I 
119TH CONGRESS 
1ST SESSION H. R. 5813 
To amend title XXVII of the Public Health Service Act, the Employee 
Retirement Income Security Act of 1974, and the Internal Revenue 
Code of 1986 to require group health plans and health insurance issuers 
offering group or individual health insurance coverage to provide coverage 
of certain items and services relating to breast or chest wall reconstruc-
tion furnished in connection with breast cancer treatment. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 24, 2025 
Mrs. CAMMACK (for herself, Mrs. DINGELL, Mrs. HINSON, Mrs. MCBATH, 
Mrs. KIM, Mrs. MCCLAIN DELANEY, Ms. VAN DUYNE, Ms. PEREZ, and 
Ms. PETTERSEN) 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 Workforce, 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 con-
cerned 
A BILL 
To amend title XXVII of the Public Health Service Act, 
the Employee Retirement Income Security Act of 1974, 
and the Internal Revenue Code of 1986 to require group 
health plans and health insurance issuers offering group 
or individual health insurance coverage to provide cov-
erage of certain items and services relating to breast 
or chest wall reconstruction furnished in connection with 
breast cancer treatment. 
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Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Women’s Health and 
Cancer Rights Modernization Act of 2025’’. 
SEC. 2. REQUIRING COVERAGE OF CERTAIN ITEMS AND 
SERVICES RELATING TO BREAST OR CHEST 
WALL RECONSTRUCTION FURNISHED IN CON-
NECTION 
WITH 
BREAST 
CANCER 
TREAT-
MENT. 
(a) PHSA.— 
(1) IN GENERAL.—Part D of title XXVII of the 
Public Health Service Act (42 U.S.C. 300gg–111 et 
seq.) is amended by adding at the end the following 
new section: 
‘‘SEC. 2799A–11. REQUIRED COVERAGE FOR CERTAIN ITEMS 
AND SERVICES RELATING TO BREAST OR 
CHEST WALL RECONSTRUCTION FURNISHED 
IN 
CONNECTION 
WITH 
BREAST 
CANCER 
TREATMENT. 
‘‘(a) IN GENERAL.—A group health plan, and a 
health insurance issuer offering group or individual health 
insurance coverage, that provides medical and surgical 
benefits with respect to the treatment of breast cancer 
shall provide, in the case of a participant or beneficiary 
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who is receiving such treatment and who elects breast or 
chest wall reconstruction in connection with such treat-
ment, coverage for— 
‘‘(1) extirpation or medical treatment of dis-
eased or damaged breast tissue, including mastec-
tomy and all forms of breast-conserving surgery; 
‘‘(2) each modality of breast reconstruction, in-
cluding— 
‘‘(A) implant-based reconstruction; 
‘‘(B) tissue-based reconstruction; and 
‘‘(C) any reconstruction modalities that are 
developed subsequent to the date of the enact-
ment of this subsection and recognized within 
Level I of the Healthcare Common Procedure 
Coding System; 
‘‘(3) within each modality specified in para-
graph (2), each type of breast reconstruction, includ-
ing— 
‘‘(A) immediate implant-based reconstruc-
tion; 
‘‘(B) delayed implant-based reconstruction; 
‘‘(C) myocutaneous flap tissue-based recon-
struction; 
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‘‘(D) microvascular free flap tissue-based 
reconstruction; structural fat grafting tissue- 
based reconstruction; 
‘‘(E) combined implant- and tissue-based 
reconstruction; and 
‘‘(F) any type of reconstruction that is de-
veloped subsequent to the effective date of this 
act and incorporated within Level I of the 
Healthcare Common Procedure Coding System; 
‘‘(4) within each type of breast reconstruction 
specified in paragraph (3), each procedural vari-
ation, iteration, or approach that is noted within the 
short 
descriptor 
or 
the 
description 
for 
the 
Healthcare Common Procedure Coding System Level 
I code covering the type of reconstruction; 
‘‘(5) all stages of reconstruction of the breast or 
chest wall on which a mastectomy or breast-con-
serving surgery has been performed, including flat 
closure; 
‘‘(6) surgery and reconstruction of the other 
breast or chest wall to produce a symmetrical ap-
pearance; 
‘‘(7) custom fabricated breast prostheses, in-
cluding replacement of such prostheses; and 
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‘‘(8) mechanical, medical, and surgical treat-
ment of physical complications of mastectomy, 
breast reconstruction surgery, chest wall surgery, ra-
diation, 
and 
lymph 
node 
surgery, 
including 
lymphedema compression treatment items (as such 
term is defined in section 1861(mmm) of the Social 
Security Act but without regard to the requirement 
in paragraph (1) of such section that such an item 
be furnished on or after January 1, 2024). 
