,i  #aaf? ,,congress  #b;d ,session  ,h4
 ,r4 #heeh  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,octob] #i1 #bjbj,mr4 
,ha/+s 7= himself1 ,ms4 ,wass]man       
,s*ultz1 ,mr4 ,bu*anan1 ,ms4 ,lee (     
,cali=nia1 ,mr4 ,deut*1 ,mr4 ,soto1 &   
,mrs4 ,davis ( ,cali=nia7 introduc$ !   
foll[+ bill2 :i* 0 ref]r$ to !          
,committee on ,en]gy & ,comm]ce1 & 9    
addition to ! ,committees on ,ways &    
,means1 & ,education & ,labor1 = a p]iod
 to be subsequ5tly det]m9$ by ! ,speak]1
 9 ea* case = consid]ation ( su*        
provisions z fall )9 ! jurisdiction ( ! 
committee conc]n$  ,a ,,bill  ,to am5d !
 ,employee ,retirem5t ,income ,security 
,act ( #aigd to provide = heal? cov]age 
( nipple-areol> complex tattoo+ 9       
connection ) recon/ructive surg]y foll[+
 ma/ectomy & to am5d titles ,,xviii &   
,,xix ( ! ,social ,security ,act to     
ext5d cov]age ( c]ta9 brea/             
recon/ructive s]vices foll[+ ma/ectomy  
"u ! ,m$ic>e & ,m$icaid programs4  #a4  
,%ort title ,?is ,act may be cit$ z !   

,compreh5sive ,brea/ ,recon/ruction ,act
 ( #bjbj4  #b4 ,provid+ = heal? cov]age 
( nipple-areol> complex tattoo+ 9       
connection ) recon/ructive surg]y foll[+
 ma/ectomy2 ext5d+ cov]age ( brea/      
recon/ructive s]vices foll[+ ma/ectomy  
"u ,m$ic>e & ,m$icaid  7a7 ,private     
heal? insurance cov]age & gr\p heal?    
plans  7#a7 ,9 g5]al ,section #gac7;a7 (
 ! ,employee ,retirem5t ,income         
,security ,act ( #aigd 7#bi ,u4,s4,c4   
#aahe;b7a77 is am5d$-- 7,a7 9 p>agraph  
7#b71 by /rik+ at ! end &2  7,b7 9      
p>agraph 7#c71 by add+ at ! end &2  7,c7
 by ins]t+ aft] p>agraph 7#c7 ! foll[+  
new p>agraph3  7#d7 tattoo+ ( !         
nipple-areol> complex pursuant to or z  
"p ( su* recon/ruction if su* tattoo+ is
 p]=m$ by a physician1 physician ext5d] 
7z def9$ 9 section #ahcd7x7 ( ! ,social 
,security ,act71 or ,/ate-lic5s$ tattoo 
arti/ 7z def9$ 9 su* section71 z        
prescrib$ by a physician2  2 &  7,d7 by 
add+ at ! end ( ! flu% matt] foll[+     
p>agraph 7#d71 z ins]t$ by subp>agraph  

7,c71 ! foll[+3 ,tattoo+ ( !            
nipple-areol> complex describ$ 9        
p>agraph 7#d7 %all be deem$ to be       
m$ically reasonable & necess>y44  7#b7  
,effective dates  7,a7 ,9 g5]al ,subject
 to subp>agraph 7,b71 ! am5dm5ts made by
 ?is section %all apply ) respect to    
plan ye>s beg9n+ aft] ! date ( enactm5t 
( ?is ,act4  7,b7 ,special rule =       
collective b>ga9+ agreem5ts ,9 ! case ( 
a gr\p heal? plan ma9ta9$ pursuant to #a
 or m collective b>ga9+ agreem5ts betwe5
 employee repres5tatives & #a or m      
employ]s ratifi$ be=e ! date ( enactm5t 
( ?is ,act1 ! am5dm5ts made by ?is      
section %all n apply to plan ye>s beg9n+
 be=e ! lat] (-- 7i7 ! date on :i* ! la/
 collective b>ga9+ agreem5ts relat+ to !
 plan t]m9ates 7det]m9$ )\t reg>d to any
 ext5sion !re( agre$ to aft] ! date (   
enactm5t ( ?is ,act72 or  7ii7 ,janu>y  
#a ( ! fir/ ye> beg9n+ at lea/ "o ye>   
aft] ! date ( ! enactm5t ( ?is ,act4  ,=
 purposes ( clause 7i71 any plan am5dm5t
 made pursuant to a collective b>ga9+   

