I 
116TH CONGRESS 
2D SESSION 
H. R. 8615 
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, to amend title XXVII of 
the Public Health Service Act to require group health plans and health 
insurance issuers offering group or individual health insurance coverage 
to provide coverage for such screening tests furnished to at-risk enrollees 
of group health plans and group or individual health insurance coverage 
without the imposition of cost-sharing requirements, and for other pur-
poses. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 16, 2020 
Mr. PAYNE (for himself, Mr. RUSH, Mr. GALLEGO, Mr. THOMPSON of Mis-
sissippi, Ms. JOHNSON of Texas, and Ms. BLUNT ROCHESTER) intro-
duced 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 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, to amend title XXVII 
of the Public Health Service Act to require group health 
plans and health insurance issuers offering group or 
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individual health insurance coverage to provide coverage 
for such screening tests furnished to at-risk enrollees 
of group health plans and group or individual health 
insurance coverage without the imposition of cost-sharing 
requirements, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; FINDINGS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Amputation Reduction and Compassion Act of 2020’’ or 
the ‘‘ARC Act of 2020’’. 
(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. 
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(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-
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. 
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(10) Once PAD is detected, amputations and 
deaths can be reduced through the use of national, 
evidence-based PAD care guidelines. 
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–7. 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 and the 
Administrator of the Health Resources and Services Ad-
ministration, shall establish and coordinate a peripheral 
artery disease education program to support, develop, and 
implement educational initiatives and outreach strategies 
that inform health care professionals 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 populations. 
‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section 
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such sums as may be necessary for each of fiscal years 
2022 through 2026.’’. 
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 (GG), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (HH), by striking the 
period at the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(II) peripheral artery disease screening 
tests furnished to at-risk beneficiaries (as such 
terms are defined in subsection (kkk)).’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(kkk) PERIPHERAL ARTERY DISEASE SCREENING 
TEST; AT-RISK BENEFICIARY.—(1) The term ‘peripheral 
artery disease screening test’ means— 
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‘‘(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. 
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‘‘(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)(II) 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 (kkk)).’’. 
(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-
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ficiaries (as such terms are defined in sec-
tion 1861(kkk))’’ after ‘‘other than person-
alized prevention plan services (as defined 
in section 1861(hhh)(1))’’; 
(ii) by striking ‘‘and’’ before ‘‘(DD)’’; 
and 
(iii) by striking ‘‘such service,;’’ at the 
end and inserting the following: ‘‘, and 
(EE) with respect to peripheral artery dis-
ease screening tests furnished to at-risk 
beneficiaries (as such terms are defined in 
section 1861(kkk)), the amount paid shall 
be 100 percent of the lesser of the actual 
charge for the services or the amount de-
termined under the payment basis deter-
mined 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 comma at the end and inserting ‘‘; 
and’’; and 
(iii) by inserting after subparagraph 
(H) the following new subparagraph: 
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‘‘(I) with respect to peripheral artery disease 
screening tests (as defined in paragraph (1) of sec-
tion 1861(kkk)) 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)(EE),’’. 
(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 ‘‘(12)’’; and 
(B) by inserting ‘‘, and (13) such deduct-
ible shall not apply with respect to peripheral 
artery disease screening tests furnished to at- 
risk beneficiaries (as such terms are defined in 
section 1861(kkk))’’ before the period at the 
end. 
(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 
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beneficiaries (as such terms are defined in sec-
tion 1861(kkk))’’ 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)(II)’’. 
(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 dis-
ease screening tests furnished to at-risk bene-
ficiaries (as such terms are defined in section 
1861(kkk)), which are performed more fre-
quently than is covered under such section;’’. 
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(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).’’. 
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(f) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to items and services 
furnished on or after January 1, 2022. 
