Comprehensive Breast Reconstruction Act of 2021
Bill: H.R.469 | Sponsor: Rep. Hastings, Alcee L. (D-FL)
Policy area: Health

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).

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.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Comprehensive Breast Reconstruction 
Act of 2021''.

SEC. 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)) is amended--
                    (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)) is amended--
                    (A) in subparagraph (GG), by striking at the end 
                ``and'';
                    (B) in subparagraph (HH), by inserting at the end 
                ``; and''; 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) is amended by adding at the end the following 
        new subsection:
    ``(kkk) Qualifying Reconstructive Breast Surgery Services.--The 
term `qualifying reconstructive breast surgery services' means, in the 
case of an individual who has a mastectomy, breast reconstruction in 
connection with such mastectomy, including--
            ``(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)) is amended--
                            (i) by striking ``and (DD)'' and inserting 
                        ``(DD)''; and
                            (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) is amended by 
                adding at the end the following new subsection:
    ``(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' means a 
        health care practitioner who is not a physician and who is 
        licensed or certified by the State in which the practitioner if 
        furnishing services to furnish items or services typically 
        furnished by a physician, such as a nurse practitioner or 
        physician assistant.
            ``(4) State-licensed tattoo artist.--For purposes of this 
        subsection and section 1861(kkk)(4), the term `State-licensed 
        tattoo artist' means an individual (as specified by the law of 
        the State in which the individual is licensed in performing 
        permanent body art and in which they are so practicing such 
        art) who maintains all public health, safety, and welfare 
        standards and regulations set forth by the State, including all 
        sterilization, sanitation, and safety regulations for tattoo 
        parlors and salons, tattoo inks, tattoo instruments, and any 
        other related paraphernalia, as well as allowing the individual 
        to perform the procedure in the prescribing physician's place 
        of business with the consent of the physician and the patient, 
        abiding by all such standards and regulations.''.
            (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)) is amended by adding at the end the 
        following new subparagraph:
                    ``(D) Including certain tattoo artists for purposes 
                of tattooing of the nipple-areolar complex after 
                mastectomy.--For purposes of this section, the term 
                `supplier' shall include a State-licensed tattoo artist 
                (as defined in section 1834(x)), but only with respect 
                to the tattooing of the nipple-areolar complex pursuant 
                to or as part of reconstructive surgery following a 
                medically necessary mastectomy and if such tattooing is 
                prescribed by a physician.''.
            (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)) is amended--
                    (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 et seq.) that the Secretary of 
                Health and Human Services determines requires State 
                legislation in order for the respective plan to meet 
                any requirement imposed by the amendments made by this 
                section, the respective plan shall not be regarded as 
                failing to comply with the requirements of such title 
                solely on the basis of its failure to meet such an 
                additional requirement before the first day of the 
                first calendar quarter beginning after the close of the 
                first regular session of the State legislature that 
                begins after the date of the enactment of this Act. For 
                purposes of the previous sentence, in the case of a 
                State that has a 2-year legislative session, each year 
                of the session shall be considered to be a separate 
                regular session of the State legislature.
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