Allergy & Asthma Patient Protection Act of 2026

[Congressional Bills 119th Congress] [From the U.S. Government Publishing Office] [H.R. 11024 Introduced in House (IH)]

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119th CONGRESS 2d Session H. R. 11024

To amend title XXVII of the Public Health Service Act to require group health plans and health insurance issuers offering group or individual health insurance coverage to provide coverage of allergy and asthma diagnostic testing and allergen immunotherapy.

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IN THE HOUSE OF REPRESENTATIVES

November 12, 2026

Mr. Onder (for himself and Mr. Bacon) introduced the following bill; which was referred to the Committee on Energy and Commerce

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A BILL

To amend title XXVII of the Public Health Service Act to require group health plans and health insurance issuers offering group or individual health insurance coverage to provide coverage of allergy and asthma diagnostic testing and allergen immunotherapy.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Allergy & Asthma Patient Protection Act of 2026''.

SEC. 2. REQUIRING COVERAGE FOR ALLERGY AND ASTHMA DIAGNOSTIC TESTING AND ALLERGEN IMMUNOTHERAPY UNDER PRIVATE HEALTH INSURANCE.

Subpart II of part A of title XXVII of the Public Health Service Act (42 U.S.C. 300gg-11 et seq.) is amended by adding at the end the following new section:

``SEC. 2730. REQUIRED COVERAGE FOR ALLERGY AND ASTHMA DIAGNOSTIC TESTING AND ALLERGEN IMMUNOTHERAPY.

``(a) Allergy and Asthma Diagnostic Testing.-- ``(1) In general.--With respect to plan years beginning on or after January 1, 2028, a group health plan and a health insurance issuer offering group or individual health insurance shall provide coverage for allergy and asthma diagnostic testing in accordance with the requirements in paragraph (2). ``(2) Requirements.--For purposes of paragraph (1), the requirements in this paragraph are that a group health plan or a health insurance issuer offering group or individual health insurance coverage may not, with respect to coverage for allergy and asthma diagnostic testing-- ``(A) impose limits on the number of allergens that may be tested with respect to an individual if the testing of such allergens is consistent with recognized clinical standards; ``(B) deny coverage for an allergy and asthma diagnostic testing service furnished on the same day as an evaluation and management service when such testing service was performed in accordance with recognized clinical standards; ``(C) deny coverage based on a lack of medical decision-making, interpretation, or similar documentation requirements; ``(D) deny coverage on the basis that both skin testing and serum testing were ordered; or ``(E) impose prior authorization, step therapy protocols, or other utilization management requirements that are inconsistent with recognized clinical standards. ``(b) Allergen Immunotherapy.-- ``(1) In general.--With respect to plan years beginning on or after January 1, 2028, in the case that a group health plan or a health insurance issuer offering group or individual health insurance coverage provides coverage for allergen immunotherapy, such plan or issuer shall-- ``(A) meet the requirements in paragraph (2) with respect to such coverage; and ``(B) provide coverage consistent with recognized clinical standards for-- ``(i) extract preparation, regardless of-- ``(I) the presence, proportion, or use of diluent in such preparation; and ``(II) the number of extract vials or allergens used in such preparation, including extracts that are separated into multiple vials due to protease activity, incompatibility of antigens, or other reasons consistent with recognized clinical standards; and ``(ii) all medically necessary components of allergen immunotherapy, including-- ``(I) the buildup phase; ``(II) dose adjustments; and ``(III) specific extract concentrations. ``(2) Requirements.--For purposes of paragraph (1), the requirements in this paragraph are that a group health plan or a health insurance issuer offering group or individual health insurance coverage may not, with respect to coverage for allergen immunotherapy, impose-- ``(A) medically unlikely edit limits, volume-based reimbursement caps, predetermined aliquot sizes, or other quantitative restrictions that are inconsistent with Current Procedural Terminology (CPT) code descriptions or recognized clinical standards; ``(B) single date of service requirements; or ``(C) documentation, prior authorization, or other utilization management requirements that are inconsistent with recognized clinical standards. ``(c) Definitions.--In this section: ``(1) Allergen immunotherapy.--The term `allergen immunotherapy' means items and services furnished to an individual for the purpose of building immune tolerance to allergens, including services identified by CPT codes 95115, 95117, 95165, 95145, 95146, 95147, 95148, 95149, and 95180 (or any successor to such codes). ``(2) Allergy and asthma diagnostic testing.--The term `allergy and asthma diagnostic testing' means items and services furnished to an individual for the purpose of diagnosing allergies or asthma, including skin testing, intradermal testing, patch testing, and spirometry, when conducted in accordance with recognized clinical standards. ``(3) Extract preparation.--The term `extract preparation' means the professional service of ordering, preparing, mixing, compounding, and providing patient-specific allergen extract for use in allergen immunotherapy consistent with recognized clinical standards. ``(4) Incompatibility of antigens.--The term `incompatibility of antigens' means an instance in which two or more allergen extracts should not be mixed in the same vial because one extract adversely affects the stability or potency of another extract. ``(5) Medically unlikely edit limit.--The term `medically unlikely edit limit' means a maximum number of units of service that a group health plan or a health insurance issuer offering group or individual health insurance covers with respect to an individual on a date. ``(6) National medical specialty organization.--The term `national medical specialty organization' means an organization whose membership consists primarily of physicians specializing in allergy, asthma, or immunology and that publishes clinical practice parameters for allergy and asthma diagnostic testing and allergen immunotherapy, including the following (or any successor organizations): ``(A) The American College of Allergy, Asthma & Immunology. ``(B) The American Academy of Allergy, Asthma & Immunology. ``(C) The American Academy of Otolaryngic Allergy. ``(7) Predetermined aliquot size.--The term `predetermined aliquot size' means an amount of allergen extract that is assigned to a dose or vial of such extract on the basis of preexisting standards with respect to such amount instead of on the basis of the amount of such extract that is required for the specific allergen immunotherapy treatment of an individual. ``(8) Protease activity.--The term `protease activity' means the ability of certain allergen extracts, including with respect to mold and cockroach allergens, to produce enzymes that break down proteins and degrade other allergens if such extracts are mixed with other allergen extracts in the same vial. ``(9) Recognized clinical standards.--The term `recognized clinical standards' means clinical standards of care with respect to allergy and asthma diagnostic testing and allergen immunotherapy that are recognized by, and align with the practice parameters published by, national medical specialty organizations. ``(10) Single date of service requirement.--The term `single date of service requirement' means a policy that requires all units associated with an allergen immunotherapy treatment set to be billed on the same date of service. ``(11) Volume-based reimbursement cap.--The term `volume- based reimbursement cap' means a limit on the amount of coverage provided by a group health plan or a health insurance issuer offering group or individual health insurance with respect to an item or service that is imposed on the basis of a predetermined maximum volume of allergen extract, regardless of the number of allergens or clinical circumstances involved.''. <all>