[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.
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