119-hr307

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 307 Introduced in House

    (IH) ]

<DOC>

119th CONGRESS
 1st Session
 H. R. 307

To amend titles XVIII and XIX of the Social Security Act to provide for 
 coverage of peripheral artery disease screening tests furnished to at-
risk beneficiaries under the Medicare and Medicaid programs without the 
 imposition of cost-sharing requirements, and for other purposes.

_______________________________________________________________________

 IN THE HOUSE OF REPRESENTATIVES

 January 9, 2025

 Mrs. McIver (for herself, Mr. Jackson of Illinois, and Ms. Kelly of 
 Illinois) introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
 Ways and Means, for a period to be subsequently determined by the 
 Speaker, in each case for consideration of such provisions as fall 
 within the jurisdiction of the committee concerned

_______________________________________________________________________

 A BILL

To amend titles XVIII and XIX of the Social Security Act to provide for 
 coverage of peripheral artery disease screening tests furnished to at-
risk beneficiaries under the Medicare and Medicaid programs without the 
 imposition of cost-sharing requirements, and for other purposes.

 Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; FINDINGS.

    (a) Short Title.--This Act may be cited as the ``Amputation 
Reduction and Compassion Act of 2025'' or the ``ARC Act of 2025''.

    (b) 

=== Findings ===
-Congress makes the following findings:

    (1) Atherosclerosis occurs when blood flow is reduced 
 because arteries become narrowed or blocked with fatty 
 deposits.

    (2) Atherosclerosis is responsible for more deaths in the 
 United States than any other condition, and heart attacks, 
 resulting from clogged coronary arteries, are the leading cause 
 of death in America.

    (3) Atherosclerosis also occurs in the legs and is known as 
 peripheral artery disease (in this subsection referred to as 
 ``PAD'') and having PAD significantly increases the risk for 
 heart attack, stroke, amputation, and death.

    (4) While most Americans are aware of atherosclerosis in 
 the heart, many Americans have never heard of PAD and Americans 
 with PAD are often unaware of the serious risks of the disease.

    (5) An estimated 21 million Americans have PAD, and about 
 200,000 of them--disproportionately minorities--suffer 
 avoidable amputations every year as a result of such disease.

    (6) According to the Dartmouth Atlas, amputation risks for 
 African Americans living with diabetes are as much as four 
 times higher than the national average.

    (7) Data analyses have similarly found that Native 
 Americans are more than twice as likely to be subjected to 
 amputation and Hispanics are up to 75 percent more likely to 
 have an amputation.

    (8) Fifty-two percent of patients with an above-the-knee 
 amputation and 33 percent of patients with a below-the-knee 
 amputation will die within two years of their amputation.

    (9) Screening and arterial testing for PAD is cost-
 effective and should be part of routine medical care.

    (10) Once PAD is detected, amputations and deaths can be 
 reduced through the use of national, evidence-based PAD care 
 guidelines.

    (11) Americans with a PAD diagnosis are associated with a 
 67-percent increase in the risk of cardiac death compared to 
 people without a PAD diagnosis. Consequently, screening for PAD 
 enables health care professionals to identify cardiac risk 
 factors earlier and take proactive measures to reduce the risk 
 of cardiac death.

SEC. 2. PERIPHERAL ARTERY DISEASE EDUCATION PROGRAM.

 Part P of title III of the Public Health Service Act (42 U.S.C. 
280g et seq.) is amended by adding at the end the following new 
section:

``

SEC. 399V-8. PERIPHERAL ARTERY DISEASE EDUCATION PROGRAM.

 ``

    (a) Establishment.--The Secretary, acting through the Director of 
the Centers for Disease Control and Prevention, in collaboration with 
the Administrator of the Centers for Medicare & Medicaid Services, the 
Administrator of the Health Resources and Services Administration, 
leading clinical and patient advocacy organizations, and other 
interested stakeholders shall establish and coordinate a peripheral 
artery disease education program to support, develop, and implement 
educational initiatives and outreach strategies that inform health care 
professionals and the public about the existence of peripheral artery 
disease and methods to reduce amputations related to such disease, 
particularly with respect to at-risk populations.
 ``

    (b) Best Practices.--The Secretary shall, as appropriate, 
identify and disseminate to health care professionals best practices 
with respect to peripheral artery disease.
 ``
            (c) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $6,000,000 for each of fiscal 
years 2026 through 2030.''.

SEC. 3. MEDICARE COVERAGE OF PERIPHERAL ARTERY DISEASE SCREENING TESTS 
 FURNISHED TO AT-RISK BENEFICIARIES WITHOUT IMPOSITION OF 
 COST-SHARING REQUIREMENTS.

