I
107TH CONGRESS
2D SESSION
H. R. 5106
To provide for coverage of scalp hair prosthesis for individuals who have
scalp hair loss as a result of alopecia areata under the Medicare and
Medicaid Programs, State children’s health insurance program (SCHIP),
Federal employees health benefits program (FEHBP), veterans health
care programs, TRICARE, and Indian Health Service (IHS).
IN THE HOUSE OF REPRESENTATIVES
JULY 11, 2002
Ms. RIVERS introduced the following bill; which was referred to the Committee
on Energy and Commerce, and in addition to the Committees on Ways
and Means, Government Reform, Veterans’ Affairs, Armed Services, and
Resources, for a period to be subsequently determined by the Speaker,
in each case for consideration of such provisions as fall within the juris-
diction of the committee concerned
A BILL
To provide for coverage of scalp hair prosthesis for individ-
uals who have scalp hair loss as a result of alopecia
areata under the Medicare and Medicaid Programs, State
children’s health insurance program (SCHIP), Federal
employees health benefits program (FEHBP), veterans
health care programs, TRICARE, and Indian Health
Service (IHS).
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Alopecia Fairness Expansion Act of 2002’’.
(b) TABLE OF CONTENTS.—The table of contents of
this Act is as follows:
Sec. 1. Short title.
Sec. 2. Medicare coverage of scalp hair prosthesis for individuals who have
scalp hair loss as a result of alopecia areata.
Sec. 3. Medicaid coverage of scalp hair prosthesis for individuals who have
scalp hair loss as a result of alopecia areata.
Sec. 4. SCHIP coverage of scalp hair prosthesis for individuals who have scalp
hair loss as a result of alopecia areata.
Sec. 5. FEHBP coverage of scalp hair prosthesis for individuals who have scalp
hair loss as a result of alopecia areata.
Sec. 6. Veterans’ coverage of scalp hair prosthesis for individuals who have
scalp hair loss as a result of alopecia areata.
Sec. 7. TRICARE coverage of scalp hair prosthesis for individuals who have
scalp hair loss as a result of alopecia areata.
Sec. 8. IHS coverage of scalp hair prosthesis for individuals who have scalp
hair loss as a result of alopecia areata.
SEC. 2. MEDICARE COVERAGE OF SCALP HAIR PROSTHESIS
FOR INDIVIDUALS WHO HAVE SCALP HAIR
LOSS AS A RESULT OF ALOPECIA AREATA.
(a) IN GENERAL.—Section 1861(s)(2) of the Social
Security Act (42 U.S.C. 1395x(s)(2)) is amended—
(1) by striking ‘‘and’’ at the end of subpara-
graph (U);
(2) by adding ‘‘and’’ at the end of subpara-
graph (V); and
(3) by adding at the end the following new sub-
paragraph:
‘‘(W) scalp hair prosthesis (which may include
artificial substitutes for scalp hair) for an individual
who has scalp hair loss as a result of alopecia areata
if the attending physician of the individual certifies
in writing the medical necessity of that proposed
course of rehabilitative treatment;’’.
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) shall apply to items furnished on or after
July 1, 2003.
SEC. 3. MEDICAID COVERAGE OF SCALP HAIR PROSTHESIS
FOR INDIVIDUALS WHO HAVE SCALP HAIR
LOSS AS A RESULT OF ALOPECIA AREATA.
(a) IN GENERAL.—Section 1905(a) of the Social Se-
curity Act (42 U.S.C. 1396d(a)) is amended—
(1) by striking ‘‘and’’ at the end of paragraph
(26);
(2) by redesignating paragraph (27) as para-
graph (28); and
(3) by inserting after paragraph (26) the fol-
lowing new paragraph:
‘‘(27) scalp hair prosthesis (which may include
artificial substitutes for scalp hair) for an individual
who has scalp hair loss as a result of alopecia areata
if the attending physician of the individual certifies
in writing the medical necessity of that proposed
course of rehabilitative treatment; and’’.
(b) EFFECTIVE DATE.—(1) Except as provided in
paragraph (2), the amendments made by subsection (a)
apply to calendar quarters beginning on or after July 1,
2003, without regard to whether or not final regulations
to carry out such amendments have been promulgated by
such date.
(2) In the case of a State plan for medical assistance
under title XIX of the Social Security Act which the Sec-
retary of Health and Human Services determines requires
State legislation (other than legislation appropriating
funds) in order for the plan to meet the additional require-
ment imposed by the amendment made by subsection (a),
the State plan shall not be regarded as failing to comply
with the requirements of such title solely on the basis of
its failure to meet this 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 the enactment of this Act.