‘‘(b) MANNER OF COVERAGE.—Coverage described in 
subsection (a) shall be provided in a manner determined 
in consultation with the attending physician and the pa-
tient and for which the patient is a medical candidate. 
Such coverage may be subject to annual deductibles and 
coinsurance provisions as are consistent with those estab-
lished for other benefits under the plan or coverage. Writ-
ten notice of the availability of such coverage shall be de-
livered to the participant upon enrollment and annually 
thereafter. 
‘‘(c) IN-NETWORK ACCESS.—A group health plan 
and a health insurance issuer offering group or individual 
health insurance coverage shall ensure that at least 1 in- 
network provider is available under such plan or coverage 
with respect to each modality, type of reconstruction, and 
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procedural variation, iteration, and approach described in 
subsection (a). 
‘‘(d) NOTICE.—A group health plan, and a health in-
surance issuer offering group or individual health insur-
ance coverage, shall provide notice to each individual en-
rolled under such plan regarding the coverage required by 
this section in accordance with regulations promulgated 
by the Secretary. Such notice shall be in writing and 
prominently positioned in any literature or correspondence 
made available or distributed by the plan or issuer and 
shall be transmitted— 
‘‘(1) upon such individual’s enrollment in such 
plan or coverage; and 
‘‘(2) as part of any yearly informational packet 
sent to the individual thereafter. 
‘‘(e) PROHIBITIONS.—A group health plan, and a 
health insurance issuer offering group or individual health 
insurance coverage, may not— 
‘‘(1) deny to a patient eligibility, or continued 
eligibility, to enroll or to renew coverage under the 
terms of the plan, solely for the purpose of avoiding 
the requirements of this section; and 
‘‘(2) penalize or otherwise reduce or limit the 
reimbursement of an attending provider, or provide 
incentives (monetary or otherwise) to an attending 
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provider, to induce such provider to provide care to 
an individual participant or beneficiary in a manner 
inconsistent with this section or with generally ac-
cepted standards of medical practice. 
‘‘(f) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to prevent a group health plan or 
a health insurance issuer offering group or individual 
health insurance coverage from negotiating the level and 
type of reimbursement with a provider for care provided 
in accordance with this section. 
‘‘(g) PREEMPTION.—Nothing in this section shall be 
construed to preempt any State law with respect to health 
insurance coverage that requires coverage of at least the 
coverage of breast cancer care otherwise required under 
this section.’’. 
(2) CONFORMING AMENDMENT.—Section 2727 
of the Public Health Service Act (42 U.S.C. 300gg– 
27) is amended by adding at the end the following 
new sentence: ‘‘The preceding sentence shall not 
apply with respect to plan years beginning on or 
after the date of the enactment of this sentence.’’. 
(b) ERISA.— 
(1) IN GENERAL.—Section 713 of the Employee 
Retirement Income Security Act of 1974 (29 U.S.C. 
1185b) is amended— 
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(A) in the header, by striking ‘‘RECON-
STRUCTIVE
SURGERY
FOLLOWING 
MASTECTOMIES’’ and inserting ‘‘CERTAIN 
ITEMS
AND
SERVICES
RELATING
TO 
BREAST
OR
CHEST
WALL
RECONSTRUC-
TION
FURNISHED
IN
CONNECTION
WITH 
BREAST CANCER TREATMENT’’; 
(B) by amending subsection (a) to read as 
follows: 
‘‘(a) IN GENERAL.—A group health plan, and a 
health insurance issuer providing health insurance cov-
erage in connection with a group health plan, that provides 
medical and surgical benefits with respect to the treatment 
of breast cancer shall provide, in the case of a participant 
or beneficiary who is receiving such treatment and who 
elects breast or chest wall reconstruction in connection 
with such treatment, coverage for— 
‘‘(1) extirpation or medical treatment of dis-
eased or damaged breast tissue, including mastec-
tomy and all forms of breast-conserving surgery; 
‘‘(2) each modality of breast reconstruction, in-
cluding— 
‘‘(A) implant-based reconstruction; 
‘‘(B) tissue-based reconstruction; and 
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‘‘(C) any reconstruction modalities that are 
developed subsequent to the date of the enact-