agreem5t relat+ to ! plan :i* am5ds !   
plan solely to con=m to any requirem5t  
add$ by ?is subsection %all n be treat$ 
z a t]m9ation ( su* collective b>ga9+   
agreem5t4  7b7 ,m$ic>e cov]age  7#a7    
,cov]age ,section #ahfa7s77#b7 ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#aciex7s77#b77 is am5d$-- 7,a7 9        
subp>agraph 7,,gg71 by /rik+ at ! end &2
  7,b7 9 subp>agraph 7,,hh71 by ins]t+  
at ! end 2 &2 &  7,c7 by add+ at ! end !
 foll[+ new subp>agraph3  7,,ii7        
qualify+ recon/ructive brea/ surg]y     
s]vices 7z def9$ 9 subsection 7kkk774  4
  7#b7 ,def9ition ,section #ahfa ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#aciex7 is am5d$ by add+ at ! end !     
foll[+ new subsection3  7kkk7 ,qualify+ 
recon/ructive brea/ surg]y s]vices ,!   
t]m qualify+ recon/ructive brea/ surg]y 
s]vices means1 9 ! case ( an individual 
:o has a ma/ectomy1 brea/ recon/ruction 
9 connection ) su* ma/ectomy1 includ+-- 
7#a7 all /ages ( recon/ruction ( ! brea/
 on :i* ! ma/ectomy has be5 p]=m$2  7#b7

 surg]y & recon/ruction ( ! o!r brea/ to
 produce a symmetrical appe>ance2  7#c7 
pro/heses & physical complications (    
ma/ectomy1 includ+ lymph$emas2 &  7#d7  
tattoo+ ( ! nipple-areol> complex       
pursuant to or z "p ( su* recon/ruction 
if su* tattoo+ is p]=m$ by a physician1 
physician ext5d]1 or ,/ate-lic5s$ tattoo
 arti/ 7z su* t]ms are def9$ 9 section  
#ahcd7x771 z prescrib$ by a physician1  
9 a mann] det]m9$ 9 consultation ) !    
att5d+ physician & ! individual4  4     
7#c7 ,paym5t  7,a7 ,9 g5]al ,section    
#ahcc7;a77#a7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #aciel7a77#a77 is       
am5d$-- 7i7 by /rik+ & 7,,dd7 & ins]t+  
7,,dd72 &  7ii7 by ins]t+ be=e !        
semicolon at ! end ! foll[+ & 7,,ee7 )  
respect to qualify+ recon/ructive brea/ 
surg]y s]vices 7z def9$ 9 section       
#ahfa7kkk771 ! am\nt paid %all be equal 
to ! am\nt payable 9 accordance )       
section #ahcd7x74  7,b7 ,paym5t         
det]m9ation ,section #ahcd ( ! ,social  
,security ,act 7#db ,u4,s4,c4 #aciem7 is

 am5d$ by add+ at ! end ! foll[+ new    
subsection3  7x7 ,qualify+ recon/ructive
 brea/ surg]y s]vices  7#a7 ,9 g5]al ,) 
respect to qualify+ recon/ructive brea/ 
surg]y s]vices describ$ 9 section       
#ahfa7kkk77#d7 = :i* paym5t is det]m9$  
"u ?is subsection1 paym5t %all be made 9
 an am\nt equal to #ajj p]c5t ( !       
reasonable & cu/om>y am\nt = nipple     
areol> tattoo+1 det]m9$ accord+ to !    
reimbursem5t rates = ,,cpt codes #aaibj1
 #aaiba1 & #aaibb 7or any successor to  
su* codes74  7#b7 ,reasonable & necess>y
 treatm5t ,qualify+ recon/ructive brea/ 
surg]y s]vices describ$ 9 section       
#ahfa7kkk77#d7 %all be deem$ to be      
reasonable & necess>y = purposes (      
section #ahfb7;a77#a77;,a74  7#c7       
,physician ext5d] ,= purposes ( ?is     
subsection & section #ahfa7kkk77#d71 !  
t]m physician ext5d] means a heal? c>e  
practition] :o is n a physician & :o is 
lic5s$ or c]tifi$ by ! ,/ate 9 :i* !    
practition] if furni%+ s]vices to furni%
 items or s]vices typically furni%$ by a

