,i  #aai? ,,congress  #a/ ,session  ,h4 
,r4 #ehac  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,octob] #bd1          
#bjbe,mrs4 ,cammack 7= h]self1 ,mrs4    
,d+ell1 ,mrs4 ,h9son1 ,mrs4 ,mc,bath1   
,mrs4 ,kim1 ,mrs4 ,mc,clain ,delaney1   
,ms4 ,van ,duyne1 ,ms4 ,p]ez1 & ,ms4    
,pett]s57 introduc$ ! foll[+ bill2 :i* 0
 ref]r$ to ! ,committee on ,en]gy &     
,comm]ce1 & 9 addition to ! ,committees 
on ,ways & ,means1 & ,education &       
,work=ce1 = 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 title ,,xxvii ( !     
,public ,heal? ,s]vice ,act1 ! ,employee
 ,retirem5t ,income ,security ,act (    
#aigd1 & ! ,int]nal ,rev5ue ,code (     
#aihf to require gr\p heal? plans &     
heal? insurance issu]s (f]+ gr\p or     
individual heal? insurance cov]age to   
provide cov]age ( c]ta9 items & s]vices 
relat+ to brea/ or *e/ wall             
recon/ruction furni%$ 9 connection )    

brea/ canc] treatm5t4  #a4 ,%ort title  
,?is ,act may be cit$ z ! ,wom5's ,heal?
 & ,canc] ,rights ,mod]nization ,act (  
#bjbe4  #b4 ,requir+ cov]age ( c]ta9    
items & s]vices relat+ to brea/ or *e/  
wall recon/ruction furni%$ 9 connection 
) brea/ canc] treatm5t  7a7 ,,phsa  7#a7
 ,9 g5]al ,"p ,d ( title ,,xxvii ( !    
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #cjj;gg-#aaa et seq47 is am5d$
 by add+ at ! end ! foll[+ new section3 
#bgii;,a-#aa4 ,requir$ cov]age = c]ta9  
items & s]vices relat+ to brea/ or *e/  
wall recon/ruction furni%$ 9 connection 
) brea/ canc] treatm5t  7a7 ,9 g5]al ,a 
gr\p heal? plan1 & a heal? insurance    
issu] (f]+ gr\p or individual heal?     
insurance cov]age1 t provides m$ical &  
surgical b5efits ) respect to ! treatm5t
 ( brea/ canc] %all provide1 9 ! case ( 
a p>ticipant or b5efici>y :o is receiv+ 
su* treatm5t & :o elects brea/ or *e/   
wall recon/ruction 9 connection ) su*   
treatm5t1 cov]age =-- 7#a7 extirpation  
or m$ical treatm5t ( diseas$ or damag$  

brea/ tissue1 includ+ ma/ectomy & all   
=ms ( brea/-cons]v+ surg]y2  7#b7 ea*   
modality ( brea/ recon/ruction1         
includ+-- 7,a7 implant-bas$             
recon/ruction2  7,b7 tissue-bas$        
recon/ruction2 &  7,c7 any recon/ruction
 modalities t are develop$ subsequ5t to 
! date ( ! enactm5t ( ?is subsection &  
recogniz$ )9 ,level ,i ( ! ,heal?c>e    
,common ,proc$ure ,cod+ ,sy/em2  7#c7 )9
 ea* modality specifi$ 9 p>agraph 7#b71 
ea* type ( brea/ recon/ruction1         
includ+-- 7,a7 imm$iate implant-bas$    
recon/ruction2  7,b7 delay$ implant-bas$
 recon/ruction2  7,c7 myocutane\s flap  
tissue-bas$ recon/ruction2  7,d7        
microvascul> free flap tissue-bas$      
recon/ruction2 /ructural fat graft+     
tissue-bas$ recon/ruction2  7,e7 comb9$ 
implant- & tissue-bas$ recon/ruction2 & 
7,f7 any type ( recon/ruction t is      
develop$ subsequ5t to ! effective date (
 ?is act & incorporat$ )9 ,level ,i ( ! 
,heal?c>e ,common ,proc$ure ,cod+       
,sy/em2  7#d7 )9 ea* type ( brea/       

