[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[S. 1217 Introduced in Senate (IS)]

112th CONGRESS
  1st Session
                                S. 1217

To amend title XVIII of the Social Security Act to provide coverage for 
      custom fabricated breast prostheses following a mastectomy.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             June 16, 2011

   Ms. Snowe (for herself, Mr. Kerry, Mr. Inouye, Mr. Akaka, and Mr. 
    Begich) introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
To amend title XVIII of the Social Security Act to provide coverage for 
      custom fabricated breast prostheses following a mastectomy.

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

SECTION 1. SHORT TITLE; FINDINGS.

    (a) Short Title.--This Act may be cited as the ``Breast Cancer 
Patient Equity Act''.
    (b) Findings.--Congress finds the following:
            (1) There are currently 2,500,000 women in the United 
        States living with breast cancer, many of whom suffer from 
        unreconstructed breast loss.
            (2) In 2010, an estimated 207,090 women were diagnosed with 
        invasive breast cancer that required surgery, with many having 
        to undergo surgical breast removal.
            (3) Annually, there are more than 130,000 women in the 
        United States who undergo mastectomies, a surgical removal of 
        the breast.
            (4) The number of breast amputations in the United States 
        is projected to increase due to the rising incidence of breast 
        cancer and the growing elderly population.
            (5) A woman suffering from the loss of her breast may not 
        be a candidate for surgical breast reconstruction or may choose 
        not to undergo additional surgery if there were a viable, less 
        costly, less invasive option available.
            (6) The results of breast reconstruction surgery can vary 
        and, as with any surgical procedure, there are inherent risks 
        associated with such surgery. Additionally, reconstruction of 
        the breast using implants can impose increased risks and costs 
        due to the eventual need for implant replacement surgery.
            (7) The number of women choosing to undergo surgical breast 
        reconstruction continues to increase, as many women lack the 
        viable option of custom fabricated prosthetic breasts to 
        restore the lost breast.
            (8) Both older women and minority women are less likely to 
        be offered or undergo surgical breast reconstruction and are 
        disproportionately disadvantaged by a lack of access to the 
        option of custom fabricated prosthetic breasts.
            (9) Currently, the Medicare program provides coverage and 
        reimbursement for custom fabricated prostheses for any body 
        part, with the exception of breasts, that has been lost.
            (10) Following passage of the Women's Health and Cancer 
        Rights Act of 1998 (Public Law 105-277; 42 U.S.C. 201 note), 
        many private insurers and group health plans began to provide 
        coverage for custom fabricated breast prostheses as an 
        alternative to surgical breast reconstruction.
            (11) While the Medicare program recognizes custom 
        fabricated breast prostheses as a discrete device and valid 
        treatment option, having assigned a billing code for such 
        option under the Healthcare Common Procedure Coding System 
        (``HCPCS'') and setting a maximum allowable fee, Medicare does 
        not provide reimbursement and denies claims as `not medically 
        necessary'. Medicare does provide reimbursement, however, for 
        more costly surgical breast reconstruction.
            (12) Due to the fact that the Medicare program does not 
        provide reimbursement for custom fabricated breast prostheses, 
        many private insurance companies have also begun to limit their 
        reimbursement for them.
            (13) The Department of Veterans Affairs does provide the 
        option of a custom fabricated prosthetic breast for women post-
        mastectomy.
            (14) Providing coverage for custom fabricated prosthetic 
        breast devices and components will not increase the incidence 
        of breast amputations.

SEC. 2. COVERAGE.

    (a) In General.--Section 1861(s)(8) of the Social Security Act (42 
U.S.C. 1395x(s)(8)) is amended--
            (1) by adding ``and'' after the semicolon at the end;
            (2) by inserting ``(A)'' after ``(8)''; and
            (3) by inserting after subparagraph (A) the following new 
        subparagraph:
            ``(B) custom fabricated breast prostheses following 
        surgical removal of the breast, including replacement of such 
        prostheses;''.
    (b) Conforming Amendment.--Section 1862(a)(7) of such Act (42 
U.S.C. 1395y(a)(7)) is amended by striking ``1861(s)(8)'' and inserting 
``1861(s)(8)(A)''.
    (c) Effective Date.--The amendments made by this section shall 
apply to items and services furnished on or after the date of enactment 
of this Act.
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