I 
119TH CONGRESS 
1ST SESSION 
H. R. 307 
To amend titles XVIII and XIX of the Social Security Act to provide for 
coverage of peripheral artery disease screening tests furnished to at- 
risk beneficiaries under the Medicare and Medicaid programs without 
the imposition of cost-sharing requirements, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JANUARY 9, 2025 
Mrs. MCIVER (for herself, Mr. JACKSON of Illinois, and Ms. KELLY of Illinois) 
introduced the following bill; which was referred to the Committee on En-
ergy 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 jurisdic-
tion of the committee concerned 
A BILL 
To amend titles XVIII and XIX of the Social Security Act 
to provide for coverage of peripheral artery disease 
screening tests furnished to at-risk beneficiaries under 
the Medicare and Medicaid programs without the imposi-
tion of cost-sharing requirements, and for other pur-
poses. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
VerDate Sep 11 2014 
22:04 Feb 05, 2025
Jkt 059200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H307.IH
H307
ssavage on LAPJG3WLY3PROD with BILLS
SECTION 1. SHORT TITLE; FINDINGS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Amputation Reduction and Compassion Act of 2025’’ or 
the ‘‘ARC Act of 2025’’. 
(b) FINDINGS.—Congress makes the following find-
ings: 
(1) Atherosclerosis occurs when blood flow is 
reduced because arteries become narrowed or 
blocked with fatty deposits. 
(2) Atherosclerosis is responsible for more 
deaths in the United States than any other condi-
tion, and heart attacks, resulting from clogged coro-
nary arteries, are the leading cause of death in 
America. 
(3) Atherosclerosis also occurs in the legs and 
is known as peripheral artery disease (in this sub-
section referred to as ‘‘PAD’’) and having PAD sig-
nificantly increases the risk for heart attack, stroke, 
amputation, and death. 
(4) While most Americans are aware of athero-
sclerosis in the heart, many Americans have never 
heard of PAD and Americans with PAD are often 
unaware of the serious risks of the disease. 
(5) An estimated 21 million Americans have 
PAD, and about 200,000 of them—disproportion-
VerDate Sep 11 2014 
22:04 Feb 05, 2025
Jkt 059200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H307.IH
H307
ssavage on LAPJG3WLY3PROD with BILLS
ately minorities—suffer avoidable amputations every 
year as a result of such disease. 
(6) According to the Dartmouth Atlas, amputa-
tion risks for African Americans living with diabetes 
are as much as four times higher than the national 
average. 
(7) Data analyses have similarly found that Na-
tive Americans are more than twice as likely to be 
subjected to amputation and Hispanics are up to 75 
percent more likely to have an amputation. 
(8) Fifty-two percent of patients with an above- 
the-knee amputation and 33 percent of patients with 
a below-the-knee amputation will die within two 
years of their amputation. 
(9) Screening and arterial testing for PAD is 
cost-effective and should be part of routine medical 
care. 
(10) Once PAD is detected, amputations and 
deaths can be reduced through the use of national, 
evidence-based PAD care guidelines. 
(11) Americans with a PAD diagnosis are asso-
ciated with a 67-percent increase in the risk of car-
diac death compared to people without a PAD diag-
nosis. Consequently, screening for PAD enables 
health care professionals to identify cardiac risk fac-
VerDate Sep 11 2014 
22:04 Feb 05, 2025
Jkt 059200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H307.IH
H307
ssavage on LAPJG3WLY3PROD with BILLS
tors earlier and take proactive measures to reduce 
the risk of cardiac death. 
SEC. 2. PERIPHERAL ARTERY DISEASE EDUCATION PRO-
GRAM. 
Part P of title III of the Public Health Service Act 
(42 U.S.C. 280g et seq.) is amended by adding at the end 
the following new section: 
‘‘SEC. 399V–8. PERIPHERAL ARTERY DISEASE EDUCATION 
PROGRAM. 
‘‘(a) 
ESTABLISHMENT.—The 
Secretary, 
acting 
through the Director of the Centers for Disease Control 
and Prevention, in collaboration with the Administrator 
of the Centers for Medicare & Medicaid Services, the Ad-
ministrator of the Health Resources and Services Admin-
istration, leading clinical and patient advocacy organiza-
tions, and other interested stakeholders shall establish and 
coordinate a peripheral artery disease education program 
to support, develop, and implement educational initiatives 
and outreach strategies that inform health care profes-
sionals and the public about the existence of peripheral 
artery disease and methods to reduce amputations related 
to such disease, particularly with respect to at-risk popu-
lations. 