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 (29), by striking ‘‘and’’ 
at the end; 
(B) by redesignating paragraph (30) as 
paragraph (31); and 
(C) by inserting after paragraph (29) the 
following new paragraph: 
‘‘(30) peripheral artery disease screening tests 
furnished to at-risk beneficiaries (as such terms are 
defined in subsection (gg)); and’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(gg) PERIPHERAL ARTERY DISEASE SCREENING 
TEST; AT-RISK BENEFICIARY.— 
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‘‘(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; 
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‘‘(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)(30) 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 (F), by striking ‘‘or’’ 
at the end; 
(B) in subparagraph (G), by striking ‘‘; 
and’’ and inserting ‘‘, or’’; and 
(C) by adding at the end the following new 
subparagraph: 
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‘‘(H) peripheral artery disease screening 
tests furnished to at-risk beneficiaries (as such 
terms are defined in section 1905(gg)); 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: 
‘‘(xii) 
Peripheral 
artery 
disease 
screening tests furnished to at-risk bene-
ficiaries (as such terms are defined in sec-
tion 1905(gg)).’’. 
(c) 
MANDATORY
COVERAGE.—Section 
1902(a)(10)(A) of the Social Security Act (42 U.S.C. 
1396a(a)(10)(A)) is amended by striking ‘‘and (29)’’ and 
inserting ‘‘(29), and (30)’’. 
(d) 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 (30)’’ and inserting ‘‘fol-
lowing paragraph (31)’’. 
(2) Section 1905(a) of the Social Security Act 
(42 U.S.C. 1396d(a)) is amended by striking ‘‘fol-
lowing paragraph (30)’’ and inserting ‘‘following 
paragraph (31)’’. 
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SEC. 5. REQUIREMENT FOR GROUP HEALTH PLANS AND 
HEALTH 
INSURANCE 
ISSUERS 
OFFERING 
GROUP OR INDIVIDUAL HEALTH INSURANCE 
COVERAGE TO PROVIDE COVERAGE FOR PE-
RIPHERAL 
ARTERY 
DISEASE 
SCREENING 
TESTS FURNISHED TO AT-RISK ENROLLEES 
WITHOUT IMPOSITION OF COST SHARING RE-
QUIREMENTS. 
(a) IN GENERAL.—Subsection (a) of section 2713 of 
the Public Health Service Act (42 U.S.C. 300gg–13) is 
amended to read as follows: 
‘‘(a) COVERAGE
OF PREVENTIVE HEALTH SERV-
ICES.— 
‘‘(1) IN GENERAL.—A group health plan and a 
health insurance issuer offering group or individual 
health insurance coverage shall, at a minimum, pro-
vide coverage for and shall not impose any cost shar-
ing requirements for— 
‘‘(A) evidence-based items or services that 
have in effect a rating of ‘A’ or ‘B’ in the cur-
rent recommendations of the United States Pre-
ventive Services Task Force; 
‘‘(B) immunizations that have in effect a 
recommendation from the Advisory Committee 
on Immunization Practices of the Centers for 
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Disease Control and Prevention with respect to 
the individual involved; 
‘‘(C) with respect to infants, children, and 
adolescents, evidence-informed preventive care 
and screenings provided for in the comprehen-
sive guidelines supported by the Health Re-
sources and Services Administration; 
‘‘(D) with respect to women, such addi-
tional preventive care and screenings not de-
scribed in subparagraph (A) as provided for in 
comprehensive guidelines supported by the 
Health Resources and Services Administration 
for purposes of this subparagraph; and 
‘‘(E) with respect to at-risk enrollees, pe-
ripheral artery disease screening tests. 
‘‘(2) PERIPHERAL ARTERY DISEASE SCREENING 
TEST; AT-RISK ENROLLEE.—For purposes of para-
graph (1)(E): 
‘‘(A) 
PERIPHERAL
ARTERY
DISEASE 
SCREENING TEST.—The term ‘peripheral artery 
disease screening test’ means— 
‘‘(i) noninvasive physiologic studies of 
extremity arteries (commonly referred to 
as ankle-brachial index testing); 
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‘‘(ii) arterial duplex scans of lower ex-
tremity arteries vascular; and 
‘‘(iii) such other items and services as 
the Secretary determines, in consultation 
with relevant stakeholders, to be appro-
priate for screening for peripheral artery 
disease for at-risk enrollees. 