recon/ruction specifi$ 9 p>agraph 7#c71 
ea* proc$ural v>iation1 it]ation1 or    
approa* t is not$ )9 ! %ort descriptor  
or ! description = ! ,heal?c>e ,common  
,proc$ure ,cod+ ,sy/em ,level ,i code   
cov]+ ! type ( recon/ruction2  7#e7 all 
/ages ( recon/ruction ( ! brea/ or *e/  
wall on :i* a ma/ectomy or brea/-cons]v+
 surg]y has be5 p]=m$1 includ+ flat     
closure2  7#f7 surg]y & recon/ruction ( 
! o!r brea/ or *e/ wall to produce a    
symmetrical appe>ance2  7#g7 cu/om      
fabricat$ brea/ pro/heses1 includ+      
replacem5t ( su* pro/heses2 &  7#h7     
me*anical1 m$ical1 & surgical treatm5t (
 physical complications ( ma/ectomy1    
brea/ recon/ruction surg]y1 *e/ wall    
surg]y1 radiation1 & lymph node surg]y1 
includ+ lymph$ema compression treatm5t  
items 7z su* t]m is def9$ 9 section     
#ahfa7mmm7 ( ! ,social ,security ,act b 
)\t reg>d to ! requirem5t 9 p>agraph    
7#a7 ( su* section t su* an item be     
furni%$ on or aft] ,janu>y #a1 #bjbd74  
7b7 ,mann] ( cov]age ,cov]age describ$ 9

 subsection 7a7 %all be provid$ 9 a     
mann] det]m9$ 9 consultation ) ! att5d+ 
physician & ! pati5t & = :i* ! pati5t is
 a m$ical c&idate4 ,su* cov]age may be  
subject to annual d$uctibles &          
co9surance provisions z are consi/5t )  
^? e/abli%$ = o!r b5efits "u ! plan or  
cov]age4 ,writt5 notice ( ! availability
 ( su* cov]age %all be deliv]$ to !     
p>ticipant ^u enrollm5t & annually      
!reaft]4  7c7 ,9-,network access ,a gr\p
 heal? plan & a heal? insurance issu]   
(f]+ gr\p or individual heal? insurance 
cov]age %all ensure t at lea/ #a        
9-network provid] is available "u su*   
plan or cov]age ) respect to ea*        
modality1 type ( recon/ruction1 &       
proc$ural v>iation1 it]ation1 & approa* 
describ$ 9 subsection 7a74  7d7 ,notice 
,a gr\p heal? plan1 & a heal? insurance 
issu] (f]+ gr\p or individual heal?     
insurance cov]age1 %all provide notice  
to ea* individual enroll$ "u su* plan   
reg>d+ ! cov]age requir$ by ?is section 
9 accordance ) regulations promulgat$ by

 ! ,secret>y4 ,su* notice %all be 9     
writ+ & prom95tly position$ 9 any       
lit]ature or correspond5ce made         
available or di/ribut$ by ! plan or     
issu] & %all be transmitt$-- 7#a7 ^u su*
 individual's enrollm5t 9 su* plan or   
cov]age2 &  7#b7 z "p ( any ye>ly       
in=mational packet s5t to ! individual  
!reaft]4  7e7 ,prohibitions ,a gr\p     
heal? plan1 & a heal? insurance issu]   
(f]+ gr\p or individual heal? insurance 
cov]age1 may n-- 7#a7 d5y to a pati5t   
eligibility1 or cont9u$ eligibility1 to 
enroll or to r5ew cov]age "u ! t]ms ( ! 
plan1 solely = ! purpose ( avoid+ !     
requirem5ts ( ?is section2 &  7#b7      
p5alize or o!rwise r$uce or limit !     
reimbursem5t ( an att5d+ provid]1 or    
provide inc5tives 7monet>y or o!rwise7  
to an att5d+ provid]1 to induce su*     
provid] to provide c>e to an individual 
p>ticipant or b5efici>y 9 a mann]       
inconsi/5t ) ?is section or ) g5]ally   
accept$ /&>ds ( m$ical practice4  7f7   
,rule ( ,con/ruction ,no?+ 9 ?is section