‘‘(b) BEST PRACTICES.—The Secretary shall, as ap-
propriate, identify and disseminate to health care profes-
VerDate Sep 11 2014 
22:04 Feb 05, 2025
Jkt 059200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H307.IH
H307
ssavage on LAPJG3WLY3PROD with BILLS
sionals best practices with respect to peripheral artery dis-
ease. 
‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section 
$6,000,000 for each of fiscal years 2026 through 2030.’’. 
SEC. 3. MEDICARE COVERAGE OF PERIPHERAL ARTERY 
DISEASE SCREENING TESTS FURNISHED TO 
AT-RISK BENEFICIARIES WITHOUT IMPOSI-
TION OF COST-SHARING REQUIREMENTS. 
(a) IN GENERAL.—Section 1861 of the Social Secu-
rity Act (42 U.S.C. 1395x) is amended— 
(1) in subsection (s)(2)— 
(A) in subparagraph (JJ), by striking the 
semicolon at the end and inserting ‘‘; and’’; and 
(B) by adding at the end the following new 
subparagraph: 
‘‘(KK) peripheral artery disease screening tests 
furnished to at-risk beneficiaries (as such terms are 
defined in subsection (nnn)).’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(nnn) PERIPHERAL ARTERY DISEASE SCREENING 
TEST; AT-RISK BENEFICIARY.—(1) The term ‘peripheral 
artery disease screening test’ means— 
VerDate Sep 11 2014 
22:04 Feb 05, 2025
Jkt 059200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H307.IH
H307
ssavage on LAPJG3WLY3PROD with BILLS
‘‘(A) noninvasive physiologic studies of extrem-
ity arteries (commonly referred to as ankle-brachial 
index testing); 
‘‘(B) arterial duplex scans of lower extremity 
arteries vascular; and 
‘‘(C) such other items and services as the Sec-
retary determines, in consultation with relevant 
stakeholders, to be appropriate for screening for pe-
ripheral artery disease for at-risk beneficiaries. 
‘‘(2) The term ‘at-risk beneficiary’ means an indi-
vidual entitled to, or enrolled for, benefits under part A 
and enrolled for benefits under part B— 
‘‘(A) who is 65 years of age or older; 
‘‘(B) who is at least 50 years of age but not 
older than 64 years of age with risk factors for ath-
erosclerosis (such as diabetes mellitus, a history of 
smoking, hyperlipidemia, and hypertension) or a 
family history of peripheral artery disease; 
‘‘(C) who is younger than 50 years of age with 
diabetes mellitus and one additional risk factor for 
atherosclerosis; or 
‘‘(D) with a known atherosclerotic disease in 
another vascular bed such as coronary, carotid, sub-
clavian, renal, or mesenteric artery stenosis, or ab-
dominal aortic aneurysm. 
VerDate Sep 11 2014 
22:04 Feb 05, 2025
Jkt 059200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H307.IH
H307
ssavage on LAPJG3WLY3PROD with BILLS
‘‘(3) The Secretary shall, in consultation with appro-
priate organizations, establish standards regarding the 
frequency for peripheral artery disease screening tests de-
scribed in subsection (s)(2)(KK) for purposes of coverage 
under this title.’’. 
(b) INCLUSION OF PERIPHERAL ARTERY DISEASE 
SCREENING TESTS IN INITIAL PREVENTIVE PHYSICAL 
EXAMINATION.—Section 1861(ww)(2) of the Social Secu-
rity Act (42 U.S.C. 1395x(ww)(2)) is amended— 
(1) in subparagraph (N), by moving the mar-
gins of such subparagraph 2 ems to the left; 
(2) by redesignating subparagraph (O) as sub-
paragraph (P); and 
(3) by inserting after subparagraph (N) the fol-
lowing new subparagraph: 
‘‘(O) Peripheral artery disease screening tests 
furnished to at risk-beneficiaries (as such terms are 
defined in subsection (nnn)).’’. 
