[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4989 Introduced in House (IH)]

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114th CONGRESS
  2d Session
                                H. R. 4989

  To amend title XIX of the Social Security Act to require States to 
provide cranial prostheses under the Medicaid program when a physician 
finds such treatment necessary for individuals affected by diseases and 
                medical conditions that cause hair loss.


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                    IN THE HOUSE OF REPRESENTATIVES

                             April 18, 2016

 Ms. Ros-Lehtinen (for herself, Ms. Eshoo, Mr. LoBiondo, Mr. Huffman, 
 Ms. Speier, and Mr. Ellison) introduced the following bill; which was 
            referred to the Committee on Energy and Commerce

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                                 A BILL


 
  To amend title XIX of the Social Security Act to require States to 
provide cranial prostheses under the Medicaid program when a physician 
finds such treatment necessary for individuals affected by diseases and 
                medical conditions that cause hair loss.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Cranial Prosthetic Medicaid Coverage 
Enhancement Act''.

SEC. 2. FINDINGS.

    The Congress finds as follows:
            (1) Individuals chronically affected by hair loss due to 
        diseases, such as the autoimmune skin condition alopecia 
        areata, as well as individuals affected by acute hair loss due 
        to chemotherapy or medical intervention face significant 
        biological, social, and psychological health challenges.
            (2) Dermatologists, oncologists, and other qualified 
        medical professionals consider cranial prosthetics to be a 
        medically necessary option when treating individuals suffering 
        from chronic, acute, or cyclical hair loss caused by a medical 
        condition.
            (3) The cost of a cranial prosthetic can represent a 
        significant financial burden for Medicaid program beneficiaries 
        and coverage benefits across States are currently inconsistent 
        and, in many cases, nonexistent.
            (4) While children participating in the Medicaid program 
        are often significantly impacted by the additional health 
        effects caused by medical condition-related hair loss, 
        inequitable and inconsistent coverage benefits for cranial 
        prosthetics means they can face serious difficulty accessing 
        treatment, even with the assistance of a healthcare 
        professional.

SEC. 3. IMPROVEMENT OF CRANIAL PROSTHESES COVERAGE UNDER MEDICAID.

    (a) In General.--Section 1902(a)(10) of the Social Security Act (42 
U.S.C. 1396a(a)(10)) is amended--
            (1) in subparagraph (F), at the end by striking ``and'';
            (2) in subparagraph (G), at the end by adding ``and''; and
            (3) by inserting after subparagraph (G) the following new 
        subparagraph:
                    ``(H) that if medical assistance is included for 
                inpatient hospital services for an individual, then the 
                plan must include making medical assistance available 
                to the individual for biennial coverage of one cranial 
                prosthesis with a benefit up to $400 if the 
                dermatologist, oncologist, or attending physician of 
                the individual certifies in writing the medical 
                necessity of that proposed course of rehabilitative 
                treatment;''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply with respect to items and services furnished on or after January 
1, 2017, without regard to whether or not final regulations to carry 
out such amendments have been promulgated by such date.
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