 %all be con/ru$ to prev5t a gr\p heal? 
plan or a heal? insurance issu] (f]+    
gr\p or individual heal? insurance      
cov]age f negotiat+ ! level & type (    
reimbursem5t ) a provid] = c>e provid$ 9
 accordance ) ?is section4  7g7         
,preemption ,no?+ 9 ?is section %all be 
con/ru$ to preempt any ,/ate law )      
respect to heal? insurance cov]age t    
requires cov]age ( at lea/ ! cov]age (  
brea/ canc] c>e o!rwise requir$ "u ?is  
section4  4  7#b7 ,con=m+ am5dm5t       
,section #bgbg ( ! ,public ,heal?       
,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#bg7
 is am5d$ by add+ at ! end ! foll[+ new 
s5t5ce3 ,! prec$+ s5t5ce %all n apply ) 
respect to plan ye>s beg9n+ on or aft] !
 date ( ! enactm5t ( ?is s5t5ce44  7b7  
,,erisa  7#a7 ,9 g5]al ,section #gac ( !
 ,employee ,retirem5t ,income ,security 
,act ( #aigd 7#bi ,u4,s4,c4 #aahe;b7 is 
am5d$-- 7,a7 9 ! head]1 by /rik+        
recon/ructive surg]y foll[+ ma/ectomies 
& ins]t+ c]ta9 items & s]vices relat+ to
 brea/ or *e/ wall recon/ruction furni%$

 9 connection ) brea/ canc] treatm5t2   
7,b7 by am5d+ subsection 7a7 to read z  
foll[s3  7a7 ,9 g5]al ,a gr\p heal?     
plan1 & a heal? insurance issu] provid+ 
heal? insurance cov]age 9 connection ) a
 gr\p heal? plan1 t provides m$ical &   
surgical b5efits ) respect to ! treatm5t
 ( brea/ canc] %all provide1 9 ! case ( 
a p>ticipant or b5efici>y :o is receiv+ 
su* treatm5t & :o elects brea/ or *e/   
wall recon/ruction 9 connection ) su*   
treatm5t1 cov]age =-- 7#a7 extirpation  
or m$ical treatm5t ( diseas$ or damag$  
brea/ tissue1 includ+ ma/ectomy & all   
=ms ( brea/-cons]v+ surg]y2  7#b7 ea*   
modality ( brea/ recon/ruction1         
includ+-- 7,a7 implant-bas$             
recon/ruction2  7,b7 tissue-bas$        
recon/ruction2 &  7,c7 any recon/ruction
 modalities t are develop$ subsequ5t to 
! date ( ! enactm5t ( ?is subsection &  
recogniz$ )9 ,level ,i ( ! ,heal?c>e    
,common ,proc$ure ,cod+ ,sy/em2  7#c7 )9
 ea* modality specifi$ 9 p>agraph 7#b71 
ea* type ( brea/ recon/ruction1         

includ+-- 7,a7 imm$iate implant-bas$    
recon/ruction2  7,b7 delay$ implant-bas$
 recon/ruction2  7,c7 myocutane\s flap  
tissue-bas$ recon/ruction2  7,d7        
microvascul> free flap tissue-bas$      
recon/ruction2 /ructural fat graft+     
tissue-bas$ recon/ruction2  7,e7 comb9$ 
implant- & tissue-bas$ recon/ruction2 & 
7,f7 any type ( recon/ruction t is      
develop$ subsequ5t to ! effective date (
 ?is act & incorporat$ )9 ,level ,i ( ! 
,heal?c>e ,common ,proc$ure ,cod+       
,sy/em2  7#d7 )9 ea* type ( brea/       
recon/ruction specifi$ 9 p>agraph 7#c71 
ea* proc$ural v>iation1 it]ation1 or    
approa* t is not$ )9 ! %ort descriptor  
or ! description = ! ,heal?c>e ,common  
,proc$ure ,cod+ ,sy/em ,level ,i code   
cov]+ ! type ( recon/ruction2  7#e7 all 
/ages ( recon/ruction ( ! brea/ or *e/  
wall on :i* a ma/ectomy or brea/-cons]v+
 surg]y has be5 p]=m$1 includ+ flat     
closure2  7#f7 surg]y & recon/ruction ( 
! o!r brea/ or *e/ wall to produce a    
symmetrical appe>ance2  7#g7 cu/om      

fabricat$ brea/ pro/heses1 includ+      
replacem5t ( su* pro/heses2 &  7#h7     
me*anical1 m$ical1 & surgical treatm5t (
 physical complications ( ma/ectomy1    
brea/ recon/ruction surg]y1 *e/ wall    
surg]y1 radiation1 & lymph node surg]y1 
includ+ lymph$ema compression treatm5t  
items 7z su* t]m is def9$ 9 section     
#ahfa7mmm7 ( ! ,social ,security ,act b 
)\t reg>d to ! requirem5t 9 p>agraph    
7#a7 ( su* section t su* an item be     
furni%$ on or aft] ,janu>y #a1 #bjbd74  
2  7,c7 by r$esignat+ subsections 7b7   
?r\gh 7e7 z subsections 7d7 ?r\gh 7g71  
respectively2  7,d7 by ins]t+ aft]      
subsection 7a7 ! foll[+ new subsections3
  7b7 ,mann] ( cov]age ,cov]age describ$
 9 subsection 7a7 %all be provid$ 9 a   
mann] det]m9$ 9 consultation ) ! att5d+ 
physician & ! pati5t & = :i* ! pati5t is
 a m$ical c&idate4 ,su* cov]age may be  
subject to annual d$uctibles &          
co9surance provisions z are consi/5t )  
^? e/abli%$ = o!r b5efits "u ! plan or  
cov]age4 ,writt5 notice ( ! availability

 ( su* cov]age %all be deliv]$ to !     
p>ticipant ^u enrollm5t & annually      
!reaft]4  7c7 ,9-,network access ,a gr\p
 heal? plan & a heal? insurance issu]   
(f]+ gr\p heal? insurance cov]age %all  
ensure t at lea/ #a 9-network provid] is
 available "u su* plan or cov]age )     
respect to ea* modality1 type (         
recon/ruction1 & proc$ural v>iation1    
it]ation1 & approa* describ$ 9          
subsection 7a74  2  7,e7 9 subsection   
7d71 z s r$esignat$1 by /rik+ p>agraphs 
7#a7 ?r\gh 7#c7 & ins]t+ ! foll[+ new   
p>agraphs3  7#a7 ^u su* p>ticipant or   
b5efici>y's enrollm5t 9 su* plan or     
cov]age2 &  7#b7 z "p ( any ye>ly       
in=mational packet s5t to ! p>ticipant  
or b5efici>y !reaft]4  2  7,f7 9        
subsection 7e77#b71 z s r$esignat$1 by  
ins]t+ or ) g5]ally accept$ /&>ds (     
m$ical practice be=e ! p]iod2 &  7,g7 9 
subsection 7g77#a71 z s r$esignat$-- 7i7
 by /rik+ 9 effect on ! date ( enactm5t 
( ?is section2 &  7ii7 by /rik+         
recon/ructive brea/ surg]y & ins]t+     

brea/ canc] c>e4  7#b7 ,cl]ical am5dm5t 
,! table ( cont5ts 9 section #a ( !     
,employee ,retirem5t ,income ,security  
,act ( #aigd 7#bi ,u4,s4,c4 #ajja note7 
is am5d$ to read z foll[s3  ,sec4 #gac4 
,requir$ cov]age ( c]ta9 items & s]vices
 relat+ to brea/ or *e/ wall            
recon/ruction furni%$ 9 connection )    
brea/ canc] treatm5t4  4  7c7 ,,irc     
7#a7 ,9 g5]al ,sub*apt] ,b ( *apt] #ajj 
( ! ,int]nal ,rev5ue ,code ( #aihf is   
am5d$ by add+ at ! end ! foll[+ new     
section3  #ihbf4 ,requir$ cov]age =     
c]ta9 items & s]vices relat+ to brea/ or
 *e/ wall recon/ruction furni%$ 9       
connection ) brea/ canc] treatm5t  7a7  
,9 g5]al ,a gr\p heal? plan t provides  
m$ical & surgical b5efits ) respect to !
 treatm5t ( brea/ canc] %all provide1 9 
! case ( a p>ticipant or b5efici>y :o is
 receiv+ su* treatm5t & :o elects brea/ 
or *e/ wall recon/ruction 9 connection )
 su* treatm5t1 cov]age =-- 7#a7         
extirpation or m$ical treatm5t ( diseas$
 or damag$ brea/ tissue1 includ+        

ma/ectomy & all =ms ( brea/-cons]v+     
surg]y2  7#b7 ea* modality ( brea/      
recon/ruction1 includ+-- 7,a7           
implant-bas$ recon/ruction2  7,b7       
tissue-bas$ recon/ruction2 &  7,c7 any  
recon/ruction modalities t are develop$ 
subsequ5t to ! date ( ! enactm5t ( ?is  
subsection & recogniz$ )9 ,level ,i ( ! 
,heal?c>e ,common ,proc$ure ,cod+       
,sy/em2  7#c7 )9 ea* modality specifi$ 9
 p>agraph 7#b71 ea* type ( brea/        
recon/ruction1 includ+-- 7,a7 imm$iate  
implant-bas$ recon/ruction2  7,b7 delay$
 implant-bas$ recon/ruction2  7,c7      
myocutane\s flap tissue-bas$            
recon/ruction2  7,d7 microvascul> free  
flap tissue-bas$ recon/ruction2         
/ructural fat graft+ tissue-bas$        
recon/ruction2  7,e7 comb9$ implant- &  
tissue-bas$ recon/ruction2 &  7,f7 any  
type ( recon/ruction t is develop$      
subsequ5t to ! effective date ( ?is act 
& incorporat$ )9 ,level ,i ( ! ,heal?c>e
 ,common ,proc$ure ,cod+ ,sy/em2  7#d7  
)9 ea* type ( brea/ recon/ruction       

specifi$ 9 p>agraph 7#c71 ea* proc$ural 
v>iation1 it]ation1 or approa* t is not$
 )9 ! %ort descriptor or ! description =
 ! ,heal?c>e ,common ,proc$ure ,cod+    
,sy/em ,level ,i code cov]+ ! type (    
recon/ruction2  7#e7 all /ages (        
recon/ruction ( ! brea/ or *e/ wall on  
:i* a ma/ectomy or brea/-cons]v+ surg]y 
has be5 p]=m$1 includ+ flat closure2    
7#f7 surg]y & recon/ruction ( ! o!r     
brea/ or *e/ wall to produce a          
symmetrical appe>ance2  7#g7 cu/om      
fabricat$ brea/ pro/heses1 includ+      
replacem5t ( su* pro/heses2 &  7#h7     
me*anical1 m$ical1 & surgical treatm5t (
 physical complications ( ma/ectomy1    
brea/ recon/ruction surg]y1 *e/ wall    
surg]y1 radiation1 & lymph node surg]y1 
includ+ lymph$ema compression treatm5t  
items 7z su* t]m is def9$ 9 section     
#ahfa7mmm7 ( ! ,social ,security ,act b 
)\t reg>d to ! requirem5t 9 p>agraph    
7#a7 ( su* section t su* an item be     
furni%$ on or aft] ,janu>y #a1 #bjbd74  
7b7 ,mann] ( cov]age ,cov]age describ$ 9