ment of this subsection and recognized within 
Level I of the Healthcare Common Procedure 
Coding System; 
‘‘(3) within each modality specified in para-
graph (2), each type of breast reconstruction, includ-
ing— 
‘‘(A) immediate implant-based reconstruc-
tion; 
‘‘(B) delayed implant-based reconstruction; 
‘‘(C) myocutaneous flap tissue-based recon-
struction; 
‘‘(D) microvascular free flap tissue-based 
reconstruction; structural fat grafting tissue- 
based reconstruction; 
‘‘(E) combined implant- and tissue-based 
reconstruction; and 
‘‘(F) any type of reconstruction that is de-
veloped subsequent to the effective date of this 
act and incorporated within Level I of the 
Healthcare Common Procedure Coding System; 
‘‘(4) within each type of breast reconstruction 
specified in paragraph (3), each procedural vari-
ation, iteration, or approach that is noted within the 
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short 
descriptor 
or 
the 
description 
for 
the 
Healthcare Common Procedure Coding System Level 
I code covering the type of reconstruction; 
‘‘(5) all stages of reconstruction of the breast or 
chest wall on which a mastectomy or breast-con-
serving surgery has been performed, including flat 
closure; 
‘‘(6) surgery and reconstruction of the other 
breast or chest wall to produce a symmetrical ap-
pearance; 
‘‘(7) custom fabricated breast prostheses, in-
cluding replacement of such prostheses; and 
‘‘(8) mechanical, medical, and surgical treat-
ment of physical complications of mastectomy, 
breast reconstruction surgery, chest wall surgery, ra-
diation, 
and 
lymph 
node 
surgery, 
including 
lymphedema compression treatment items (as such 
term is defined in section 1861(mmm) of the Social 
Security Act but without regard to the requirement 
in paragraph (1) of such section that such an item 
be furnished on or after January 1, 2024).’’; 
(C) 
by 
redesignating 
subsections 
(b) 
through (e) as subsections (d) through (g), re-
spectively; 
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(D) by inserting after subsection (a) the 
following new subsections: 
‘‘(b) MANNER OF COVERAGE.—Coverage described in 
subsection (a) shall be provided in a manner determined 
in consultation with the attending physician and the pa-
tient and for which the patient is a medical candidate. 
Such coverage may be subject to annual deductibles and 
coinsurance provisions as are consistent with those estab-
lished for other benefits under the plan or coverage. Writ-
ten notice of the availability of such coverage shall be de-
livered to the participant upon enrollment and annually 
thereafter. 
‘‘(c) IN-NETWORK ACCESS.—A group health plan 
and a health insurance issuer offering group health insur-
ance coverage shall ensure that at least 1 in-network pro-
vider is available under such plan or coverage with respect 
to each modality, type of reconstruction, and procedural 
variation, iteration, and approach described in subsection 
(a).’’; 
(E) in subsection (d), as so redesignated, 
by striking paragraphs (1) through (3) and in-
serting the following new paragraphs: 
‘‘(1) upon such participant or beneficiary’s en-
rollment in such plan or coverage; and 
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‘‘(2) as part of any yearly informational packet 
sent to the participant or beneficiary thereafter.’’; 
(F) in subsection (e)(2), as so redesig-
nated, by inserting ‘‘or with generally accepted 
standards of medical practice’’ before the pe-
riod; and 
(G) in subsection (g)(1), as so redesig-
nated— 
(i) by striking ‘‘in effect on the date 
of enactment of this section’’; and 
(ii) by striking ‘‘reconstructive breast 
surgery’’ and inserting ‘‘breast cancer 
care’’. 
(2) CLERICAL AMENDMENT.—The table of con-
tents in section 1 of the Employee Retirement In-
come Security Act of 1974 (29 U.S.C. 1001 note) is 
amended to read as follows: 
‘‘Sec. 713. Required coverage of certain items and services relating to breast 
or chest wall reconstruction furnished in connection with breast 
cancer treatment.’’. 
(c) IRC.— 
(1) IN
GENERAL.—Subchapter B of chapter 
100 of the Internal Revenue Code of 1986 is amend-
ed by adding at the end the following new section: 
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‘‘SEC. 9826. REQUIRED COVERAGE FOR CERTAIN ITEMS 
AND SERVICES RELATING TO BREAST OR 
CHEST WALL RECONSTRUCTION FURNISHED 
IN 
CONNECTION 
WITH 
BREAST 
CANCER 
TREATMENT. 