(c) PAYMENT.— 
(1) IN GENERAL.—Section 1833(a) of the So-
cial Security Act (42 U.S.C. 1395l(a)) is amended— 
(A) in paragraph (1)— 
(i) in subparagraph (N), by inserting 
‘‘and other than peripheral artery disease 
screening tests furnished to at-risk bene-
VerDate Sep 11 2014 
22:04 Feb 05, 2025
Jkt 059200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H307.IH
H307
ssavage on LAPJG3WLY3PROD with BILLS
ficiaries (as such terms are defined in sec-
tion 1861(nnn))’’ after ‘‘other than person-
alized prevention plan services (as defined 
in section 1861(hhh)(1))’’; 
(ii) by striking ‘‘and’’ before ‘‘(HH)’’; 
and 
(iii) by adding at the end the fol-
lowing: ‘‘and (II) with respect to peripheral 
artery disease screening tests furnished to 
at-risk beneficiaries (as such terms are de-
fined in section 1861(nnn)), the amount 
paid shall be 100 percent of the lesser of 
the actual charge for the services or the 
amount determined under the payment 
basis determined under section 1848;’’; 
and 
(B) in paragraph (2)— 
(i) in subparagraph (G), by striking 
‘‘and’’ at the end; 
(ii) in subparagraph (H), by striking 
the semicolon at the end and inserting ‘‘; 
and’’; and 
(iii) by inserting after subparagraph 
(H) the following new subparagraph: 
VerDate Sep 11 2014 
22:04 Feb 05, 2025
Jkt 059200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H307.IH
H307
ssavage on LAPJG3WLY3PROD with BILLS
‘‘(I) with respect to peripheral artery disease 
screening tests (as defined in paragraph (1) of sec-
tion 1861(nnn)) furnished by an outpatient depart-
ment of a hospital to at-risk beneficiaries (as defined 
in paragraph (2) of such section), the amount deter-
mined under paragraph (1)(II);’’. 
(2) NO DEDUCTIBLE.—Section 1833(b) of the 
Social Security Act (42 U.S.C. 1395l(b)) is amend-
ed, in the first sentence— 
(A) by striking ‘‘, and’’ before ‘‘(13)’’; and 
(B) by inserting before the period at the 
end the following: ‘‘, and (14) such deductible 
shall not apply with respect to peripheral artery 
disease screening tests furnished to at-risk 
beneficiaries (as such terms are defined in sec-
tion 1861(nnn))’’. 
(3) EXCLUSION FROM PROSPECTIVE PAYMENT 
SYSTEM FOR HOSPITAL OUTPATIENT DEPARTMENT 
SERVICES.—Section 1833(t)(1)(B)(iv) of the Social 
Security Act (42 U.S.C. 1395l(t)(1)(B)(iv)) is 
amended— 
(A) by striking ‘‘, or personalized’’ and in-
serting ‘‘, personalized’’; and 
(B) by inserting ‘‘, or peripheral artery 
disease screening tests furnished to at-risk 
VerDate Sep 11 2014 
22:04 Feb 05, 2025
Jkt 059200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H307.IH
H307
ssavage on LAPJG3WLY3PROD with BILLS
beneficiaries (as such terms are defined in sec-
tion 1861(nnn))’’ after ‘‘personalized prevention 
plan 
services 
(as 
defined 
in 
section 
1861(hhh)(1))’’. 
(4) 
CONFORMING
AMENDMENT.—Section 
1848(j)(3) of the Social Security Act (42 U.S.C. 
1395w–4(j)(3)) is amended by striking ‘‘(2)(FF) 
(including administration of the health risk assess-
ment),’’ and inserting ‘‘(2)(FF) (including adminis-
tration of the health risk assessment), (2)(KK),’’. 
(d) EXCLUSION FROM COVERAGE AND MEDICARE AS 
SECONDARY PAYER FOR TESTS PERFORMED MORE FRE-
QUENTLY THAN ALLOWED.—Section 1862(a)(1) of the 
Social Security Act (42 U.S.C. 1395y(a)(1)) is amended— 
(1) in subparagraph (O), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (P), by striking the semi-
colon at the end and inserting ‘‘, and’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(Q) in the case of peripheral artery disease 
screening tests furnished to at-risk beneficiaries (as 
such terms are defined in section 1861(nnn)), which 
are performed more frequently than is covered under 
such section;’’. 
VerDate Sep 11 2014 
22:04 Feb 05, 2025
Jkt 059200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H307.IH
H307
ssavage on LAPJG3WLY3PROD with BILLS
(e) AUTHORITY TO MODIFY OR ELIMINATE COV-
ERAGE
OF CERTAIN PREVENTIVE SERVICES.—Section 
1834(n) of the Social Security Act (42 U.S.C. 1395m(n)) 
is amended— 
(1) by redesignating subparagraphs (A) and 
(B) of paragraph (1) as clauses (i) and (ii), respec-
tively, and moving the margins of such clauses, as 
so redesignated, 2 ems to the right; 
(2) by redesignating paragraphs (1) and (2) as 
subparagraphs (A) and (B), respectively, and mov-
ing the margins of such subparagraphs, as so redes-
ignated, 2 ems to the right; 
(3) by striking ‘‘CERTAIN PREVENTIVE SERV-
ICES’’ and all that follows through ‘‘any other provi-
sion of this title’’ and inserting: ‘‘CERTAIN PREVEN-
TIVE SERVICES.— 
‘‘(1) IN GENERAL.—Notwithstanding any other 
provision of this title’’; and 
(4) by adding at the end the following new 
paragraph: 
‘‘(2) INAPPLICABILITY.—The Secretarial au-
thority described in paragraph (1) shall not apply 
with respect to preventive services described in sec-
tion 1861(ww)(2)(O).’’. 