    (a) In General.--

Section 1861 of the Social Security Act (42 U.S.C. 
1395x) is amended--

    (1) in subsection

    (s)

    (2) --
        (A) in subparagraph

    (JJ) , by striking the semicolon 
 at the end and inserting ``; and''; and
        (B) by adding at the end the following new 
 subparagraph:
 ``

    (KK) peripheral artery disease screening tests furnished 
 to at-risk beneficiaries (as such terms are defined in 
 subsection

    (nnn) ).''; and

    (2) by adding at the end the following new subsection:
 ``

    (nnn) Peripheral Artery Disease Screening Test; At-Risk 
Beneficiary.--

    (1) The term `peripheral artery disease screening test' 
means--
 ``
        (A) noninvasive physiologic studies of extremity arteries 
 (commonly referred to as ankle-brachial index testing);
 ``
        (B) arterial duplex scans of lower extremity arteries 
 vascular; and
 ``
            (C) such other items and services as the Secretary 
 determines, in consultation with relevant stakeholders, to be 
 appropriate for screening for peripheral artery disease for at-
 risk beneficiaries.
 ``

    (2) The term `at-risk beneficiary' means an individual entitled 
to, or enrolled for, benefits under part A and enrolled for benefits 
under part B--
 ``
        (A) who is 65 years of age or older;
 ``
        (B) who is at least 50 years of age but not older than 64 
 years of age with risk factors for atherosclerosis (such as 
 diabetes mellitus, a history of smoking, hyperlipidemia, and 
 hypertension) or a family history of peripheral artery disease;
 ``
            (C) who is younger than 50 years of age with diabetes 
 mellitus and one additional risk factor for atherosclerosis; or
 ``
            (D) with a known atherosclerotic disease in another 
 vascular bed such as coronary, carotid, subclavian, renal, or 
 mesenteric artery stenosis, or abdominal aortic aneurysm.
 ``

    (3) The Secretary shall, in consultation with appropriate 
organizations, establish standards regarding the frequency for 
peripheral artery disease screening tests described in subsection

    (s)

    (2) (KK) for purposes of coverage under this title.''.

    (b) Inclusion of Peripheral Artery Disease Screening Tests in 
Initial Preventive Physical Examination.--

Section 1861

    (ww)

    (2) of the 
Social Security Act (42 U.S.C. 1395x

    (ww)

    (2) ) is amended--

    (1) in subparagraph
        (N) , by moving the margins of such 
 subparagraph 2 ems to the left;

    (2) by redesignating subparagraph
        (O) as subparagraph
        (P) ; 
 and

    (3) by inserting after subparagraph
        (N) the following new 
 subparagraph:
 ``
        (O) Peripheral artery disease screening tests furnished 
 to at risk-beneficiaries (as such terms are defined in 
 subsection

    (nnn) ).''.
            (c) Payment.--

    (1) In general.--

Section 1833

    (a) of the Social Security Act 
 (42 U.S.C. 1395l

    (a) ) is amended--
        (A) in paragraph

    (1) --
            (i) in subparagraph
        (N) , by inserting ``and 
 other than peripheral artery disease screening 
 tests furnished to at-risk beneficiaries (as 
 such terms are defined in 

section 1861

    (nnn) )'' 
 after ``other than personalized prevention plan 
 services (as defined in 

section 1861

    (hhh)

    (1) )'';
            (ii) by striking ``and'' before ``

    (HH) ''; 
 and
            (iii) by adding at the end the following: 
 ``and
            (II) with respect to peripheral artery 
 disease screening tests furnished to at-risk 
 beneficiaries (as such terms are defined in 
 

section 1861

    (nnn) ), the amount paid shall be 
 100 percent of the lesser of the actual charge 
 for the services or the amount determined under 
 the payment basis determined under 

section 1848;''; and
        (B) in paragraph

    (2) --
            (i) in subparagraph
        (G) , by striking 
 ``and'' at the end;
            (ii) in subparagraph
        (H) , by striking the 
 semicolon at the end and inserting ``; and''; 
 and
            (iii) by inserting after subparagraph
        (H) the following new subparagraph:
 ``
            (I) with respect to peripheral artery disease screening 
 tests (as defined in paragraph

    (1) of 

section 1861

    (nnn) ) 
 furnished by an outpatient department of a hospital to at-risk 
 beneficiaries (as defined in paragraph

    (2) of such section), 
 the amount determined under paragraph

    (1)
            (II) ;''.

    (2) No deductible.--

Section 1833

    (b) of the Social Security 
 Act (42 U.S.C. 1395l

    (b) ) is amended, in the first sentence--
        (A) by striking ``, and'' before ``

    (13) ''; and
        (B) by inserting before the period at the end the 
 following: ``, and

    (14) such deductible shall not apply 
 with respect to peripheral artery disease screening 
 tests furnished to at-risk beneficiaries (as such terms 
 are defined in 

section 1861

    (nnn) )''.

