[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8128 Introduced in House (IH)]
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118th CONGRESS
2d Session
H. R. 8128
To require health insurance coverage for scalp cooling items.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
April 26, 2024
Ms. DeLauro 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, Armed Services, Veterans'
Affairs, and Oversight and Accountability, 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 require health insurance coverage for scalp cooling items.
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 ``Access to Scalp Cooling Therapy Act
of 2024''.
SEC. 2. REQUIRING COVERAGE FOR SCALP COOLING ITEMS UNDER GROUP HEALTH
PLANS AND GROUP AND INDIVIDUAL HEALTH INSURANCE COVERAGE,
SPECIFIED FEDERAL HEALTH CARE PROGRAMS, AND THE FEDERAL
EMPLOYEES HEALTH BENEFITS PROGRAM.
(a) Group Health Plans and Health Insurance Coverage.--Subpart II
of part A of title XXVII of the Public Health Service Act (42 U.S.C.
300gg-11 et seq.) is amended by adding at the end the following new
section:
``SEC. 2730. REQUIRED COVERAGE OF SCALP COOLING ITEMS.
``(a) In General.--With respect to a plan year beginning on or
after January 1, 2025, a group health plan and a health insurance
issuer offering group or individual health insurance coverage shall
provide benefits under such plan or such coverage for scalp cooling
items (as defined in subsection (c)) in accordance with the requirement
described in subsection (b).
``(b) Coverage Requirement.--For purposes of subsection (a), the
requirement described in this subsection is, with respect to the
imposition or application of any financial requirement (as defined in
subsection (c)) with respect to coverage of scalp cooling items under a
group health plan or group or individual health insurance coverage, the
requirement that such financial requirement be the same as such
requirement applicable to intravenous or injection anticancer drugs
furnished under such plan or such coverage for which benefits are
provided under such plan or such coverage.
``(c) Definitions.--In this section:
``(1) Financial requirement.--The term `financial
requirement' means, with respect to an item or service
furnished under a group health plan or group or individual
health insurance coverage, any copayment, coinsurance,
deductible, annual limit, lifetime limit, or out-of-pocket
maximum applied under such plan or such coverage with respect
to such item or service.
``(2) Scalp cooling item.--The term `scalp cooling item'
means a cooling cap, hypothermia cap, cold cap, or any other
therapeutic device used to cool the scalp of an individual to
prevent or reduce hair loss during chemotherapy.''.
(b) ERISA.--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:
``SEC. 726. REQUIRED COVERAGE OF SCALP COOLING ITEMS.
``(a) In General.--With respect to a plan year beginning on or
after January 1, 2025, a group health plan and a health insurance
issuer offering group or individual health insurance coverage shall
provide benefits under such plan or such coverage for scalp cooling
items (as defined in subsection (c)) in accordance with the requirement
described in subsection (b).
``(b) Coverage Requirement.--For purposes of subsection (a), the
requirement described in this subsection is, with respect to the
imposition or application of any financial requirement (as defined in
subsection (c)) with respect to coverage of scalp cooling items under a
group health plan or group or individual health insurance coverage, the
requirement that such financial requirement be the same as such
requirement applicable to intravenous or injection anticancer drugs
furnished under such plan or such coverage for which benefits are
provided under such plan or such coverage.
``(c) Definitions.--In this section:
``(1) Financial requirement.--The term `financial
requirement' means, with respect to an item or service
furnished under a group health plan or group or individual
health insurance coverage, any copayment, coinsurance,
deductible, annual limit, lifetime limit, or out-of-pocket
maximum applied under such plan or such coverage with respect
to such item or service.
``(2) Scalp cooling item.--The term `scalp cooling item'
means a cooling cap, hypothermia cap, cold cap, or any other
therapeutic device used to cool the scalp of an individual to
prevent or reduce hair loss during chemotherapy.''.
