Women’s Health and Cancer Rights Modernization Act of 2025 | ChamberLight
Bills · HR 5813
IN COMMITTEE· 119TH CONGRESS
House BillHR 5813Health
Women’s Health and Cancer Rights Modernization Act of 2025
INTRO OCT 24· LAST ACTION OCT 24
READING
14MIN
COSPONSORS
13BIPARTISAN
READER REACTIONS0 TOTAL
NO VOTES YET · BE THE FIRST
Introduced only
LEGISLATIVE PROGRESS
STEP 2 / 8
Introduced
In Committee
Reported
Passed House
Passed Senate
Conference
To President
Became Law
WHAT THE BILL DOES
AI-written
This bill matters because it updates an important existing law (the Women's Health and Cancer Rights Act) to keep pace with advancements in medical science and the evolving needs of breast cancer survivors. The current law, enacted in 1998, might not explicitly cover all modern reconstructive techniques or related care, potentially leaving patients with limited choices or significant out-of-pocket costs at a vulnerable time.
If this bill becomes law, patients facing breast cancer would have comprehensive insurance coverage for the full spectrum of reconstructive options, including advanced surgical methods, custom prostheses, and management of complications. This ensures that their choice of treatment is based on medical need and personal preference, not financial constraints. If it doesn't pass, patients may continue to encounter uneven coverage for various reconstruction types, potentially restricting their access to the best available care and increasing their financial burden for these often vital and emotionally significant procedures.
KEY PROVISIONS
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PROVISION 01
Requires health plans to cover all modern modalities and types of breast reconstruction, including implant-based, tissue-based, and any future methods recognized by healthcare coding systems.
Ensures patients have access to the full spectrum of advanced reconstructive options available today and in the future.
PROVISION 02
Mandates coverage for related services, such as flat closure, surgery for symmetrical appearance of the other breast, custom breast prostheses, and treatment for physical complications like lymphedema.
Provides holistic care beyond just the primary reconstruction, addressing common physical, emotional, and practical needs after breast cancer.
PROVISION 03
Stipulates that coverage decisions must be made in consultation with the attending physician and the patient, and that plans must ensure at least one in-network provider is available for each covered service.
Empowers patients in their treatment decisions, ensures medical necessity is determined by healthcare professionals, and improves access to specialized care.
PROVISION 04
Prohibits health plans from denying eligibility or continued coverage solely to avoid these requirements, and from penalizing providers for offering care consistent with the bill.
Protects patient access to comprehensive care and ensures providers can recommend the best treatment without financial disincentives.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Workforce, 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.
This bill matters because it updates an important existing law (the Women's Health and Cancer Rights Act) to keep pace with advancements in medical science and the evolving needs of breast cancer survivors. The current law, enacted in 1998, might not explicitly cover all modern reconstructive techniques or related care, potentially leaving patients with limited choices or significant out-of-pocket costs at a vulnerable time.
If this bill becomes law, patients facing breast cancer would have comprehensive insurance coverage for the full spectrum of reconstructive options, including advanced surgical methods, custom prostheses, and management of complications. This ensures that their choice of treatment is based on medical need and personal preference, not financial constraints. If it doesn't pass, patients may continue to encounter uneven coverage for various reconstruction types, potentially restricting their access to the best available care and increasing their financial burden for these often vital and emotionally significant procedures.
KEY PROVISIONS
AI-extracted
high
Requires health plans to cover all modern modalities and types of breast reconstruction, including implant-based, tissue-based, and any future methods recognized by healthcare coding systems.
Ensures patients have access to the full spectrum of advanced reconstructive options available today and in the future.
high
Mandates coverage for related services, such as flat closure, surgery for symmetrical appearance of the other breast, custom breast prostheses, and treatment for physical complications like lymphedema.
Provides holistic care beyond just the primary reconstruction, addressing common physical, emotional, and practical needs after breast cancer.
med
Stipulates that coverage decisions must be made in consultation with the attending physician and the patient, and that plans must ensure at least one in-network provider is available for each covered service.
Empowers patients in their treatment decisions, ensures medical necessity is determined by healthcare professionals, and improves access to specialized care.
high
Prohibits health plans from denying eligibility or continued coverage solely to avoid these requirements, and from penalizing providers for offering care consistent with the bill.
Protects patient access to comprehensive care and ensures providers can recommend the best treatment without financial disincentives.
beginning on or after the date of the enactment of this sentence.
The amendment to the Public Health Service Act applies to plan years.
GLOSSARY
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Group Health Plan
A health plan provided by an employer or employee organization to its employees or members.
Health Insurance Issuer
A company that offers health insurance coverage.
Individual Health Insurance Coverage
Health insurance purchased directly by an individual, not through an employer or group.
Breast or Chest Wall Reconstruction
Surgical procedures to rebuild the breast or chest wall following mastectomy or breast-conserving surgery for breast cancer.
Mastectomy
Surgical removal of an entire breast due to cancer or other medical reasons.
Breast-conserving Surgery
Surgery to remove only the cancerous part of the breast and some surrounding tissue, rather than the entire breast.
Lymphedema
Swelling, often in an arm or leg, caused by a blockage in the lymphatic system, which can be a complication of breast cancer treatment.
Healthcare Common Procedure Coding System (HCPCS)
ACTION TIMELINE
2 EVENTS
OCT 24, 25
Introduced in House
INTROREFERRAL
OCT 24, 25
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Workforce, 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 standardized system of codes used by healthcare professionals to describe medical procedures, services, and supplies for billing and insurance purposes.
