[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5106 Introduced in House (IH)]







107th CONGRESS
  2d Session
                                H. R. 5106

 To provide for coverage of scalp hair prosthesis for individuals who 
have scalp hair loss as a result of alopecia areata under the Medicare 
   and Medicaid Programs, State children's health insurance program 
 (SCHIP), Federal employees health benefits program (FEHBP), veterans 
    health care programs, TRICARE, and Indian Health Service (IHS).


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 11, 2002

  Ms. Rivers introduced the following bill; which was referred to the 
Committee on Energy and Commerce, and in addition to the Committees on 
 Ways and Means, Government Reform, Veterans' Affairs, Armed Services, 
   and Resources, 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

_______________________________________________________________________

                                 A BILL


 
 To provide for coverage of scalp hair prosthesis for individuals who 
have scalp hair loss as a result of alopecia areata under the Medicare 
   and Medicaid Programs, State children's health insurance program 
 (SCHIP), Federal employees health benefits program (FEHBP), veterans 
    health care programs, TRICARE, and Indian Health Service (IHS).

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Alopecia Fairness 
Expansion Act of 2002''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title.
Sec. 2. Medicare coverage of scalp hair prosthesis for individuals who 
                            have scalp hair loss as a result of 
                            alopecia areata.
Sec. 3. Medicaid coverage of scalp hair prosthesis for individuals who 
                            have scalp hair loss as a result of 
                            alopecia areata.
Sec. 4. SCHIP coverage of scalp hair prosthesis for individuals who 
                            have scalp hair loss as a result of 
                            alopecia areata.
Sec. 5. FEHBP coverage of scalp hair prosthesis for individuals who 
                            have scalp hair loss as a result of 
                            alopecia areata.
Sec. 6. Veterans' coverage of scalp hair prosthesis for individuals who 
                            have scalp hair loss as a result of 
                            alopecia areata.
Sec. 7. TRICARE coverage of scalp hair prosthesis for individuals who 
                            have scalp hair loss as a result of 
                            alopecia areata.
Sec. 8. IHS coverage of scalp hair prosthesis for individuals who have 
                            scalp hair loss as a result of alopecia 
                            areata.

SEC. 2. MEDICARE COVERAGE OF SCALP HAIR PROSTHESIS FOR INDIVIDUALS WHO 
              HAVE SCALP HAIR LOSS AS A RESULT OF ALOPECIA AREATA.

    (a) In General.--Section 1861(s)(2) of the Social Security Act (42 
U.S.C. 1395x(s)(2)) is amended--
            (1) by striking ``and'' at the end of subparagraph (U);
            (2) by adding ``and'' at the end of subparagraph (V); and
            (3) by adding at the end the following new subparagraph:
            ``(W) scalp hair prosthesis (which may include artificial 
        substitutes for scalp hair) for an individual who has scalp 
        hair loss as a result of alopecia areata if the attending 
        physician of the individual certifies in writing the medical 
        necessity of that proposed course of rehabilitative 
        treatment;''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to items furnished on or after July 1, 2003.

SEC. 3. MEDICAID COVERAGE OF SCALP HAIR PROSTHESIS FOR INDIVIDUALS WHO 
              HAVE SCALP HAIR LOSS AS A RESULT OF ALOPECIA AREATA.

    (a) In General.--Section 1905(a) of the Social Security Act (42 
U.S.C. 1396d(a)) is amended--
            (1) by striking ``and'' at the end of paragraph (26);
            (2) by redesignating paragraph (27) as paragraph (28); and
            (3) by inserting after paragraph (26) the following new 
        paragraph:
            ``(27) scalp hair prosthesis (which may include artificial 
        substitutes for scalp hair) for an individual who has scalp 
        hair loss as a result of alopecia areata if the attending 
        physician of the individual certifies in writing the medical 
        necessity of that proposed course of rehabilitative treatment; 
        and''.
    (b) Effective Date.--(1) Except as provided in paragraph (2), the 
amendments made by subsection (a) apply to calendar quarters beginning 
on or after July 1, 2003, without regard to whether or not final 
regulations to carry out such amendments have been promulgated by such 
date.
    (2) In the case of a State plan for medical assistance under title 
XIX of the Social Security Act which the Secretary of Health and Human 
Services determines requires State legislation (other than legislation 
appropriating funds) in order for the plan to meet the additional 
requirement imposed by the amendment made by subsection (a), the State 
plan shall not be regarded as failing to comply with the requirements 
of such title solely on the basis of its failure to meet this 
additional requirement before the first day of the first calendar 
quarter beginning after the close of the first regular session of the 
State legislature that begins after the date of the enactment of this 
Act. For purposes of the previous sentence, in the case of a State that 
has a 2-year legislative session, each year of such session shall be 
deemed to be a separate regular session of the State legislature.