 physician1 su* z a nurse practition] or
 physician assi/ant4  7#d7 ,/ate-lic5s$ 
tattoo arti/ ,= purposes ( ?is          
subsection & section #ahfa7kkk77#d71 !  
t]m ,/ate-lic5s$ tattoo arti/ means an  
individual 7z specifi$ by ! law ( !     
,/ate 9 :i* ! individual is lic5s$ 9    
p]=m+ p]man5t body art & 9 :i* !y are s 
practic+ su* art7 :o ma9ta9s all public 
heal?1 safety1 & welf>e /&>ds &         
regulations set =? by ! ,/ate1 includ+  
all /]ilization1 sanitation1 & safety   
regulations = tattoo p>lors & salons1   
tattoo inks1 tattoo in/rum5ts1 & any o!r
 relat$ p>aph]nalia1 z well z all[+ !   
individual to p]=m ! proc$ure 9 !       
prescrib+ physician's place ( bus9ess ) 
! cons5t ( ! physician & ! pati5t1 abid+
 by all su* /&>ds & regulations4  4     
7#d7 ,includ+ c]ta9 tattoo arti/s z     
,m$ic>e provid]s = purposes ( tattoo+ ( 
! nipple-areol> complex aft] ma/ectomy  
,section #ahff7;j77#a7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#acie;cc7j77#a77 is am5d$ by add+ at !  

end ! foll[+ new subp>agraph3  7,d7     
,includ+ c]ta9 tattoo arti/s = purposes 
( tattoo+ ( ! nipple-areol> complex aft]
 ma/ectomy ,= purposes ( ?is section1 ! 
t]m suppli] %all include a ,/ate-lic5s$ 
tattoo arti/ 7z def9$ 9 section         
#ahcd7x771 b only ) respect to ! tattoo+
 ( ! nipple-areol> complex pursuant to  
or z "p ( recon/ructive surg]y foll[+ a 
m$ically necess>y ma/ectomy & if su*    
tattoo+ is prescrib$ by a physician4  4 
7#e7 ,effective date ,! am5dm5ts made by
 ?is subsection %all apply ) respect to 
items & s]vices furni%$ on or aft]      
,janu>y #a ( ! fir/ ye> beg9n+ aft] !   
date ( ! enactm5t ( ?is ,act4  7c7      
,m$icaid cov]age  7#a7 ,9 g5]al ,section
 #aije7;a7 ( ! ,social ,security ,act   
7#db ,u4,s4,c4 #acif;d7a77 is am5d$--   
7,a7 by r$esignat+ p>agraph 7#cj7 z     
p>agraph 7#ca72  7,b7 9 p>agraph 7#bi71 
by /rik+ at ! end &2  7,c7 by ins]t+    
aft] p>agraph 7#bi7 ! foll[+ new        
p>agraph3  7#cj7 qualify+ recon/ructive 
brea/ surg]y s]vices 7z def9$ 9 section 

#ahfa7kkk772 &  2 &  7,d7 by add+ at !  
end ( ! flu% matt] foll[+ p>agraph      
7#ca71 z r$esignat$ by subp>agraph 7,a71
 ! foll[+ new s5t5ce3 ,= purposes (     
p>agraph 7#cj71 qualify+ recon/ructive  
brea/ surg]y s]vices describ$ 9 section 
#ahfa7kkk77#d7 %all be deem$ to be      
m$ically reasonable & necess>y44  7#b7  
,effective date  7,a7 ,9 g5]al ,subject 
to subp>agraph 7,b71 ! am5dm5ts made by 
?is section %all take effect ) respect  
to m$ical assi/ance provid$ on or aft]  
,janu>y #a ( ! fir/ ye> beg9n+ aft] !   
date ( ! enactm5t ( ?is ,act4  7,b7     
,exception = ,/ate legislation ,9 ! case
 ( a ,/ate plan "u title ,,xix ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#acif et seq47 t ! ,secret>y ( ,heal? & 
,human ,s]vices det]m9es requires ,/ate 
legislation 9 ord] = ! respective plan  
to meet any requirem5t impos$ by !      
am5dm5ts made by ?is section1 !         
respective plan %all n be reg>d$ z fail+
 to comply ) ! requirem5ts ( su* title  
solely on ! basis ( its failure to meet 

su* an additional requirem5t be=e ! fir/
 day ( ! fir/ cal5d> qu>t] beg9n+ aft] !
 close ( ! fir/ regul> session ( ! ,/ate
 legislature t beg9s aft] ! date ( !    
enactm5t ( ?is ,act4 ,= purposes ( !    
previ\s s5t5ce1 9 ! case ( a ,/ate t has
 a #b-ye> legislative session1 ea* ye> (
 ! session %all be consid]$ to be a     
sep>ate regul> session ( ! ,/ate        
legislature4