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[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 5445 Introduced in Senate (IS)]

<DOC>

118th CONGRESS
  2d Session
                                S. 5445

To amend title XVIII of the Social Security Act to provide coverage of 
contraceptive items and services at no cost-sharing under the Medicare 
                    program, and for other purposes.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                            December 5, 2024

Ms. Hassan (for herself, Ms. Murkowski, Ms. Duckworth, and Ms. Collins) 
introduced the following bill; which was read twice and referred to the 
                          Committee on Finance

_______________________________________________________________________

                                 A BILL

 
To amend title XVIII of the Social Security Act to provide coverage of 
contraceptive items and services at no cost-sharing under the Medicare 
                    program, and for other purposes.

    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 ``Closing the Contraception Coverage 
Gap Act''.

SEC. 2. PROVIDING COVERAGE OF CONTRACEPTIVE ITEMS AND SERVICES AT NO 
              COST-SHARING UNDER THE MEDICARE PROGRAM.

    (a) Part B Coverage.--
            (1) In general.--Section 1861 of the Social Security Act 
        (42 U.S.C. 1395x) is amended--
                    (A) in subsection (s)(2)--
                            (i) in subparagraph (JJ), by inserting 
                        ``and'' after the semicolon at the end; and
                            (ii) by adding at the end the following new 
                        subparagraph:
            ``(KK) contraceptive items and services (as defined in 
        subsection (nnn)) furnished to individuals on or after January 
        1, 2026.''; and
                    (B) by adding at the end the following new 
                subsection:
    ``(nnn) Contraceptive Items and Services.--
            ``(1) In general.--The term `contraceptive items and 
        services' means items and services furnished by a physician or 
        practitioner (as defined in section 1842(b)(18)(C))--
                    ``(A) that--
                            ``(i) align with guidance as of January 12, 
                        2022, issued in accordance with in section 
                        2713(a)(4) of the Public Health Service Act 
                        (including patient-centered counseling 
                        services); and
                            ``(ii) may be furnished for the purpose of 
                        contraception; or
                    ``(B) that are ancillary clinical services.
            ``(2) Ancillary clinical services.--For purposes of 
        paragraph (1)(B), the term `ancillary clinical services' 
        means--
                    ``(A) clinical services that are related to the 
                items and services described in paragraph (1)(A), 
                including consultations, examinations, procedures, 
                device insertion, ultrasound, pain management, patient 
                education, referrals, and counseling; and
                    ``(B) follow-up services related to the provision 
                or use of the items and services described in paragraph 
                (1)(A), including management of side effects, 
                counseling for continued adherence, and device removal.
            ``(3) Clarification.--The term `contraceptive items and 
        services' includes items and services described in paragraph 
        (1) regardless of whether such items and services are actually 
        furnished for purposes of contraception.
            ``(4) Patient-centered counseling services.--For purposes 
        of paragraph (1)(A), the Secretary shall issue guidance 
        regarding the coverage of patient-centered counseling. Such 
        guidance shall--
                    ``(A) align with guidance as of January 12, 2022, 
                issued in accordance with section 2713(a)(4) of the 
                Public Health Service Act.; and
                    ``(B) include the coverage of counseling to all 
                patients on the full range of contraceptive items and 
                services described in paragraph (1).''.
            (2) Payment.--Section 1833 of the Social Security Act (42 
        U.S.C. 1395l) is amended--
                    (A) in subsection (a)(1)--
                            (i) by striking ``and'' before ``(HH)''; 
                        and
                            (ii) by inserting the following before the 
                        semicolon: ``and (II) with respect to 
                        contraceptive items and services (as defined in 
                        section 1861(nnn)), the amount paid shall be an 
                        amount equal to 100 percent of the lesser of 
                        the actual charge for the items and services or 
                        the amount determined under a payment basis 
                        determined appropriate by the Secretary''; and
                    (B) in subsection (b), in the first sentence--
                            (i) by striking ``, and (13)'' and 
                        inserting ``(13)''; and
                            (ii) by striking ``1861(n)..'' and 
                        inserting ``1861(n) , and (14) such deductible 
                        shall not apply with respect to contraceptive 
                        items and services (as defined in section 
                        1861(nnn)).''.
            (3) Exclusion modification.--Section 1862(a)(1) of the 
        Social Security Act (42 U.S.C. 1395y(a)(1)) is amended--
                    (A) in subparagraph (O), by striking ``and'' at the 
                end;
                    (B) in subparagraph (P), by striking the semicolon 
                and inserting ``, and''; and
                    (C) by adding at the end the following new 
                subparagraph:
            ``(Q) in the case of contraceptive items and services (as 
        defined in section 1861(nnn)), which are not furnished or 
        ordered by a physician or practitioner (as defined in section 
        1842(b)(18)(C));''.
            (4) Quality measures.--The Secretary of Health and Human 
        Services may, for the purposes of ensuring quality in services, 
        develop measures of contraceptive counseling, care, and access, 
        including but not limited to validated survey instruments.
