[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5204 Introduced in House (IH)]
107th CONGRESS
2d Session
H. R. 5204
To provide for coverage of hormone replacement therapy and alternative
treatments for hormone replacement therapy (HRT) under the Medicare and
Medicaid programs, group health plans and individual health insurance
coverage, and other Federal health insurance programs.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 24, 2002
Ms. Lee introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committees on
Ways and Means, Education and the Workforce, Government Reform,
Veterans' Affairs, and Armed Services, 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 hormone replacement therapy and alternative
treatments for hormone replacement therapy (HRT) under the Medicare and
Medicaid programs, group health plans and individual health insurance
coverage, and other Federal health insurance programs.
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 ``Hormone
Replacement Therapy Alternative Treatment Fairness Act''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings.
Sec. 3. Medicare coverage of hormone replacement therapy and
alternative treatments for hormone
replacement therapy.
Sec. 4. Medicaid coverage of alternative treatments for hormone
replacement therapy.
Sec. 5. Coverage of hormone replacement therapy and alternative
treatments for hormone replacement therapy
under group health plans and individual
health insurance coverage.
Sec. 6. Coverage of alternative treatments for hormone replacement
therapy under FEHBP.
Sec. 7. Coverage of alternative treatments for hormone replacement
therapy under veterans' benefits.
Sec. 8. Coverage of alternative treatments for hormone replacement
therapy under TRICARE.
SEC. 2. FINDINGS.
Congress finds the following:
(1) 50 million women in the United States suffer from
symptoms or conditions related to menopause, including
osteoporosis, hot flashes, heart disease, and depression.
(2) The Women's Health Initiative terminated its study on
the synthetic version of hormone replacement therapy (HRT)
three years early due to findings that the combination of
estrogen and progestin increases the risk of heart disease,
stroke, blood clots, and breast cancer.
(3) Only 35 percent of women in the United States who are
undergoing menopause take prescribed synthetic HRT for
treatment of menopausal symptoms.
(4) Natural estrogen and progestin, which may not be
available by prescription, could be useful in treating
menopause symptoms and related conditions.
(5) 33 percent of women in the United States who are
undergoing menopause routinely use alternative treatments for
menopausal symptoms, such as Soy, Black Cohosh, Chasteberry,
Pro-Gest, Hops, Red Clover, Dong Quai, Evening Primose Oil,
Vitamin E, Flax Seed Oil, Ginseng, and natural DHEA.
(6) Women deserve relief from ailments relating to
menopause.
(7) Government insurance programs such as medicare,
medicaid, the Federal Employees Health Benefits Program
(FEHBP), and the Department of Veterans' Affairs do not cover
non-prescription alternative HRT treatments.
(8) Most private insurance does not cover non-prescription
alternative HRT treatments.
SEC. 3. MEDICARE COVERAGE OF HORMONE REPLACEMENT THERAPY AND
ALTERNATIVE TREATMENTS FOR HORMONE REPLACEMENT THERAPY.
(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)(i) hormone replacement therapy for treatment of
menopausal symptoms and (ii) an alternative therapy for hormone
replacement therapy for treatment of menopausal symptoms if the
therapy is recommended by a health care provider who is
licensed, accredited, or certified under State law and if it
has been proven safe and effective in peer-reviewed scientific
studies;''.
(b) Effective Date.--The amendments made by subsection (a) shall
apply to therapies furnished on or after the date of the enactment of
this Act.
SEC. 4. MEDICAID COVERAGE OF ALTERNATIVE TREATMENTS FOR HORMONE
REPLACEMENT THERAPY.
(a) Requirement for Coverage.--Section 1902(a)(10) of the Social
Security Act (42 U.S.C. 1396a(a)(10)) is amended--
(1) in subparagraph (A) in the matter before clause (i), by
striking ``and (21)'' and inserting ``, (21), and (27)''; and
(2) in subparagraph (C)(iv)--
(A) by striking ``and (17)'' and inserting ``,
(17), and (27)''; and
(B) by striking ``through (24)'' and inserting
``through (27)''.
(b) Description of Covered Therapies.--Section 1905(a) of such 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) an alternative therapy for hormone replacement
therapy for treatment of menopausal symptoms if the therapy is
recommended by a health care provider who is licensed,
accredited, or certified under State law and if it has been
proven safe and effective in peer-reviewed scientific studies;
and''.
(c) Effective Date.--The amendments made by this section apply to
therapies furnished on or after the date of the enactment of this Act,
without regard to whether or not final regulations to carry out such
amendments have been promulgated by such date.
SEC. 5. COVERAGE OF HORMONE REPLACEMENT THERAPY AND ALTERNATIVE
TREATMENTS FOR HORMONE REPLACEMENT THERAPY UNDER GROUP
HEALTH PLANS AND INDIVIDUAL HEALTH INSURANCE COVERAGE.
