VGM & ASSOCIATESHealthcare MSO
Full Menu Search

Government Relations Advocate for the Breast Cancer Patient Equity Act

Published in Government Relations on June 20, 2024

Government Relations

The week of June 3rd, Nikki Jensen, VP of Essentially Women and Ike Isaacson, SVP of VGM Government & Regulatory Relations traveled to Washington D.C. to advocate for H.R. 4779/S. 3069, the Breast Cancer Patient Equity Act.  This bill would allow Medicare to recognize custom breast prosthesis as an eligible breast replacement following mastectomy surgery.  Currently, Medicare beneficiaries are allowed the option of an off-the-shelf prosthetic or surgical reconstruction.  Since December 2020, this bill has had an inflated Congressional Budget Office (CBO) score; misrepresenting the cost of this bill.  Nikki and Ike met with the offices of Senate lead sponsors, Sen. Tammy Duckworth (D-IL) and Sen. Lisa Murkowski (R-AK) as well as House leads, Rep. Mariannette Miller-Meeks (R-IA) and Rep. Judy Chu (D-CA) to request letters be sent to the CBO to re-score the bill. 

This bill is significant because some women are not candidates based on medical recommendations or for personal reasons, do not choose to undergo additional surgical procedures after their mastectomy surgery.   Limitations to off-the-shelf prosthetics include proper fit against the chest wall after surgery and/or radiation, finding symmetry to their remaining breast or matching skin tone.

One in eight women will be diagnosed with breast cancer in their lifetime.  Women don’t know what option they may need until faced with the decision.  The objective of the Breast Cancer Patient Equity Act is to ensure women have the appropriate choice to make the decision that’s best for them at that time.  Approximately 70% of state Medicaid programs, Tricare, and many private insurance payers allow coverage for custom breast prosthesis.  

We encourage you to contact your legislators to advocate for this bill.  

Get Connected

Stay up-to-date on the latest resources and news provided by VGM & Associates.

Sign Up for Email

From Our Experts

The Return of Competitive Bidding thumbnail The Return of Competitive Bidding The Centers for Medicare & Medicaid Services (CMS) appear to be laying the groundwork for another round of the Competitive Bidding Program (CBP). While full implementation will take a couple of years, an official announcement is expected this summer—potentially as early as July. Out With The Old RAC, In With The New thumbnail Out With The Old RAC, In With The New On April 28, 2025, CMS awarded Cotiviti GOV Services LLC, the new RAC Recovery Audit Contractor (RAC) Region 3, 4, and 5 contracts. RAC Region 3 includes the following Medicare Administrative Contractor (MAC) jurisdictions: JJ, JM, and JN. RAC Region 4 includes jurisdictions: JE, JF, and JL. And RAC Region 5 includes jurisdictions: JA, JB, JC, JD, as well as the HH/H MACs: J6, J15, JK, and JM. Iowa Leads the Charge! All Four Representatives Back H.R. 2005—Will Your State Step Up? thumbnail Iowa Leads the Charge! All Four Representatives Back H.R. 2005—Will Your State Step Up? At VGM Group, Inc. we have the pleasure of serving our members and partners throughout the country.  One of the many ways we do this is through legislative advocacy, working with our partners to create a more equitable and effective healthcare system. All our VGM units are dedicated to advancing our partners' businesses, streamlining operations, and working every day to enhance reimbursement for the quality in-home healthcare our industry provides all people. Mike Hamilton Of ADMEA Honored With The Mal Mixon Advocate Award thumbnail Mike Hamilton Of ADMEA Honored With The Mal Mixon Advocate Award Last week, during the 2025 AAHomecare Washington Legislative Conference, Mike Hamilton, Executive Director of ADMEA, was honored with the prestigious Mal Mixon Advocate Award. VGM Senior Leaders Engage in Advocacy at AAHomecare Legislative Conference thumbnail VGM Senior Leaders Engage in Advocacy at AAHomecare Legislative Conference This week, VGM leaders attended the AAHomecare Legislative Conference in Washington, D.C., a premier event dedicated to advancing healthcare policy and advocacy. AAHomecare provided attendees with valuable insights, equipping them with key discussion points and strategies for effective meetings with legislators. Champion of Change: Paula Vineyard of Elana Health & Loop Medical Leads Healthcare Advocacy in West Virginia thumbnail Champion of Change: Paula Vineyard of Elana Health & Loop Medical Leads Healthcare Advocacy in West Virginia On Thursday, May 8, Paula Vineyard, owner of Elana Health & Loop Medical, took a pivotal step in healthcare advocacy by hosting a meeting with Tyler Ohrn, Field Representative for Congresswoman Carol Miller of West Virginia's First District. The hour-long discussion centered on the pressing need for congressional support of H.R. 2005. Manufacturer Survey On Tariffs thumbnail Manufacturer Survey On Tariffs The American Association for Homecare and VGM Group are seeking valuable insights from durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) manufacturers and vendor partners regarding tariffs imposed on certain countries. Key Payers Denied Your Application Citing Their Network Is Closed – Now What? thumbnail Key Payers Denied Your Application Citing Their Network Is Closed – Now What? This experience has increasingly become one of the most common questions we receive from our provider members as more and more payers move to narrow their provider networks. The reasons payers seek to narrow their networks are simple. Payers are highly motivated to achieve their goals while doing less work and are not required to allow providers into their networks unless there is a patient access issue. For those of you fortunate enough to be a part of a narrow network, this may not be much of

Be Part of Something Bigger

Become a Member