HR4606-119

What This Bill Does

Ally's Act creates parallel hearing-device coverage requirements in the Public Health Service Act, ERISA, and the Internal Revenue Code. Group health plans and health insurance issuers offering group or individual coverage must at minimum cover auditory implant devices, including auditory osseointegrated bone-conduction implants and cochlear implants, external sound processors, device and processor maintenance, upgrades or replacements every five years, adhesive adapters, softband headbands, repairs, comprehensive hearing assessments, preoperative medical assessments, surgery determined necessary by a treating physician or qualified audiologist, postoperative medical visits, postoperative audiology visits for activation and fitting, and aural rehabilitation and treatment services. Plans must make financial requirements no more restrictive than the predominant requirements applied to substantially all medical and surgical benefits and may not impose separate cost sharing only for these items. Treatment limitations must likewise be no more restrictive and may not be separate only for hearing-device coverage. Plans and issuers may not deny or limit medically necessary covered items or services. A qualifying individual is someone whom a physician or qualified audiologist determines meets an indication, including unilateral or bilateral hearing loss, for an auditory implant device and external sound processor.

Who Benefits and How

Patients needing cochlear implants benefit from mandatory coverage for implants, external sound processors, surgery, activation, fitting, and rehabilitation when medically necessary. Bone-conduction implant users benefit from coverage of auditory osseointegrated devices, softband headbands, adhesive adapters, maintenance, and repairs. Pediatric hearing patients benefit from five-year upgrade or replacement coverage and postoperative audiology visits. Audiology providers benefit because qualified-audiologist medical-necessity determinations and activation, fitting, and rehabilitation services drive covered care.

Who Bears the Burden and How

Public Health Service insurers must cover the listed hearing devices and services without separate or more restrictive cost sharing or treatment limits. ERISA employers sponsoring group health plans must add coverage for devices, processors, maintenance, five-year upgrades, repairs, assessments, surgery, visits, and rehabilitation. Internal Revenue Code plan administrators must apply the same coverage mandate under new section 9826. Department of Health and Human Services, Department of Labor, and Treasury administrators must oversee parallel statutory coverage rules.

Key Provisions

• Requires coverage of auditory implant devices, external sound processors, maintenance, repairs, and five-year upgrades or replacements.
• Requires coverage of hearing assessments, preoperative assessments, implant-related surgery, postoperative visits, activation, fitting, and aural rehabilitation.
• Prohibits separate or more restrictive cost sharing for covered hearing devices and services.
• Prohibits separate or more restrictive treatment limitations for covered hearing devices and services.
• Bars denial or limitation of medically necessary covered items or services determined by a physician or qualified audiologist.
• Extends parallel requirements through the Public Health Service Act, ERISA, and the Internal Revenue Code.