[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1903 Introduced in House (IH)]







110th CONGRESS
  1st Session
                                H. R. 1903

 To amend the Public Health Service Act and Employee Retirement Income 
   Security Act of 1974 to require that group and individual health 
    insurance coverage and group health plans provide coverage for 
reconstructive prosthetic urology surgery if they provide coverage for 
                       prostate cancer treatment.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 17, 2007

  Mr. Towns introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
Education and Labor, 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 amend the Public Health Service Act and Employee Retirement Income 
   Security Act of 1974 to require that group and individual health 
    insurance coverage and group health plans provide coverage for 
reconstructive prosthetic urology surgery if they provide coverage for 
                       prostate cancer treatment.

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

SECTION 1. SHORT TITLE; FINDINGS.

    (a) Short Title.--This Act may be cited as the ``Post-Prostate 
Cancer Treatment Equity Act of 2007''.
    (b) Findings.--Congress finds the following:
            (1) Prostate cancer will strike about one in six men during 
        their lifetime.
            (2) Many of these men will have a prostatectomy and about 
        half of those will experience significant complications.
            (3) For some 6,000 of these men annually reconstructive 
        prosthetic urology surgery is their only option to address 
        these complications.
            (4) Medicare covers reconstructive prosthetic urology 
        surgery, as does two-third of private health benefits coverage. 
        However, about one-third of private health benefits coverage 
        does not cover this surgery.
            (5) To address a similar concern with respect to breast 
        cancer, Congress enacted the Women's Health and Cancer Rights 
        Act of 1998 that requires private health benefits coverage to 
        provide coverage for reconstructive surgery following 
        mastectomies.
            (6) Men should have a right to access to reconstructive 
        surgery following a prostatectomy just as women have the right 
        to access to reconstructive surgery following a mastectomy.

SEC. 2. AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 
              1974.

    (a) In General.--Subpart B of part 7 of subtitle B of title I of 
the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1185 et 
seq.) is amended by adding at the end the following new section:

``SEC. 714. REQUIRED COVERAGE FOR RECONSTRUCTIVE PROSTHETIC UROLOGY 
              SURGERY FOLLOWING PROSTATE CANCER TREATMENT.

    ``(a) In General.--A group health plan, and a health insurance 
issuer providing health insurance coverage in connection with a group 
health plan, that provides medical and surgical benefits with respect 
to prostate cancer treatment shall provide, in a case of a participant 
or beneficiary who is receiving benefits in connection with such 
prostate cancer treatment, coverage for--
            ``(1) all stages of reconstructive prosthetic urology 
        surgery; and
            ``(2) prostheses and physical complications of 
        prostatectomy;
in a manner determined in consultation with the attending physician and 
the patient. Such coverage may be subject to annual deductibles and 
coinsurance provisions as may be deemed appropriate and as are 
consistent with those established for other benefits under the plan or 
coverage. Written notice of the availability of such coverage shall be 
delivered to the participant upon enrollment and annually thereafter.
    ``(b) Notice.--A group health plan, and a health insurance issuer 
providing health insurance coverage in connection with a group health 
plan shall provide notice to each participant and beneficiary under 
such plan regarding the coverage required by this section in accordance 
with regulations promulgated by the Secretary. Such notice shall be in 
writing and prominently positioned in any literature or correspondence 
made available or distributed by the plan or issuer and shall be 
transmitted--
            ``(1) in the next mailing made by the plan or issuer to the 
        participant or beneficiary;
            ``(2) as part of any yearly informational packet sent to 
        the participant or beneficiary; or
            ``(3) not later than January 1, 2008;
whichever is earlier.
    ``(c) Prohibitions.--A group health plan, and a health insurance 
issuer offering group health insurance coverage in connection with a 
group health plan, may not--
            ``(1) deny to a patient eligibility or continued 
        eligibility, to enroll or to renew coverage under the terms of 
        the plan, solely for the purposes of avoiding the requirements 
        of this section; and
            ``(2) penalize or otherwise reduce or limit the 
        reimbursement of an attending provider, or provide incentives 
        (monetary or otherwise) to an attending provider, to induce 
        such provider to provide care to an individual participant or 
        beneficiary in a manner inconsistent with this section.
    ``(d) Rule of Construction.--Nothing in this section shall be 
construed to prevent a group health plan or a health insurance issuer 
offering group health insurance coverage from negotiating the level and 
type of reimbursement with a provider for care provided in accordance 
with this section.
    ``(e) Preemption, Relation to State Laws.--
            ``(1) In general.--Nothing in this section shall be 
        construed to preempt any State law in effect on the date of 
        enactment of this section with respect to health insurance 
        coverage that requires coverage of at least the coverage of 
        reconstructive prosthetic urology surgery otherwise required in 
        this section.
            ``(2) ERISA.--Nothing in this section shall be construed to 
        affect or modify the provisions of section 514 with respect to 
        group health plans.''.
    (b) Clerical Amendment.--The table of contents in section 1 of the 
Employee Retirement Income Security Act of 1974 (29 U.S.C. 1001 note) 
is amended by inserting after the item relating to section 713 the 
following new item:

