[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1410 Introduced in House (IH)]






109th CONGRESS
  1st Session
                                H. R. 1410

To provide for coverage of hormone replacement therapy for treatment of 
  menopausal symptoms, and for coverage of an alternative therapy for 
 hormone replacement therapy for such symptoms, 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

                             March 17, 2005

    Ms. Lee (for herself, Mr. Payne, and Mr. Owens) 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, and Veterans' Affairs, 
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 for treatment of 
  menopausal symptoms, and for coverage of an alternative therapy for 
 hormone replacement therapy for such symptoms, 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 ``Menopausal Hormone 
Replacement Therapies and Alternative Treatments and 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 menopausal hormone replacement therapy and 
                            alternative treatments for menopausal 
                            hormone replacement therapy.
Sec. 4. Medicaid coverage of alternative treatments for menopausal 
                            hormone replacement therapy.
Sec. 5. Coverage of menopausal hormone replacement therapy and 
                            alternative treatments for menopausal 
                            hormone replacement therapy under group 
                            health plans and individual health 
                            insurance coverage.
Sec. 6. Coverage of menopausal hormone replacement therapy and 
                            alternative treatments for menopausal 
                            hormone replacement therapy under FEHBP.
Sec. 7. Coverage of alternative treatments for menopausal hormone 
                            replacement therapy under Department of 
                            Veterans Affairs health care system.

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 MENOPAUSAL HORMONE REPLACEMENT THERAPY AND 
              ALTERNATIVE TREATMENTS FOR MENOPAUSAL 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 (Y);
            (2) by adding ``and'' at the end of subparagraph (Z); and
            (3) by adding at the end the following new subparagraph:
            ``(AA)(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, if it has 
        been proven safe and effective in peer-reviewed scientific 
        studies, and if it is administered only after the health care 
        provider obtains the informed consent of the patient to receive 
        it;''.
    (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 MENOPAUSAL 
              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 (28)''.
    (b) Description of Covered Therapies.--Section 1905(a) of such Act 
(42 U.S.C. 1396d(a)) is amended--
            (1) by redesignating paragraph (28) as paragraph (29); and
            (2) by inserting after paragraph (27) the following new 
        paragraph:
            ``(28) 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, if it has been proven 
        safe and effective in peer-reviewed scientific studies, and if 
        it is administered only after the health care provider obtains 
        the informed consent of the patient to receive it; 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 MENOPAUSAL HORMONE REPLACEMENT THERAPY AND 
              ALTERNATIVE TREATMENTS FOR MENOPAUSAL 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 MENOPAUSAL HORMONE 
              REPLACEMENT THERAPY AND ALTERNATIVE TREATMENTS FOR 
              MENOPAUSAL HORMONE REPLACEMENT THERAPY.

    ``(a) Requirements.--
            ``(1) Menopausal 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 menopausal 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;
                    ``(B) it has been proven safe and effective in 
                peer-reviewed scientific studies; and
                    ``(C) it is administered only after the health care 
                provider obtains the informed consent of the patient to 
                receive it.
    ``(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 MENOPAUSAL HORMONE 
              REPLACEMENT THERAPY AND ALTERNATIVE TREATMENTS FOR 
              MENOPAUSAL HORMONE REPLACEMENT THERAPY.

    ``(a) Requirements.--
            ``(1) Menopausal 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 menopausal 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;
                    ``(B) it has been proven safe and effective in 
                peer-reviewed scientific studies; and
                    ``(C) it is administered only after the health care 
                provider obtains the informed consent of the patient to 
                receive it.
    ``(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:

``714. Standard relating to coverage of menopausal hormone replacement 
                            therapy and alternative treatments for 
                            menopausal 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:

``9813. Standard relating to coverage of menopausal hormone replacement 
                            therapy and alternative treatments for 
                            menopausal hormone replacement therapy.''
; and
                            (ii) by inserting after section 9812 the 
                        following:

``SEC. 9813. STANDARD RELATING TO COVERAGE OF MENOPAUSAL HORMONE 
              REPLACEMENT THERAPY AND ALTERNATIVE TREATMENTS FOR 
              MENOPAUSAL HORMONE REPLACEMENT THERAPY.

    ``(a) Menopausal 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 Menopausal 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;
            ``(2) it has been proven safe and effective in peer-
        reviewed scientific studies; and
            ``(3) it is administered only after the health care 
        provider obtains the informed consent of the patient to receive 
        it.''
                    (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 MENOPAUSAL HORMONE 
              REPLACEMENT THERAPY AND ALTERNATIVE TREATMENTS FOR 
              MENOPAUSAL 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 MENOPAUSAL HORMONE REPLACEMENT THERAPY AND 
              ALTERNATIVE TREATMENTS FOR MENOPAUSAL 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;
            ``(B) it has been proven safe and effective in peer-
        reviewed scientific studies; and
            ``(C) it is administered only after the health care 
        provider obtains the informed consent of the patient to receive 
        it.''.
    (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 MENOPAUSAL HORMONE 
              REPLACEMENT THERAPY UNDER DEPARTMENT OF VETERANS AFFAIRS 
              HEALTH CARE SYSTEM.

    (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, if the therapy has 
        been proven safe and effective in peer-reviewed scientific 
        studies, and if it is administered only after the health care 
        provider obtains the informed consent of the patient to receive 
        it.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to therapies furnished on or after the date of the enactment of 
this Act.
                                 <all>