBrian K. Fitzpatrick
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TrackValerie P. Foushee
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TrackLois Frankel
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TrackScott Franklin
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TrackJohn Garamendi
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TrackCarlos A. Gimenez
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TrackDaniel S. Goldman
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TrackPaul A. Gosar
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TrackJosh Gottheimer
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TrackGlenn Grothman
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TrackJosh Harder
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TrackAndy Harris
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TrackJames A. Himes
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TrackAshley Hinson
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TrackChrissy Houlahan
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TrackVal T. Hoyle
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TrackGlenn Ivey
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TrackPramila Jayapal
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TrackJulie Johnson
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TrackRobin L. Kelly
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TrackRo Khanna
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TrackYoung Kim
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TrackRaja Krishnamoorthi
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TrackGreg Landsman
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TrackNicholas A. Langworthy
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TrackMike Levin
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TrackStephen F. Lynch
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TrackSeth Magaziner
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TrackNicole Malliotakis
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TrackJohn Mannion
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TrackDoris O. Matsui
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TrackSarah McBride
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TrackApril McClain Delaney
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TrackJames P. McGovern
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TrackDaniel Meuser
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TrackKweisi Mfume
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TrackMariannette Miller-Meeks
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TrackDave Min
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TrackGwen Moore
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TrackFrank J. Mrvan
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TrackGregory F. Murphy
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TrackJoe Neguse
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TrackTroy E. Nehls
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TrackEleanor Holmes Norton
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TrackZachary Nunn
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TrackJohnny Olszewski
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TrackIlhan Omar
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TrackBurgess Owens
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TrackJimmy Panetta
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TrackChris Pappas
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TrackMarie Gluesenkamp Perez
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TrackBrittany Pettersen
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TrackMark Pocan
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TrackMike Quigley
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TrackJamie Raskin
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TrackDeborah K. Ross
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TrackJohn H. Rutherford
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TrackPatrick Ryan
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TrackMaria Elvira Salazar
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TrackAndrea Salinas
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TrackDerek Schmidt
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TrackKim Schrier
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TrackTerri A. Sewell
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TrackLateefah Simon
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TrackMichael K. Simpson
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TrackDarren Soto
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TrackGreg Stanton
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TrackMarilyn Strickland
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TrackThomas R. Suozzi
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TrackRashida Tlaib
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TrackJill N. Tokuda
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TrackJefferson Van Drew
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TrackEugene Vindman
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TrackJames R. Walkinshaw
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TrackDebbie Wasserman Schultz
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TrackRobert J. Wittman
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TrackRudy Yakym III
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Actions
2 actions
| Date | Action |
|---|---|
| May. 08, 2025 | Introduced in House |
| May. 08, 2025 | Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned. |
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