,i #aafth ,,congress #b;d ,session ,h4 ,r4 #heeh ,,in ,,the ,,house ,,of ,,representatives ,october #i1 #bjbj,mr4 ,hastings 7for himself1 ,ms4 ,wasserman ,schultz1 ,mr4 ,buchanan1 ,ms4 ,lee of ,california1 ,mr4 ,deutch1 ,mr4 ,soto1 and ,mrs4 ,davis of ,california7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committees on ,ways and ,means1 and ,education and ,labor1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to amend the ,employee ,retirement ,income ,security ,act of #aigd 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 programs4 #a4 ,short title ,this ,act may be cited as the ,comprehensive ,breast ,reconstruction ,act of #bjbj4 #b4 ,providing for health coverage of nipple-areolar complex tattooing in connection with reconstructive surgery following mastectomy2 extending coverage of breast reconstructive services following mastectomy under ,medicare and ,medicaid 7a7 ,private health insurance coverage and group health plans 7#a7 ,in general ,section #gac7;a7 of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aahe;b7a77 is amended-- 7,a7 in paragraph 7#b71 by striking at the end and2 7,b7 in paragraph 7#c71 by adding at the end and2 7,c7 by inserting after paragraph 7#c7 the following new paragraph3 7#d7 tattooing of the nipple-areolar complex pursuant to or as part of such reconstruction if such tattooing is performed by a physician1 physician extender 7as defined in section #ahcd7x7 of the ,social ,security ,act71 or ,state-licensed tattoo artist 7as defined in such section71 as prescribed by a physician2 2 and 7,d7 by adding at the end of the flush matter following paragraph 7#d71 as inserted by subparagraph 7,c71 the following3 ,tattooing of the nipple-areolar complex described in paragraph 7#d7 shall be deemed to be medically reasonable and necessary44 7#b7 ,effective dates 7,a7 ,in general ,subject to subparagraph 7,b71 the amendments made by this section shall apply with respect to plan years beginning after the date of enactment of this ,act4 7,b7 ,special rule for collective bargaining agreements ,in the case of a group health plan maintained pursuant to #a or more collective bargaining agreements between employee representatives and #a or more employers ratified before the date of enactment of this ,act1 the amendments made by this section shall not apply to plan years beginning before the later of-- 7i7 the date on which the last collective bargaining agreements relating to the plan terminates 7determined without regard to any extension thereof agreed to after the date of enactment of this ,act72 or 7ii7 ,january #a of the first year beginning at least one year after the date of the enactment of this ,act4 ,for purposes of clause 7i71 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 agreement4 7b7 ,medicare coverage 7#a7 ,coverage ,section #ahfa7s77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#b77 is amended-- 7,a7 in subparagraph 7,,gg71 by striking at the end and2 7,b7 in subparagraph 7,,hh71 by inserting at the end 2 and2 and 7,c7 by adding at the end the following new subparagraph3 7,,ii7 qualifying reconstructive breast surgery services 7as defined in subsection 7kkk774 4 7#b7 ,definition ,section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7 is amended by adding at the end the following new subsection3 7kkk7 ,qualifying reconstructive breast surgery services ,the term qualifying reconstructive breast surgery services means1 in the case of an individual who has a mastectomy1 breast reconstruction in connection with such mastectomy1 including-- 7#a7 all stages of reconstruction of the breast on which the mastectomy has been performed2 7#b7 surgery and reconstruction of the other breast to produce a symmetrical appearance2 7#c7 prostheses and physical complications of mastectomy1 including lymphedemas2 and 7#d7 tattooing of the nipple-areolar complex pursuant to or as part of such reconstruction if such tattooing is performed by a physician1 physician extender1 or ,state-licensed tattoo artist 7as such terms are defined in section #ahcd7x771 as prescribed by a physician1 in a manner determined in consultation with the attending physician and the individual4 4 7#c7 ,payment 7,a7 ,in general ,section #ahcc7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77#a77 is amended-- 7i7 by striking and 7,,dd7 and inserting 7,,dd72 and 7ii7 by inserting before the semicolon at the end the following and 7,,ee7 with respect to qualifying reconstructive breast surgery services 7as defined in section #ahfa7kkk771 the amount paid shall be equal to the amount payable in accordance with section #ahcd7x74 7,b7 ,payment determination ,section #ahcd of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7 is amended by adding at the end the following new subsection3 7x7 ,qualifying reconstructive breast surgery services 7#a7 ,in general ,with respect to qualifying reconstructive breast surgery services described in section #ahfa7kkk77#d7 for which payment is determined under this subsection1 payment shall be made in an amount equal to #ajj percent of the reasonable and customary amount for nipple areolar tattooing1 determined according to the reimbursement rates for ,,cpt codes #aaibj1 #aaiba1 and #aaibb 7or any successor to such codes74 7#b7 ,reasonable and necessary treatment ,qualifying reconstructive breast surgery services described in section #ahfa7kkk77#d7 shall be deemed to be reasonable and necessary for purposes of section #ahfb7;a77#a77;,a74 7#c7 ,physician extender ,for purposes of this subsection and section #ahfa7kkk77#d71 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 physician1 such as a nurse practitioner or physician assistant4 7#d7 ,state-licensed tattoo artist ,for purposes of this subsection and section #ahfa7kkk77#d71 the term ,state-licensed tattoo artist means an individual 7as 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 art7 who maintains all public health1 safety1 and welfare standards and regulations set forth by the ,state1 including all sterilization1 sanitation1 and safety regulations for tattoo parlors and salons1 tattoo inks1 tattoo instruments1 and any other related paraphernalia1 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 patient1 abiding by all such standards and regulations4 4 7#d7 ,including certain tattoo artists as ,medicare providers for purposes of tattooing of the nipple-areolar complex after mastectomy ,section #ahff7;j77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7j77#a77 is amended by adding at the end the following new subparagraph3 7,d7 ,including certain tattoo artists for purposes of tattooing of the nipple-areolar complex after mastectomy ,for purposes of this section1 the term supplier shall include a ,state-licensed tattoo artist 7as defined in section #ahcd7x771 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 physician4 4 7#e7 ,effective date ,the amendments made by this subsection shall apply with respect to items and services furnished on or after ,january #a of the first year beginning after the date of the enactment of this ,act4 7c7 ,medicaid coverage 7#a7 ,in general ,section #aije7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a77 is amended-- 7,a7 by redesignating paragraph 7#cj7 as paragraph 7#ca72 7,b7 in paragraph 7#bi71 by striking at the end and2 7,c7 by inserting after paragraph 7#bi7 the following new paragraph3 7#cj7 qualifying reconstructive breast surgery services 7as defined in section #ahfa7kkk772 and 2 and 7,d7 by adding at the end of the flush matter following paragraph 7#ca71 as redesignated by subparagraph 7,a71 the following new sentence3 ,for purposes of paragraph 7#cj71 qualifying reconstructive breast surgery services described in section #ahfa7kkk77#d7 shall be deemed to be medically reasonable and necessary44 7#b7 ,effective date 7,a7 ,in general ,subject to subparagraph 7,b71 the amendments made by this section shall take effect with respect to medical assistance provided on or after ,january #a of the first year beginning after the date of the enactment of this ,act4 7,b7 ,exception for ,state legislation ,in the case of a ,state plan under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 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 section1 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 ,act4 ,for purposes of the previous sentence1 in the case of a ,state that has a #b-year legislative session1 each year of the session shall be considered to be a separate regular session of the ,state legislature4