Text: H.R.383 — 112th Congress (2011-2012)All Information (Except Text)

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Introduced in House (01/20/2011)


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.