HB 1345 — An Act amending the act of June 13, 1967 (P.L.31, No.21), known as the Human Services Code, in public assistance, providing for medical assistance coverage for menopause treatments.

PRINTER'S NO.     1534

                     THE GENERAL ASSEMBLY OF PENNSYLVANIA



                         HOUSE BILL
                         No. 1345
                                               Session of
                                                 2025

     INTRODUCED BY CEPHAS, HANBIDGE, GUENST, PIELLI, OTTEN, PROBST,
        WAXMAN, HILL-EVANS, HOHENSTEIN, KENYATTA, RABB, D. MILLER,
        SANCHEZ, FRANKEL, SHUSTERMAN, CEPEDA-FREYTIZ, RIVERA AND
        O'MARA, APRIL 30, 2025

     REFERRED TO COMMITTEE ON HUMAN SERVICES, APRIL 30, 2025


                                    AN ACT
 1   Amending the act of June 13, 1967 (P.L.31, No.21), entitled "An
 2      act to consolidate, editorially revise, and codify the public
 3      welfare laws of the Commonwealth," in public assistance,
 4      providing for medical assistance coverage for menopause
 5      treatments.
 6      The General Assembly of the Commonwealth of Pennsylvania
 7   hereby enacts as follows:
 8      Section 1.    The act of June 13, 1967 (P.L.31, No.21), known
 9   as the Human Services Code, is amended by adding a section to
10   read:
11      Section 443.16.    Medical Assistance Coverage for Menopause
12   Treatments.--(a)    Subject to Federal approval, the department
13   shall provide medical assistance coverage for hormonal and non-
14   hormonal treatments for the management of menopausal symptoms
15   for eligible and enrolled medical assistance recipients.
16   Coverage under this section shall include all of the following:
17      (1)   Coverage for all drugs, devices and combination products
18   approved by the United States Food and Drug Administration for
 1   the treatment of menopausal symptoms.
 2      (2)   Coverage for behavioral therapy that assists individuals
 3   in coping with menopausal symptoms.
 4      (3)   Coverage for therapy to treat menopause that has been
 5   induced by a hysterectomy.
 6      (b)   The department shall seek a State plan amendment or
 7   Federal waiver from the Centers for Medicare and Medicaid
 8   Services, if needed, for the provision of hormonal and non-
 9   hormonal treatments for the management of menopausal symptoms
10   under the medical assistance program.
11      (c)   As used in this section, the following words and phrases
12   shall have the meanings given to them in this subsection unless
13   the context clearly indicates otherwise:
14      "Hysterectomy."    A surgical procedure to remove a woman's
15   uterus, which may include removal of the cervix, ovaries or
16   fallopian tubes.
17      "Menopausal symptoms."    Any of the following:
18      (1)   Irregular menstrual periods.
19      (2)   Hot flashes.
20      (3)   Vaginal or bladder changes.
21      (4)   Decreased fertility.
22      (5)   Loss of bone density, including osteoporosis.
23      (6)   Elevated low-density lipoprotein cholesterol levels.
24      (7)   Sleep disturbances, including night sweats.
25      "Menopause."    The permanent cessation of menstruation
26   resulting from the loss of ovarian follicular function,
27   characterized by the end of ovulation and a decline in estrogen
28   and progesterone production.
29      Section 2.     If a necessary State plan amendment or Federal
30   waiver under section 443.16 of the act is approved by the

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 1   Centers for Medicare and Medicaid Services, the Secretary of
 2   Human Services shall transmit notice of the approval to the
 3   Legislative Reference Bureau for publication in the next
 4   available issue of the Pennsylvania Bulletin.
 5      Section 3.     This act shall take effect as follows:
 6             (1)   Except as provided under paragraph (2), the addition
 7      of section 443.16 of the act shall take effect 30 days
 8      following publication of the notice under section 2 of this
 9      act.
10             (2)   The addition of section 443.16(b) and (c) of the act
11      shall take effect immediately.
12             (3)   The remainder of this act shall take effect
13      immediately.




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