[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.
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