``Sec. 714. Required coverage for reconstructive prosthetic urology 
                            surgery following prostate cancer 
                            treatment.''.
    (c) Effective Dates.--
            (1) In general.--The amendments made by this section shall 
        apply with respect to plan years beginning on or after the 
        first day of the sixth month beginning after the date of the 
        enactment of this Act.
            (2) Special rule for collective bargaining agreements.--In 
        the case of a group health plan maintained pursuant to 1 or 
        more collective bargaining agreements between employee 
        representative and 1 or more employers, any plan amendment made 
        pursuant to a collective bargaining agreement relating to the 
        plan which amends the plan solely to conform to any requirement 
        added by this section shall not be treated as a termination of 
        such collective bargaining agreement.

SEC. 3. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT.

    (a) Group Market.--Subpart 2 of part A of title XXVII of the Public 
Health Service Act (42 U.S.C. 300gg-4 et seq.) is amended by adding at 
the end the following new section:

``SEC. 2707. REQUIRED COVERAGE FOR RECONSTRUCTIVE PROSTHETIC UROLOGY 
              SURGERY FOLLOWING PROSTATE CANCER TREATMENT.

    ``The provisions of section 714 of the Employee Retirement Income 
Security Act of 1974 shall apply to group health plans, and health 
insurance issuers providing health insurance coverage in connection 
with group health plans, as if included in this subpart.''.
    (b) Individual Market.--Subpart 3 of part B of title XXVII of the 
Public Health Service Act (42 U.S.C. 300gg-51 et seq.) is amended by 
adding at the end the following new section:

``SEC. 2753. REQUIRED COVERAGE FOR RECONSTRUCTIVE PROSTHETIC UROLOGY 
              SURGERY FOLLOWING PROSTATE CANCER TREATMENT.

    ``The provisions of section 2707 of the title 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.''.
    (c) Effective Dates.--
            (1) Group plans.--
                    (A) In general.--The amendment made by subsection 
                (a) shall apply to group health plans for plan years 
                beginning on or after the first day of the sixth month 
                beginning after the date of the enactment of this Act.
                    (B) Special rule for collective bargaining 
                agreement.--In the case of a group health plan 
                maintained pursuant to 1 or more collective bargaining 
                agreements between employee representatives and 1 or 
                more employers, any plan amendment made pursuant to a 
                collective bargaining agreement relating to the plan 
                which amends the plan solely to conform to any 
                requirement added by the amendment made by subsection 
                (a) shall not be treated as a termination of such 
                collective bargaining agreement.
            (2) Individual plans.--The amendment made by subsection (b) 
        shall apply with respect to health insurance coverage offered, 
        sold, issued, renewed, in effect, or operated in the individual 
        market on or after the first day of the sixth month beginning 
        after the date of the enactment of this Act.
                                 <all>