Comprehensive Breast Reconstruction Act of 2021
This bill provides for Medicare, Medicaid, and private health insurance coverage of certain tattooing services in connection with post-mastectomy breast reconstruction, and aligns the scope of Medicare and Medicaid coverage of such breast reconstruction with that of private health insurance.
Specifically, the bill provides for coverage of reconstructive tattooing services that are performed by a health care practitioner or state-licensed tattoo artist pursuant to a physician prescription, and expands Medicare and Medicaid coverage to include all stages of reconstruction, surgery to produce a symmetrical appearance, and prostheses and physical complications of mastectomies (e.g., lymphedemas).
[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 469 Introduced in House (IH)]
<DOC>
117th CONGRESS
1st Session
H. R. 469
To amend the Employee Retirement Income Security Act of 1974 to provide
for health coverage of nipple-areolar complex tattooing in connection
with reconstructive surgery following mastectomy and to amend titles
XVIII and XIX of the Social Security Act to extend coverage of certain
breast reconstructive services following mastectomy under the Medicare
and Medicaid programs.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
January 25, 2021
Mr. Hastings (for himself, Ms. Wasserman Schultz, Miss Gonzalez-Colon,
Mrs. Demings, Ms. Scanlon, Mr. Thompson of Mississippi, Ms. Jackson
Lee, Mr. Soto, Mr. Deutch, Mr. Johnson of Georgia, Mr. Bishop of
Georgia, and Ms. Lee of California) introduced the following bill;
which was referred to the Committee on Energy and Commerce, and in
addition to the Committees on Ways and Means, and Education and Labor,
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
_______________________________________________________________________
A BILL
To amend the Employee Retirement Income Security Act of 1974 to provide
for health coverage of nipple-areolar complex tattooing in connection
with reconstructive surgery following mastectomy and to amend titles
XVIII and XIX of the Social Security Act to extend coverage of certain
breast reconstructive services following mastectomy under the Medicare
and Medicaid programs.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Comprehensive Breast Reconstruction
Act of 2021''.
SEC. 2. PROVIDING FOR HEALTH COVERAGE OF NIPPLE-AREOLAR COMPLEX
TATTOOING IN CONNECTION WITH RECONSTRUCTIVE SURGERY
FOLLOWING MASTECTOMY; EXTENDING COVERAGE OF BREAST
RECONSTRUCTIVE SERVICES FOLLOWING MASTECTOMY UNDER
MEDICARE AND MEDICAID.
(a) Private Health Insurance Coverage and Group Health Plans.--
(1) In general.--Section 713(a) of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1185b(a)) is amended--
(A) in paragraph (2), by striking at the end
``and'';
(B) in paragraph (3), by adding at the end ``and'';
(C) by inserting after paragraph (3) the following
new paragraph:
``(4) tattooing of the nipple-areolar complex pursuant to
or as part of such reconstruction if such tattooing is
performed by a physician, physician extender (as defined in
section 1834(x) of the Social Security Act, or State-licensed
tattoo artist (as defined in such section), as prescribed by a
physician;''; and
(D) by adding at the end of the flush matter
following paragraph (4), as inserted by subparagraph
(C), the following: ``Tattooing of the nipple-areolar
complex described in paragraph (4) shall be deemed to
be medically reasonable and necessary.''.
(2) Effective dates.--
(A) In general.--Subject to subparagraph (B), the
amendments made by this section shall apply with
respect to plan years beginning after the date of
enactment of this Act.
(B) Special rule for collective bargaining
agreements.--In the case of a group health plan
maintained pursuant to 1 or more collective bargaining
agreements between employee representatives and 1 or
more employers ratified before the date of enactment of
this Act, the amendments made by this section shall not
apply to plan years beginning before the later of--
(i) the date on which the last collective
bargaining agreements relating to the plan
terminates (determined without regard to any
extension thereof agreed to after the date of
enactment of this Act), or
(ii) January 1 of the first year beginning
at least one year after the date of the
enactment of this Act.
For purposes of clause (i), any plan amendment made
pursuant to a collective bargaining agreement relating
to the plan which amends the plan solely to conform to
any requirement added by this subsection shall not be
treated as a termination of such collective bargaining
agreement.
(b) Medicare Coverage.--
(1) Coverage.--Section 1861(s)(2) of the Social Security
Act (42 U.S.C. 1395x(s)(2)) is amended--
(A) in subparagraph (GG), by striking at the end
``and'';
(B) in subparagraph (HH), by inserting at the end
``; and''; and
(C) by adding at the end the following new
subparagraph:
``(II) qualifying reconstructive breast surgery
services (as defined in subsection (kkk)).''.
