Medicare Breast Reconstruction Access and Information Act
Summary
What This Bill Does
The Medicare Breast Reconstruction Access and Information Act adds a Medicare payment condition to Social Security Act section 1834. Beginning one year after enactment, Medicare may not pay for a mastectomy unless the supplier furnishing it, before the procedure, informs the individual that breast reconstruction surgery following a medically necessary mastectomy is covered under Medicare pursuant to national coverage determination 140.2 and documents that information in the patient's medical record. The bill does not create a new reconstruction benefit; it forces notice of an existing coverage policy and ties mastectomy payment to documentation of that notice.
Who Benefits and How
Medicare beneficiaries undergoing mastectomy benefit from advance notice that Medicare covers breast reconstruction after medically necessary mastectomy. Breast cancer patients benefit if documented notice improves awareness of reconstruction options before surgery. Patient advocates benefit from a concrete Medicare payment lever for informed decision-making. Reconstructive surgery providers benefit if more beneficiaries learn about existing Medicare coverage.
Who Bears the Burden and How
Mastectomy suppliers must provide notice before surgery and document that notice in the medical record. CMS must enforce the Medicare payment denial rule for noncompliant mastectomy claims. Hospitals and surgical practices must update workflows, patient materials, and documentation systems. Medicare contractors must review claims for compliance after the one-year effective date.
Key Provisions
- Requires pre-mastectomy notice that Medicare covers breast reconstruction after medically necessary mastectomy under national coverage determination 140.2.
- Requires documentation of that notice in the beneficiary's medical record.
- Prohibits Medicare payment for mastectomies furnished without the required notice and documentation.
- Provides a one-year implementation period after enactment.
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers with clause-level evidence links.
At a Glance
What This Bill Does
Conditions Medicare payment for mastectomies on suppliers informing beneficiaries before surgery that Medicare covers breast reconstruction after medically necessary mastectomy and documenting that notice in the medical record.
Key Policy Areas
Medicare, Breast Cancer, Patient Information
Primary Purpose
Conditions Medicare payment for mastectomies on suppliers informing beneficiaries before surgery that Medicare covers breast reconstruction after medically necessary mastectomy and documenting that notice in the medical record.
Policy Domains
Resolution provisions
Identified Gains
- Medicare beneficiaries undergoing mastectomy
- Breast cancer patients
- Patient advocates
- Reconstructive surgery providers
Identified Costs
- Mastectomy suppliers
- Centers for Medicare and Medicaid Services
- Hospitals
- Medicare contractors
Sponsors
Legislative Progress
In CommitteeMs. Waters (for herself, Ms. Garcia of Texas, Ms. Norton, …
Referred to the Committee on Energy and Commerce, and in …
Introduced in House
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Mastectomy suppliers, Reconstructive surgery providers
Positive-direction: Reconstructive surgery providers
Negative-direction: Mastectomy suppliers
Medicare beneficiaries undergoing mastectomy
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology