I
107TH CONGRESS
2D SESSION
H. R. 5204
To provide for coverage of hormone replacement therapy and alternative
treatments for hormone replacement therapy (HRT) under the Medicare
and Medicaid programs, group health plans and individual health insur-
ance coverage, and other Federal health insurance programs.
IN THE HOUSE OF REPRESENTATIVES
JULY 24, 2002
Ms. LEE 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, Government Reform, Veterans’
Affairs, and Armed Services, 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 provide for coverage of hormone replacement therapy
and alternative treatments for hormone replacement ther-
apy (HRT) under the Medicare and Medicaid programs,
group health plans and individual health insurance cov-
erage, and other Federal health insurance programs.
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
‘‘Hormone Replacement Therapy Alternative Treatment
Fairness Act’’.
(b) TABLE OF CONTENTS.—The table of contents of
this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings.
Sec. 3. Medicare coverage of hormone replacement therapy and alternative
treatments for hormone replacement therapy.
Sec. 4. Medicaid coverage of alternative treatments for hormone replacement
therapy.
Sec. 5. Coverage of hormone replacement therapy and alternative treatments
for hormone replacement therapy under group health plans and
individual health insurance coverage.
Sec. 6. Coverage of alternative treatments for hormone replacement therapy
under FEHBP.
Sec. 7. Coverage of alternative treatments for hormone replacement therapy
under veterans’ benefits.
Sec. 8. Coverage of alternative treatments for hormone replacement therapy
under TRICARE.
SEC. 2. FINDINGS.
Congress finds the following:
(1) 50 million women in the United States suf-
fer from symptoms or conditions related to meno-
pause, including osteoporosis, hot flashes, heart dis-
ease, and depression.
(2) The Women’s Health Initiative terminated
its study on the synthetic version of hormone re-
placement therapy (HRT) three years early due to
findings that the combination of estrogen and pro-
gestin increases the risk of heart disease, stroke,
blood clots, and breast cancer.
(3) Only 35 percent of women in the United
States who are undergoing menopause take pre-
scribed synthetic HRT for treatment of menopausal
symptoms.
(4) Natural estrogen and progestin, which may
not be available by prescription, could be useful in
treating menopause symptoms and related condi-
tions.
(5) 33 percent of women in the United States
who are undergoing menopause routinely use alter-
native treatments for menopausal symptoms, such as
Soy, Black Cohosh, Chasteberry, Pro-Gest, Hops,
Red Clover, Dong Quai, Evening Primose Oil, Vita-
min E, Flax Seed Oil, Ginseng, and natural DHEA.
(6) Women deserve relief from ailments relating
to menopause.
(7) Government insurance programs such as
medicare, medicaid, the Federal Employees Health
Benefits Program (FEHBP), and the Department
of Veterans’ Affairs do not cover non-prescription al-
ternative HRT treatments.
(8) Most private insurance does not cover non-
prescription alternative HRT treatments.
SEC. 3. MEDICARE COVERAGE OF HORMONE REPLACE-
MENT THERAPY AND ALTERNATIVE TREAT-
MENTS FOR HORMONE REPLACEMENT THER-
APY.
(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)(i) hormone replacement therapy for treat-
ment of menopausal symptoms and (ii) an alter-
native therapy for hormone replacement therapy for
treatment of menopausal symptoms if the therapy is
recommended by a health care provider who is li-
censed, accredited, or certified under State law and
if it has been proven safe and effective in peer-re-
viewed scientific studies;’’.
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) shall apply to therapies furnished on or
after the date of the enactment of this Act.
SEC. 4. MEDICAID COVERAGE OF ALTERNATIVE TREAT-
MENTS FOR HORMONE REPLACEMENT THER-
APY.
(a) 
REQUIREMENT
FOR
COVERAGE.—Section
1902(a)(10) of the Social Security Act (42 U.S.C.
1396a(a)(10)) is amended—
(1) in subparagraph (A) in the matter before
clause (i), by striking ‘‘and (21)’’ and inserting ‘‘,
(21), and (27)’’; and
(2) in subparagraph (C)(iv)—
(A) by striking ‘‘and (17)’’ and inserting
‘‘, (17), and (27)’’; and
(B) by striking ‘‘through (24)’’ and insert-
ing ‘‘through (27)’’.
