[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4779 Introduced in House (IH)]
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118th CONGRESS
1st Session
H. R. 4779
To amend title XVIII of the Social Security Act to provide coverage for
custom fabricated breast prostheses following a mastectomy.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 20, 2023
Ms. Chu (for herself and Mrs. Miller-Meeks) 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 provide coverage for
custom fabricated breast prostheses following a mastectomy.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; FINDINGS.
(a) Short Title.--This Act may be cited as the ``Breast Cancer
Patient Equity Act''.
(b) Findings.--Congress finds the following:
(1) There are currently more than 4,000,000 women with a
history of breast cancer in the United States, many of whom
experience unreconstructed breast loss.
(2) In 2023, an estimated 297,790 women will be diagnosed
with invasive breast cancer that required surgery, with many
having to undergo surgical breast removal.
(3) In 2023, an estimated 43,100 women in the United States
are expected to die from breast cancer.
(4) Annually, there are more than 100,000 women in the
United States who undergo mastectomies, a surgical removal of
the breast.
(5) The number of breast mastectomies in the United States
has increased among younger women, ages 18 to 34 years old, at
a rate of 30 percent and at a rate of 15 percent for women ages
35 to 44 years old.
(6) The results of breast reconstruction surgery can vary
and, as with any surgical procedure, there are inherent risks
associated with such surgery. Additionally, reconstruction of
the breast using implants requires lifelong follow up to ensure
the health of the patient.
(7) While the number of women choosing to undergo surgical
breast reconstruction continues to increase, many women
continue to lack the viable option of custom fabricated
prosthetic breasts to restore the lost breast.
(8) Both older women and minority women are less likely to
be offered or undergo surgical breast reconstruction and are
disproportionately disadvantaged by a lack of access to the
option of custom fabricated prosthetic breasts.
(9) Currently, the Medicare program provides coverage and
reimbursement for custom fabricated prostheses for any body
part, with the exception of breasts, that has been lost.
(10) Following passage of the Women's Health and Cancer
Rights Act of 1998 (Public Law 105-277; 42 U.S.C. 201 note),
many private insurers and group health plans began to provide
coverage for custom fabricated breast prostheses as an
alternative to surgical breast reconstruction.
(11) While the Medicare program recognizes custom
fabricated breast prostheses as a discrete device and valid
treatment option, having assigned a billing code for such
option under the Healthcare Common Procedure Coding System
(``HCPCS'') and setting a maximum allowable fee, Medicare does
not provide reimbursement and denies claims as `not medically
necessary'. Medicare does provide reimbursement, however, for
more costly surgical breast reconstruction.
(12) Due to the fact that the Medicare program does not
provide reimbursement for custom fabricated breast prostheses,
many private insurance companies have also begun to limit their
reimbursement for them.
(13) The Department of Veterans Affairs does provide the
option of a custom fabricated prosthetic breast for women post-
mastectomy.
(14) Providing coverage for custom fabricated prosthetic
breast devices and components will not increase the incidence
of breast mastectomies.
SEC. 2. COVERAGE.
(a) In General.--Section 1861(s)(8) of the Social Security Act (42
U.S.C. 1395x(s)(8)) is amended--
(1) by adding ``and'' after the semicolon at the end;
(2) by inserting ``(A)'' after ``(8)''; and
(3) by inserting after subparagraph (A) the following new
subparagraph:
``(B) custom fabricated breast prostheses following
surgical removal of the breast, including replacement of such
prostheses;''.
(b) Conforming Amendment.--Section 1862(a)(7) of such Act (42
U.S.C. 1395y(a)(7)) is amended by striking ``1861(s)(8)'' and inserting
``1861(s)(8)(A)''.
(c) Effective Date.--The amendments made by this section shall
apply to items and services furnished on or after the date of enactment
of this Act.
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