(a) Group Health Plans.--
(1) Public health service act amendments.--(A) Subpart 2 of
part A of title XXVII of the Public Health Service Act is
amended by adding at the end the following new section:
``SEC. 2707. STANDARD RELATING TO COVERAGE OF HORMONE REPLACEMENT
THERAPY AND ALTERNATIVE TREATMENTS FOR HORMONE
REPLACEMENT THERAPY.
``(a) Requirements.--
``(1) Hormone replacement therapy.--If a group health plan,
or a health insurance issuer offering group health insurance
coverage, provides benefits for outpatient prescription drugs,
the plan or coverage may not exclude or restrict benefits for
hormone replacement therapy for treatment of menopausal
symptoms.
``(2) Alternative treatments for hormone replacement
therapy.--If a group health plan, or a health insurance issuer
offering group health insurance coverage, provides benefits for
hormone replacement therapy for treatment of menopausal
symptoms, the plan or coverage may not exclude or restrict
benefits for an alternative therapy for hormone replacement
therapy for treatment of menopausal symptoms if--
``(A) the therapy is recommended by a health care
provider who is licensed, accredited, or certified
under State law; and
``(B) it has been proven safe and effective in
peer-reviewed scientific studies.
``(b) Notice.--A group health plan under this part shall comply
with the notice requirement under section 714(b) of the Employee
Retirement Income Security Act of 1974 with respect to the requirements
of this section as if such section applied to such plan.''.
(B) Section 2723(c) of such Act (42 U.S.C. 300gg-23(c)) is
amended by striking ``section 2704'' and inserting ``sections
2704 and 2707''.
(2) ERISA amendments.--(A) Subpart B of part 7 of subtitle
B of title I of the Employee Retirement Income Security Act of
1974 is amended by adding at the end the following new section:
``SEC. 714. STANDARD RELATING TO COVERAGE OF HORMONE REPLACEMENT
THERAPY AND ALTERNATIVE TREATMENTS FOR HORMONE
REPLACEMENT THERAPY.
``(a) Requirements.--
``(1) Hormone replacement therapy.--If a group health plan,
or a health insurance issuer offering group health insurance
coverage, provides benefits for outpatient prescription drugs,
the plan or coverage may not exclude or restrict benefits for
hormone replacement therapy for treatment of menopausal
symptoms.
``(2) Alternative treatments for hormone replacement
therapy.--If a group health plan, or a health insurance issuer
offering group health insurance coverage, provides benefits for
hormone replacement therapy for treatment of menopausal
symptoms, the plan or coverage may not exclude or restrict
benefits for an alternative therapy for hormone replacement
therapy for treatment of menopausal symptoms if--
``(A) the therapy is recommended by a health care
provider who is licensed, accredited, or certified
under State law; and
``(B) it has been proven safe and effective in
peer-reviewed scientific studies.
``(b) Notice Under Group Health Plan.--The imposition of the
requirement of this section shall be treated as a material modification
in the terms of the plan described in section 102(a)(1), for purposes
of assuring notice of such requirements under the plan; except that the
summary description required to be provided under the last sentence of
section 104(b)(1) with respect to such modification shall be provided
by not later than 60 days after the first day of the first plan year in
which such requirement apply.''.
(B) Section 731(c) of such Act (29 U.S.C. 1191(c)) is
amended by striking ``section 711'' and inserting ``sections
711 and 714''.
(C) Section 732(a) of such Act (29 U.S.C. 1191a(a)) is
amended by striking ``section 711'' and inserting ``sections
711 and 714''.
(D) The table of contents in section 1 of such Act is
amended by inserting after the item relating to section 713 the
following new item:
``Sec. 714. Standard relating to coverage of hormone replacement
therapy and alternative treatments for
hormone replacement therapy.''.
(3) Internal revenue code amendments.--
(A) In general.--Subchapter B of chapter 100 of the
Internal Revenue Code of 1986 is amended--
(i) in the table of sections, by inserting
after the item relating to section 9812 the
following new item:
``Sec. 9813. Standard relating to
coverage of hormone replacement
therapy and alternative
treatments for hormone
replacement therapy.'';
and
(ii) by inserting after section 9812 the
following:
``SEC. 9813. STANDARD RELATING TO COVERAGE OF HORMONE REPLACEMENT
THERAPY AND ALTERNATIVE TREATMENTS FOR HORMONE
REPLACEMENT THERAPY.
``(a) Hormone Replacement Therapy.--If a group health plan provides
benefits for outpatient prescription drugs, the plan may not exclude or
restrict benefits for hormone replacement therapy for treatment of
menopausal symptoms.
``(b) Alternative Treatments for Hormone Replacement Therapy.--If a
group health plan provides benefits for hormone replacement therapy for
treatment of menopausal symptoms, the plan may not exclude or restrict
benefits for an alternative therapy for hormone replacement therapy for
treatment of menopausal symptoms if--
``(1) the therapy is recommended by a health care provider
who is licensed, accredited, or certified under State law; and
``(2) it has been proven safe and effective in peer-
reviewed scientific studies.''
