Gabriel Rosenberg Dyspraxia/DCD Coverage Act
- Bill Number
- H.R. 2943
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-04-17: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Oversight and Government Reform, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- Last Updated
- 2025-05-20T13:43:10Z
AI-Generated Summary
Purpose
The Gabriel Rosenberg Dyspraxia/DCD Coverage Act (H.R. 2943) aims to assess how well insurance programs cover treatments for dyspraxia/developmental coordination disorder (DCD), a condition that affects motor skills, coordination, and daily activities, often starting in childhood. By directing a government study, the bill seeks to identify gaps in coverage and provide recommendations to improve access to necessary therapies and services.
Key Provisions
- Study Mandate: The Comptroller General of the United States (head of the Government Accountability Office, or GAO, an independent agency that audits government programs) must conduct a comprehensive study on insurance coverage for items and services related to treating dyspraxia/DCD.
- Scope of Coverage Examined:
- Group health plans and individual health insurance (private plans).
- Federal health care programs, including Medicare (for seniors and certain disabled individuals) and Medicaid (state-federal program for low-income people).
- Other federal programs, such as those for veterans or federal employees under chapter 89 of title 5, U.S. Code.
- Report Requirements: Within one year of the bill's enactment, the GAO must submit a report to Congress detailing:
- Whether Medicare covers such treatments.
- State-by-state coverage under Medicaid.
- Coverage in other federal programs.
- The level of coverage in private insurance plans.
- Types of covered services (e.g., physical therapy, occupational therapy).
- Any age limits on coverage.
- Barriers to access, such as shortages of specialized providers.
- Compliance by private plans with federal rules against discrimination in coverage for developmental disabilities (under section 2726 of the Public Health Service Act).
- Whether adults with a childhood diagnosis of DCD lose coverage because they no longer meet "child" criteria.
- Recommendations for the Centers for Medicare & Medicaid Services (CMS) to issue guidance on covering these services in Medicare and Medicaid.
- Suggestions for private insurers to enhance coverage.
- Introduction and Referral: Introduced on April 17, 2025, by Rep. Lawler and Rep. Gottheimer; referred to the House Committees on Energy and Commerce, Ways and Means, and Oversight and Government Reform.
Significant Changes to Existing Law
This bill introduces no direct changes to current insurance laws or coverage requirements. Instead, it mandates a GAO study, which could indirectly influence future legislation or regulations based on the findings. It builds on existing federal protections, such as non-discrimination rules for developmental disorders, but does not amend them.
Potential Impacts
- On Government Agencies: The GAO will expend resources on the study, and CMS may need to act on recommendations, potentially leading to new guidance or rules for Medicare and Medicaid. States could face pressure to standardize Medicaid coverage.
- On Citizens: Individuals with dyspraxia/DCD (estimated to affect 5-6% of children) and their families may benefit from increased awareness and potential future expansions in treatment access, reducing out-of-pocket costs for therapies. However, immediate impacts are limited to the informational report.
- On International Relations: None; the bill focuses solely on U.S. domestic health insurance.
- Broader Effects: Could highlight inequities in coverage for neurodevelopmental disorders, prompting insurers to review policies voluntarily and encouraging advocacy for similar conditions.
Main Stakeholders Affected
- Individuals and Families: People diagnosed with dyspraxia/DCD, particularly children and transitioning adults, who rely on therapies for motor skill development.
- Healthcare Providers: Therapists and specialists (e.g., occupational and physical therapists) who treat DCD, potentially gaining from reduced coverage barriers.
- Insurers and Plans: Private health insurers, group plans, and federal programs like Medicare/Medicaid, which may need to evaluate and possibly expand coverage based on study outcomes.
- Government Entities: Congress (receives the report), GAO (conducts study), CMS (potential guidance issuer), and state Medicaid agencies.
- Advocacy Groups: Organizations supporting developmental disorders, who could use the report to push for policy changes.
Notable Legal, Constitutional, or Political Implications
- Legal: The bill reinforces existing federal requirements for equitable coverage of developmental disabilities without creating new mandates, avoiding challenges under laws like the Affordable Care Act. Recommendations could lead to administrative actions by CMS, which must comply with statutory authority.
- Constitutional: No direct implications; it aligns with Congress's power to oversee federal spending and health programs under the Commerce Clause.
- Political: Raises visibility for underrecognized conditions like DCD, potentially fostering bipartisan support for children's health issues. Named after Gabriel Rosenberg, it personalizes the effort, which may encourage similar "namesake" bills. The multi-committee referral signals broad jurisdictional interest in health policy reform.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Rep. Lawler, Michael [R-NY-17]
Cosponsors (1)
Rep. Gottheimer, Josh [D-NJ-5]
Recent Actions
- 2025-04-17: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Oversight and Government Reform, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-04-17: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Oversight and Government Reform, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-04-17: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Oversight and Government Reform, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-04-17: Introduced in House
- 2025-04-17: Introduced in House
Bill Versions
- Gabriel Rosenberg Dyspraxia/DCD Coverage Act — issued 2025-04-17 — PDF (4 pages)