For purposes of the previous sentence, in the case of a
State that has a 2-year legislative session, each year of
such session shall be deemed to be a separate regular ses-
sion of the State legislature.
SEC. 4. SCHIP COVERAGE OF SCALP HAIR PROSTHESIS FOR
INDIVIDUALS WHO HAVE SCALP HAIR LOSS
AS A RESULT OF ALOPECIA AREATA.
(a) IN GENERAL.—Section 2103(a) of the Social Se-
curity Act (42 U.S.C. 1397cc(a)) is amended by adding
after and below paragraph (4) the following:
‘‘No coverage may be approved under this section
unless the coverage provides benefits for scalp hair
prosthesis (which may include artificial substitutes
for scalp hair) for an individual who has scalp hair
loss as a result of alopecia areata if the attending
physician of the individual certifies in writing the
medical necessity of that proposed course of rehabili-
tative treatment.’’.
(b) EFFECTIVE DATE.—(1) Except as provided in
paragraph (2), the amendments made by subsection (a)
apply to calendar quarters beginning on or after July 1,
2003, without regard to whether or not final regulations
to carry out such amendments have been promulgated by
such date.
(2) In the case of a State plan for medical assistance
under title XIX of the Social Security Act which the Sec-
retary of Health and Human Services determines requires
State legislation (other than legislation appropriating
funds) in order for the plan to meet the additional require-
ment imposed by the amendment made by subsection (a),
the State plan shall not be regarded as failing to comply
with the requirements of such title solely on the basis of
its failure to meet this 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 the enactment of this Act.
For purposes of the previous sentence, in the case of a
State that has a 2-year legislative session, each year of
such session shall be deemed to be a separate regular ses-
sion of the State legislature.
SEC. 5. FEHBP COVERAGE OF SCALP HAIR PROSTHESIS
FOR INDIVIDUALS WHO HAVE SCALP HAIR
LOSS AS A RESULT OF ALOPECIA AREATA.
(a) IN GENERAL.—Section 8902 of title 5, United
States Code, is amended by adding at the end the fol-
lowing:
‘‘(p)(1) A contract may not be made or a plan ap-
proved which does not include coverage for scalp hair pros-
thesis (which may include artificial substitutes for scalp
hair) for an individual who has scalp hair loss as a result
of alopecia areata if the attending physician of the indi-
vidual certifies in writing the medical necessity of that
proposed course of rehabilitative treatment.
‘‘(2) The coverage required under this subsection is
not subject to dollar limits, deductibles, and coinsurance
provisions that are less favorable than those for other
prosthesis coverage under a health benefits plan, except
that a plan may provide that the plan will only pay for
80 percent of the customary and usual costs of the scalp
hair prosthesis exclusive of any deductible.’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) shall apply with respect to items furnished
on or after January 1, 2004.
SEC. 6. VETERANS’ COVERAGE OF SCALP HAIR PROSTHESIS
FOR INDIVIDUALS WHO HAVE SCALP HAIR
LOSS AS A RESULT OF ALOPECIA AREATA.
(a) IN GENERAL.—Section 1701(6) of title 38,
United States Code, is amended by adding at the end the
following new subparagraph:
‘‘(G) Scalp hair prosthesis (which may include
artificial substitutes for scalp hair) for a person who
has scalp hair loss as a result of alopecia areata;’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) shall apply to items furnished on or after
October 1, 2002.
SEC. 7. TRICARE COVERAGE OF SCALP HAIR PROSTHESIS
FOR INDIVIDUALS WHO HAVE SCALP HAIR
LOSS AS A RESULT OF ALOPECIA AREATA.
(a) IN GENERAL.—Section 1074c of title 10, United
States Code, is amended by striking ‘‘resulting from the
treatment of a malignant disease’’ and inserting ‘‘(includ-
ing alopecia resulting from the treatment of a malignant
disease)’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) shall apply with respect to items furnished
on or after October 1, 2002.
SEC. 8. IHS COVERAGE OF SCALP HAIR PROSTHESIS FOR
INDIVIDUALS WHO HAVE SCALP HAIR LOSS
AS A RESULT OF ALOPECIA AREATA.
(a) IN GENERAL.—The Indian Health Care Improve-
ment Act (25 U.S.C. 1601 et seq.) is amended by inserting
after section 225 the following new section:
‘‘SCALP HAIR PROSTHESIS
‘‘SEC. 226. The Secretary, through the Service, shall
provide scalp hair prosthesis (which may include artificial
substitutes for scalp hair) for an Indian who has scalp
hair loss as a result of alopecia areata if the attending
physician of the Indian certifies in writing the medical ne-
cessity of that proposed course of rehabilitative treat-
ment.’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) shall apply with respect to items furnished
on or after January 1, 2003.
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