 subsection 7a7 %all be provid$ 9 a     
mann] det]m9$ 9 consultation ) ! att5d+ 
physician & ! pati5t & = :i* ! pati5t is
 a m$ical c&idate4 ,su* cov]age may be  
subject to annual d$uctibles &          
co9surance provisions z are consi/5t )  
^? e/abli%$ = o!r b5efits "u ! plan4    
,writt5 notice ( ! availability ( su*   
cov]age %all be deliv]$ to ! p>ticipant 
or b5efici>y ^u enrollm5t & annually    
!reaft]4  7c7 ,9-,network access ,a gr\p
 heal? plan %all ensure t at lea/ #a    
9-network provid] is available "u su*   
plan ) respect to ea* modality1 type (  
recon/ruction1 & proc$ural v>iation1    
it]ation1 & approa* describ$ 9          
subsection 7a74  7d7 ,notice ,a gr\p    
heal? plan %all provide notice to ea*   
p>ticipant & b5efici>y "u su* plan      
reg>d+ ! cov]age requir$ by ?is section 
9 accordance ) regulations promulgat$ by
 ! ,secret>y4 ,su* notice %all be 9     
writ+ & prom95tly position$ 9 any       
lit]ature or correspond5ce made         
available or di/ribut$ by ! plan or     

issu] & %all be transmitt$-- 7#a7 ^u su*
 p>ticipant or b5efici>y's enrollm5t 9  
su* plan2 &  7#b7 z "p ( any ye>ly      
in=mational packet s5t to ! p>ticipant  
or b5efici>y !reaft]4  7e7 ,prohibitions
 ,a gr\p heal? plan may n-- 7#a7 d5y to 
a pati5t eligibility1 or cont9u$        
eligibility1 to enroll or to r5ew       
cov]age "u ! t]ms ( ! plan1 solely = !  
purpose ( avoid+ ! requirem5ts ( ?is    
section2 &  7#b7 p5alize or o!rwise     
r$uce or limit ! reimbursem5t ( an      
att5d+ provid]1 or provide inc5tives    
7monet>y or o!rwise7 to an att5d+       
provid]1 to induce su* provid] to       
provide c>e to an individual p>ticipant 
or b5efici>y 9 a mann] inconsi/5t ) ?is 
section or ) g5]ally accept$ /&>ds (    
m$ical practice4  7f7 ,rule (           
,con/ruction ,no?+ 9 ?is section %all be
 con/ru$ to prev5t a gr\p heal? plan f  
negotiat+ ! level & type ( reimbursem5t 
) a provid] = c>e provid$ 9 accordance )
 ?is section4  7g7 ,preemption ,no?+ 9  
?is section %all be con/ru$ to preempt  

any ,/ate law ) respect to heal?        
insurance cov]age t requires cov]age (  
at lea/ ! cov]age ( brea/ canc] c>e     
o!rwise requir$ "u ?is section4  4  7#b7
 ,cl]ical am5dm5t ,! table ( sections = 
su* sub*apt] is am5d$ by ins]t+ aft] !  
entry relat+ to section #ihbe ! foll[+3 
,sec4 #ihbf4 ,requir$ cov]age = c]ta9   
items & s]vices relat+ to brea/ or *e/  
wall recon/ruction furni%$ 9 connection 
) brea/ canc] treatm5t4  4  7d7 ,report 
,n lat] t #a ye> aft] ! date ( !        
enactm5t ( ?is ,act1 ! ,comptroll]      
,g5]al ( ! ,unit$ ,/ates %all submit to 
! appropriate committees ( ,congress a  
report describ+ any gaps or b>ri]s 9    
access to brea/ recon/ruction1 includ+  
microsurgical brea/ recon/ruction4  7e7 
,effective date  7#a7 ,9 g5]al ,!       
am5dm5ts made by ?is section %all apply 
to plan ye>s beg9n+ on or 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]s1 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 section %all n be treat$ z a
 t]m9ation ( su* collective b>ga9+      
agreem5t4