(2) Definition.--Section 1861 of the Social Security Act
(42 U.S.C. 1395x) is amended by adding at the end the following
new subsection:
``(kkk) Qualifying Reconstructive Breast Surgery Services.--The
term `qualifying reconstructive breast surgery services' means, in the
case of an individual who has a mastectomy, breast reconstruction in
connection with such mastectomy, including--
``(1) all stages of reconstruction of the breast on which
the mastectomy has been performed;
``(2) surgery and reconstruction of the other breast to
produce a symmetrical appearance;
``(3) prostheses and physical complications of mastectomy,
including lymphedemas; and
``(4) tattooing of the nipple-areolar complex pursuant to
or as part of such reconstruction if such tattooing is
performed by a physician, physician extender, or State-licensed
tattoo artist (as such terms are defined in section 1834(x), as
prescribed by a physician;
in a manner determined in consultation with the attending physician and
the individual.''.
(3) Payment.--
(A) In general.--Section 1833(a)(1) of the Social
Security Act (42 U.S.C. 1395l(a)(1)) is amended--
(i) by striking ``and (DD)'' and inserting
``(DD)''; and
(ii) by inserting before the semicolon at
the end the following `` and (EE) with respect
to qualifying reconstructive breast surgery
services (as defined in section 1861(kkk)), the
amount paid shall be equal to the amount
payable in accordance with section 1834(x)''.
(B) Payment determination.--Section 1834 of the
Social Security Act (42 U.S.C. 1395m) is amended by
adding at the end the following new subsection:
``(x) Qualifying Reconstructive Breast Surgery Services.--
``(1) In general.--With respect to qualifying
reconstructive breast surgery services described in section
1861(kkk)(4) for which payment is determined under this
subsection, payment shall be made in an amount equal to 100
percent of the reasonable and customary amount for nipple
areolar tattooing, determined according to the reimbursement
rates for CPT codes 11920, 11921, and 11922 (or any successor
to such codes).
``(2) Reasonable and necessary treatment.--Qualifying
reconstructive breast surgery services described in section
1861(kkk)(4) shall be deemed to be reasonable and necessary for
purposes of section 1862(a)(1)(A).
``(3) Physician extender.--For purposes of this subsection
and section 1861(kkk)(4), the term `physician extender' means a
health care practitioner who is not a physician and who is
licensed or certified by the State in which the practitioner if
furnishing services to furnish items or services typically
furnished by a physician, such as a nurse practitioner or
physician assistant.
``(4) State-licensed tattoo artist.--For purposes of this
subsection and section 1861(kkk)(4), the term `State-licensed
tattoo artist' means an individual (as specified by the law of
the State in which the individual is licensed in performing
permanent body art and in which they are so practicing such
art) who maintains all public health, safety, and welfare
standards and regulations set forth by the State, including all
sterilization, sanitation, and safety regulations for tattoo
parlors and salons, tattoo inks, tattoo instruments, and any
other related paraphernalia, as well as allowing the individual
to perform the procedure in the prescribing physician's place
of business with the consent of the physician and the patient,
abiding by all such standards and regulations.''.
(4) Including certain tattoo artists as medicare providers
for purposes of tattooing of the nipple-areolar complex after
mastectomy.--Section 1866(j)(1) of the Social Security Act (42
U.S.C. 1395cc(j)(1)) is amended by adding at the end the
following new subparagraph:
``(D) Including certain tattoo artists for purposes
of tattooing of the nipple-areolar complex after
mastectomy.--For purposes of this section, the term
`supplier' shall include a State-licensed tattoo artist
(as defined in section 1834(x)), but only with respect
to the tattooing of the nipple-areolar complex pursuant
to or as part of reconstructive surgery following a
medically necessary mastectomy and if such tattooing is
prescribed by a physician.''.
(5) Effective date.--The amendments made by this subsection
shall apply with respect to items and services furnished on or
after January 1 of the first year beginning after the date of
the enactment of this Act.
(c) Medicaid Coverage.--
(1) In general.--Section 1905(a) of the Social Security Act
(42 U.S.C. 1396d(a)) is amended--
(A) by redesignating paragraph (30) as paragraph
(31);
(B) in paragraph (29), by striking at the end
``and'';
(C) by inserting after paragraph (29) the following
new paragraph:
``(30) qualifying reconstructive breast surgery services
(as defined in section 1861(kkk)); and''; and
(D) by adding at the end of the flush matter
following paragraph (31), as redesignated by
subparagraph (A), the following new sentence: ``For
purposes of paragraph (30), qualifying reconstructive
breast surgery services described in section
1861(kkk)(4) shall be deemed to be medically reasonable
and necessary.''.
(2) Effective date.--
(A) In general.--Subject to subparagraph (B), the
amendments made by this section shall take effect with
respect to medical assistance provided on or after
January 1 of the first year beginning after the date of
the enactment of this Act.
(B) Exception for state legislation.--In the case
of a State plan under title XIX of the Social Security
Act (42 U.S.C. 1396 et seq.) that the Secretary of
Health and Human Services determines requires State
legislation in order for the respective plan to meet
any requirement imposed by the amendments made by this
section, the respective plan 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 the enactment of this Act. 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.
<all>
Introduced in House
Introduced in House
Sponsor introductory remarks on measure. (CR E66-67)
Referred to the Subcommittee on Health.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Labor, 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.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Labor, 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.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Labor, 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.
Referred to the Subcommittee on Health.
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