[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[H.R. 383 Introduced in House (IH)]

112th CONGRESS
  1st Session
                                H. R. 383

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

                            January 20, 2011

Ms. Lee of California 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, Oversight 
   and 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 of 
2011''.
    (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) The Women's Health Initiative terminated its study of 
        hormone therapy three years early because of findings that the 
        combination of estrogen and progestin increases the risk of 
        heart disease, stroke, blood clots, and breast cancer, and that 
        estrogen alone increases the risk of stroke and, in women over 
        65 years of age, increases the risk of dementia.
            (2) The National Institutes of Health has stated 
        unequivocally that while menopause is a natural process in 
        women's lives, some women at midlife experience hot flashes, 
        night sweats, vaginal dryness, sleep disturbances, and mood 
        disturbances that disrupt quality of life. Women who have had 
        menopause induced by surgery, chemotherapy, or radiation are 
        more likely to experience these symptoms.
            (3) Women deserve relief from menopause-related symptoms.
            (4) The National Institutes of Health have stated that 
        while estrogen and progestin have been found to be effective 
        remedies for these symptoms, these remedies are not without 
        risk.
            (5) Concerned about these risks, women seek alternative 
        types of treatments for symptoms that disrupt quality of life, 
        such as hot flashes, night sweats, vaginal dryness, sleep 
        disturbances, and mood disturbances.
            (6) The National Institutes of Health have found that 
        although there are many alternatives to synthetic hormones 
        available, including bio-identical or ``natural'' hormones as 
        well as herbal remedies and food supplements, the effectiveness 
        and long-term safety of these products need to be rigorously 
        studied in diverse populations.
            (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 treatments for menopause-related 
        symptoms because of a lack of demonstrated safety and efficacy 
        of these products.
            (8) Most private health insurance coverage does not cover 
        non-prescription alternative treatments for menopause-related 
        symptoms because of a lack of demonstrated safety and efficacy 
        of these products.

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 (EE);
            (2) by adding ``and'' at the end of subparagraph (FF); and
            (3) by adding at the end the following new subparagraph:
            ``(GG)(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 (28)'' and inserting ``, (28), and (29)''; and
            (2) in subparagraph (C)(iv)--
                    (A) by striking ``and (17)'' and inserting ``, 
                (17), and (29)''; and
                    (B) by striking ``through (24)'' and inserting 
                ``through (29)''.
    (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 (28);
            (2) by redesignating paragraph (29) as paragraph (30); and
            (3) by inserting after paragraph (28) the following new 
        paragraph:
            ``(29) 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) Public Health Service Act Amendments.--
            (1) In general.--Title XXVII of the Public Health Service 
        Act is amended by inserting after section 2728 of such Act (42 
        U.S.C. 300gg-28), as redesignated by section 1001(2) of the 
        Patient Protection and Affordable Care Act (Public Law 111-
        148), the following new section:

``SEC. 2729. 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 or 
        individual 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 or individual 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 716(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. A health 
insurance issuer under this part shall comply with the notice 
requirement under such section with respect to the requirements of this 
section as if such section applied to such issuer and such issuer were 
a group health plan.
    ``(c) Effective Date.--Notwithstanding any other provision of law, 
this section shall apply with respect to plan years beginning on or 
after the date of the enactment of the Menopausal Hormone Replacement 
Therapies and Alternative Treatments and Fairness Act of 2011 and with 
respect to health insurance coverage issued on or after such date.''.
            (2) Conforming amendment.--Section 2724(c) of such Act (42 
        U.S.C. 300gg-23(c)), as redesignated by sections 1001(4) and 
        1563(c)(14)(B) of the Patient Protection and Affordable Care 
        Act (Public Law 111-148) is amended by striking ``section 
        2704'' and inserting ``sections 2704 and 2729''.
            (3) Application rule.--For purposes of applying section 
        2729 of the Public Health Service Act, as inserted by paragraph 
        (1), to individual health insurance coverage before 2014, the 
        provisions of such section shall be treated as also included 
        under part B of title XXVII of the Public Health Service Act.
    (b) ERISA Amendments.--
            (1) In general.--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. 716. 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 the last sentence of section 
102(a), for purposes of assuring notice of such requirements under the 
plan; except that the summary description required to be provided under 
the fourth 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 applies.''.
            (2) Conforming amendments.--
                    (A) Section 731(c) of such Act (29 U.S.C. 1191(c)) 
                is amended by striking ``section 711'' and inserting 
                ``sections 711 and 716''.
                    (B) Section 732(a) of such Act (29 U.S.C. 1191a(a)) 
                is amended by striking ``section 711'' and inserting 
                ``sections 711 and 716''.
                    (C) The table of contents in section 1 of such Act 
                is amended by inserting after the item relating to 
                section 714 the following new item:

``Sec. 716. Standard relating to coverage of menopausal hormone 
                            replacement therapy and alternative 
                            treatments for menopausal hormone 
                            replacement therapy.''.
    (c) Internal Revenue Code Amendments.--
            (1) In general.--Subchapter B of chapter 100 of the 
        Internal Revenue Code of 1986 is amended by adding at the end 
        the following:

``SEC. 9816. 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.''
            (2) Conforming amendments.--
                    (A) Section 4980D(d)(1) of such Code is amended by 
                striking ``section 9811'' and inserting ``sections 9811 
                and 9816''.
                    (B) The table of sections for subchapter B of 
                chapter 100 of such Code is amended by adding at the 
                end the following new item:

``Sec. 9816. Standard relating to coverage of menopausal hormone 
                            replacement therapy and alternative 
                            treatments for menopausal hormone 
                            replacement therapy.''.
    (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.
    (e) Effective Date.--The amendments made by subsections (b) and (c) 
shall apply with respect to group health plans for plan years beginning 
on or after the date of the enactment of this Act.

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:
                    ``(H) 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>