Comprehensive Breast Reconstruction Act of 2021

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. Short title This Act may be cited as the Comprehensive Breast Reconstruction Act of 2021 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) (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) (A) in subparagraph (GG), by striking at the end and (B) in subparagraph (HH), by inserting at the end ; 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 (kkk) Qualifying reconstructive breast surgery services The term qualifying reconstructive breast surgery services (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) (i) by striking and (DD) (DD) (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 (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 (4) State-licensed tattoo artist For purposes of this subsection and section 1861(kkk)(4), the term State-licensed tattoo artist . (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) (D) Including certain tattoo artists for purposes of tattooing of the nipple–areolar complex after mastectomy For purposes of this section, the term supplier . (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) (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

Summary: 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).