HR 584 IHCommentsClose CommentsPermalink

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.CommentsClose CommentsPermalink

January 15, 2009CommentsClose CommentsPermalink

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 Labor, 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 concernedCommentsClose CommentsPermalink

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.CommentsClose CommentsPermalink

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

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 2009’.CommentsClose CommentsPermalink





(b) Table of Contents- The table of contents of this Act is as follows:CommentsClose CommentsPermalink





Sec. 1. Short title; table of contents.CommentsClose CommentsPermalink





Sec. 2. Findings.CommentsClose CommentsPermalink





Sec. 3. Medicare coverage of menopausal hormone replacement therapy and alternative treatments for menopausal hormone replacement therapy.CommentsClose CommentsPermalink





Sec. 4. Medicaid coverage of alternative treatments for menopausal hormone replacement therapy.CommentsClose CommentsPermalink





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.CommentsClose CommentsPermalink





Sec. 6. Coverage of menopausal hormone replacement therapy and alternative treatments for menopausal hormone replacement therapy under FEHBP.CommentsClose CommentsPermalink





Sec. 7. Coverage of alternative treatments for menopausal hormone replacement therapy under Department of Veterans Affairs health care system.CommentsClose CommentsPermalink

SEC. 2. FINDINGS.

Congress finds the following:CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(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 hade menopause induced by surgery, chemotherapy, or radiation are more likely to experience these symptoms.CommentsClose CommentsPermalink





(3) Women deserve relief from menopause-related symptoms.CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink

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--CommentsClose CommentsPermalink





(1) by striking ‘and’ at the end of subparagraph (DD);CommentsClose CommentsPermalink





(2) by adding ‘and’ at the end of subparagraph (EE); andCommentsClose CommentsPermalink





(3) by adding at the end the following new subparagraph:CommentsClose CommentsPermalink





‘(FF)(i) hormone replacement therapy for treatment of menopausal symptoms; andCommentsClose CommentsPermalink





‘(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;’.CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink

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--CommentsClose CommentsPermalink





(1) in subparagraph (A) in the matter before clause (i), by striking ‘and (21)’ and inserting ‘, (21), and (28)’; andCommentsClose CommentsPermalink





(2) in subparagraph (C)(iv)--CommentsClose CommentsPermalink





(A) by striking ‘and (17)’ and inserting ‘, (17), and (28)’; andCommentsClose CommentsPermalink





(B) by striking ‘through (24)’ and inserting ‘through (28)’.CommentsClose CommentsPermalink





(b) Description of Covered Therapies- Section 1905(a) of such Act (42 U.S.C. 1396d(a)) is amended--CommentsClose CommentsPermalink





(1) by striking ‘and’ at the end of paragraph (27)CommentsClose CommentsPermalink





(2) by redesignating paragraph (28) as paragraph (29); andCommentsClose CommentsPermalink





(3) by inserting after paragraph (27) the following new paragraph:CommentsClose CommentsPermalink





‘(28) 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’.CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink

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) Group Health Plans-CommentsClose CommentsPermalink





(1) PUBLIC HEALTH SERVICE ACT AMENDMENTS-CommentsClose CommentsPermalink





(A) IN GENERAL- Subpart 2 of part A of title XXVII of the Public Health Service Act is amended by adding at the end the following new section:CommentsClose CommentsPermalink

‘SEC. 2708. STANDARD RELATING TO COVERAGE OF MENOPAUSAL HORMONE REPLACEMENT THERAPY AND ALTERNATIVE TREATMENTS FOR MENOPAUSAL HORMONE REPLACEMENT THERAPY.

‘(a) Requirements-CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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--CommentsClose CommentsPermalink





‘(A) the therapy is recommended by a health care provider who is licensed, accredited, or certified under State law;CommentsClose CommentsPermalink





‘(B) it has been proven safe and effective in peer-reviewed scientific studies; andCommentsClose CommentsPermalink





‘(C) it is administered only after the health care provider obtains the informed consent of the patient to receive it.CommentsClose CommentsPermalink





‘(b) Notice- A group health plan under this part shall comply with the notice requirement under section 714(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.’.CommentsClose CommentsPermalink





(B) CONFORMING AMENDMENT- Section 2723(c) of such Act (42 U.S.C. 300gg-23(c)) is amended by striking ‘section 2704’ and inserting ‘sections 2704 and 2708’.CommentsClose CommentsPermalink





(2) ERISA AMENDMENTS-CommentsClose CommentsPermalink





(A) 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:CommentsClose CommentsPermalink

‘SEC. 715. STANDARD RELATING TO COVERAGE OF MENOPAUSAL HORMONE REPLACEMENT THERAPY AND ALTERNATIVE TREATMENTS FOR MENOPAUSAL HORMONE REPLACEMENT THERAPY.