(b) DESCRIPTION OF COVERED THERAPIES.—Sec-
tion 1905(a) of such 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) an alternative therapy for hormone re-
placement therapy for treatment of menopausal
symptoms if the therapy is recommended by a health
care provider who is licensed, accredited, or certified
under State law and if it has been proven safe and
effective in peer-reviewed scientific studies; and’’.
(c) EFFECTIVE DATE.—The amendments made by
this section apply to therapies furnished on or after the
date of the enactment of this Act, without regard to
whether or not final regulations to carry out such amend-
ments have been promulgated by such date.
SEC. 5. COVERAGE OF HORMONE REPLACEMENT THERAPY
AND ALTERNATIVE TREATMENTS FOR HOR-
MONE 
REPLACEMENT 
THERAPY 
UNDER
GROUP HEALTH PLANS AND INDIVIDUAL
HEALTH INSURANCE COVERAGE.
(a) GROUP HEALTH PLANS.—
(1) PUBLIC
HEALTH
SERVICE
ACT
AMEND-
MENTS.—(A) Subpart 2 of part A of title XXVII of
the Public Health Service Act is amended by adding
at the end the following new section:
‘‘SEC. 2707. STANDARD RELATING TO COVERAGE OF HOR-
MONE REPLACEMENT THERAPY AND ALTER-
NATIVE TREATMENTS FOR HORMONE RE-
PLACEMENT THERAPY.
‘‘(a) REQUIREMENTS.—
‘‘(1) HORMONE REPLACEMENT THERAPY.—If a
group health plan, or a health insurance issuer offer-
ing group health insurance coverage, provides bene-
fits for outpatient prescription drugs, the plan or
coverage may not exclude or restrict benefits for
hormone replacement therapy for treatment of men-
opausal symptoms.
‘‘(2) ALTERNATIVE
TREATMENTS
FOR
HOR-
MONE REPLACEMENT THERAPY.—If a group health
plan, or a health insurance issuer offering group
health insurance coverage, provides benefits for hor-
mone replacement therapy for treatment of meno-
pausal symptoms, the plan or coverage may not ex-
clude or restrict benefits for an alternative therapy
for hormone replacement therapy for treatment of
menopausal symptoms if—
‘‘(A) the therapy is recommended by a
health care provider who is licensed, accredited,
or certified under State law; and
‘‘(B) it has been proven safe and effective
in peer-reviewed scientific studies.
‘‘(b) NOTICE.—A group health plan under this part
shall comply with the notice requirement under section
714(b) of the Employee Retirement Income Security Act
of 1974 with respect to the requirements of this section
as if such section applied to such plan.’’.
(B) Section 2723(c) of such Act (42 U.S.C.
300gg–23(c)) is amended by striking ‘‘section 2704’’
and inserting ‘‘sections 2704 and 2707’’.
(2) ERISA AMENDMENTS.—(A) Subpart B of
part 7 of subtitle B of title I of the Employee Re-
tirement Income Security Act of 1974 is amended by
adding at the end the following new section:
‘‘SEC. 714. STANDARD RELATING TO COVERAGE OF HOR-
MONE REPLACEMENT THERAPY AND ALTER-
NATIVE TREATMENTS FOR HORMONE RE-
PLACEMENT THERAPY.
‘‘(a) REQUIREMENTS.—
‘‘(1) HORMONE REPLACEMENT THERAPY.—If a
group health plan, or a health insurance issuer offer-
ing group health insurance coverage, provides bene-
fits for outpatient prescription drugs, the plan or
coverage may not exclude or restrict benefits for
hormone replacement therapy for treatment of men-
opausal symptoms.
