Bill Summary
The "Medicare Breast Reconstruction Access and Information Act" aims to enhance the provision of information regarding breast reconstruction surgery for individuals undergoing mastectomy under the Medicare program. Specifically, it amends the Social Security Act to require that, starting one year after the enactment of the legislation, healthcare providers must inform patients that breast reconstruction surgery is covered by Medicare following a medically necessary mastectomy. Additionally, providers must document that this information has been communicated in the patient's medical record. This legislation seeks to ensure that patients are aware of their options for breast reconstruction and receive the necessary support and documentation related to their post-mastectomy care.
Possible Impacts
The "Medicare Breast Reconstruction Access and Information Act" could have several implications for individuals affected by breast cancer and those considering mastectomy and reconstruction options. Here are three examples of how this legislation might impact people:
1. **Increased Awareness of Coverage Options**: With the requirement for healthcare providers to inform patients about the coverage of breast reconstruction surgery following a mastectomy, individuals may have a better understanding of their options. This could empower patients to make informed decisions regarding their treatment and reconstruction choices, potentially leading to higher rates of breast reconstruction among those who might not have been aware that it was covered by Medicare.
2. **Improved Documentation and Patient Care**: The mandate for healthcare providers to document the provision of information regarding breast reconstruction in medical records could improve overall patient care. This documentation ensures that patients receive consistent and accurate information, which could enhance communication between patients and healthcare providers. As a result, patients may feel more supported and understood throughout their treatment journey.
3. **Potential Impact on Healthcare Providers**: Healthcare providers will need to adapt their practices to comply with the new requirements. This could involve additional training for staff, changes in patient intake procedures, and the need for improved record-keeping systems. While this may initially create a burden, it could ultimately lead to more comprehensive care and a focus on patient education, benefiting both providers and patients in the long run.
[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4545 Introduced in House (IH)]
<DOC>
119th CONGRESS
1st Session
H. R. 4545
To amend title XVIII of the Social Security Act to require the
provision of certain information with respect to breast reconstruction
surgery under the Medicare program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 17, 2025
Ms. Waters (for herself, Ms. Garcia of Texas, Ms. Norton, Ms.
Velazquez, Ms. Wasserman Schultz, Mrs. Dingell, Ms. Clarke of New York,
Mr. Fields, Mr. Johnson of Georgia, Ms. Tlaib, Mr. Thompson of
Mississippi, Ms. Sewell, Mr. Gottheimer, Mrs. Watson Coleman, Mr.
Thanedar, Ms. Lee of Pennsylvania, Mr. Latimer, Ms. Wilson of Florida,
Mr. Veasey, Mr. Cohen, Mr. Lynch, Mrs. McIver, Mr. Garcia of Illinois,
Mrs. Cherfilus-McCormick, Ms. Salinas, and Mr. Olszewski) introduced
the following bill; which was 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
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to require the
provision of certain information with respect to breast reconstruction
surgery under the Medicare program.
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 ``Medicare Breast Reconstruction
Access and Information Act''.
SEC. 2. REQUIRING THE PROVISION OF CERTAIN INFORMATION WITH RESPECT TO
BREAST RECONSTRUCTION SURGERY.
Section 1834 of the Social Security Act (42 U.S.C. 1395m) is
amended by adding at the end the following new subsection:
``(aa) Requirement To Provide Certain Information With Respect to
Breast Reconstruction Surgery.--Notwithstanding any other provision of
this part, no payment may be made under this part for a mastectomy
furnished to an individual on or after the date that is 1 year after
the date of the enactment of this subsection unless the supplier
furnishing such mastectomy, prior to the furnishing of such
mastectomy--
``(1) informs such individual that breast reconstruction
surgery following a medically necessary mastectomy is covered
under this part pursuant to national coverage determination
140.2; and
``(2) documents the provision of such information in the
medical record of such individual.''.
<all>