Medicare Breast Reconstruction Access and Information Act
Summary
HB4545, titled the Medicare Breast Reconstruction Access and Information Act, would amend the Social Security Act to require that, before Medicare payment is made for a mastectomy, the supplier must inform the patient that breast reconstruction surgery after a medically necessary mastectomy is covered under Medicare. The bill also requires that this notice be documented in the patient’s medical record. The requirement would apply beginning one year after enactment.
The bill is aimed at ensuring Medicare beneficiaries receive clear information about an available post-mastectomy benefit, with the stated goal of improving access to breast reconstruction services and reducing the chance that patients are unaware of coverage. It does not create a new reconstruction benefit; rather, it reinforces awareness of existing coverage under Medicare’s national coverage determination 140.2.
Impact
The bill would amend Section 1834 of the Social Security Act by adding a new Medicare payment condition tied to mastectomy services. In practice, Medicare would be prohibited from paying for a mastectomy unless the furnishing supplier first provides notice about breast reconstruction coverage and records that notice in the medical record. The affected parties are Medicare suppliers, providers involved in mastectomy care, and Medicare beneficiaries who may be eligible for reconstruction after medically necessary mastectomy.
Sentiment
Based on the bill text and the absence of recorded opposition, the measure appears to be framed as a patient-information and access bill with a generally supportive policy posture. The broad bipartisan-style list of House cosponsors suggests interest in improving beneficiary awareness of covered reconstructive options. No committee debate or vote history was provided, so there is no recorded public controversy in the available materials.
Contention
The main policy issue likely to arise is the administrative burden on suppliers and providers who would need to give the required notice and document compliance before Medicare payment can be made. Another possible point of contention is whether conditioning payment on this disclosure requirement could create billing delays or compliance disputes. On the other side, supporters would likely emphasize patient education, informed decision-making, and improved access to reconstruction after mastectomy.
To Mandate Coverage For Breast Reconstruction Surgeries; To Require Prior Authorization For Breast Reconstruction Surgeries; And To Establish A Minimum Reimbursement Rate For Breast Reconstruction Surgeries.