SEC. 4. SCHIP COVERAGE OF SCALP HAIR PROSTHESIS FOR INDIVIDUALS WHO 
              HAVE SCALP HAIR LOSS AS A RESULT OF ALOPECIA AREATA.

    (a) In General.--Section 2103(a) of the Social Security Act (42 
U.S.C. 1397cc(a)) is amended by adding after and below paragraph (4) 
the following:
        ``No coverage may be approved under this section unless the 
        coverage provides benefits for scalp hair prosthesis (which may 
        include artificial substitutes for scalp hair) for an 
        individual who has scalp hair loss as a result of alopecia 
        areata if the attending physician of the individual certifies 
        in writing the medical necessity of that proposed course of 
        rehabilitative treatment.''.
    (b) Effective Date.--(1) Except as provided in paragraph (2), the 
amendments made by subsection (a) apply to calendar quarters beginning 
on or after July 1, 2003, without regard to whether or not final 
regulations to carry out such amendments have been promulgated by such 
date.
    (2) In the case of a State plan for medical assistance under title 
XIX of the Social Security Act which the Secretary of Health and Human 
Services determines requires State legislation (other than legislation 
appropriating funds) in order for the plan to meet the additional 
requirement imposed by the amendment made by subsection (a), the State 
plan shall not be regarded as failing to comply with the requirements 
of such title solely on the basis of its failure to meet this 
additional requirement before the first day of the first calendar 
quarter beginning after the close of the first regular session of the 
State legislature that begins after the date of the enactment of this 
Act. For purposes of the previous sentence, in the case of a State that 
has a 2-year legislative session, each year of such session shall be 
deemed to be a separate regular session of the State legislature.

SEC. 5. FEHBP COVERAGE OF SCALP HAIR PROSTHESIS FOR INDIVIDUALS WHO 
              HAVE SCALP HAIR LOSS AS A RESULT OF ALOPECIA AREATA.

    (a) In General.--Section 8902 of title 5, United States Code, is 
amended by adding at the end the following:
    ``(p)(1) A contract may not be made or a plan approved which does 
not include coverage for scalp hair prosthesis (which may include 
artificial substitutes for scalp hair) for an individual who has scalp 
hair loss as a result of alopecia areata if the attending physician of 
the individual certifies in writing the medical necessity of that 
proposed course of rehabilitative treatment.
    ``(2) The coverage required under this subsection is not subject to 
dollar limits, deductibles, and coinsurance provisions that are less 
favorable than those for other prosthesis coverage under a health 
benefits plan, except that a plan may provide that the plan will only 
pay for 80 percent of the customary and usual costs of the scalp hair 
prosthesis exclusive of any deductible.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply with respect to items furnished on or after January 1, 2004.

SEC. 6. VETERANS' COVERAGE OF SCALP HAIR PROSTHESIS FOR INDIVIDUALS WHO 
              HAVE SCALP HAIR LOSS AS A RESULT OF ALOPECIA AREATA.

    (a) In General.--Section 1701(6) of title 38, United States Code, 
is amended by adding at the end the following new subparagraph:
            ``(G) Scalp hair prosthesis (which may include artificial 
        substitutes for scalp hair) for a person who has scalp hair 
        loss as a result of alopecia areata;''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to items furnished on or after October 1, 2002.

SEC. 7. TRICARE COVERAGE OF SCALP HAIR PROSTHESIS FOR INDIVIDUALS WHO 
              HAVE SCALP HAIR LOSS AS A RESULT OF ALOPECIA AREATA.

    (a) In General.--Section 1074c of title 10, United States Code, is 
amended by striking ``resulting from the treatment of a malignant 
disease'' and inserting ``(including alopecia resulting from the 
treatment of a malignant disease)''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply with respect to items furnished on or after October 1, 2002.

SEC. 8. IHS COVERAGE OF SCALP HAIR PROSTHESIS FOR INDIVIDUALS WHO HAVE 
              SCALP HAIR LOSS AS A RESULT OF ALOPECIA AREATA.

    (a) In General.--The Indian Health Care Improvement Act (25 U.S.C. 
1601 et seq.) is amended by inserting after section 225 the following 
new section:

                        ``scalp hair prosthesis

    ``Sec. 226. The Secretary, through the Service, shall provide scalp 
hair prosthesis (which may include artificial substitutes for scalp 
hair) for an Indian who has scalp hair loss as a result of alopecia 
areata if the attending physician of the Indian certifies in writing 
the medical necessity of that proposed course of rehabilitative 
treatment.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply with respect to items furnished on or after January 1, 2003.
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