Section 1 Short title
This Act may be cited as the “Access to Scalp Cooling Therapy Act of 2024”.
Access to Scalp Cooling Therapy Act of 2024
A BILL
To require health insurance coverage for scalp cooling items.
Sec. 2 Requiring coverage for scalp cooling items under group health plans and group and individual health insurance coverage, specified federal health care programs, and the federal employees health benefits program
Group health plans and health insurance coverage— Subpart II of part A of title XXVII of the Public Health Service Act (42 U.S.C. 300gg–11 et seq.) is amended by adding at the end the following new section:
“2730. Required coverage of scalp cooling items
“(a) In general—With respect to a plan year beginning on or after January 1, 2025, a group health plan and a health insurance issuer offering group or individual health insurance coverage shall provide benefits under such plan or such coverage for scalp cooling items (as defined in subsection (c)) in accordance with the requirement described in subsection (b).
“(b) Coverage requirement—For purposes of subsection (a), the requirement described in this subsection is, with respect to the imposition or application of any financial requirement (as defined in subsection (c)) with respect to coverage of scalp cooling items under a group health plan or group or individual health insurance coverage, the requirement that such financial requirement be the same as such requirement applicable to intravenous or injection anticancer drugs furnished under such plan or such coverage for which benefits are provided under such plan or such coverage.
“(c) Definitions—In this section:
“(1) Financial requirement—The term “financial requirement” means, with respect to an item or service furnished under a group health plan or group or individual health insurance coverage, any copayment, coinsurance, deductible, annual limit, lifetime limit, or out-of-pocket maximum applied under such plan or such coverage with respect to such item or service.
“(2) Scalp cooling item—The term “scalp cooling item” means a cooling cap, hypothermia cap, cold cap, or any other therapeutic device used to cool the scalp of an individual to prevent or reduce hair loss during chemotherapy.”
ERISA— Subpart B of part 7, of subtitle B, of title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1185 et seq.) is amended by adding at the end the following:
“726. Required coverage of scalp cooling items
“(a) In general—With respect to a plan year beginning on or after January 1, 2025, a group health plan and a health insurance issuer offering group or individual health insurance coverage shall provide benefits under such plan or such coverage for scalp cooling items (as defined in subsection (c)) in accordance with the requirement described in subsection (b).
“(b) Coverage requirement—For purposes of subsection (a), the requirement described in this subsection is, with respect to the imposition or application of any financial requirement (as defined in subsection (c)) with respect to coverage of scalp cooling items under a group health plan or group or individual health insurance coverage, the requirement that such financial requirement be the same as such requirement applicable to intravenous or injection anticancer drugs furnished under such plan or such coverage for which benefits are provided under such plan or such coverage.
“(c) Definitions—In this section:
“(1) Financial requirement—The term “financial requirement” means, with respect to an item or service furnished under a group health plan or group or individual health insurance coverage, any copayment, coinsurance, deductible, annual limit, lifetime limit, or out-of-pocket maximum applied under such plan or such coverage with respect to such item or service.
“(2) Scalp cooling item—The term “scalp cooling item” means a cooling cap, hypothermia cap, cold cap, or any other therapeutic device used to cool the scalp of an individual to prevent or reduce hair loss during chemotherapy.”
Clerical amendment— The table of contents in section 1 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1001 et seq.) is amended by inserting after the item relating to section 725 the following:
IRC—
In general— Subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following:
“9826. Required coverage of scalp cooling items
“(a) In general—With respect to a plan year beginning on or after January 1, 2025, a group health plan and a health insurance issuer offering group or individual health insurance coverage shall provide benefits under such plan or such coverage for scalp cooling items (as defined in subsection (c)) in accordance with the requirement described in subsection (b).
“(b) Coverage requirement—For purposes of subsection (a), the requirement described in this subsection is, with respect to the imposition or application of any financial requirement (as defined in subsection (c)) with respect to coverage of scalp cooling items under a group health plan or group or individual health insurance coverage, the requirement that such financial requirement be the same as such requirement applicable to intravenous or injection anticancer drugs furnished under such plan or such coverage for which benefits are provided under such plan or such coverage.
“(c) Definitions—In this section:
“(1) Financial requirement—The term “financial requirement” means, with respect to an item or service furnished under a group health plan or group or individual health insurance coverage, any copayment, coinsurance, deductible, annual limit, lifetime limit, or out-of-pocket maximum applied under such plan or such coverage with respect to such item or service.