(B) Conforming amendment.--Section 4980D(d)(1) of
such Code is amended by striking ``section 9811'' and
inserting ``sections 9811 and 9813''.
(b) Individual Health Insurance.--(1) Part B of title XXVII of the
Public Health Service Act is amended by inserting after section 2752
the following new section:
``SEC. 2753. STANDARD RELATING TO COVERAGE OF HORMONE REPLACEMENT
THERAPY AND ALTERNATIVE TREATMENTS FOR HORMONE
REPLACEMENT THERAPY.
``(a) In General.--The provisions of section 2707(a) shall apply to
health insurance coverage offered by a health insurance issuer in the
individual market in the same manner as they apply to health insurance
coverage offered by a health insurance issuer in connection with a
group health plan in the small or large group market.
``(b) Notice.--A health insurance issuer under this part shall
comply with the notice requirement under section 714(b) of the Employee
Retirement Income Security Act of 1974 with respect to the requirements
referred to in subsection (a) as if such section applied to such issuer
and such issuer were a group health plan.''.
(2) Section 2762(b)(2) of such Act (42 U.S.C. 300gg-62(b)(2)) is
amended by striking ``section 2751'' and inserting ``sections 2751 and
2753''.
(c) Effective Date.--The amendments made by this section shall
apply with respect to therapies furnished on or after the date of the
enactment of this Act.
(d) Coordination of Administration.--The Secretary of Labor, the
Secretary of the Treasury, and the Secretary of Health and Human
Services shall ensure, through the execution of an interagency
memorandum of understanding among such Secretaries, that--
(1) regulations, rulings, and interpretations issued by
such Secretaries relating to the same matter over which two or
more such Secretaries have responsibility under the provisions
of this section (and the amendments made thereby) are
administered so as to have the same effect at all times; and
(2) coordination of policies relating to enforcing the same
requirements through such Secretaries in order to have a
coordinated enforcement strategy that avoids duplication of
enforcement efforts and assigns priorities in enforcement.
SEC. 6. COVERAGE OF HORMONE REPLACEMENT THERAPY AND ALTERNATIVE
TREATMENTS FOR HORMONE REPLACEMENT THERAPY UNDER FEHBP.
(a) In General.--Section 8902 of title 5, United States Code, is
amended by adding at the end the following new subsection:
``(p)(1) If a contract or plan provides benefits for outpatient
prescription drugs, the contract or plan may not exclude or restrict
benefits for hormone replacement therapy for treatment of menopausal
symptoms.
``(2) If a contract or plan provides benefits for hormone
replacement therapy for treatment of menopausal symptoms, the contract
or plan may not exclude or restrict benefits for an alternative therapy
for hormone replacement therapy for treatment of menopausal symptoms
if--
``(A) the therapy is recommended by a health care provider
who is licensed, accredited, or certified under State law; and
``(B) it has been proven safe and effective in peer-
reviewed scientific studies.''.
(b) Effective Date.--The amendment made by this section shall apply
with respect to contracts made and plans approved on or after the date
of the enactment of this Act.
SEC. 7. COVERAGE OF ALTERNATIVE TREATMENTS FOR HORMONE REPLACEMENT
THERAPY UNDER VETERANS' BENEFITS.
(a) In General.--Section 1701(6) of title 38, United States Code,
is amended by adding at the end the following new subparagraph:
``(G) An alternative therapy for hormone
replacement therapy for treatment of menopausal
symptoms if the therapy is recommended by a health care
provider who is licensed, accredited, or certified
under State law and if it has been proven safe and
effective in peer-reviewed scientific studies.''.
(b) Effective Date.--The amendments made by subsection (a) shall
apply to therapies made on or after the date of the enactment of this
Act.
SEC. 8. COVERAGE OF ALTERNATIVE TREATMENTS FOR HORMONE REPLACEMENT
THERAPY UNDER TRICARE.
(a) In General.--(1) Chapter 55 of title 10, United States Code, is
amended by inserting after section 1074k the following new section:
``Sec. 1074l. TRICARE program: benefits for alternative treatments for
hormone replacement therapy
``Each contract under the TRICARE program shall provide benefits
for an alternative therapy for hormone replacement therapy for
treatment of menopausal symptoms if--
``(1) the therapy is recommended by a health care provider
who is licensed, accredited, or certified under State law; and
``(2) it has been proven safe and effective in peer-
reviewed scientific studies.''.
(2) The table of sections at the beginning of such chapter is
amended by inserting after the item relating to section 1074k the
following new item:
``1074l. TRICARE program: benefits for alternative treatments for
hormone replacement therapy.''.
(b) Effective Date.--Section 1074l of title 10, United States Code,
as added by subsection (a), shall apply to therapies furnished on or
after the date of the enactment of this Act.
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