text: SECTION 1. SHORT TITLE.
  
      This Act may be cited as the ``Treatment of Children's Deformities 
  Act of 1998''.
  
  SEC. 2. COVERAGE OF MINOR CHILD'S CONGENITAL OR DEVELOPMENTAL DEFORMITY 
                OR DISORDER.
  
      (a) Group Health Plans.--
              (1) Public health service act amendments.--(A) Subpart 2 of 
          part A of title XXVII of the Public Health Service Act, as 
          amended by section 703(a) of Public Law 104-204, is amended by 
          adding at the end the following new section:
  
  ``SEC. 2706. STANDARDS RELATING TO BENEFITS FOR MINOR CHILD'S 
                CONGENITAL OR DEVELOPMENTAL DEFORMITY OR DISORDER.
  
      ``(a) Requirements for Reconstructive Surgery.--
              ``(1) In general.--A group health plan, and a health 
          insurance issuer offering group health insurance coverage, that 
          provides coverage for surgical benefits shall provide coverage 
          for outpatient and inpatient diagnosis and treatment of a minor 
          child's congenital or developmental deformity, disease, or 
          injury. A minor child shall include any individual through 21 
          years of age.
              ``(2) Requirements.--Any coverage provided under paragraph 
          (1) shall be subject to pre-authorization or pre-certification 
          as required by the plan or issuer, and such coverage shall 
          include any surgical treatment which, in the opinion of the 
          treating physician, is medically necessary to approximate a 
          normal appearance.
              ``(3) Treatment defined.--
                      ``(A) In general.--In this section, the term 
                  `treatment' includes reconstructive surgical procedures 
                  (procedures that are generally performed to improve 
                  function, but may also be performed to approximate a 
                  normal appearance) that are performed on abnormal 
                  structures of the body caused by congenital defects, 
                  developmental abnormalities, trauma, infection, tumors, 
                  or disease, including--
                              ``(i) procedures that do not materially 
                          affect the function of the body part being 
                          treated; and
                              ``(ii) procedures for secondary conditions 
                          and follow-up treatment.
                      ``(B) Exception.--Such term does not include 
                  cosmetic surgery performed to reshape normal structures 
                  of the body to improve appearance or self-esteem.
      ``(b) Notice.--A group health plan under this part shall comply 
  with the notice requirement under section 713(b) of the Employee 
  Retirement Income Security Act of 1974 with respect to the requirements 
  of this section as if such section applied to such plan.''.
              (B) Section 2723(c) of such Act (42 U.S.C. 300gg-23(c)), as 
          amended by section 604(b)(2) of Public Law 104-204, is amended 
          by striking ``section 2704'' and inserting ``sections 2704 and 
          2706''.
              (2) ERISA amendments.--(A) Subpart B of part 7 of subtitle 
          B of title I of the Employee Retirement Income Security Act of 
          1974, as amended by section 702(a) of Public Law 104-204, is 
          amended by adding at the end the following new section:
  
  ``SEC. 713. STANDARDS RELATING TO BENEFITS FOR MINOR CHILD'S CONGENITAL 
                OR DEVELOPMENTAL DEFORMITY OR DISORDER.
  
      ``(a) Requirements for Reconstructive Surgery.--
              ``(1) In general.--A group health plan, and a health 
          insurance issuer offering group health insurance coverage, that 
          provides coverage for surgical benefits shall provide coverage 
          for outpatient and inpatient diagnosis and treatment of a minor 
          child's congenital or developmental deformity, disease, or 
          injury. A minor child shall include any individual through 21 
          years of age.
              ``(2) Requirements.--Any coverage provided under paragraph 
          (1) shall be subject to pre-authorization or pre-certification 
          as required by the plan or issuer, and such coverage shall 
          include any surgical treatment which, in the opinion of the 
          treating physician, is medically necessary to approximate a 
          normal appearance.
              ``(3) Treatment defined.--
                      ``(A) In general.--In this section, the term 
                  `treatment' includes reconstructive surgical procedures 
                  (procedures that are generally performed to improve 
                  function, but may also be performed to approximate a 
                  normal appearance) that are performed on abnormal 
                  structures of the body caused by congenital defects, 
                  developmental abnormalities, trauma, infection, tumors, 
                  or disease, including--
                              ``(i) procedures that do not materially 
                          affect the function of the body part being 
                          treated; and
                              ``(ii) procedures for secondary conditions 
                          and follow-up treatment.
                      ``(B) Exception.--Such term does not include 
                  cosmetic surgery performed to reshape normal structures 
                  of the body to improve appearance or self-esteem.
      ``(b) Notice Under Group Health Plan.--The imposition of the 
  requirements of this section shall be treated as a material 
  modification in the terms of the plan described in section 102(a)(1), 
  for purposes of assuring notice of such requirements under the plan; 
  except that the summary description required to be provided under the 
  last sentence of section 104(b)(1) with respect to such modification 
  shall be provided by not later than 60 days after the first day of the 
  first plan year in which such requirements apply.''.
              (B) Section 731(c) of such Act (29 U.S.C. 1191(c)), as 
          amended by section 603(b)(1) of Public Law 104-204, is amended 
          by striking ``section 711'' and inserting ``sections 711 and 
          713''.
              (C) Section 732(a) of such Act (29 U.S.C. 1191a(a)), as 
          amended by section 603(b)(2) of Public Law 104-204, is amended 
          by striking ``section 711'' and inserting ``sections 711 and 
          713''.
              (D) The table of contents in section 1 of such Act is 
          amended by inserting after the item relating to section 712 the 
          following new item:
  
  ``Sec. 713. Standards relating to benefits for minor child's congenital 
                              or developmental deformity or disorder.''.
              (3) Internal revenue code amendments.--Subchapter B of 
          chapter 100 of the Internal Revenue Code of 1986 (as amended by 
          section 1531(a) of the Taxpayer Relief Act of 1997) is 
          amended--
                      (A) in the table of sections, by inserting after 
                  the item relating to section 9812 the following new 
                  item:
  
                                ``Sec. 9813. Standards relating to 
                                          benefits for minor child's 
                                          congenital or developmental 
                                          deformity or disorder.''; and
                      (B) by inserting after section 9812 the following:
  
  ``SEC. 9813. STANDARDS RELATING TO BENEFITS FOR MINOR CHILD'S 
                CONGENITAL OR DEVELOPMENTAL DEFORMITY OR DISORDER.
  