‘(a) Requirements-CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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--CommentsClose CommentsPermalink





‘(A) the therapy is recommended by a health care provider who is licensed, accredited, or certified under State law;CommentsClose CommentsPermalink





‘(B) it has been proven safe and effective in peer-reviewed scientific studies; andCommentsClose CommentsPermalink





‘(C) it is administered only after the health care provider obtains the informed consent of the patient to receive it.CommentsClose CommentsPermalink





‘(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.’.CommentsClose CommentsPermalink





(B) CONFORMING AMENDMENTS-CommentsClose CommentsPermalink





(i) Section 731(c) of such Act (29 U.S.C. 1191(c)) is amended by striking ‘section 711’ and inserting ‘sections 711 and 715’.CommentsClose CommentsPermalink





(ii) Section 732(a) of such Act (29 U.S.C. 1191a(a)) is amended by striking ‘section 711’ and inserting ‘sections 711 and 715’.CommentsClose CommentsPermalink





(iii) 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:CommentsClose CommentsPermalink





‘Sec. 715. Standard relating to coverage of menopausal hormone replacement therapy and alternative treatments for menopausal hormone replacement therapy.’.CommentsClose CommentsPermalink





(3) INTERNAL REVENUE CODE AMENDMENTS-CommentsClose CommentsPermalink





(A) IN GENERAL- Subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following:CommentsClose CommentsPermalink

‘SEC. 9813. 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.CommentsClose CommentsPermalink





‘(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--CommentsClose CommentsPermalink





‘(1) the therapy is recommended by a health care provider who is licensed, accredited, or certified under State law;CommentsClose CommentsPermalink





‘(2) it has been proven safe and effective in peer-reviewed scientific studies; andCommentsClose CommentsPermalink





‘(3) it is administered only after the health care provider obtains the informed consent of the patient to receive it.’CommentsClose CommentsPermalink





(A) CONFORMING AMENDMENTS-CommentsClose CommentsPermalink





(i) Section 4980D(d)(1) of such Code is amended by striking ‘section 9811’ and inserting ‘sections 9811 and 9813’.CommentsClose CommentsPermalink





(ii) The table of sections for subchapter B of chapter 100 of such Code is amended by adding at the end the following new item:CommentsClose CommentsPermalink





‘Sec. 9813. Standard relating to coverage of menopausal hormone replacement therapy and alternative treatments for menopausal hormone replacement therapy.’.CommentsClose CommentsPermalink





(4) EFFECTIVE DATE- The amendments made by this subsection shall apply with respect to group health plans for plan years beginning on or after the date of the enactment of this Act.CommentsClose CommentsPermalink





(b) Individual Health Insurance-CommentsClose CommentsPermalink





(1) IN GENERAL- Part B of title XXVII of the Public Health Service Act is amended by inserting after section 2753 the following new section:CommentsClose CommentsPermalink

‘SEC. 2754. STANDARD RELATING TO COVERAGE OF MENOPAUSAL HORMONE REPLACEMENT THERAPY AND ALTERNATIVE TREATMENTS FOR MENOPAUSAL HORMONE REPLACEMENT THERAPY.

‘(a) In General- The provisions of section 2708(a) shall apply to health insurance coverage offered by a health insurance issuer in the individual market in the same manner as they apply to health insurance coverage offered by a health insurance issuer in connection with a group health plan in the small or large group market.CommentsClose CommentsPermalink





‘(b) Notice- A health insurance issuer under this part shall comply with the notice requirement under section 715(b) of the Employee Retirement Income Security Act of 1974 with respect to the requirements referred to in subsection (a) as if such section applied to such issuer and such issuer were a group health plan.’.CommentsClose CommentsPermalink





(2) CONFORMING AMENDMENT- Section 2762(b)(2) of such Act (42 U.S.C. 300gg-62(b)(2)) is amended by striking ‘section 2751’ and inserting ‘sections 2751 and 2754’.CommentsClose CommentsPermalink





(3) EFFECTIVE DATE- The amendments made by this subsection shall apply with respect to therapies furnished on or after the date of the enactment of this Act.CommentsClose CommentsPermalink





(c) 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--CommentsClose CommentsPermalink





(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; andCommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink

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:CommentsClose CommentsPermalink





‘(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.CommentsClose CommentsPermalink





‘(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--CommentsClose CommentsPermalink





‘(A) the therapy is recommended by a health care provider who is licensed, accredited, or certified under State law;CommentsClose CommentsPermalink





‘(B) it has been proven safe and effective in peer-reviewed scientific studies; andCommentsClose CommentsPermalink





‘(C) it is administered only after the health care provider obtains the informed consent of the patient to receive it.’.CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink

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:CommentsClose CommentsPermalink





‘(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.’.CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink