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