(2) Clerical amendment.--The table of contents in section 1
of the Employee Retirement Income Security Act of 1974 (29
U.S.C. 1001 et seq.) is amended by inserting after the item
relating to section 725 the following:
``Sec. 726. Required coverage of scalp cooling items.''.
(c) IRC.--
(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. 9826. REQUIRED COVERAGE OF SCALP COOLING ITEMS.
``(a) In General.--With respect to a plan year beginning on or
after January 1, 2025, a group health plan and a health insurance
issuer offering group or individual health insurance coverage shall
provide benefits under such plan or such coverage for scalp cooling
items (as defined in subsection (c)) in accordance with the requirement
described in subsection (b).
``(b) Coverage Requirement.--For purposes of subsection (a), the
requirement described in this subsection is, with respect to the
imposition or application of any financial requirement (as defined in
subsection (c)) with respect to coverage of scalp cooling items under a
group health plan or group or individual health insurance coverage, the
requirement that such financial requirement be the same as such
requirement applicable to intravenous or injection anticancer drugs
furnished under such plan or such coverage for which benefits are
provided under such plan or such coverage.
``(c) Definitions.--In this section:
``(1) Financial requirement.--The term `financial
requirement' means, with respect to an item or service
furnished under a group health plan or group or individual
health insurance coverage, any copayment, coinsurance,
deductible, annual limit, lifetime limit, or out-of-pocket
maximum applied under such plan or such coverage with respect
to such item or service.
``(2) Scalp cooling item.--The term `scalp cooling item'
means a cooling cap, hypothermia cap, cold cap, or any other
therapeutic device used to cool the scalp of an individual to
prevent or reduce hair loss during chemotherapy.''.
(2) Clerical amendment.--The table of sections for
subchapter B of chapter 100 of the Internal Revenue Code of
1986 is amended by adding at the end the following new item:
``Sec. 9826. Required coverage of scalp cooling items.''.
(d) Medicare.--
(1) Coverage.--
(A) In general.--Section 1861 of the Social
Security Act (42 U.S.C. 1395x) is amended--
(i) in subsection (s)(2)--
(I) in subparagraph (GG), by
striking ``and'' at the end;
(II) in subparagraph (HH), by
striking the period and inserting ``;
and''; and
(III) by adding at the end the
following new subparagraph:
``(II) scalp cooling items (as
defined in subsection (lll));''; and
(ii) by adding at the end the following new
subsection:
``(lll) Scalp Cooling Items.--The term `scalp cooling item' means a
cooling cap, hypothermia cap, cold cap, or any other therapeutic device
used to cool the scalp of an individual to prevent or reduce hair loss
during chemotherapy furnished on or after January 1, 2025.''
(B) Exclusion modification.--Section 1862(a)(1) of
the Social Security Act (42 U.S.C. 1395y(a)(1)) is
amended--
(i) in subparagraph (O), by striking
``and'' at the end;
(ii) in subparagraph (P), by striking the
semicolon and inserting ``, and''; and
(iii) by adding at the end the following
new subparagraph:
``(Q) in the case of scalp cooling
items (as defined in section
1861(lll)), which are not furnished to
prevent or reduce hair loss during
chemotherapy;''.
(2) Payment.--Section 1833(a)(1) of the Social Security Act
(42 U.S.C. 1395l(a)(1)) is amended--
(A) by striking ``and (DD)'' and inserting ``
(DD)''; and
(B) by inserting before the semicolon at the end
the following: ``and (EE) with respect to scalp cooling
items (as defined in section 1861(lll)), the amount
paid shall be equal to 80 percent of the lesser of the
actual charge or an amount determined appropriate by
the Secretary;''.