‘‘(a) IN GENERAL.—A group health plan that pro-
vides medical and surgical benefits with respect to the 
treatment of breast cancer shall provide, in the case of 
a participant or beneficiary who is receiving such treat-
ment and who elects breast or chest wall reconstruction 
in connection with such treatment, coverage for— 
‘‘(1) extirpation or medical treatment of dis-
eased or damaged breast tissue, including mastec-
tomy and all forms of breast-conserving surgery; 
‘‘(2) each modality of breast reconstruction, in-
cluding— 
‘‘(A) implant-based reconstruction; 
‘‘(B) tissue-based reconstruction; and 
‘‘(C) any reconstruction modalities that are 
developed subsequent to the date of the enact-
ment of this subsection and recognized within 
Level I of the Healthcare Common Procedure 
Coding System; 
‘‘(3) within each modality specified in para-
graph (2), each type of breast reconstruction, includ-
ing— 
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‘‘(A) immediate implant-based reconstruc-
tion; 
‘‘(B) delayed implant-based reconstruction; 
‘‘(C) myocutaneous flap tissue-based recon-
struction; 
‘‘(D) microvascular free flap tissue-based 
reconstruction; structural fat grafting tissue- 
based reconstruction; 
‘‘(E) combined implant- and tissue-based 
reconstruction; and 
‘‘(F) any type of reconstruction that is de-
veloped subsequent to the effective date of this 
act and incorporated within Level I of the 
Healthcare Common Procedure Coding System; 
‘‘(4) within each type of breast reconstruction 
specified in paragraph (3), each procedural vari-
ation, iteration, or approach that is noted within the 
short 
descriptor 
or 
the 
description 
for 
the 
Healthcare Common Procedure Coding System Level 
I code covering the type of reconstruction; 
‘‘(5) all stages of reconstruction of the breast or 
chest wall on which a mastectomy or breast-con-
serving surgery has been performed, including flat 
closure; 
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‘‘(6) surgery and reconstruction of the other 
breast or chest wall to produce a symmetrical ap-
pearance; 
‘‘(7) custom fabricated breast prostheses, in-
cluding replacement of such prostheses; and 
‘‘(8) mechanical, medical, and surgical treat-
ment of physical complications of mastectomy, 
breast reconstruction surgery, chest wall surgery, ra-
diation, 
and 
lymph 
node 
surgery, 
including 
lymphedema compression treatment items (as such 
term is defined in section 1861(mmm) of the Social 
Security Act but without regard to the requirement 
in paragraph (1) of such section that such an item 
be furnished on or after January 1, 2024). 
‘‘(b) MANNER OF COVERAGE.—Coverage described in 
subsection (a) shall be provided in a manner determined 
in consultation with the attending physician and the pa-
tient and for which the patient is a medical candidate. 
Such coverage may be subject to annual deductibles and 
coinsurance provisions as are consistent with those estab-
lished for other benefits under the plan. Written notice 
of the availability of such coverage shall be delivered to 
the participant or beneficiary upon enrollment and annu-
ally thereafter. 
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‘‘(c) IN-NETWORK ACCESS.—A group health plan 
shall ensure that at least 1 in-network provider is available 
under such plan with respect to each modality, type of 
reconstruction, and procedural variation, iteration, and 
approach described in subsection (a). 
‘‘(d) NOTICE.—A group health plan shall provide no-
tice to each participant and beneficiary under such plan 
regarding the coverage required by this section in accord-
ance with regulations promulgated by the Secretary. Such 
notice shall be in writing and prominently positioned in 
any literature or correspondence made available or distrib-
uted by the plan or issuer and shall be transmitted— 
‘‘(1) upon such participant or beneficiary’s en-
rollment in such plan; and 
‘‘(2) as part of any yearly informational packet 
sent to the participant or beneficiary thereafter. 
‘‘(e) PROHIBITIONS.—A group health plan may not— 
‘‘(1) deny to a patient eligibility, or continued 
eligibility, to enroll or to renew coverage under the 
terms of the plan, solely for the purpose of avoiding 
the requirements of this section; and 
‘‘(2) penalize or otherwise reduce or limit the 
reimbursement of an attending provider, or provide 
incentives (monetary or otherwise) to an attending 
provider, to induce such provider to provide care to 
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an individual participant or beneficiary in a manner 
inconsistent with this section or with generally ac-
cepted standards of medical practice. 
‘‘(f) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to prevent a group health plan 
from negotiating the level and type of reimbursement with 
a provider for care provided in accordance with this sec-
tion. 
‘‘(g) PREEMPTION.—Nothing in this section shall be 
construed to preempt any State law with respect to health 
insurance coverage that requires coverage of at least the 
coverage of breast cancer care otherwise required under 
this section.’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions for such subchapter is amended by inserting 
after the entry relating to section 9825 the fol-
lowing: 
‘‘Sec. 9826. Required coverage for certain items and services relating to breast 
or chest wall reconstruction furnished in connection with breast 
cancer treatment.’’. 
(d) REPORT.—Not later that 1 year after the date 
of the enactment of this Act, the Comptroller General of 
the United States shall submit to the appropriate commit-
tees of Congress a report describing any gaps or barriers 
in access to breast reconstruction, including microsurgical 
breast reconstruction. 
(e) EFFECTIVE DATE.— 
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(1) IN GENERAL.—The amendments made by 
this section shall apply to plan years beginning on 
or after the date of the enactment of this Act. 
(2) SPECIAL
RULE
FOR
COLLECTIVE
BAR-
GAINING
AGREEMENTS.—In the case of a group 
health plan maintained pursuant to 1 or more collec-
tive bargaining agreements between employee rep-
resentatives and 1 or more employers, 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 section shall not be treated as a termination of 
such collective bargaining agreement. 
Æ 
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