I 

110TH CONGRESS 

1ST SESSION H. R. 1903 

To amend the Public Health Service Act and Employee Retirement Income 

Security Act of 1974 to require that group and individual health insurance coverage and group health plans provide coverage for reconstructive 

prosthetic urology surgery if they provide coverage for prostate cancer 

treatment. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 17, 2007 

Mr. TOWNS introduced the following bill; which was referred to the Committee 

on Energy and Commerce, and in addition to the Committee on Education and Labor, 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 amend the Public Health Service Act and Employee Retirement Income Security Act of 1974 to require that 

group and individual health insurance coverage and 

group health plans provide coverage for reconstructive 

prosthetic urology surgery if they provide coverage for 

prostate cancer treatment. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE; FINDINGS. 

2 (a) SHORT TITLE.—This Act may be cited as the 

3 ‘‘Post-Prostate Cancer Treatment Equity Act of 2007’’. 

4 (b) FINDINGS.—Congress finds the following: 

5 (1) Prostate cancer will strike about one in six 

6 men during their lifetime. 

7 (2) Many of these men will have a prostatec8 tomy and about half of those will experience signifi9 cant complications. 

10 (3) For some 6,000 of these men annually re11 constructive prosthetic urology surgery is their only 

12 option to address these complications. 

13 (4) Medicare covers reconstructive prosthetic 

14 urology surgery, as does two-third of private health 

15 benefits coverage. However, about one-third of pri16 vate health benefits coverage does not cover this sur17 gery. 

18 (5) To address a similar concern with respect to 

19 breast cancer, Congress enacted the Women’s 

20 Health and Cancer Rights Act of 1998 that requires 

21 private health benefits coverage to provide coverage 

22 for reconstructive surgery following mastectomies. 

23 (6) Men should have a right to access to recon24 structive surgery following a prostatectomy just as 

25 women have the right to access to reconstructive 

26 surgery following a mastectomy. 


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1 SEC. 2. AMENDMENTS TO THE EMPLOYEE RETIREMENT IN2 COME SECURITY ACT OF 1974. 

3 (a) IN GENERAL.—Subpart B of part 7 of subtitle 

4 B of title I of the Employee Retirement Income Security 

5 Act of 1974 (29 U.S.C. 1185 et seq.) is amended by add6 ing at the end the following new section: 

7 ‘‘SEC. 714. REQUIRED COVERAGE FOR RECONSTRUCTIVE 

8 PROSTHETIC UROLOGY SURGERY FOL9 LOWING PROSTATE CANCER TREATMENT. 

10 ‘‘(a) IN GENERAL.—A group health plan, and a 

11 health insurance issuer providing health insurance cov12 erage in connection with a group health plan, that provides 

13 medical and surgical benefits with respect to prostate can14 cer treatment shall provide, in a case of a participant or 

15 beneficiary who is receiving benefits in connection with 

16 such prostate cancer treatment, coverage for— 

17 ‘‘(1) all stages of reconstructive prosthetic urol18 ogy surgery; and 

19 ‘‘(2) prostheses and physical complications of 

20 prostatectomy; 

21 in a manner determined in consultation with the attending 

22 physician and the patient. Such coverage may be subject 

23 to annual deductibles and coinsurance provisions as may 

24 be deemed appropriate and as are consistent with those 

25 established for other benefits under the plan or coverage. 

26 Written notice of the availability of such coverage shall 


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1 be delivered to the participant upon enrollment and annu2 ally thereafter. 

3 ‘‘(b) NOTICE.—A group health plan, and a health in4 surance issuer providing health insurance coverage in con5 nection with a group health plan shall provide notice to 

6 each participant and beneficiary under such plan regard7 ing the coverage required by this section in accordance 

8 with regulations promulgated by the Secretary. Such no9 tice shall be in writing and prominently positioned in any 

10 literature or correspondence made available or distributed 

11 by the plan or issuer and shall be transmitted— 

12 ‘‘(1) in the next mailing made by the plan or 

13 issuer to the participant or beneficiary; 

14 ‘‘(2) as part of any yearly informational packet 

15 sent to the participant or beneficiary; or 

16 ‘‘(3) not later than January 1, 2008; 

17 whichever is earlier. 

18 ‘‘(c) PROHIBITIONS.—A group health plan, and a 

19 health insurance issuer offering group health insurance 

20 coverage in connection with a group health plan, may 

21 not— 

22 ‘‘(1) deny to a patient eligibility or continued 

23 eligibility, to enroll or to renew coverage under the 

24 terms of the plan, solely for the purposes of avoiding 

25 the requirements of this section; and 


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1 ‘‘(2) penalize or otherwise reduce or limit the 

2 reimbursement of an attending provider, or provide 

3 incentives (monetary or otherwise) to an attending 

4 provider, to induce such provider to provide care to 

5 an individual participant or beneficiary in a manner 

6 inconsistent with this section. 

