[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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