Medicare Breast Reconstruction Access and Information Act
- Sponsor
- Rep. Waters, Maxine [D-CA-43]
- Committees
- Ways and Means Committee (primary)
- Last action
- Jul 17, 2025
Bottom line
The bill mandates that Medicare providers explicitly inform mastectomy patients about their covered breast reconstruction options and document this disclosure, aiming to ensure informed consent and access to care.
What it actually does
This bill amends the Social Security Act to require healthcare providers to inform Medicare beneficiaries undergoing a mastectomy that breast reconstruction surgery is covered under Medicare Part B, pursuant to national coverage determination 140.2. Providers must also document the provision of this information in the patient's medical record. Failure to comply with this requirement, which takes effect one year after enactment, would result in no Medicare payment for the mastectomy.
Proponents argue
Supporters argue that this bill empowers Medicare beneficiaries by ensuring they are fully aware of their healthcare options and rights following a mastectomy. They contend that explicit disclosure prevents situations where patients might forgo covered reconstruction due to a lack of information, thereby promoting patient autonomy and equitable access to care.
Opponents contend
Critics might argue that this bill adds an unnecessary administrative burden on healthcare providers, who are already obligated to obtain informed consent and typically discuss all relevant treatment options, including reconstruction. They may contend that existing regulations and ethical standards already ensure patients are adequately informed, making this specific mandate redundant.
The bill is very short and clearly written, making it easy for any reader to understand its provisions quickly.
Section 2, amending Section 1834 of the Social Security Act (42 U.S.C. 1395m)
Mandatory Information Disclosure for Mastectomy Patients
This provision requires that, starting one year after the bill's enactment, Medicare will not make payments for mastectomies unless the healthcare provider first informs the patient that breast reconstruction surgery following a medically necessary mastectomy is covered under Medicare Part B. The provider must also document that this information was given to the patient in their medical record. This ensures patients are aware of their full range of post-mastectomy options covered by their insurance.
Supporters argue
Supporters argue this provision closes a potential information gap, ensuring that all Medicare patients facing a mastectomy are explicitly informed of their right to covered breast reconstruction. This proactive disclosure can help patients make more informed decisions about their care and improve their quality of life post-mastectomy.
Critics contend
Critics might contend that this provision adds an unnecessary layer of bureaucracy to an already complex healthcare system. They may argue that providers already have a professional and ethical obligation to discuss all treatment options, including reconstruction, and that adding a specific documentation requirement could lead to increased administrative costs without significantly improving patient outcomes.
Tradeoffs
The bill balances the goal of enhancing patient empowerment and informed decision-making with the potential for increased administrative burden on healthcare providers. It also highlights the tension between general informed consent practices and specific, mandated disclosures for particular procedures.