ARC Act of 2025
- Sponsor
- Rep. McIver, LaMonica [D-NJ-10]
- Committees
- Ways and Means Committee (primary)
- Last action
- Jan 14, 2025
Bottom line
The ARC Act aims to reduce preventable amputations and associated deaths by expanding access to no-cost PAD screening and promoting education and quality measures within federal health programs.
What it actually does
This bill establishes a Peripheral Artery Disease (PAD) education program at the CDC, authorizes appropriations for it, and mandates Medicare and Medicaid coverage for PAD screening tests for at-risk beneficiaries. Crucially, it eliminates cost-sharing requirements (deductibles and copayments) for these screenings under both programs. The bill also directs the Secretary of Health and Human Services to develop quality measures for lower-limb amputation prevention and promotes a pilot program for amputation prevention.
Proponents argue
Proponents argue that Peripheral Artery Disease (PAD) is a serious, often undiagnosed condition leading to hundreds of thousands of avoidable amputations annually, disproportionately affecting minority populations. By making screening tests free under Medicare and Medicaid, this bill will enable earlier detection, facilitate timely interventions, and ultimately save lives and reduce healthcare costs associated with advanced disease and amputations. The education program and quality measures will further support a proactive approach to patient care.
Opponents contend
Opponents might raise concerns about the potential increase in federal healthcare spending due to expanded coverage and the elimination of cost-sharing, especially without a clear understanding of the long-term cost-effectiveness of widespread screening. Some may argue that existing preventive care frameworks are sufficient or that resources could be better allocated to other public health priorities, or that the bill could lead to over-screening or false positives, creating unnecessary anxiety and follow-up procedures.
The bill is moderately complex due to its amendments to the Social Security Act, but its core provisions are clear. A diligent reader can understand its main impacts within the time given.
Section 2, Part P of title III of the Public Health Service Act
Peripheral Artery Disease Education Program
This provision directs the Secretary of Health and Human Services, through the CDC and in collaboration with CMS and other stakeholders, to establish a national education program. The program's goal is to inform healthcare professionals and the public about PAD, its risks, and methods to reduce amputations, with a particular focus on at-risk populations. It also mandates the identification and dissemination of best practices for PAD care.
Supporters argue
Supporters argue that increased public and professional awareness is critical for early detection and prevention of PAD-related complications. An education program ensures that individuals, particularly those at higher risk, understand the importance of screening and that healthcare providers are equipped with the latest best practices.
Critics contend
No specific opposition is typically raised against public health education programs, though some might argue about the efficiency or reach of such programs, or whether the authorized funding is optimally allocated compared to direct medical interventions.
Tradeoffs
The main tension is ensuring the program effectively reaches the most vulnerable populations and translates awareness into action, balancing broad outreach with targeted interventions.
Section 3(a), Social Security Act (SSA) Section 1861(s)(2) and 1861(nnn)
Medicare Coverage of PAD Screening Tests
This section amends Medicare law to include peripheral artery disease (PAD) screening tests as a covered medical service under Part B. It defines 'peripheral artery disease screening test' to include ankle-brachial index testing and arterial duplex scans, with flexibility for the Secretary to add other appropriate tests. It also specifies 'at-risk beneficiaries' who are eligible for coverage, including individuals 65 or older, those 50-64 with risk factors, those under 50 with diabetes and another risk factor, or those with known atherosclerotic disease elsewhere.
Section 3(c), SSA Section 1833(a) and 1833(b)
Elimination of Medicare Cost-Sharing for PAD Screening
This provision amends Medicare payment rules to ensure that peripheral artery disease screening tests furnished to at-risk beneficiaries are covered at 100% of the approved amount, meaning beneficiaries will not be responsible for any deductible or coinsurance. It specifically exempts these screenings from the standard Part B deductible and the usual coinsurance rates, including when performed in hospital outpatient departments.
Section 4(a), SSA Section 1905(a) and 1905(kk)
Medicaid Coverage of PAD Screening Tests
This section mandates that State Medicaid plans must cover peripheral artery disease (PAD) screening tests for at-risk beneficiaries. Similar to Medicare, it defines 'peripheral artery disease screening test' and 'at-risk beneficiary' for the purposes of Medicaid coverage, ensuring consistency across federal health programs. The Secretary is also directed to establish standards for the frequency of these screenings.
Section 4(b), SSA Section 1916(a)(2), 1916(b)(2), and 1916A(b)(3)(B)
Elimination of Medicaid Cost-Sharing for PAD Screening
This provision amends Medicaid law to prohibit states from imposing any cost-sharing requirements (premiums, deductibles, coinsurance, or copayments) for peripheral artery disease screening tests furnished to at-risk beneficiaries. This applies to both standard Medicaid programs and those operating under alternative cost-sharing methodologies, ensuring these screenings are completely free for eligible beneficiaries.
Section 5
Development and Implementation of Quality Measures
This section directs the Secretary of Health and Human Services to develop and implement quality measures specifically for nontraumatic, lower-limb, major amputations. These measures are intended to encourage appropriate diagnostic screening, including PAD screening, and alternative treatments like revascularization, to reduce the incidence of such amputations. The Secretary must complete testing and validation within 18 months and incorporate these measures into various Medicare quality reporting programs, including MIPS and alternative payment models.
Section 6, SSA Section 1115A(b)(2)(B)
Amputation Prevention Pilot Program
This section amends the Social Security Act to add a new model for the Center for Medicare and Medicaid Innovation (CMMI) to test. This model will promote voluntary, nontraumatic lower-limb major amputation prevention programs at hospitals, ambulatory surgical centers, and office-based centers. The goal is to increase access to prevention services, reduce amputation rates, and lower costs through patient risk modification, early screening, testing and treatment for PAD, and improved care coordination for high-risk individuals. CMMI is directed to test this model within 18 months.
Excludes peripheral artery disease screening tests from the prospective payment system for hospital outpatient department services.
Section 3(c)(3), SSA Section 1833(t)(1)(B)(iv)
Why it matters:This is standard legislative practice for technical adjustments to existing payment methodologies, ensuring that the new covered service is paid under the intended fee schedule (100% of actual charge or determined payment basis) rather than being bundled into a hospital outpatient payment.
Case for: Supporters argue this ensures proper reimbursement for the specific screening tests, aligning with the intent to cover them without cost-sharing and preventing them from being undervalued or underprovided if subject to a less favorable bundled payment.
Case against: No specific case against this technical exclusion is typically made, as it's a mechanism to ensure the primary policy intent (no cost-sharing, 100% payment) is realized within the complex Medicare payment structure.
Estimated impact: Ensures that hospitals providing these screenings are reimbursed appropriately, facilitating access for beneficiaries.
Limits the Secretary's authority to modify or eliminate coverage of certain preventive services by explicitly stating that this authority shall not apply to peripheral artery disease screening tests.
Section 3(e), SSA Section 1834(n)
Why it matters:This is a protective measure, common in legislation establishing new mandated benefits, to ensure that the newly covered service cannot be easily removed or altered by future administrative action without further Congressional approval.
Case for: Proponents argue this provides long-term stability and certainty for PAD screening coverage, preventing future administrations from undermining the bill's intent to provide this critical preventive service.
Case against: Critics might argue that it reduces the flexibility of the Secretary to adapt Medicare coverage to evolving medical evidence or budgetary constraints, potentially locking in services that may become less relevant or cost-effective over time.
Estimated impact: Ensures the permanence of PAD screening coverage under Medicare, barring future legislative changes.