    (3) Exclusion from prospective payment system for hospital 
 outpatient department services.--

Section 1833

    (t)

    (1)
        (B)
            (iv) of 
 the Social Security Act (42 U.S.C. 1395l

    (t)

    (1)
        (B)
            (iv) ) is 
 amended--
        (A) by striking ``, or personalized'' and inserting 
 ``, personalized''; and
        (B) by inserting ``, or peripheral artery disease 
 screening tests furnished to at-risk beneficiaries (as 
 such terms are defined in 

section 1861

    (nnn) )'' after 
 ``personalized prevention plan services (as defined in 
 

section 1861

    (hhh)

    (1) )''.

    (4) Conforming amendment.--

Section 1848

    (j)

    (3) of the Social 
 Security Act (42 U.S.C. 1395w-4

    (j)

    (3) ) is amended by striking 
 ``

    (2) (FF) (including administration of the health risk 
 assessment),'' and inserting ``

    (2) (FF) (including 
 administration of the health risk assessment),

    (2) (KK) ,''.
            (d) Exclusion From Coverage and Medicare as Secondary Payer for 
Tests Performed More Frequently Than Allowed.--

Section 1862

    (a)

    (1) of 
the Social Security Act (42 U.S.C. 1395y

    (a)

    (1) ) is amended--

    (1) in subparagraph
        (O) , by striking ``and'' at the end;

    (2) in subparagraph
        (P) , by striking the semicolon at the 
 end and inserting ``, and''; and

    (3) by adding at the end the following new subparagraph:
 ``
        (Q) in the case of peripheral artery disease screening 
 tests furnished to at-risk beneficiaries (as such terms are 
 defined in 

section 1861

    (nnn) ), which are performed more 
 frequently than is covered under such section;''.

    (e) Authority To Modify or Eliminate Coverage of Certain Preventive 
Services.--

Section 1834

    (n) of the Social Security Act (42 U.S.C. 
1395m

    (n) ) is amended--

    (1) by redesignating subparagraphs
        (A) and
        (B) of paragraph

    (1) as clauses
            (i) and
            (ii) , respectively, and moving the 
 margins of such clauses, as so redesignated, 2 ems to the 
 right;

    (2) by redesignating paragraphs

    (1) and

    (2) as 
 subparagraphs
        (A) and
        (B) , respectively, and moving the margins 
 of such subparagraphs, as so redesignated, 2 ems to the right;

    (3) by striking ``Certain Preventive Services'' and all 
 that follows through ``any other provision of this title'' and 
 inserting: ``Certain Preventive Services.--
 ``

    (1) In general.--Notwithstanding any other provision of 
 this title''; and

    (4) by adding at the end the following new paragraph:
 ``

    (2) Inapplicability.--The Secretarial authority described 
 in paragraph

    (1) shall not apply with respect to preventive 
 services described in 

section 1861

    (ww)

    (2)
        (O) .''.

    (f) Effective Date.--The amendments made by this section shall 
apply with respect to items and services furnished on or after January 
1, 2026.

SEC. 4. MEDICAID COVERAGE OF PERIPHERAL ARTERY DISEASE SCREENING TESTS 
 FURNISHED TO AT-RISK BENEFICIARIES WITHOUT IMPOSITION OF 
 COST-SHARING REQUIREMENTS.

    (a) In General.--

Section 1905 of the Social Security Act (42 U.S.C. 
1396d) is amended--

    (1) in subsection

    (a) --
        (A) in paragraph

    (31) , by striking ``and'' at the 
 end;
        (B) by redesignating paragraph

    (32) as paragraph

    (33) ; and
            (C) by inserting after paragraph

    (31) the following 
 new paragraph:
 ``

    (32) peripheral artery disease screening tests furnished 
 to at-risk beneficiaries (as such terms are defined in 
 subsection

    (kk) ); and''; and

    (2) by adding at the end the following new subsection:
 ``

    (kk) Peripheral Artery Disease Screening Test; At-Risk 
Beneficiary.--
 ``

    (1) Peripheral artery disease screening test.--The term 
 `peripheral artery disease screening test' means--
 ``
        (A) noninvasive physiologic studies of extremity 
 arteries (commonly referred to as ankle-brachial index 
 testing);
 ``
        (B) arterial duplex scans of lower extremity 
 arteries vascular; and
 ``
            (C) such other items and services as the 
 Secretary determines, in consultation with relevant 
 stakeholders, to be appropriate for screening for 
 peripheral artery disease for at-risk beneficiaries.
 ``