    (b) Part C Cost-Sharing for Contraceptive Items and Services.--
            (1) In general.--Section 1852(a)(1)(B) of the Social 
        Security Act (42 U.S.C. 1395w-22(a)(1)(B)) is amended--
                    (A) in clause (iv)--
                            (i) by redesignating subclause (VIII) as 
                        subclause (IX); and
                            (ii) by inserting after subclause (VII) the 
                        following new subclause:
                                    ``(VIII) Contraceptive items and 
                                services (as defined in section 
                                1861(nnn)).''; and
                    (B) in clause (v), by striking ``and (VI)'' and 
                inserting ``(VI), and (VIII)''.
            (2) Effective date.--The amendments made by this subsection 
        shall apply with respect to plan years beginning on or after 
        January 1, 2026.
    (c) Part D Coverage and Cost-Sharing for Contraceptive Drugs.--
            (1) Coverage.--Section 1860D-4(b)(3)(G) of the Social 
        Security Act (42 U.S.C. 1395w-104(b)(3)(G)) is amended--
                    (A) in clause (ii)(I), by adding at the end the 
                following new sentence: ``Such identification shall 
                include the drugs described in clause (iv)(VII).''; and
                    (B) in clause (iv), by adding at the end the 
                following new subclause:
                                    ``(VII) Covered part D drugs 
                                described in guidelines issued pursuant 
                                to section 2713(a)(4) of the Public 
                                Health Service Act and that may be 
                                furnished for purposes of contraception 
                                (regardless of whether such drugs are 
                                actually furnished for purposes of 
                                contraception).''.
            (2) Cost-sharing.--Section 1860D-2 of the Social Security 
        Act (42 U.S.C. 1395w-102) is amended--
                    (A) in subsection (b)--
                            (i) in paragraph (1)(A), in the matter 
                        preceding clause (i), by striking ``and (9)'' 
                        and inserting ``, (9), and (10)'';
                            (ii) in paragraph (2)(A), in the matter 
                        preceding clause (i), by striking ``and (9)'' 
                        and inserting ``, (9), and (10)'';
                            (iii) in paragraph (3)(A), in the matter 
                        preceding clause (i), by striking ``and (9)'' 
                        and inserting ``(9), and (10)''; and
                            (iv) by adding at the end the following new 
                        paragraph:
            ``(10) Treatment of cost-sharing for contraceptive drugs.--
        For plan years beginning on or after January 1, 2026, with 
        respect to a covered part D drug that is described in 
        guidelines issued pursuant to section 2713(a)(4) of the Public 
        Health Service Act and that may be furnished for purposes of 
        contraception (regardless of whether such drug is actually 
        furnished for purposes of contraception)--
                    ``(A) the deductible under paragraph (1) shall not 
                apply; and
                    ``(B) there shall be no coinsurance or other cost-
                sharing under this part with respect to such drug.''; 
                and
                    (B) in subsection (c), by adding at the end the 
                following new paragraph:
            ``(7) Treatment of cost-sharing for contraceptive drugs.--
        The coverage is provided in accordance with subsection 
        (b)(10).''.
            (3) Conforming amendments to cost-sharing for low-income 
        individuals.--Section 1860D-14(a) of the Social Security Act 
        (42 U.S.C. 1395w-114(a)) is amended--
                    (A) in paragraph (1)(D), in each of clauses (ii) 
                and (iii), by striking ``paragraph (6)'' and inserting 
                ``paragraphs (6) and (7)'';
                    (B) in paragraph (2)--
                            (i) in subparagraph (B), by striking ``and 
                        (9)'' and inserting ``, (9), and (10)'';
                            (ii) in subparagraph (D), by striking 
                        ``paragraph (6)'' and inserting ``paragraphs 
                        (6) and (7)''; and
                            (iii) in subparagraph (E), by striking 
                        ``paragraph (6)'' and inserting ``paragraphs 
                        (6) and (7)''; and
                    (C) by adding at the end the following new 
                paragraph:
            ``(7) No application of cost-sharing or deductible for 
        contraceptive drugs.--For plan years beginning on or after 
        January 1, 2026, with respect to a covered part D drug that is 
        described in guidelines issued pursuant to section 2713(a)(4) 
        of the Public Health Service Act and that is furnished for 
        purposes of contraception--
                    ``(A) the deductible under section 1860D-2(b)(1) 
                shall not apply; and
                    ``(B) there shall be no cost-sharing under this 
                section with respect to such drug.''.
            (4) Effective date.--The amendments made by this subsection 
        shall apply with respect to plan years beginning on or after 
        January 1, 2026.
    (d) Ensuring Comparable Coverage for Dual Eligible Individuals.--In 
implementing the amendments made by this section, the Secretary of 
Health and Human Services shall ensure that the coverage of 
contraceptive items and services (as defined in section 1861(nnn) of 
the Social Security Act (as added by subsection (a)) and covered part D 
drugs described in section 1860D-4(b)(3)(G)(VII) of such Act (as added 
by subsection (c)(1)) with respect to individuals who are dually 
eligible for benefits under the Medicare program under title XVIII of 
such Act and for medical assistance under a State plan under title XIX 
of such Act (or a waiver of such plan) is at least as comprehensive as 
the coverage of such items and services and drugs for such individuals 
under such State plans (or waivers of such plans), as determined by the 
Secretary based on an annual review of such State plans (and waivers of 
such plans).

