I 

116TH CONGRESS 

2D SESSION H. R. 8558 

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 

OCTOBER 9, 2020 

Mr. HASTINGS (for himself, Ms. WASSERMAN SCHULTZ, Mr. BUCHANAN, Ms. 

LEE of California, Mr. DEUTCH, Mr. SOTO, and Mrs. DAVIS 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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Comprehensive Breast 

3 Reconstruction Act of 2020’’. 

4 SEC. 2. PROVIDING FOR HEALTH COVERAGE OF NIPPLE5 AREOLAR COMPLEX TATTOOING IN CONNEC6 TION WITH RECONSTRUCTIVE SURGERY FOL7 LOWING MASTECTOMY; EXTENDING COV8 ERAGE OF BREAST RECONSTRUCTIVE SERV9 ICES FOLLOWING MASTECTOMY UNDER 

10 MEDICARE AND MEDICAID. 

11 (a) PRIVATE HEALTH INSURANCE COVERAGE AND

12 GROUP HEALTH PLANS.— 

13 (1) IN GENERAL.—Section 713(a) of the Em14 ployee Retirement Income Security Act of 1974 (29 

15 U.S.C. 1185b(a)) is amended— 

16 (A) in paragraph (2), by striking at the 

17 end ‘‘and’’; 

18 (B) in paragraph (3), by adding at the end 

19 ‘‘and’’; 

20 (C) by inserting after paragraph (3) the 

21 following new paragraph: 

22 ‘‘(4) tattooing of the nipple-areolar complex 

23 pursuant to or as part of such reconstruction if such 

24 tattooing is performed by a physician, physician ex25 tender (as defined in section 1834(x) of the Social 

26 Security Act), or State-licensed tattoo artist (as deVerDate Sep 11 2014 02:13 Nov 01, 2020 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H8558.IH H8558

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1 fined in such section), as prescribed by a physi2 cian;’’; and 

3 (D) by adding at the end of the flush mat4 ter following paragraph (4), as inserted by sub5 paragraph (C), the following: ‘‘Tattooing of the 

6 nipple-areolar complex described in paragraph 

7 (4) shall be deemed to be medically reasonable 

8 and necessary.’’. 

9 (2) EFFECTIVE DATES.— 

10 (A) IN GENERAL.—Subject to subpara11 graph (B), the amendments made by this sec12 tion shall apply with respect to plan years be13 ginning after the date of enactment of this Act. 

14 (B) SPECIAL RULE FOR COLLECTIVE BAR15 GAINING AGREEMENTS.—In the case of a group 

16 health plan maintained pursuant to 1 or more 

17 collective bargaining agreements between em18 ployee representatives and 1 or more employers 

19 ratified before the date of enactment of this 

20 Act, the amendments made by this section shall 

21 not apply to plan years beginning before the 

22 later of— 

23 (i) the date on which the last collec24 tive bargaining agreements relating to the 

25 plan terminates (determined without reVerDate Sep 11 2014 02:13 Nov 01, 2020 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H8558.IH H8558

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1 gard to any extension thereof agreed to 

2 after the date of enactment of this Act); or 

3 (ii) January 1 of the first year begin4 ning at least one year after the date of the 

5 enactment of this Act. 

6 For purposes of clause (i), any plan amendment 

7 made pursuant to a collective bargaining agree8 ment relating to the plan which amends the 

9 plan solely to conform to any requirement 

10 added by this subsection shall not be treated as 

11 a termination of such collective bargaining 

12 agreement. 

13 (b) MEDICARE COVERAGE.— 

14 (1) COVERAGE.—Section 1861(s)(2) of the So15 cial Security Act (42 U.S.C. 1395x(s)(2)) is amend16 ed— 

17 (A) in subparagraph (GG), by striking at 

18 the end ‘‘and’’; 

19 (B) in subparagraph (HH), by inserting at 

20 the end ‘‘; and’’; and 

21 (C) by adding at the end the following new 

22 subparagraph: 

23 ‘‘(II) qualifying reconstructive breast sur24 gery services (as defined in subsection (kkk)).’’. 


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1 (2) DEFINITION.—Section 1861 of the Social 

2 Security Act (42 U.S.C. 1395x) is amended by add3 ing at the end the following new subsection: 

4 ‘‘(kkk) QUALIFYING RECONSTRUCTIVE BREAST SUR5 GERY SERVICES.—The term ‘qualifying reconstructive 

6 breast surgery services’ means, in the case of an individual 

7 who has a mastectomy, breast reconstruction in connec8 tion with such mastectomy, including— 

9 ‘‘(1) all stages of reconstruction of the breast 

10 on which the mastectomy has been performed; 

11 ‘‘(2) surgery and reconstruction of the other 

12 breast to produce a symmetrical appearance; 

13 ‘‘(3) prostheses and physical complications of 

14 mastectomy, including lymphedemas; and 

15 ‘‘(4) tattooing of the nipple-areolar complex 

16 pursuant to or as part of such reconstruction if such 

17 tattooing is performed by a physician, physician ex18 tender, or State-licensed tattoo artist (as such terms 

19 are defined in section 1834(x)), as prescribed by a 

20 physician, 

21 in a manner determined in consultation with the attending 

22 physician and the individual.’’. 

23 (3) PAYMENT.— 


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1 (A) IN GENERAL.—Section 1833(a)(1) of 

2 the Social Security Act (42 U.S.C. 1395l(a)(1)) 

3 is amended— 

4 (i) by striking ‘‘and (DD)’’ and in5 serting ‘‘(DD)’’; and 

6 (ii) by inserting before the semicolon 

7 at the end the following ‘‘and (EE) with 

8 respect to qualifying reconstructive breast 

9 surgery services (as defined in section 

10 1861(kkk)), the amount paid shall be 

11 equal to the amount payable in accordance 

12 with section 1834(x)’’. 

