Ensuring Lasting Smiles Act
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Progress
Where this bill stands in the legislative process.
- Introduced
- Passed Senate
- Passed House
- To President
- Became Law
Overview
The Ensuring Lasting Smiles Act aims to improve health insurance coverage for individuals born with congenital anomalies or birth defects. Specifically, it expands coverage to include outpatient and inpatient services related to the diagnosis and treatment of conditions affecting the eyes, ears, teeth, mouth, or jaw, focusing on reconstructive and corrective procedures. The bill also mandates notice to plan participants about this enhanced coverage and requires a study on network adequacy and cost changes related to these services.
Key provisions
- Expands health insurance coverage to include outpatient and inpatient services for congenital anomalies and birth defects impacting the eyes, ears, teeth, mouth, or jaw.
- Covers reconstructive and corrective procedures, including dental, orthodontic, and prosthodontic support.
- Excludes coverage for purely cosmetic surgery not related to a medical determination of a congenital anomaly.
- Requires health plans to provide notice to participants about the expanded coverage starting January 1, 2026.
- Mandates a study by the Secretary of Health and Human Services to assess network adequacy and cost changes related to the new coverage.
- Includes amendments to the Public Health Service Act, ERISA, and the Internal Revenue Code to implement the changes.
- Defines ‘congenital anomaly or birth defect’ broadly to encompass various conditions.
- Allows for cost-sharing requirements consistent with other medical benefits, but no more restrictive.
Bill text
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Sponsors
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