SEC. 3. HHS STUDY AND REPORT ON PRESCRIPTION DRUG COVERAGE FOR MEDICARE 
              BENEFICIARIES LIVING WITH DISABILITIES.

    (a) Study.--The Secretary of Health and Human Services (in this 
section referred to as the ``Secretary'') shall conduct a study on--
            (1) the adequacy of access to prescription drug coverage, 
        including oral contraceptives, among Medicare beneficiaries 
        living with disabilities who are enrolled under the original 
        Medicare fee-for-service program under parts A and B of title 
        XVIII of the Social Security Act (but not enrolled under part C 
        or D of such title XVIII); and
            (2) providing coverage of over-the-counter contraceptive 
        drugs under the Medicare program under such title XVIII with no 
        cost-sharing.
    (b) Report.--Not later than 1 year after the date of enactment of 
this Act, the Secretary shall submit to Congress a report on the study 
conducted under subsection (a), together with recommendations for such 
legislation and administrative action as the Secretary determines 
appropriate.

SEC. 4. GAO STUDY AND REPORT ON CONTRACEPTIVE COVERAGE REQUIREMENTS 
              UNDER COMMERCIAL AND PUBLIC HEALTH PLANS.

    (a) Study.--The Comptroller General of the United States (in this 
section referred to as the ``Comptroller General'') shall conduct a 
study on the forms of health insurance (including commercial plans and 
public health programs (including Medicaid, Medicare, and TRICARE)), 
that are not required by State or Federal law to do one or both of the 
following:
            (1) Cover all forms of contraception approved by the Food 
        and Drug Administration.
            (2) Waive cost-sharing for such contraception.
    (b) Report.--Not later than 1 year after the date of enactment of 
this Act, the Comptroller General shall submit to Congress a report on 
the study conducted under subsection (a), together with recommendations 
for such legislation and administrative action as the Comptroller 
General determines appropriate.

SEC. 5. GAO STUDY AND REPORT ON DIFFERENCE IN COVERAGE OF CONTRACEPTIVE 
              ITEMS AND SERVICES FOR DUAL ELIGIBLES.

    (a) Study.--The Comptroller General of the United States (in this 
section referred to as the ``Comptroller General'') shall conduct a 
study on the difference in coverage of contraceptive items and services 
for individuals who are dually eligible for Medicare and Medicaid 
benefits.
    (b) Report.--Not later than 2 years after the date of enactment of 
this Act, the Comptroller General shall submit to Congress a report on 
the study conducted under subsection (a), together with recommendations 
for such legislation and administrative action as the Secretary 
determines appropriate.
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