‘‘(2) ALTERNATIVE
TREATMENTS
FOR
HOR-
MONE REPLACEMENT THERAPY.—If a group health
plan, or a health insurance issuer offering group
health insurance coverage, provides benefits for hor-
mone replacement therapy for treatment of meno-
pausal symptoms, the plan or coverage may not ex-
clude or restrict benefits for an alternative therapy
for hormone replacement therapy for treatment of
menopausal symptoms if—
‘‘(A) the therapy is recommended by a
health care provider who is licensed, accredited,
or certified under State law; and
‘‘(B) it has been proven safe and effective
in peer-reviewed scientific studies.
‘‘(b) NOTICE UNDER GROUP HEALTH PLAN.—The
imposition of the requirement of this section shall be treat-
ed as a material modification in the terms of the plan de-
scribed in section 102(a)(1), for purposes of assuring no-
tice of such requirements under the plan; except that the
summary description required to be provided under the
last sentence of section 104(b)(1) with respect to such
modification shall be provided by not later than 60 days
after the first day of the first plan year in which such
requirement apply.’’.
(B) Section 731(c) of such Act (29 U.S.C.
1191(c)) is amended by striking ‘‘section 711’’ and
inserting ‘‘sections 711 and 714’’.
(C) Section 732(a) of such Act (29 U.S.C.
1191a(a)) is amended by striking ‘‘section 711’’ and
inserting ‘‘sections 711 and 714’’.
(D) The table of contents in section 1 of such
Act is amended by inserting after the item relating
to section 713 the following new item:
‘‘Sec. 714. Standard relating to coverage of hormone replacement therapy and
alternative treatments for hormone replacement therapy.’’.
(3) 
INTERNAL
REVENUE
CODE
AMEND-
MENTS.—
(A) IN GENERAL.—Subchapter B of chap-
ter 100 of the Internal Revenue Code of 1986
is amended—
(i) in the table of sections, by insert-
ing after the item relating to section 9812
the following new item:
‘‘Sec. 9813. Standard relating to coverage of hormone replace-
ment therapy and alternative treatments for hor-
mone replacement therapy.’’;
and
(ii) by inserting after section 9812 the
following:
‘‘SEC. 9813. STANDARD RELATING TO COVERAGE OF HOR-
MONE REPLACEMENT THERAPY AND ALTER-
NATIVE TREATMENTS FOR HORMONE RE-
PLACEMENT THERAPY.
‘‘(a) HORMONE
REPLACEMENT
THERAPY.—If a
group health plan provides benefits for outpatient pre-
scription drugs, the plan may not exclude or restrict bene-
fits for hormone replacement therapy for treatment of
menopausal symptoms.
‘‘(b) ALTERNATIVE TREATMENTS
FOR HORMONE
REPLACEMENT THERAPY.—If a group health plan pro-
vides benefits for hormone replacement therapy for treat-
ment of menopausal symptoms, the plan may not exclude
or restrict benefits for an alternative therapy for hormone
replacement therapy for treatment of menopausal symp-
toms if—
‘‘(1) the therapy is recommended by a health
care provider who is licensed, accredited, or certified
under State law; and
‘‘(2) it has been proven safe and effective in
peer-reviewed scientific studies.’’
(B) CONFORMING
AMENDMENT.—Section
4980D(d)(1) of such Code is amended by strik-
ing ‘‘section 9811’’ and inserting ‘‘sections
9811 and 9813’’.
(b) INDIVIDUAL HEALTH INSURANCE.—(1) Part B
of title XXVII of the Public Health Service Act is amend-
ed by inserting after section 2752 the following new sec-
tion:
‘‘SEC. 2753. STANDARD RELATING TO COVERAGE OF HOR-
MONE REPLACEMENT THERAPY AND ALTER-
NATIVE TREATMENTS FOR HORMONE RE-
PLACEMENT THERAPY.
‘‘(a) IN
GENERAL.—The provisions of section
2707(a) shall apply to health insurance coverage offered
by a health insurance issuer in the individual market in
the same manner as they apply to health insurance cov-
erage offered by a health insurance issuer in connection
with a group health plan in the small or large group mar-
ket.
‘‘(b) NOTICE.—A health insurance issuer under this
part shall comply with the notice requirement under sec-
tion 714(b) of the Employee Retirement Income Security
Act of 1974 with respect to the requirements referred to
in subsection (a) as if such section applied to such issuer
and such issuer were a group health plan.’’.
