To amend title XVIII of the Social Security Act to provide coverage for wigs as durable medical equipment under the Medicare program, and for other purposes.
- Bill Number
- H.R. 7546
- Origin Chamber
- House
- Congress
- 119th Congress, Session 2
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2026-02-12: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, 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 concerned.
- Last Updated
- 2026-06-10T08:07:19Z
AI-Generated Summary
Purpose
This bill aims to expand Medicare coverage to include wigs, referred to as "cranial prostheses," as a form of durable medical equipment (items like wheelchairs or oxygen equipment that help with medical needs and can be used repeatedly). The goal is to help Medicare beneficiaries who experience hair loss due to certain health conditions by making these items more accessible and affordable.
Key Provisions
- Definition Expansion: Amends Section 1861(n) of the Social Security Act to define durable medical equipment as including cranial prostheses, but only if a dermatologist (skin specialist), oncologist (cancer specialist), or attending physician provides a written certification. This certification must confirm the medical necessity for rehabilitation or hair loss caused by conditions like autoimmune diseases (disorders where the immune system attacks the body), cancer, or chemotherapy (cancer treatment drugs).
- Coverage Restrictions: Adds a new rule in Section 1862(a)(1) of the Social Security Act to deny Medicare payment for cranial prostheses that lack the required physician certification, ensuring coverage is limited to medically justified cases.
Significant Changes to Existing Law
- Previously, Medicare did not routinely cover wigs as durable medical equipment, often leaving patients to pay out-of-pocket or seek limited coverage under other categories (like prosthetics for specific injuries). This bill explicitly adds wigs to the durable medical equipment category under strict medical certification, creating a new pathway for reimbursement while maintaining safeguards against unnecessary claims.
Potential Impacts
- On Citizens: Medicare enrollees with qualifying hair loss conditions (e.g., cancer patients undergoing treatment) could gain access to covered wigs, reducing financial burdens and improving quality of life by supporting emotional and rehabilitative needs during illness.
- On Government Agencies: The Centers for Medicare & Medicaid Services (CMS), which administers Medicare, would need to update policies, process new claims, and verify certifications, potentially increasing program costs due to expanded benefits. No direct impact on international relations is anticipated.
- Broader Effects: Could set a precedent for covering other appearance-related medical aids, influencing future healthcare policy discussions.
Main Stakeholders Affected
- Medicare Beneficiaries: Primarily individuals with cancer, autoimmune diseases, or chemotherapy-related hair loss who rely on Medicare for healthcare.
- Healthcare Providers: Dermatologists, oncologists, and attending physicians, who must provide certifications to enable coverage.
- Suppliers and Manufacturers: Companies producing and selling wigs or cranial prostheses, which may see increased demand and Medicare reimbursements.
- Government Entities: CMS and Congress, responsible for implementation and funding oversight.
Notable Legal, Constitutional, or Political Implications
- Legal: Strengthens Medicare's framework by clarifying coverage for prosthetics, potentially reducing disputes over claim denials through standardized certification. It aligns with existing laws on durable medical equipment but requires CMS rulemaking to operationalize.
- Constitutional: No major issues; it operates within Congress's authority to regulate federal spending and social welfare programs under the Social Security Act.
- Political: Highlights bipartisan interest in patient-centered healthcare (introduced by Representatives McGovern and Pressley), focusing on underserved needs like cancer care support. Could influence budget debates on Medicare expansions without broad fiscal overhauls.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Rep. McGovern, James P. [D-MA-2]
Cosponsors (4)
Rep. Pressley, Ayanna [D-MA-7], Rep. Schakowsky, Janice D. [D-IL-9], Rep. DelBene, Suzan K. [D-WA-1], Del. Norton, Eleanor Holmes [D-DC-At Large]
Recent Actions
- 2026-02-12: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, 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 concerned.
- 2026-02-12: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, 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 concerned.
- 2026-02-12: Introduced in House
- 2026-02-12: Introduced in House
Bill Versions
- To amend title XVIII of the Social Security Act to provide coverage for wigs as durable medical equipment under the Medicare program, and for other purposes. — issued 2026-02-12 — PDF (2 pages)