I 

114TH CONGRESS 

2D SESSION H. R. 4989 

To amend title XIX of the Social Security Act to require States to provide 

cranial prostheses under the Medicaid program when a physician finds 

such treatment necessary for individuals affected by diseases and medical 

conditions that cause hair loss. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 18, 2016 

Ms. ROS-LEHTINEN (for herself, Ms. ESHOO, Mr. LOBIONDO, Mr. HUFFMAN, 

Ms. SPEIER, and Mr. ELLISON) introduced the following bill; which was 

referred to the Committee on Energy and Commerce 

A BILL 

To amend title XIX of the Social Security Act to require 

States to provide cranial prostheses under the Medicaid 

program when a physician finds such treatment necessary for individuals affected by diseases and medical 

conditions that cause hair loss. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Cranial Prosthetic 

5 Medicaid Coverage Enhancement Act’’. 

6 SEC. 2. FINDINGS. 

7 The Congress finds as follows: 


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•HR 4989 IH

1 (1) Individuals chronically affected by hair loss 

2 due to diseases, such as the autoimmune skin condi3 tion alopecia areata, as well as individuals affected 

4 by acute hair loss due to chemotherapy or medical 

5 intervention face significant biological, social, and 

6 psychological health challenges. 

7 (2) Dermatologists, oncologists, and other 

8 qualified medical professionals consider cranial pros9 thetics to be a medically necessary option when 

10 treating individuals suffering from chronic, acute, or 

11 cyclical hair loss caused by a medical condition. 

12 (3) The cost of a cranial prosthetic can rep13 resent a significant financial burden for Medicaid 

14 program beneficiaries and coverage benefits across 

15 States are currently inconsistent and, in many cases, 

16 nonexistent. 

17 (4) While children participating in the Medicaid 

18 program are often significantly impacted by the ad19 ditional health effects caused by medical condition20 related hair loss, inequitable and inconsistent cov21 erage benefits for cranial prosthetics means they can 

22 face serious difficulty accessing treatment, even with 

23 the assistance of a healthcare professional. 


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•HR 4989 IH

1 SEC. 3. IMPROVEMENT OF CRANIAL PROSTHESES COV2 ERAGE UNDER MEDICAID. 

3 (a) IN GENERAL.—Section 1902(a)(10) of the Social 

4 Security Act (42 U.S.C. 1396a(a)(10)) is amended— 

5 (1) in subparagraph (F), at the end by striking 

6 ‘‘and’’; 

7 (2) in subparagraph (G), at the end by adding 

8 ‘‘and’’; and 

9 (3) by inserting after subparagraph (G) the fol10 lowing new subparagraph: 

11 ‘‘(H) that if medical assistance is included 

12 for inpatient hospital services for an individual, 

13 then the plan must include making medical as14 sistance available to the individual for biennial 

15 coverage of one cranial prosthesis with a benefit 

16 up to $400 if the dermatologist, oncologist, or 

17 attending physician of the individual certifies in 

18 writing the medical necessity of that proposed 

19 course of rehabilitative treatment;’’. 

20 (b) EFFECTIVE DATE.—The amendments made by 

21 subsection (a) shall apply with respect to items and serv22 ices furnished on or after January 1, 2017, without regard 

23 to whether or not final regulations to carry out such 

24 amendments have been promulgated by such date. 

Æ 


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