“(2) Scalp cooling item—The term “scalp cooling item” means a cooling cap, hypothermia cap, cold cap, or any other therapeutic device used to cool the scalp of an individual to prevent or reduce hair loss during chemotherapy.”
Clerical amendment— The table of sections for subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following new item:
Medicare—
Coverage—
in subsection (s)(2)—
in subparagraph (GG), by striking “and” at the end;
in subparagraph (HH), by striking the period and inserting “; and”; and
by adding at the end the following new subparagraph:
“(II) scalp cooling items (as defined in subsection (lll));”
by adding at the end the following new subsection:
“(lll) Scalp Cooling Items—The term “scalp cooling item” means a cooling cap, hypothermia cap, cold cap, or any other therapeutic device used to cool the scalp of an individual to prevent or reduce hair loss during chemotherapy furnished on or after January 1, 2025.”
Exclusion modification— Section 1862(a)(1) of the Social Security Act (42 U.S.C. 1395y(a)(1)) is amended—
in subparagraph (O), by striking “and” at the end;
in subparagraph (P), by striking the semicolon and inserting “, and”; and
by adding at the end the following new subparagraph:
“(Q) in the case of scalp cooling items (as defined in section 1861(lll)), which are not furnished to prevent or reduce hair loss during chemotherapy;”
by striking “and (DD)” and inserting “ (DD)”; and
by inserting before the semicolon at the end the following: “and (EE) with respect to scalp cooling items (as defined in section 1861(lll)), the amount paid shall be equal to 80 percent of the lesser of the actual charge or an amount determined appropriate by the Secretary;”.
Medicaid—
in section 1902(a)(10)(A), by striking “and (30)” and inserting “(30), and (31)”; and
in section 1905(a)—
in paragraph (30), by striking “and” at the end;
by redesignating paragraph (31) as paragraph (32); and
by inserting after paragraph (30) the following new paragraph:
“(31) cooling caps, hypothermia caps, cold caps, and any other therapeutic devices used to cool the scalp of an individual to prevent or reduce hair loss during chemotherapy.”
Effective date—
In general— Subject to subparagraph (B), the amendments made by this subsection shall apply with respect to medical assistance furnished in calendar quarters beginning on or after January 1, 2025.
Exception for state legislation— In the case of a State plan under title XIX of the Social Security Act (or a waiver of such plan), which the Secretary of Health and Human Services determines requires State legislation in order for the respective plan (or waiver) to meet any requirement imposed by the amendments made by this subsection, the respective plan (or waiver) shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet such an 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 enactment of this subsection. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of the session shall be considered to be a separate regular session of the State legislature.
CHIP—
in subsection (a), by striking “paragraphs (5), (6), (7) and (8) of”; and
in subsection (c), by adding at the end the following new paragraph:
“(11) Coverage of scalp cooling items.—The child health assistance provided to a targeted low-income child shall include cooling caps, hypothermia caps, cold caps, and any other therapeutic devices used to cool the scalp of an individual to prevent or reduce hair loss during chemotherapy.”
Effective date—
In general— Subject to subparagraph (B), the amendments made by this subsection shall take effect with respect to child health assistance provided on or after January 1, 2025.
Exception for state legislation— In the case of a State child health plan under title XXI of the Social Security Act (or a waiver of such plan), which the Secretary of Health and Human Services determines requires State legislation in order for the respective plan (or waiver) to meet any requirement imposed by the amendments made by this section, the respective plan (or waiver) shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet such an 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 enactment of this section. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of the session shall be considered to be a separate regular session of the State legislature.
FEHBP— Section 8902 of title 5, United States Code, is amended by adding at the end the following new subsection:
“(p) A contract may not be made or a plan approved which does not provide for the coverage required under section 2730 of the Public Health Service Act.”
TRICARE— Section 1077(a) of title 10, United States Code, is amended by adding at the end the following new paragraph:
“(19) A cooling cap, hypothermia cap, cold cap, or any other therapeutic device used to cool the scalp of an individual to prevent or reduce hair loss during chemotherapy.”
VA—
In general— Chapter 17 of title 38, United States Code, is amended by inserting after section 1720I the following new section:
“The Secretary shall make available to a veteran who receives chemotherapy pursuant to this chapter a cooling cap, hypothermia cap, cold cap, or any other therapeutic device used to cool the scalp of an individual to prevent or reduce hair loss during chemotherapy.”
Clerical amendment— The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 1720I the following new item: