,i #aaith ,,congress #ast ,session ,h4 ,r4 #ehac ,,in ,,the ,,house ,,of ,,representatives ,october #bd1 #bjbe,mrs4 ,cammack 7for herself1 ,mrs4 ,dingell1 ,mrs4 ,hinson1 ,mrs4 ,mc,bath1 ,mrs4 ,kim1 ,mrs4 ,mc,clain ,delaney1 ,ms4 ,van ,duyne1 ,ms4 ,perez1 and ,ms4 ,pettersen7 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 ,workforce1 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 title ,,xxvii of the ,public ,health ,service ,act1 the ,employee ,retirement ,income ,security ,act of #aigd1 and the ,internal ,revenue ,code of #aihf to require group health plans and health insurance issuers offering group or individual health insurance coverage to provide coverage of certain items and services relating to breast or chest wall reconstruction furnished in connection with breast cancer treatment4 #a4 ,short title ,this ,act may be cited as the ,women's ,health and ,cancer ,rights ,modernization ,act of #bjbe4 #b4 ,requiring coverage of certain items and services relating to breast or chest wall reconstruction furnished in connection with breast cancer treatment 7a7 ,,phsa 7#a7 ,in general ,part ,d of title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#aaa et seq47 is amended by adding at the end the following new section3 #bgii;,a-#aa4 ,required coverage for certain items and services relating to breast or chest wall reconstruction furnished in connection with breast cancer treatment 7a7 ,in general ,a group health plan1 and a health insurance issuer offering group or individual health insurance coverage1 that provides medical and surgical benefits with respect to the treatment of breast cancer shall provide1 in the case of a participant or beneficiary who is receiving such treatment and who elects breast or chest wall reconstruction in connection with such treatment1 coverage for-- 7#a7 extirpation or medical treatment of diseased or damaged breast tissue1 including mastectomy and all forms of breast-conserving surgery2 7#b7 each modality of breast reconstruction1 including-- 7,a7 implant-based reconstruction2 7,b7 tissue-based reconstruction2 and 7,c7 any reconstruction modalities that are developed subsequent to the date of the enactment of this subsection and recognized within ,level ,i of the ,healthcare ,common ,procedure ,coding ,system2 7#c7 within each modality specified in paragraph 7#b71 each type of breast reconstruction1 including-- 7,a7 immediate implant-based reconstruction2 7,b7 delayed implant-based reconstruction2 7,c7 myocutaneous flap tissue-based reconstruction2 7,d7 microvascular free flap tissue-based reconstruction2 structural fat grafting tissue-based reconstruction2 7,e7 combined implant- and tissue-based reconstruction2 and 7,f7 any type of reconstruction that is developed subsequent to the effective date of this act and incorporated within ,level ,i of the ,healthcare ,common ,procedure ,coding ,system2 7#d7 within each type of breast reconstruction specified in paragraph 7#c71 each procedural variation1 iteration1 or approach that is noted within the short descriptor or the description for the ,healthcare ,common ,procedure ,coding ,system ,level ,i code covering the type of reconstruction2 7#e7 all stages of reconstruction of the breast or chest wall on which a mastectomy or breast-conserving surgery has been performed1 including flat closure2 7#f7 surgery and reconstruction of the other breast or chest wall to produce a symmetrical appearance2 7#g7 custom fabricated breast prostheses1 including replacement of such prostheses2 and 7#h7 mechanical1 medical1 and surgical treatment of physical complications of mastectomy1 breast reconstruction surgery1 chest wall surgery1 radiation1 and lymph node surgery1 including lymphedema compression treatment items 7as such term is defined in section #ahfa7mmm7 of the ,social ,security ,act but without regard to the requirement in paragraph 7#a7 of such section that such an item be furnished on or after ,january #a1 #bjbd74 7b7 ,manner of coverage ,coverage described in subsection 7a7 shall be provided in a manner determined in consultation with the attending physician and the patient and for which the patient is a medical candidate4 ,such coverage may be subject to annual deductibles and coinsurance provisions as are consistent with those established for other benefits under the plan or coverage4 ,written notice of the availability of such coverage shall be delivered to the participant upon enrollment and annually thereafter4 7c7 ,in-,network access ,a group health plan and a health insurance issuer offering group or individual health insurance coverage shall ensure that at least #a in-network provider is available under such plan or coverage with respect to each modality1 type of reconstruction1 and procedural variation1 iteration1 and approach described in subsection 7a74 7d7 ,notice ,a group health plan1 and a health insurance issuer offering group or individual health insurance coverage1 shall provide notice to each individual enrolled under such plan regarding the coverage required by this section in accordance with regulations promulgated by the ,secretary4 ,such notice shall be in writing and prominently positioned in any literature or correspondence made available or distributed by the plan or issuer and shall be transmitted-- 7#a7 upon such individual's enrollment in such plan or coverage2 and 7#b7 as part of any yearly informational packet sent to the individual thereafter4 7e7 ,prohibitions ,a group health plan1 and a health insurance issuer offering group or individual health insurance coverage1 may not-- 7#a7 deny to a patient eligibility1 or continued eligibility1 to enroll or to renew coverage under the terms of the plan1 solely for the purpose of avoiding the requirements of this section2 and 7#b7 penalize or otherwise reduce or limit the reimbursement of an attending provider1 or provide incentives 7monetary or otherwise7 to an attending provider1 to induce such provider to provide care to an individual participant or beneficiary in a manner inconsistent with this section or with generally accepted standards of medical practice4 7f7 ,rule of ,construction ,nothing in this section shall be construed to prevent a group health plan or a health insurance issuer offering group or individual health insurance coverage from negotiating the level and type of reimbursement with a provider for care provided in accordance with this section4 7g7 ,preemption ,nothing in this section shall be construed to preempt any ,state law with respect to health insurance coverage that requires coverage of at least the coverage of breast cancer care otherwise required under this section4 4 7#b7 ,conforming amendment ,section #bgbg of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#bg7 is amended by adding at the end the following new sentence3 ,the preceding sentence shall not apply with respect to plan years beginning on or after the date of the enactment of this sentence44 7b7 ,,erisa 7#a7 ,in general ,section #gac of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aahe;b7 is amended-- 7,a7 in the header1 by striking reconstructive surgery following mastectomies and inserting certain items and services relating to breast or chest wall reconstruction furnished in connection with breast cancer treatment2 7,b7 by amending subsection 7a7 to read as follows3 7a7 ,in general ,a group health plan1 and a health insurance issuer providing health insurance coverage in connection with a group health plan1 that provides medical and surgical benefits with respect to the treatment of breast cancer shall provide1 in the case of a participant or beneficiary who is receiving such treatment and who elects breast or chest wall reconstruction in connection with such treatment1 coverage for-- 7#a7 extirpation or medical treatment of diseased or damaged breast tissue1 including mastectomy and all forms of breast-conserving surgery2 7#b7 each modality of breast reconstruction1 including-- 7,a7 implant-based reconstruction2 7,b7 tissue-based reconstruction2 and 7,c7 any reconstruction modalities that are developed subsequent to the date of the enactment of this subsection and recognized within ,level ,i of the ,healthcare ,common ,procedure ,coding ,system2 7#c7 within each modality specified in paragraph 7#b71 each type of breast reconstruction1 including-- 7,a7 immediate implant-based reconstruction2 7,b7 delayed implant-based reconstruction2 7,c7 myocutaneous flap tissue-based reconstruction2 7,d7 microvascular free flap tissue-based reconstruction2 structural fat grafting tissue-based reconstruction2 7,e7 combined implant- and tissue-based reconstruction2 and 7,f7 any type of reconstruction that is developed subsequent to the effective date of this act and incorporated within ,level ,i of the ,healthcare ,common ,procedure ,coding ,system2 7#d7 within each type of breast reconstruction specified in paragraph 7#c71 each procedural variation1 iteration1 or approach that is noted within the short descriptor or the description for the ,healthcare ,common ,procedure ,coding ,system ,level ,i code covering the type of reconstruction2 7#e7 all stages of reconstruction of the breast or chest wall on which a mastectomy or breast-conserving surgery has been performed1 including flat closure2 7#f7 surgery and reconstruction of the other breast or chest wall to produce a symmetrical appearance2 7#g7 custom fabricated breast prostheses1 including replacement of such prostheses2 and 7#h7 mechanical1 medical1 and surgical treatment of physical complications of mastectomy1 breast reconstruction surgery1 chest wall surgery1 radiation1 and lymph node surgery1 including lymphedema compression treatment items 7as such term is defined in section #ahfa7mmm7 of the ,social ,security ,act but without regard to the requirement in paragraph 7#a7 of such section that such an item be furnished on or after ,january #a1 #bjbd74 2 7,c7 by redesignating subsections 7b7 through 7e7 as subsections 7d7 through 7g71 respectively2 7,d7 by inserting after subsection 7a7 the following new subsections3 7b7 ,manner of coverage ,coverage described in subsection 7a7 shall be provided in a manner determined in consultation with the attending physician and the patient and for which the patient is a medical candidate4 ,such coverage may be subject to annual deductibles and coinsurance provisions as are consistent with those established for other benefits under the plan or coverage4 ,written notice of the availability of such coverage shall be delivered to the participant upon enrollment and annually thereafter4 7c7 ,in-,network access ,a group health plan and a health insurance issuer offering group health insurance coverage shall ensure that at least #a in-network provider is available under such plan or coverage with respect to each modality1 type of reconstruction1 and procedural variation1 iteration1 and approach described in subsection 7a74 2 7,e7 in subsection 7d71 as so redesignated1 by striking paragraphs 7#a7 through 7#c7 and inserting the following new paragraphs3 7#a7 upon such participant or beneficiary's enrollment in such plan or coverage2 and 7#b7 as part of any yearly informational packet sent to the participant or beneficiary thereafter4 2 7,f7 in subsection 7e77#b71 as so redesignated1 by inserting or with generally accepted standards of medical practice before the period2 and 7,g7 in subsection 7g77#a71 as so redesignated-- 7i7 by striking in effect on the date of enactment of this section2 and 7ii7 by striking reconstructive breast surgery and inserting breast cancer care4 7#b7 ,clerical amendment ,the table of contents in section #a of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #ajja note7 is amended to read as follows3 ,sec4 #gac4 ,required coverage of certain items and services relating to breast or chest wall reconstruction furnished in connection with breast cancer treatment4 4 7c7 ,,irc 7#a7 ,in general ,subchapter ,b of chapter #ajj of the ,internal ,revenue ,code of #aihf is amended by adding at the end the following new section3 #ihbf4 ,required coverage for certain items and services relating to breast or chest wall reconstruction furnished in connection with breast cancer treatment 7a7 ,in general ,a group health plan that provides medical and surgical benefits with respect to the treatment of breast cancer shall provide1 in the case of a participant or beneficiary who is receiving such treatment and who elects breast or chest wall reconstruction in connection with such treatment1 coverage for-- 7#a7 extirpation or medical treatment of diseased or damaged breast tissue1 including mastectomy and all forms of breast-conserving surgery2 7#b7 each modality of breast reconstruction1 including-- 7,a7 implant-based reconstruction2 7,b7 tissue-based reconstruction2 and 7,c7 any reconstruction modalities that are developed subsequent to the date of the enactment of this subsection and recognized within ,level ,i of the ,healthcare ,common ,procedure ,coding ,system2 7#c7 within each modality specified in paragraph 7#b71 each type of breast reconstruction1 including-- 7,a7 immediate implant-based reconstruction2 7,b7 delayed implant-based reconstruction2 7,c7 myocutaneous flap tissue-based reconstruction2 7,d7 microvascular free flap tissue-based reconstruction2 structural fat grafting tissue-based reconstruction2 7,e7 combined implant- and tissue-based reconstruction2 and 7,f7 any type of reconstruction that is developed subsequent to the effective date of this act and incorporated within ,level ,i of the ,healthcare ,common ,procedure ,coding ,system2 7#d7 within each type of breast reconstruction specified in paragraph 7#c71 each procedural variation1 iteration1 or approach that is noted within the short descriptor or the description for the ,healthcare ,common ,procedure ,coding ,system ,level ,i code covering the type of reconstruction2 7#e7 all stages of reconstruction of the breast or chest wall on which a mastectomy or breast-conserving surgery has been performed1 including flat closure2 7#f7 surgery and reconstruction of the other breast or chest wall to produce a symmetrical appearance2 7#g7 custom fabricated breast prostheses1 including replacement of such prostheses2 and 7#h7 mechanical1 medical1 and surgical treatment of physical complications of mastectomy1 breast reconstruction surgery1 chest wall surgery1 radiation1 and lymph node surgery1 including lymphedema compression treatment items 7as such term is defined in section #ahfa7mmm7 of the ,social ,security ,act but without regard to the requirement in paragraph 7#a7 of such section that such an item be furnished on or after ,january #a1 #bjbd74 7b7 ,manner of coverage ,coverage described in subsection 7a7 shall be provided in a manner determined in consultation with the attending physician and the patient and for which the patient is a medical candidate4 ,such coverage may be subject to annual deductibles and coinsurance provisions as are consistent with those established for other benefits under the plan4 ,written notice of the availability of such coverage shall be delivered to the participant or beneficiary upon enrollment and annually thereafter4 7c7 ,in-,network access ,a group health plan shall ensure that at least #a in-network provider is available under such plan with respect to each modality1 type of reconstruction1 and procedural variation1 iteration1 and approach described in subsection 7a74 7d7 ,notice ,a group health plan shall provide notice to each participant and beneficiary under such plan regarding the coverage required by this section in accordance with regulations promulgated by the ,secretary4 ,such notice shall be in writing and prominently positioned in any literature or correspondence made available or distributed by the plan or issuer and shall be transmitted-- 7#a7 upon such participant or beneficiary's enrollment in such plan2 and 7#b7 as part of any yearly informational packet sent to the participant or beneficiary thereafter4 7e7 ,prohibitions ,a group health plan may not-- 7#a7 deny to a patient eligibility1 or continued eligibility1 to enroll or to renew coverage under the terms of the plan1 solely for the purpose of avoiding the requirements of this section2 and 7#b7 penalize or otherwise reduce or limit the reimbursement of an attending provider1 or provide incentives 7monetary or otherwise7 to an attending provider1 to induce such provider to provide care to an individual participant or beneficiary in a manner inconsistent with this section or with generally accepted standards of medical practice4 7f7 ,rule of ,construction ,nothing in this section shall be construed to prevent a group health plan from negotiating the level and type of reimbursement with a provider for care provided in accordance with this section4 7g7 ,preemption ,nothing in this section shall be construed to preempt any ,state law with respect to health insurance coverage that requires coverage of at least the coverage of breast cancer care otherwise required under this section4 4 7#b7 ,clerical amendment ,the table of sections for such subchapter is amended by inserting after the entry relating to section #ihbe the following3 ,sec4 #ihbf4 ,required coverage for certain items and services relating to breast or chest wall reconstruction furnished in connection with breast cancer treatment4 4 7d7 ,report ,not later that #a year after the date of the enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit to the appropriate committees of ,congress a report describing any gaps or barriers in access to breast reconstruction1 including microsurgical breast reconstruction4 7e7 ,effective date 7#a7 ,in general ,the amendments made by this section shall apply to plan years beginning on or after the date of the 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 employers1 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 section shall not be treated as a termination of such collective bargaining agreement4