Medicare Breast Reconstruction Access and Information Act

Bill Number: H.R. 4545
Origin Chamber: House
Congress: 119th Congress, Session 1
Policy Area: Health
Status: Introduced
Latest Action: 2025-07-17: 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.
Last Updated: 2026-02-04T04:11:36Z

AI-Generated Summary

Medicare Breast Reconstruction Access and Information Act (H.R. 4545)

Purpose

This legislation aims to ensure that Medicare beneficiaries undergoing a mastectomy (surgical removal of one or both breasts, often due to breast cancer) receive clear information about their coverage for breast reconstruction surgery afterward. It promotes informed decision-making by requiring healthcare providers to discuss this option before the procedure.

Key Provisions

Amends Section 1834 of the Social Security Act, which governs Medicare payments for certain medical services.
Prohibits Medicare payments for a mastectomy performed one year after the bill's enactment unless the provider (e.g., surgeon or facility) takes two specific actions before the surgery:
Informs the patient that breast reconstruction following a medically necessary mastectomy is covered under Medicare, referencing National Coverage Determination (NCD) 140.2—a policy that outlines Medicare's rules for covering such procedures.
Documents this discussion in the patient's medical record.
The requirement applies only to mastectomies covered under Medicare Part B (outpatient services).

Significant Changes to Existing Law

Introduces a new subsection (aa) to Section 1834, linking Medicare reimbursement directly to the provision of information and documentation.
Builds on existing Medicare coverage for breast reconstruction (established under the Women's Health and Cancer Rights Act of 1998) but adds an enforcement mechanism by tying it to payment eligibility, which was not previously required in this explicit form.
No changes to the scope of coverage itself; focuses instead on transparency and patient education.

Potential Impacts

On citizens: Empowers Medicare enrollees, particularly women facing mastectomies, by ensuring they know about reconstruction options, potentially leading to higher rates of utilization and better post-surgical outcomes. It may reduce barriers to care caused by lack of awareness.
On government agencies: The Centers for Medicare & Medicaid Services (CMS) will need to oversee compliance through audits or claims reviews, possibly increasing administrative workload but improving program integrity.
On international relations: No direct impact, as this is a domestic healthcare policy focused on U.S. Medicare beneficiaries.
Overall, could enhance equity in healthcare access without significantly expanding costs, as it leverages existing coverage rules.

Main Stakeholders Affected

Medicare beneficiaries: Primarily women over 65 or with disabilities undergoing mastectomies, who gain better access to information.
Healthcare providers: Surgeons, hospitals, and facilities performing mastectomies, who must now inform patients and document discussions to receive payment.
CMS and federal government: Responsible for implementing and enforcing the new requirements.
Patient advocacy groups: Organizations focused on breast cancer and women's health, who may benefit from increased awareness and utilization of reconstruction services.

Notable Legal, Constitutional, or Political Implications

Legal: Strengthens patient rights to informed consent under Medicare by mandating disclosure of covered benefits, aligning with broader federal healthcare transparency laws. It uses payment conditions as a compliance tool, which is a common regulatory approach but could face challenges if providers argue it imposes undue administrative burdens.
Constitutional: No apparent conflicts; supports equal protection in healthcare access without infringing on free speech or due process, as the requirement is factual and tied to existing coverage.
Political: Reflects bipartisan support for women's health issues, introduced by a diverse group of House members. It could set a precedent for similar information mandates in other Medicare procedures, potentially influencing future health equity debates without major fiscal controversy.

This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.

Sponsor

Rep. Waters, Maxine [D-CA-43]

Cosponsors (29)

Rep. Garcia, Sylvia R. [D-TX-29], Del. Norton, Eleanor Holmes [D-DC-At Large], Rep. Velázquez, Nydia M. [D-NY-7], Rep. Wasserman Schultz, Debbie [D-FL-25], Rep. Dingell, Debbie [D-MI-6], Rep. Clarke, Yvette D. [D-NY-9], Rep. Fields, Cleo [D-LA-6], Rep. Johnson, Henry C. "Hank" [D-GA-4], Rep. Tlaib, Rashida [D-MI-12], Rep. Thompson, Bennie G. [D-MS-2], Rep. Sewell, Terri A. [D-AL-7], Rep. Gottheimer, Josh [D-NJ-5], Rep. Watson Coleman, Bonnie [D-NJ-12], Rep. Thanedar, Shri [D-MI-13], Rep. Lee, Summer L. [D-PA-12], Rep. Latimer, George [D-NY-16], Rep. Wilson, Frederica S. [D-FL-24], Rep. Veasey, Marc A. [D-TX-33], Rep. Cohen, Steve [D-TN-9], Rep. Lynch, Stephen F. [D-MA-8], Rep. McIver, LaMonica [D-NJ-10], Rep. García, Jesús G. "Chuy" [D-IL-4], Rep. Cherfilus-McCormick, Sheila [D-FL-20], Rep. Salinas, Andrea [D-OR-6], Rep. Olszewski, Johnny [D-MD-2], Rescom. Hernández, Pablo Jose [D-PR-At Large], Rep. Trahan, Lori [D-MA-3], Rep. McDonald Rivet, Kristen [D-MI-8], Rep. Johnson, Julie [D-TX-32]

Recent Actions

2025-07-17: 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.
2025-07-17: 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.
2025-07-17: Introduced in House
2025-07-17: Introduced in House

Bill Versions

Medicare Breast Reconstruction Access and Information Act — issued 2025-07-17 — PDF (2 pages)