(2) Section 2762(b)(2) of such Act (42 U.S.C.
300gg–62(b)(2)) is amended by striking ‘‘section 2751’’
and inserting ‘‘sections 2751 and 2753’’.
(c) EFFECTIVE DATE.—The amendments made by
this section shall apply with respect to therapies furnished
on or after the date of the enactment of this Act.
(d) COORDINATION OF ADMINISTRATION.—The Sec-
retary of Labor, the Secretary of the Treasury, and the
Secretary of Health and Human Services shall ensure,
through the execution of an interagency memorandum of
understanding among such Secretaries, that—
(1) regulations, rulings, and interpretations
issued by such Secretaries relating to the same mat-
ter over which two or more such Secretaries have re-
sponsibility under the provisions of this section (and
the amendments made thereby) are administered so
as to have the same effect at all times; and
(2) coordination of policies relating to enforcing
the same requirements through such Secretaries in
order to have a coordinated enforcement strategy
that avoids duplication of enforcement efforts and
assigns priorities in enforcement.
SEC. 6. COVERAGE OF HORMONE REPLACEMENT THERAPY
AND ALTERNATIVE TREATMENTS FOR HOR-
MONE 
REPLACEMENT 
THERAPY 
UNDER
FEHBP.
(a) IN GENERAL.—Section 8902 of title 5, United
States Code, is amended by adding at the end the fol-
lowing new subsection:
‘‘(p)(1) If a contract or plan provides benefits for out-
patient prescription drugs, the contract or plan may not
exclude or restrict benefits for hormone replacement ther-
apy for treatment of menopausal symptoms.
‘‘(2) If a contract or plan provides benefits for hor-
mone replacement therapy for treatment of menopausal
symptoms, the contract or plan may not exclude or restrict
benefits for an alternative therapy for hormone replace-
ment therapy for treatment of menopausal symptoms if—
‘‘(A) the therapy is recommended by a health
care provider who is licensed, accredited, or certified
under State law; and
‘‘(B) it has been proven safe and effective in
peer-reviewed scientific studies.’’.
(b) EFFECTIVE DATE.—The amendment made by
this section shall apply with respect to contracts made and
plans approved on or after the date of the enactment of
this Act.
SEC. 7. COVERAGE OF ALTERNATIVE TREATMENTS FOR
HORMONE REPLACEMENT THERAPY UNDER
VETERANS’ BENEFITS.
(a) IN GENERAL.—Section 1701(6) of title 38,
United States Code, is amended by adding at the end the
following new subparagraph:
‘‘(G) An alternative therapy for hormone
replacement therapy for treatment of meno-
pausal symptoms if the therapy is recommended
by a health care provider who is licensed, ac-
credited, or certified under State law and if it
has been proven safe and effective in peer-re-
viewed scientific studies.’’.
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) shall apply to therapies made on or after
the date of the enactment of this Act.
SEC. 8. COVERAGE OF ALTERNATIVE TREATMENTS FOR
HORMONE REPLACEMENT THERAPY UNDER
TRICARE.
(a) IN GENERAL.—(1) Chapter 55 of title 10, United
States Code, is amended by inserting after section 1074k
the following new section:
‘‘§ 1074l. TRICARE program: benefits for alternative
treatments 
for 
hormone 
replacement
therapy
‘‘Each contract under the TRICARE program shall
provide benefits for an alternative therapy for hormone re-
placement therapy for treatment of menopausal symptoms
if—
‘‘(1) the therapy is recommended by a health
care provider who is licensed, accredited, or certified
under State law; and
‘‘(2) it has been proven safe and effective in
peer-reviewed scientific studies.’’.
(2) The table of sections at the beginning of such
chapter is amended by inserting after the item relating
to section 1074k the following new item:
‘‘1074l. TRICARE program: benefits for alternative treatments for hormone re-
placement therapy.’’.
(b) EFFECTIVE DATE.—Section 1074l of title 10,
United States Code, as added by subsection (a), shall
apply to therapies furnished on or after the date of the
enactment of this Act.
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