I 
109TH CONGRESS 
1ST SESSION H. R. 1410 
To provide for coverage of hormone replacement therapy for treatment of 
menopausal symptoms, and for coverage of an alternative therapy for 
hormone replacement therapy for such symptoms, 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 
MARCH 17, 2005 
Ms. LEE (for herself, Mr. PAYNE, and Mr. OWENS) 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, and Veterans’ Affairs, 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 con-
cerned 
A BILL 
To provide for coverage of hormone replacement therapy 
for treatment of menopausal symptoms, and for coverage 
of an alternative therapy for hormone replacement ther-
apy for such symptoms, under the Medicare and Med-
icaid Programs, group health plans and individual health 
insurance coverage, 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 
‘‘Menopausal Hormone Replacement Therapies and Alter-
native Treatments and 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 menopausal hormone replacement therapy and al-
ternative treatments for menopausal hormone replacement 
therapy. 
Sec. 4. Medicaid coverage of alternative treatments for menopausal hormone re-
placement therapy. 
Sec. 5. Coverage of menopausal hormone replacement therapy and alternative 
treatments for menopausal hormone replacement therapy under 
group health plans and individual health insurance coverage. 
Sec. 6. Coverage of menopausal hormone replacement therapy and alternative 
treatments for menopausal hormone replacement therapy under 
FEHBP. 
Sec. 7. Coverage of alternative treatments for menopausal hormone replacement 
therapy under Department of Veterans Affairs health care sys-
tem. 
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 MENOPAUSAL HORMONE 
REPLACEMENT THERAPY AND ALTERNATIVE 
TREATMENTS FOR MENOPAUSAL HORMONE 
REPLACEMENT THERAPY. 
(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 (Y); 
(2) by adding ‘‘and’’ at the end of subpara-
graph (Z); and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(AA)(i) hormone replacement therapy for 
treatment of menopausal symptoms and (ii) an al-
ternative therapy for hormone replacement therapy 
for treatment of menopausal symptoms if the ther-
apy is recommended by a health care provider who 
is licensed, accredited, or certified under State law, 
if it has been proven safe and effective in peer-re-
viewed scientific studies, and if it is administered 
only after the health care provider obtains the in-
formed consent of the patient to receive it;’’. 
(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 MENOPAUSAL HORMONE RE-
PLACEMENT THERAPY. 
(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 (28)’’. 
(b) DESCRIPTION OF COVERED THERAPIES.—Sec-
tion 1905(a) of such Act (42 U.S.C. 1396d(a)) is amend-
ed— 
(1) by redesignating paragraph (28) as para-
graph (29); and 
(2) by inserting after paragraph (27) the fol-
lowing new paragraph: 
‘‘(28) 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, if it has been proven safe and effec-
tive in peer-reviewed scientific studies, and if it is 
administered only after the health care provider ob-
tains the informed consent of the patient to receive 
it; 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 MENOPAUSAL HORMONE REPLACE-
MENT THERAPY AND ALTERNATIVE TREAT-
MENTS FOR MENOPAUSAL HORMONE RE-
PLACEMENT 
THERAPY 
UNDER 
GROUP 
HEALTH PLANS AND INDIVIDUAL HEALTH IN-
SURANCE 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 MENO-
PAUSAL HORMONE REPLACEMENT THERAPY 
AND ALTERNATIVE TREATMENTS FOR MENO-
PAUSAL HORMONE REPLACEMENT THERAPY. 
‘‘(a) REQUIREMENTS.—
‘‘(1) MENOPAUSAL
HORMONE
REPLACEMENT 
THERAPY.—If a group health plan, or a health in-
surance issuer offering group health insurance cov-
erage, provides benefits for outpatient prescription 
drugs, the plan or coverage may not exclude or re-
strict benefits for hormone replacement therapy for 
treatment of menopausal symptoms. 
‘‘(2) ALTERNATIVE
TREATMENTS
FOR
MENO-
PAUSAL HORMONE REPLACEMENT THERAPY.—If a 
group health plan, or a health insurance issuer offer-
ing group health insurance coverage, provides bene-
fits for hormone replacement therapy for treatment 
of menopausal symptoms, the plan or coverage may 
not exclude or restrict benefits for an alternative 
therapy for hormone replacement therapy for treat-
ment of menopausal symptoms if— 
‘‘(A) the therapy is recommended by a 
health care provider who is licensed, accredited, 
or certified under State law; 
‘‘(B) it has been proven safe and effective 
in peer-reviewed scientific studies; and 
‘‘(C) it is administered only after the 
health care provider obtains the informed con-
sent of the patient to receive it.