(e) Medicaid.--
(1) In general.--Title XIX of the Social Security Act (42
U.S.C. 1396 et seq.) is amended--
(A) in section 1902(a)(10)(A), by striking ``and
(30)'' and inserting ``(30), and (31)''; and
(B) in section 1905(a)--
(i) in paragraph (30), by striking ``and''
at the end;
(ii) by redesignating paragraph (31) as
paragraph (32); and
(iii) by inserting after paragraph (30) the
following new paragraph:
``(31) cooling caps, hypothermia caps, cold caps, and any
other therapeutic devices used to cool the scalp of an
individual to prevent or reduce hair loss during
chemotherapy.''.
(2) Effective date.--
(A) In general.--Subject to subparagraph (B), the
amendments made by this subsection shall apply with
respect to medical assistance furnished in calendar
quarters beginning on or after January 1, 2025.
(B) Exception for state legislation.--In the case
of a State plan under title XIX of the Social Security
Act (or a waiver of such plan), which the Secretary of
Health and Human Services determines requires State
legislation in order for the respective plan (or
waiver) to meet any requirement imposed by the
amendments made by this subsection, the respective plan
(or waiver) shall not be regarded as failing to comply
with the requirements of such title solely on the basis
of its failure to meet such an additional requirement
before the first day of the first calendar quarter
beginning after the close of the first regular session
of the State legislature that begins after the date of
enactment of this subsection. For purposes of the
previous sentence, in the case of a State that has a 2-
year legislative session, each year of the session
shall be considered to be a separate regular session of
the State legislature.
(f) CHIP.--
(1) In general.--Section 2103 of the Social Security Act
(42 U.S.C. 1397cc) is amended--
(A) in subsection (a), by striking ``paragraphs
(5), (6), (7) and (8) of''; and
(B) in subsection (c), by adding at the end the
following new paragraph:
``(11) Coverage of scalp cooling items.--The child health
assistance provided to a targeted low-income child shall
include cooling caps, hypothermia caps, cold caps, and any
other therapeutic devices used to cool the scalp of an
individual to prevent or reduce hair loss during
chemotherapy.''.
(2) Effective date.--
(A) In general.--Subject to subparagraph (B), the
amendments made by this subsection shall take effect
with respect to child health assistance provided on or
after January 1, 2025.
(B) Exception for state legislation.--In the case
of a State child health plan under title XXI of the
Social Security Act (or a waiver of such plan), which
the Secretary of Health and Human Services determines
requires State legislation in order for the respective
plan (or waiver) to meet any requirement imposed by the
amendments made by this section, the respective plan
(or waiver) shall not be regarded as failing to comply
with the requirements of such title solely on the basis
of its failure to meet such an additional requirement
before the first day of the first calendar quarter
beginning after the close of the first regular session
of the State legislature that begins after the date of
enactment of this section. For purposes of the previous
sentence, in the case of a State that has a 2-year
legislative session, each year of the session shall be
considered to be a separate regular session of the
State legislature.
(g) FEHBP.--Section 8902 of title 5, United States Code, is amended
by adding at the end the following new subsection:
``(p) A contract may not be made or a plan approved which
does not provide for the coverage required under section 2730
of the Public Health Service Act.''.
(h) TRICARE.--Section 1077(a) of title 10, United States Code, is
amended by adding at the end the following new paragraph:
``(19) A cooling cap, hypothermia cap, cold cap, or any
other therapeutic device used to cool the scalp of an
individual to prevent or reduce hair loss during
chemotherapy.''.
(i) VA.--
(1) In general.--Chapter 17 of title 38, United States
Code, is amended by inserting after section 1720I the following
new section:
``Sec. 1720J. Provision of scalp cooling items.
``The Secretary shall make available to a veteran who
receives chemotherapy pursuant to this chapter a cooling cap,
hypothermia cap, cold cap, or any other therapeutic device used
to cool the scalp of an individual to prevent or reduce hair
loss during chemotherapy.''.
(2) Clerical amendment.--The table of sections at the
beginning of such chapter is amended by inserting after the
item relating to section 1720I the following new item:
``1720J. Provision of scalp cooling items.''.
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