VerDate Sep 11 2014 
22:04 Feb 05, 2025
Jkt 059200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H307.IH
H307
ssavage on LAPJG3WLY3PROD with BILLS
(f) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to items and services 
furnished on or after January 1, 2026. 
SEC. 4. MEDICAID COVERAGE OF PERIPHERAL ARTERY 
DISEASE SCREENING TESTS FURNISHED TO 
AT-RISK BENEFICIARIES WITHOUT IMPOSI-
TION OF COST-SHARING REQUIREMENTS. 
(a) IN GENERAL.—Section 1905 of the Social Secu-
rity Act (42 U.S.C. 1396d) is amended— 
(1) in subsection (a)— 
(A) in paragraph (31), by striking ‘‘and’’ 
at the end; 
(B) by redesignating paragraph (32) as 
paragraph (33); and 
(C) by inserting after paragraph (31) the 
following new paragraph: 
‘‘(32) peripheral artery disease screening tests 
furnished to at-risk beneficiaries (as such terms are 
defined in subsection (kk)); and’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(kk) PERIPHERAL ARTERY DISEASE SCREENING 
TEST; AT-RISK BENEFICIARY.— 
VerDate Sep 11 2014 
22:04 Feb 05, 2025
Jkt 059200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H307.IH
H307
ssavage on LAPJG3WLY3PROD with BILLS
‘‘(1) PERIPHERAL ARTERY DISEASE SCREENING 
TEST.—The term ‘peripheral artery disease screen-
ing test’ means— 
‘‘(A) noninvasive physiologic studies of ex-
tremity arteries (commonly referred to as ankle- 
brachial index testing); 
‘‘(B) arterial duplex scans of lower extrem-
ity arteries vascular; and 
‘‘(C) such other items and services as the 
Secretary determines, in consultation with rel-
evant stakeholders, to be appropriate for 
screening for peripheral artery disease for at- 
risk beneficiaries. 
‘‘(2) AT-RISK BENEFICIARY.—The term ‘at-risk 
beneficiary’ means an individual enrolled under a 
State plan (or a waiver of such plan)— 
‘‘(A) who is 65 years of age or older; 
‘‘(B) who is at least 50 years of age but 
not older than 64 years of age with risk factors 
for atherosclerosis (such as diabetes mellitus, a 
history of smoking, hyperlipidemia, and hyper-
tension) or a family history of peripheral artery 
disease; 
VerDate Sep 11 2014 
22:04 Feb 05, 2025
Jkt 059200
PO 00000
Frm 00013
Fmt 6652
Sfmt 6201
E:\BILLS\H307.IH
H307
ssavage on LAPJG3WLY3PROD with BILLS
‘‘(C) who is younger than 50 years of age 
with diabetes mellitus and one additional risk 
factor for atherosclerosis; or 
‘‘(D) with a known atherosclerotic disease 
in another vascular bed such as coronary, ca-
rotid, subclavian, renal, or mesenteric artery 
stenosis, or abdominal aortic aneurysm. 
‘‘(3) FREQUENCY.—The Secretary shall, in con-
sultation with appropriate organizations, establish 
standards regarding the frequency for peripheral ar-
tery disease screening tests described in subsection 
(a)(31) for purposes of coverage under a State plan 
under this title.’’. 
(b) NO COST SHARING.— 
(1) IN
GENERAL.—Subsections (a)(2) and 
(b)(2) of section 1916 of the Social Security Act (42 
U.S.C. 1396o) are each amended— 
(A) in subparagraph (I), by striking ‘‘or’’ 
at the end; 
(B) in subparagraph (J), by striking ‘‘; 
and’’ and inserting ‘‘, or’’; and 
(C) by adding at the end the following new 
subparagraph: 
VerDate Sep 11 2014 
22:04 Feb 05, 2025
Jkt 059200
PO 00000
Frm 00014
Fmt 6652
Sfmt 6201
E:\BILLS\H307.IH
H307
ssavage on LAPJG3WLY3PROD with BILLS
‘‘(K) peripheral artery disease screening 
tests furnished to at-risk beneficiaries (as such 
terms are defined in section 1905(kk)); and’’. 
