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S. 1045 (112th): Children’s Access to Reconstructive Evaluation & Surgery (CARES) Act of 2011

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The summary below was written by the Congressional Research Service, which is a nonpartisan division of the Library of Congress.

5/23/2011--Introduced. Children's Access to Reconstructive Evaluation & Surgery (CARES) Act of 2011 - Amends the Public Health Service Act, the Employee Retirement Income Security Act of 1974 (ERISA), and the Internal Revenue Code to require a group or individual health plan that covers surgical benefits to also cover outpatient and inpatient diagnosis and treatment of a congenital or developmental deformity, disease, or injury of a minor child (defined as child under the age of 22).

Requires that such coverage: (1) be subject to pre-authorization or pre-certification requirements of the plan or issuer, and (2) include any surgical treatment deemed by the treating physician to be medically necessary to approximate a normal appearance. Defines "treatment" to include reconstructive surgical procedures that are performed on abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, burns, infection, tumors, or disease, including: (1) procedures that do not materially affect the function of the body part being treated, and (2) procedures for secondary conditions and follow-up treatment. Excludes cosmetic surgery performed to reshape normal structures of the body to improve appearance or self-esteem.

Applies the provisions of this Act to grandfathered health plans under the Patient Protection and Affordable Care Act.