7 ‘‘(d) RULE OF CONSTRUCTION.—Nothing in this sec8 tion shall be construed to prevent a group health plan or 

9 a health insurance issuer offering group health insurance 

10 coverage from negotiating the level and type of reimburse11 ment with a provider for care provided in accordance with 

12 this section. 

13 ‘‘(e) PREEMPTION, RELATION TO STATE LAWS.— 

14 ‘‘(1) IN GENERAL.—Nothing in this section 

15 shall be construed to preempt any State law in effect 

16 on the date of enactment of this section with respect 

17 to health insurance coverage that requires coverage 

18 of at least the coverage of reconstructive prosthetic 

19 urology surgery otherwise required in this section. 

20 ‘‘(2) ERISA.—Nothing in this section shall be 

21 construed to affect or modify the provisions of sec22 tion 514 with respect to group health plans.’’. 

23 (b) CLERICAL AMENDMENT.—The table of contents 

24 in section 1 of the Employee Retirement Income Security 

25 Act of 1974 (29 U.S.C. 1001 note) is amended by insertVerDate Aug 31 2005 23:49 Apr 19, 2007 Jkt 059200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H1903.IH H1903

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1 ing after the item relating to section 713 the following 

2 new item: 

‘‘Sec. 714. Required coverage for reconstructive prosthetic urology surgery following prostate cancer treatment.’’. 

3 (c) EFFECTIVE DATES.— 

4 (1) IN GENERAL.—The amendments made by 

5 this section shall apply with respect to plan years be6 ginning on or after the first day of the sixth month 

7 beginning after the date of the enactment of this 

8 Act. 

9 (2) SPECIAL RULE FOR COLLECTIVE BAR10 GAINING AGREEMENTS.—In the case of a group 

11 health plan maintained pursuant to 1 or more collec12 tive bargaining agreements between employee rep13 resentative and 1 or more employers, any plan 

14 amendment made pursuant to a collective bargaining 

15 agreement relating to the plan which amends the 

16 plan solely to conform to any requirement added by 

17 this section shall not be treated as a termination of 

18 such collective bargaining agreement. 

19 SEC. 3. AMENDMENTS TO THE PUBLIC HEALTH SERVICE 

20 ACT. 

21 (a) GROUP MARKET.—Subpart 2 of part A of title 

22 XXVII of the Public Health Service Act (42 U.S.C. 

23 300gg-4 et seq.) is amended by adding at the end the fol24 lowing new section: 


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1 ‘‘SEC. 2707. REQUIRED COVERAGE FOR RECONSTRUCTIVE 

2 PROSTHETIC UROLOGY SURGERY FOL3 LOWING PROSTATE CANCER TREATMENT. 

4 ‘‘The provisions of section 714 of the Employee Re5 tirement Income Security Act of 1974 shall apply to group 

6 health plans, and health insurance issuers providing health 

7 insurance coverage in connection with group health plans, 

8 as if included in this subpart.’’. 

9 (b) INDIVIDUAL MARKET.—Subpart 3 of part B of 

10 title XXVII of the Public Health Service Act (42 U.S.C. 

11 300gg–51 et seq.) is amended by adding at the end the 

12 following new section: 

13 ‘‘SEC. 2753. REQUIRED COVERAGE FOR RECONSTRUCTIVE 

14 PROSTHETIC UROLOGY SURGERY FOL15 LOWING PROSTATE CANCER TREATMENT. 

16 ‘‘The provisions of section 2707 of the title shall 

17 apply to health insurance coverage offered by a health in18 surance issuer in the individual market in the same man19 ner as they apply to health insurance coverage offered by 

20 a health insurance issuer in connection with a group 

21 health plan in the small or large group market.’’. 

22 (c) EFFECTIVE DATES.— 

23 (1) GROUP PLANS.— 

24 (A) IN GENERAL.—The amendment made 

25 by subsection (a) shall apply to group health 

26 plans for plan years beginning on or after the 


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1 first day of the sixth month beginning after the 

2 date of the enactment of this Act. 

3 (B) SPECIAL RULE FOR COLLECTIVE BAR4 GAINING AGREEMENT.—In the case of a group 

5 health plan maintained pursuant to 1 or more 

6 collective bargaining agreements between em7 ployee representatives and 1 or more employers, 

8 any plan amendment made pursuant to a collec9 tive bargaining agreement relating to the plan 

10 which amends the plan solely to conform to any 

11 requirement added by the amendment made by 

12 subsection (a) shall not be treated as a termi13 nation of such collective bargaining agreement. 

14 (2) INDIVIDUAL PLANS.—The amendment made 

15 by subsection (b) shall apply with respect to health 

16 insurance coverage offered, sold, issued, renewed, in 

17 effect, or operated in the individual market on or 

18 after the first day of the sixth month beginning after 

19 the date of the enactment of this Act. 

Æ 


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