‘‘(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 MENO-
PAUSAL HORMONE REPLACEMENT THERAPY 
AND ALTERNATIVE TREATMENTS FOR MENO-
PAUSAL HORMONE REPLACEMENT THERAPY. 
‘‘(a) REQUIREMENTS.— 
‘‘(1) MENOPAUSAL
HORMONE
REPLACEMENT 
THERAPY.—If a group health plan, or a health in-
surance issuer offering group health insurance cov-
erage, provides benefits for outpatient prescription 
drugs, the plan or coverage may not exclude or re-
strict benefits for hormone replacement therapy for 
treatment of menopausal symptoms.
‘‘(2) ALTERNATIVE
TREATMENTS
FOR
MENO-
PAUSAL HORMONE REPLACEMENT THERAPY.—If a 
group health plan, or a health insurance issuer offer-
ing group health insurance coverage, provides bene-
fits for hormone replacement therapy for treatment 
of menopausal symptoms, the plan or coverage may 
not exclude or restrict benefits for an alternative 
therapy for hormone replacement therapy for treat-
ment of menopausal symptoms if— 
‘‘(A) the therapy is recommended by a 
health care provider who is licensed, accredited, 
or certified under State law; 
‘‘(B) it has been proven safe and effective 
in peer-reviewed scientific studies; and 
‘‘(C) it is administered only after the 
health care provider obtains the informed con-
sent of the patient to receive it. 
‘‘(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: 
‘‘714. Standard relating to coverage of menopausal hormone replacement ther-
apy and alternative treatments for menopausal hormone re-
placement 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: 
‘‘9813. Standard relating to coverage of menopausal hormone replacement ther-
apy and alternative treatments for menopausal hormone re-
placement therapy.’’ 
; and 
(ii) by inserting after section 9812 the 
following:
‘‘SEC. 9813. STANDARD RELATING TO COVERAGE OF MENO-
PAUSAL HORMONE REPLACEMENT THERAPY 
AND ALTERNATIVE TREATMENTS FOR MENO-
PAUSAL HORMONE REPLACEMENT THERAPY. 
‘‘(a) MENOPAUSAL HORMONE REPLACEMENT THER-
APY.—If a group health plan provides benefits for out-
patient prescription drugs, the plan may not exclude or 
restrict benefits for hormone replacement therapy for 
treatment of menopausal symptoms. 
‘‘(b) ALTERNATIVE TREATMENTS FOR MENOPAUSAL 
HORMONE REPLACEMENT THERAPY.—If a group health 
plan provides benefits for hormone replacement therapy 
for treatment of menopausal symptoms, the plan may not 
exclude or restrict benefits for an alternative therapy for 
hormone replacement therapy for treatment of meno-
pausal symptoms if— 
‘‘(1) the therapy is recommended by a health 
care provider who is licensed, accredited, or certified 
under State law; 
‘‘(2) it has been proven safe and effective in 
peer-reviewed scientific studies; and 
‘‘(3) it is administered only after the health 
care provider obtains the informed consent of the 
patient to receive it.’’ 
(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 MENO-
PAUSAL HORMONE REPLACEMENT THERAPY 
AND ALTERNATIVE TREATMENTS FOR MENO-
PAUSAL HORMONE REPLACEMENT 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 MENOPAUSAL HORMONE REPLACE-
MENT THERAPY AND ALTERNATIVE TREAT-
MENTS FOR MENOPAUSAL HORMONE RE-
PLACEMENT 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; 
‘‘(B) it has been proven safe and effective in 
peer-reviewed scientific studies; and 
‘‘(C) it is administered only after the health 
care provider obtains the informed consent of the 
patient to receive it.’’. 
(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 
MENOPAUSAL 
HORMONE 
REPLACEMENT 
THERAPY 
UNDER 
DEPARTMENT 
OF 
VET-
ERANS AFFAIRS HEALTH CARE SYSTEM. 
(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 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, if the therapy has been proven safe 
and effective in peer-reviewed scientific studies, and 
if it is administered only after the health care pro-
vider obtains the informed consent of the patient to 
receive it.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply to therapies furnished on or 
after the date of the enactment of this Act. 
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