(2) APPLICATION TO ALTERNATIVE COST SHAR-
ING.—Section 1916A(b)(3)(B) of the Social Security 
Act (42 U.S.C. 1396o–1(b)(3)(B)) is amended by 
adding at the end the following new clause: 
‘‘(xv) Peripheral artery disease screen-
ing tests furnished to at-risk beneficiaries 
(as such terms are defined in section 
1905(kk)).’’. 
(c) CONFORMING AMENDMENTS.— 
(1) Section 1902(nn)(3) of the Social Security 
Act (42 U.S.C. 1396a(nn)(3)) is amended by strik-
ing ‘‘following paragraph (31)’’ and inserting ‘‘fol-
lowing paragraph (32)’’. 
(2) Section 1905(a) of the Social Security Act 
(42 U.S.C. 1396d(a)) is amended by striking ‘‘fol-
lowing paragraph (31)’’ and inserting ‘‘following 
paragraph (32)’’. 
SEC. 5. DEVELOPMENT AND IMPLEMENTATION OF QUALITY 
MEASURES. 
(a) DEVELOPMENT.—The Secretary of Health and 
Human Services (referred to in this section as the ‘‘Sec-
retary’’) shall, in consultation with relevant stakeholders, 
VerDate Sep 11 2014 
22:04 Feb 05, 2025
Jkt 059200
PO 00000
Frm 00015
Fmt 6652
Sfmt 6201
E:\BILLS\H307.IH
H307
ssavage on LAPJG3WLY3PROD with BILLS
develop quality measures for nontraumatic, lower-limb, 
major amputation that utilize appropriate diagnostic 
screening (including peripheral artery disease screening) 
in order to encourage alternative treatments (including 
revascularization) in lieu of such an amputation. 
(b) IMPLEMENTATION.—Not later than 18 months 
after the date of enactment of this Act, the Secretary shall 
complete appropriate testing and validation of the meas-
ures developed under subsection (a) and shall incorporate 
such measures in quality reporting programs for appro-
priate providers of services and suppliers under the Medi-
care program under title XVIII of the Social Security Act 
(42 U.S.C. 1395 et seq.), including for purposes of— 
(1) the merit-based incentive payment system 
under section 1848(q) of such Act (42 U.S.C. 
1395w–4(q)); 
(2) incentive payments for participation in eligi-
ble alternative payment models under section 
1833(z) of such Act (42 U.S.C. 1395l(z)); 
(3) the shared savings program under section 
1899 of such Act (42 U.S.C. 1395jjj); 
(4) models under section 1115A of such Act 
(42 U.S.C. 1315a); and 
(5) such other payment systems or models as 
the Secretary may specify. 
VerDate Sep 11 2014 
22:04 Feb 05, 2025
Jkt 059200
PO 00000
Frm 00016
Fmt 6652
Sfmt 6201
E:\BILLS\H307.IH
H307
ssavage on LAPJG3WLY3PROD with BILLS
SEC. 6. AMPUTATION PREVENTION PILOT PROGRAM. 
(a) IN GENERAL.—Section 1115A(b)(2)(B) of the 
Social Security Act (42 U.S.C. 1315a(b)(2)(B)) is amend-
ed by adding at the end the following new clause: 
‘‘(xxviii) Promoting voluntary, non-
traumatic lower-limb major amputation 
prevention programs at hospitals, ambula-
tory surgical centers, and office-based cen-
ters that will increase access to amputation 
prevention services, reduce amputation 
rates, and reduce costs to such hospitals, 
surgical centers, and office-based centers, 
through— 
‘‘(I) patient risk modification and 
management; 
‘‘(II) early screening and detec-
tion and surveillance; 
‘‘(III) testing and treatment for 
peripheral artery disease; and 
‘‘(IV) improved care coordination 
for individuals at high risk for ampu-
tation.’’. 
(b) TESTING OF MODEL.—Not later than 18 months 
after the date of the enactment of this Act, the Deputy 
Administrator and Director of the Center for Medicare 
VerDate Sep 11 2014 
22:04 Feb 05, 2025
Jkt 059200
PO 00000
Frm 00017
Fmt 6652
Sfmt 6201
E:\BILLS\H307.IH
H307
ssavage on LAPJG3WLY3PROD with BILLS
and Medicaid Innovation shall test the model described 
under subsection (a). 
Æ 
VerDate Sep 11 2014 
22:04 Feb 05, 2025
Jkt 059200
PO 00000
Frm 00018
Fmt 6652
Sfmt 6301
E:\BILLS\H307.IH
H307
ssavage on LAPJG3WLY3PROD with BILLS