    (2) At-risk beneficiary.--The term `at-risk beneficiary' 
 means an individual enrolled under a State plan (or a waiver of 
 such plan)--
 ``
        (A) who is 65 years of age or older;
 ``
        (B) who is at least 50 years of age but not older 
 than 64 years of age with risk factors for 
 atherosclerosis (such as diabetes mellitus, a history 
 of smoking, hyperlipidemia, and hypertension) or a 
 family history of peripheral artery disease;
 ``
            (C) who is younger than 50 years of age with 
 diabetes mellitus and one additional risk factor for 
 atherosclerosis; or
 ``
            (D) with a known atherosclerotic disease in 
 another vascular bed such as coronary, carotid, 
 subclavian, renal, or mesenteric artery stenosis, or 
 abdominal aortic aneurysm.
 ``

    (3) Frequency.--The Secretary shall, in consultation with 
 appropriate organizations, establish standards regarding the 
 frequency for peripheral artery disease screening tests 
 described in subsection

    (a)

    (31) for purposes of coverage under 
 a State plan under this title.''.

    (b) No Cost Sharing.--

    (1) In general.--Subsections

    (a)

    (2) and

    (b)

    (2) of 

section 1916 of the Social Security Act (42 U.S.C. 1396o) are each 
 amended--
        (A) in subparagraph
            (I) , by striking ``or'' at the 
 end;
        (B) in subparagraph
        (J) , by striking ``; and'' and 
 inserting ``, or''; and
            (C) by adding at the end the following new 
 subparagraph:
 ``
        (K) peripheral artery disease screening tests 
 furnished to at-risk beneficiaries (as such terms are 
 defined in 

section 1905

    (kk) ); and''.

    (2) Application to alternative cost sharing.--

Section 1916A

    (b)

    (3)
        (B) of the Social Security Act (42 U.S.C. 1396o-
 1

    (b)

    (3)
        (B) ) is amended by adding at the end the following new 
 clause:
 ``
            (xv) Peripheral artery disease screening 
 tests furnished to at-risk beneficiaries (as 
 such terms are defined in 

section 1905

    (kk) ).''.
            (c) Conforming Amendments.--

    (1) Section 1902

    (nn)

    (3) of the Social Security Act (42 
 U.S.C. 1396a

    (nn)

    (3) ) is amended by striking ``following 
 paragraph

    (31) '' and inserting ``following paragraph

    (32) ''.

    (2) Section 1905

    (a) of the Social Security Act (42 U.S.C. 
 1396d

    (a) ) is amended by striking ``following paragraph

    (31) '' 
 and inserting ``following paragraph

    (32) ''.

SEC. 5. DEVELOPMENT AND IMPLEMENTATION OF QUALITY MEASURES.

    (a) Development.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary'') shall, in 
consultation with relevant stakeholders, develop quality measures for 
nontraumatic, lower-limb, major amputation that utilize appropriate 
diagnostic screening (including peripheral artery disease screening) in 
order to encourage alternative treatments (including revascularization) 
in lieu of such an amputation.

    (b) Implementation.--Not later than 18 months after the date of 
enactment of this Act, the Secretary shall complete appropriate testing 
and validation of the measures developed under subsection

    (a) and shall 
incorporate such measures in quality reporting programs for appropriate 
providers of services and suppliers under the Medicare program under 
title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), 
including for purposes of--

    (1) the merit-based incentive payment system under 

section 1848

    (q) of such Act (42 U.S.C. 1395w-4

    (q) );

    (2) incentive payments for participation in eligible 
 alternative payment models under 

section 1833

    (z) of such Act 
 (42 U.S.C. 1395l

    (z) );

    (3) the shared savings program under 

section 1899 of such 
 Act (42 U.S.C. 1395jjj);

    (4) models under 

section 1115A of such Act (42 U.S.C. 
 1315a); and

    (5) such other payment systems or models as the Secretary 
 may specify.

SEC. 6. AMPUTATION PREVENTION PILOT PROGRAM.

    (a) In General.--

Section 1115A

    (b)

    (2)
        (B) of the Social Security Act 
(42 U.S.C. 1315a

    (b)

    (2)
        (B) ) is amended by adding at the end the 
following new clause:
 ``
            (xxviii) Promoting voluntary, 
 nontraumatic lower-limb major amputation 
 prevention programs at hospitals, ambulatory 
 surgical centers, and office-based centers that 
 will increase access to amputation prevention 
 services, reduce amputation rates, and reduce 
 costs to such hospitals, surgical centers, and 
 office-based centers, through--
 ``
            (I) patient risk modification and 
 management;
 ``
            (II) early screening and 
 detection and surveillance;
 ``
            (III) testing and treatment for 
 peripheral artery disease; and
 ``
            (IV) improved care coordination 
 for individuals at high risk for 
 amputation.''.

    (b) Testing of Model.--Not later than 18 months after the date of 
the enactment of this Act, the Deputy Administrator and Director of the 
Center for Medicare and Medicaid Innovation shall test the model 
described under subsection

    (a) .
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