      ``(a) Requirements for Reconstructive Surgery.--
              ``(1) In general.--A group health plan, and a health 
          insurance issuer offering group health insurance coverage, that 
          provides coverage for surgical benefits shall provide coverage 
          for outpatient and inpatient diagnosis and treatment of a minor 
          child's congenital or developmental deformity, disease, or 
          injury. A minor child shall include any individual through 21 
          years of age.
              ``(2) Requirements.--Any coverage provided under paragraph 
          (1) shall be subject to pre-authorization or pre-certification 
          as required by the plan or issuer, and such coverage shall 
          include any surgical treatment which, in the opinion of the 
          treating physician, is medically necessary to approximate a 
          normal appearance.
              ``(3) Treatment defined.--
                      ``(A) In general.--In this section, the term 
                  `treatment' includes reconstructive surgical procedures 
                  (procedures that are generally performed to improve 
                  function, but may also be performed to approximate a 
                  normal appearance) that are performed on abnormal 
                  structures of the body caused by congenital defects, 
                  developmental abnormalities, trauma, infection, tumors, 
                  or disease, including--
                              ``(i) procedures that do not materially 
                          affect the function of the body part being 
                          treated; and
                              ``(ii) procedures for secondary conditions 
                          and follow-up treatment.
                      ``(B) Exception.--Such term does not include 
                  cosmetic surgery performed to reshape normal structures 
                  of the body to improve appearance or self-esteem.''.
      (b) Individual Health Insurance.--(1) Part B of title XXVII of the 
  Public Health Service Act, as amended by section 605(a) of Public Law 
  104-204, is amended by inserting after section 2751 the following new 
  section:
  
  ``SEC. 2752. STANDARDS RELATING TO BENEFITS FOR MINOR CHILD'S 
                CONGENITAL OR DEVELOPMENTAL DEFORMITY OR DISORDER.
  
      ``(a) Requirements for Reconstructive Surgery.--
              ``(1) In general.--A group health plan, and a health 
          insurance issuer offering group health insurance coverage, that 
          provides coverage for surgical benefits shall provide coverage 
          for outpatient and inpatient diagnosis and treatment of a minor 
          child's congenital or developmental deformity, disease, or 
          injury. A minor child shall include any individual through 21 
          years of age.
              ``(2) Requirements.--Any coverage provided under paragraph 
          (1) shall be subject to pre-authorization or pre-certification 
          as required by the plan or issuer, and such coverage shall 
          include any surgical treatment which, in the opinion of the 
          treating physician, is medically necessary to approximate a 
          normal appearance.
              ``(3) Treatment defined.--
                      ``(A) In general.--In this section, the term 
                  `treatment' includes reconstructive surgical procedures 
                  (procedures that are generally performed to improve 
                  function, but may also be performed to approximate a 
                  normal appearance) that are performed on abnormal 
                  structures of the body caused by congenital defects, 
                  developmental abnormalities, trauma, infection, tumors, 
                  or disease, including--
                              ``(i) procedures that do not materially 
                          affect the function of the body part being 
                          treated; and
                              ``(ii) procedures for secondary conditions 
                          and follow-up treatment.
                      ``(B) Exception.--Such term does not include 
                  cosmetic surgery performed to reshape normal structures 
                  of the body to improve appearance or self-esteem.
      ``(b) Notice.--A health insurance issuer under this part shall 
  comply with the notice requirement under section 713(b) of the Employee 
  Retirement Income Security Act of 1974 with respect to the requirements 
  referred to in subsection (a) as if such section applied to such issuer 
  and such issuer were a group health plan.''.
      (2) Section 2762(b)(2) of such Act (42 U.S.C. 300gg-62(b)(2)), as 
  added by section 605(b)(3)(B) of Public Law 104-204, is amended by 
  striking ``section 2751'' and inserting ``sections 2751 and 2752''.
      (c) Effective Dates.--(1) The amendments made by subsection (a) 
  shall apply with respect to group health plans for plan years beginning 
  on or after January 1, 1999.
      (2) The amendment made by subsection (b) shall apply with respect 
  to health insurance coverage offered, sold, issued, renewed, in effect, 
  or operated in the individual market on or after such date.
      (d) Coordinated Regulations.--Section 104(1) of Health Insurance 
  Portability and Accountability Act of 1996 is amended by striking 
  ``this subtitle (and the amendments made by this subtitle and section 
  401)'' and inserting ``the provisions of part 7 of subtitle B of title 
  I of the Employee Retirement Income Security Act of 1974, the 
  provisions of parts A and C of title XXVII of the Public Health Service 
  Act, and chapter 100 of the Internal Revenue Code of 1986''.
target: Treatment of Children's Deformities Act of 1998 - Amends the Public Health Service Act, the Employee Retirement Income Security Act of 1974 (ERISA), and the Internal Revenue Code to set standards requiring that group and individual health insurance coverage and group health plans provide coverage for treatment of a minor child's congenital or developmental deformity or disorder due to trauma, infection, tumor, or disease.
feat_title: Treatment of Children's Deformities Act of 1998