13 (B) PAYMENT DETERMINATION.—Section 

14 1834 of the Social Security Act (42 U.S.C. 

15 1395m) is amended by adding at the end the 

16 following new subsection: 

17 ‘‘(x) QUALIFYING RECONSTRUCTIVE BREAST SUR18 GERY SERVICES.— 

19 ‘‘(1) IN GENERAL.—With respect to qualifying 

20 reconstructive breast surgery services described in 

21 section 1861(kkk)(4) for which payment is deter22 mined under this subsection, payment shall be made 

23 in an amount equal to 100 percent of the reasonable 

24 and customary amount for nipple areolar tattooing, 

25 determined according to the reimbursement rates for 


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1 CPT codes 11920, 11921, and 11922 (or any suc2 cessor to such codes). 

3 ‘‘(2) REASONABLE AND NECESSARY TREAT4 MENT.—Qualifying reconstructive breast surgery 

5 services described in section 1861(kkk)(4) shall be 

6 deemed to be reasonable and necessary for purposes 

7 of section 1862(a)(1)(A). 

8 ‘‘(3) PHYSICIAN EXTENDER.—For purposes of 

9 this subsection and section 1861(kkk)(4), the term 

10 ‘physician extender’ means a health care practitioner 

11 who is not a physician and who is licensed or cer12 tified by the State in which the practitioner if fur13 nishing services to furnish items or services typically 

14 furnished by a physician, such as a nurse practi15 tioner or physician assistant. 

16 ‘‘(4) STATE-LICENSED TATTOO ARTIST.—For 

17 purposes of this subsection and section 

18 1861(kkk)(4), the term ‘State-licensed tattoo artist’ 

19 means an individual (as specified by the law of the 

20 State in which the individual is licensed in per21 forming permanent body art and in which they are 

22 so practicing such art) who maintains all public 

23 health, safety, and welfare standards and regulations 

24 set forth by the State, including all sterilization, 

25 sanitation, and safety regulations for tattoo parlors 


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1 and salons, tattoo inks, tattoo instruments, and any 

2 other related paraphernalia, as well as allowing the 

3 individual to perform the procedure in the pre4 scribing physician’s place of business with the con5 sent of the physician and the patient, abiding by all 

6 such standards and regulations.’’. 

7 (4) INCLUDING CERTAIN TATTOO ARTISTS AS

8 MEDICARE PROVIDERS FOR PURPOSES OF

9 TATTOOING OF THE NIPPLE-AREOLAR COMPLEX

10 AFTER MASTECTOMY.—Section 1866(j)(1) of the So11 cial Security Act (42 U.S.C. 1395cc(j)(1)) is amend12 ed by adding at the end the following new subpara13 graph: 

14 ‘‘(D) INCLUDING CERTAIN TATTOO ART15 ISTS FOR PURPOSES OF TATTOOING OF THE

16 NIPPLE-AREOLAR COMPLEX AFTER MASTEC17 TOMY.—For purposes of this section, the term 

18 ‘supplier’ shall include a State-licensed tattoo 

19 artist (as defined in section 1834(x)), but only 

20 with respect to the tattooing of the nipple21 areolar complex pursuant to or as part of re22 constructive surgery following a medically nec23 essary mastectomy and if such tattooing is pre24 scribed by a physician.’’. 


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1 (5) EFFECTIVE DATE.—The amendments made 

2 by this subsection shall apply with respect to items 

3 and services furnished on or after January 1 of the 

4 first year beginning after the date of the enactment 

5 of this Act. 

6 (c) MEDICAID COVERAGE.— 

7 (1) IN GENERAL.—Section 1905(a) of the So8 cial Security Act (42 U.S.C. 1396d(a)) is amend9 ed— 

10 (A) by redesignating paragraph (30) as 

11 paragraph (31); 

12 (B) in paragraph (29), by striking at the 

13 end ‘‘and’’; 

14 (C) by inserting after paragraph (29) the 

15 following new paragraph: 

16 ‘‘(30) qualifying reconstructive breast surgery 

17 services (as defined in section 1861(kkk)); and’’; and 

18 (D) by adding at the end of the flush mat19 ter following paragraph (31), as redesignated 

20 by subparagraph (A), the following new sen21 tence: ‘‘For purposes of paragraph (30), quali22 fying reconstructive breast surgery services de23 scribed in section 1861(kkk)(4) shall be deemed 

24 to be medically reasonable and necessary.’’. 

25 (2) EFFECTIVE DATE.— 


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1 (A) IN GENERAL.—Subject to subpara2 graph (B), the amendments made by this sec3 tion shall take effect with respect to medical as4 sistance provided on or after January 1 of the 

5 first year beginning after the date of the enact6 ment of this Act. 

7 (B) EXCEPTION FOR STATE LEGISLA8 TION.—In the case of a State plan under title 

9 XIX of the Social Security Act (42 U.S.C. 1396 

10 et seq.) that the Secretary of Health and 

11 Human Services determines requires State leg12 islation in order for the respective plan to meet 

13 any requirement imposed by the amendments 

14 made by this section, the respective plan shall 

15 not be regarded as failing to comply with the 

16 requirements of such title solely on the basis of 

17 its failure to meet such an additional require18 ment before the first day of the first calendar 

19 quarter beginning after the close of the first 

20 regular session of the State legislature that be21 gins after the date of the enactment of this Act. 

22 For purposes of the previous sentence, in the 

23 case of a State that has a 2-year legislative ses24 sion, each year of the session shall be considVerDate Sep 11 2014 02:13 Nov 01, 2020 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H8558.IH H8558

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1 ered to be a separate regular session of the 

2 State legislature. 

Æ 


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