Cranial Prosthetic Medicaid Coverage Enhancement Act

Bill: 114-hr-4989
Sponsor: full_name: Rep. Ros-Lehtinen, Ileana [R-FL-27]
Introduced: 2016-04-18
Policy area: Health
Subjects: Health technology, devices, supplies

Hospital care

Long-term, rehabilitative, and terminal care

Medicaid
Latest action: action_date: 2016-04-22
text: Referred to the Subcommittee on Health.

Summaries:
action_date: 2016-04-18
action_desc: Introduced in House
text: <p><strong>Cranial Prosthetic Medicaid Coverage Enhancement Act</strong></p> <p>This bill amends title XIX (Medicaid) of the Social Security Act to alter&nbsp;coverage requirements under a&nbsp;state plan for medical assistance. Specifically, a state plan&nbsp;that provides medical assistance for an individual's inpatient hospital services shall also provide biennial medical assistance to the individual for one&nbsp;cranial prosthesis, as specified by the bill. (A cranial prosthesis is a custom-made wig designed for a patient who has suffered hair loss as a result of a medical condition or treatment.)</p>

tv_txt: I 114th CONGRESS 2d Session H. R. 4989 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. Short title This Act may be cited as the Cranial Prosthetic Medicaid Coverage Enhancement Act . 2. Findings The Congress finds as follows: (1) Individuals chronically affected by hair loss due to diseases, such as the autoimmune skin condition alopecia areata, as well as individuals affected by acute hair loss due to chemotherapy or medical intervention face significant biological, social, and psychological health challenges. (2) Dermatologists, oncologists, and other qualified medical professionals consider cranial prosthetics to be a medically necessary option when treating individuals suffering from chronic, acute, or cyclical hair loss caused by a medical condition. (3) The cost of a cranial prosthetic can represent a significant financial burden for Medicaid program beneficiaries and coverage benefits across States are currently inconsistent and, in many cases, nonexistent. (4) While children participating in the Medicaid program are often significantly impacted by the additional health effects caused by medical condition-related hair loss, inequitable and inconsistent coverage benefits for cranial prosthetics means they can face serious difficulty accessing treatment, even with the assistance of a healthcare professional. 3. Improvement of cranial prostheses coverage under Medicaid (a) In general Section 1902(a)(10) of the Social Security Act ( 42 U.S.C. 1396a(a)(10) ) is amended— (1) in subparagraph (F), at the end by striking and ; (2) in subparagraph (G), at the end by adding and ; and (3) by inserting after subparagraph (G) the following new subparagraph: (H) that if medical assistance is included for inpatient hospital services for an individual, then the plan must include making medical assistance available to the individual for biennial coverage of one cranial prosthesis with a benefit up to $400 if the dermatologist, oncologist, or 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 with respect to items and services furnished on or after January 1, 2017, without regard to whether or not final regulations to carry out such amendments have been promulgated by such date.