HR 4543
Medicaid Breast Cancer Access to Treatment Act
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Bill overview
This bill, the Medicaid Breast Cancer Access to Treatment Act, amends the Social Security Act to expand Medicaid coverage for individuals diagnosed with breast or cervical cancer. Specifically, it requires Medicaid to cover certain treatments and services related to these cancers, including breast reconstruction following medically necessary mastectomies. The bill also adjusts how Medicaid calculates its federal medical assistance percentage (FMAP) and modifies cost-sharing rules for patients receiving covered services.
Key provisions
- Requires Medicaid to cover individuals diagnosed with breast or cervical cancer who meet specific criteria.
- Includes breast reconstruction following medically necessary mastectomy as a covered medical service.
- Adjusts the FMAP calculation to reflect coverage for these patients.
- Modifies cost-sharing rules for individuals receiving covered breast cancer treatments.
- Redefines the criteria for individuals eligible for Medicaid coverage related to breast or cervical cancer.
Who is affected
- Medicaid recipients
- Individuals diagnosed with breast or cervical cancer
- Healthcare providers who treat breast cancer patients
Notable changes
- Expands Medicaid coverage to include breast reconstruction services.
- Changes the criteria used to determine eligibility for breast cancer-related Medicaid coverage.
- Modifies the FMAP calculation to account for the expanded coverage.
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Primary sponsor
Cosponsors
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119th CONGRESS — 1st Session
H. R. 4543
IN THE HOUSE OF REPRESENTATIVES
A BILL
To amend title XIX of the Social Security Act to require coverage for certain individual with breast or cervical cancer under the Medicaid program.
This Act may be cited as the Medicaid Breast Cancer Access to Treatment Act
.
Section 1902 of the Social Security Act (42 U.S.C. 1396a) is amended—
in subsection (a)(10)—
in subparagraph (A)—
in the matter preceding clause (i), by striking and (30)
and inserting (30), and (32)
;
in clause (i)—
in subclause (VIII), by striking or
at the end;
in subclause (IX), by adding or
at the end; and
by adding at the end the following new subclause:
in clause (ii), by striking subclause (XVIII); and
in the matter at the end, in subdivision (XIV), by striking subparagraph (A)(10)(ii)(XVIII)
and inserting subparagraph (A)(10)(i)(X)
; and
in subsection (aa)—
by striking paragraphs (1) and (2);
by redesignating paragraphs (3) and (4) as paragraphs (1) and (2), respectively; and
in paragraph (2), as so redesignated, by inserting as in effect on the day before the date of the enactment of the Patient Protection and Affordable Care Act,
after (42 U.S.C. 300gg(c)),
.
Section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)) is amended—
in paragraph (31), by striking and
at the end;
by redesignating paragraph (32) as paragraph (33); and
by inserting after paragraph (31) the following new paragraph:
Section 1905(b)(4) of the Social Security Act (42 U.S.C. 1396d(b)(4)) is amended by striking section 1902(a)(10)(A)(ii)(XVIII)
and inserting section 1902(a)(10)(A)(i)(X)
.
Subsections (a)(2) and (b)(2) of section 1916 of the Social Security Act (42 U.S.C. 1396o) are each amended—
in subparagraph (I), by striking or
at the end;
in subparagraph (J), by striking ; and
at the end and inserting , or
; and
by adding at the end the following new subparagraph:
Section 1916A(b)(3) of the Social Security Act (42 U.S.C. 1396o–1(b)(3)) is amended—
in subparagraph (A)(v), by striking 1902(a)(10)(A)(ii)(XVIII)
and inserting 1902(a)(10)(A)(i)(X)
; and
in subparagraph (B)(viii), by striking 1902(a)(10)(A)(ii)(XVIII)
and inserting 1902(a)(10)(A)(i)(X)
.
The amendments made by this section shall apply beginning 1 year after the date of the enactment of this Act.