‘‘(B) AT-RISK ENROLLEE.—The term ‘at- 
risk enrollee’ means an individual enrolled in a 
group health plan or group or individual health 
insurance coverage— 
‘‘(i) who is 65 years of age or older; 
‘‘(ii) who is at least 50 years of age 
but not older than 64 years of age with 
risk factors for atherosclerosis (such as di-
abetes mellitus, a history of smoking, 
hyperlipidemia, and hypertension) or a 
family history of peripheral artery disease; 
‘‘(iii) who is younger than 50 years of 
age with diabetes mellitus and one addi-
tional risk factor for atherosclerosis; or 
‘‘(iv) with a known atherosclerotic dis-
ease in another vascular bed such as coro-
nary, carotid, subclavian, renal, or mesen-
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teric artery stenosis, or abdominal aortic 
aneurysm. 
‘‘(C) FREQUENCY.—The Secretary shall, 
in consultation with appropriate organizations, 
establish standards regarding the frequency for 
peripheral artery disease screening tests de-
scribed in paragraph (1)(E) for purposes of 
coverage under this section. 
‘‘(3) CLARIFICATION REGARDING BREAST CAN-
CER SCREENING, MAMMOGRAPHY, AND PREVENTION 
RECOMMENDATIONS.—For the purposes of this Act, 
and for the purposes of any other provision of law, 
the current recommendations of the United States 
Preventive Service Task Force regarding breast can-
cer screening, mammography, and prevention shall 
be considered the most current other than those 
issued in or around November 2009. 
‘‘(4) RULE
OF
CONSTRUCTION.—Nothing in 
this subsection shall be construed to prohibit a plan 
or issuer from providing coverage for services in ad-
dition to those recommended by the United States 
Preventive Services Task Force or to deny coverage 
for services that are not recommended by such Task 
Force.’’. 
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(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply with respect to plan years begin-
ning on or after January 1, 2022. 
SEC. 6. DISALLOWANCE OF PAYMENT FOR NONTRAUMATIC 
AMPUTATION SERVICES FURNISHED WITH-
OUT ANATOMICAL TESTING SERVICES. 
Section 1834 of the Social Security Act (42 U.S.C. 
1395m) is amended by adding at the end the following 
new subsection: 
‘‘(x) DISALLOWANCE OF PAYMENT FOR NONTRAU-
MATIC AMPUTATION SERVICES FURNISHED WITHOUT 
ANATOMICAL TESTING SERVICES.— 
‘‘(1) IN
GENERAL.—In the case of nontrau-
matic amputation services furnished by a supplier on 
or after January 1, 2022, to an individual entitled 
to, or enrolled for, benefits under part A and en-
rolled for benefits under this part, for which pay-
ment is made under this part, payment may only be 
made under this part if such supplier furnishes ana-
tomical testing services to such individual during the 
3-month period preceding the date on which such 
nontraumatic amputation services is furnished. 
‘‘(2) DEFINITIONS.—In this subsection: 
‘‘(A) ANATOMICAL
TESTING
SERVICES.— 
The term ‘anatomical testing services’ means 
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arterial duplex scanning, computed tomography 
angiography, 
and 
magnetic 
resonance 
angiography. 
‘‘(B) NONTRAUMATIC AMPUTATION SERV-
ICES.—The term ‘nontraumatic amputation 
services’ means amputations as a result of ath-
erosclerotic vascular disease or a related 
comorbity of such disease (including diabe-
tes).’’. 
SEC. 7. 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, 
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.—After appropriate testing 
and validation of the measures developed under subsection 
(a), the Secretary shall incorporate such measures in qual-
ity reporting programs for appropriate providers of serv-
ices and suppliers under the Medicare program under title 
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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. 
Æ 
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