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[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8128 Introduced in House (IH)]

<DOC>

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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