I
119THCONGRESS
1
STSESSION 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
JANUARY9, 2025
Mrs. M
CIVER(for herself, Mr. JACKSONof Illinois, and Ms. KELLYof Illinois)
introduced the following bill; which was referred to the Committee on En-
ergy 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 jurisdic-
tion 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 imposi-
tion of cost-sharing requirements, and for other pur-
poses.
Be it enacted by the Senate and House of Representa-1
tives of the United States of America in Congress assembled, 2
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SECTION 1. SHORT TITLE; FINDINGS. 1
(a) S
HORTTITLE.—This Act may be cited as the 2
‘‘Amputation Reduction and Compassion Act of 2025’’ or 3
the ‘‘ARC Act of 2025’’. 4
(b) F
INDINGS.—Congress makes the following find-5
ings: 6
(1) Atherosclerosis occurs when blood flow is 7
reduced because arteries become narrowed or 8
blocked with fatty deposits. 9
(2) Atherosclerosis is responsible for more 10
deaths in the United States than any other condi-11
tion, and heart attacks, resulting from clogged coro-12
nary arteries, are the leading cause of death in 13
America. 14
(3) Atherosclerosis also occurs in the legs and 15
is known as peripheral artery disease (in this sub-16
section referred to as ‘‘PAD’’) and having PAD sig-17
nificantly increases the risk for heart attack, stroke, 18
amputation, and death. 19
(4) While most Americans are aware of athero-20
sclerosis in the heart, many Americans have never 21
heard of PAD and Americans with PAD are often 22
unaware of the serious risks of the disease. 23
(5) An estimated 21 million Americans have 24
PAD, and about 200,000 of them—disproportion-25
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ately minorities—suffer avoidable amputations every 1
year as a result of such disease. 2
(6) According to the Dartmouth Atlas, amputa-3
tion risks for African Americans living with diabetes 4
are as much as four times higher than the national 5
average. 6
(7) Data analyses have similarly found that Na-7
tive Americans are more than twice as likely to be 8
subjected to amputation and Hispanics are up to 75 9
percent more likely to have an amputation. 10
(8) Fifty-two percent of patients with an above- 11
the-knee amputation and 33 percent of patients with 12
a below-the-knee amputation will die within two 13
years of their amputation. 14
(9) Screening and arterial testing for PAD is 15
cost-effective and should be part of routine medical 16
care. 17
(10) Once PAD is detected, amputations and 18
deaths can be reduced through the use of national, 19
evidence-based PAD care guidelines. 20
(11) Americans with a PAD diagnosis are asso-21
ciated with a 67-percent increase in the risk of car-22
diac death compared to people without a PAD diag-23
nosis. Consequently, screening for PAD enables 24
health care professionals to identify cardiac risk fac-25
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tors earlier and take proactive measures to reduce 1
the risk of cardiac death. 2
SEC. 2. PERIPHERAL ARTERY DISEASE EDUCATION PRO-3
GRAM. 4
Part P of title III of the Public Health Service Act 5
(42 U.S.C. 280g et seq.) is amended by adding at the end 6
the following new section: 7
‘‘SEC. 399V–8. PERIPHERAL ARTERY DISEASE EDUCATION 8
PROGRAM. 9
‘‘(a) E
STABLISHMENT.—The Secretary, acting 10
through the Director of the Centers for Disease Control 11
and Prevention, in collaboration with the Administrator 12
of the Centers for Medicare & Medicaid Services, the Ad-13
ministrator of the Health Resources and Services Admin-14
istration, leading clinical and patient advocacy organiza-15
tions, and other interested stakeholders shall establish and 16
coordinate a peripheral artery disease education program 17
to support, develop, and implement educational initiatives 18
and outreach strategies that inform health care profes-19
sionals and the public about the existence of peripheral 20
artery disease and methods to reduce amputations related 21
to such disease, particularly with respect to at-risk popu-22
lations. 23
‘‘(b) B
ESTPRACTICES.—The Secretary shall, as ap-24
propriate, identify and disseminate to health care profes-25
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sionals best practices with respect to peripheral artery dis-1
ease. 2
‘‘(c) A
UTHORIZATION OF APPROPRIATIONS.—There 3
is authorized to be appropriated to carry out this section 4
$6,000,000 for each of fiscal years 2026 through 2030.’’. 5
SEC. 3. MEDICARE COVERAGE OF PERIPHERAL ARTERY 6
DISEASE SCREENING TESTS FURNISHED TO 7
AT-RISK BENEFICIARIES WITHOUT IMPOSI-8
TION OF COST-SHARING REQUIREMENTS. 9
(a) I
NGENERAL.—Section 1861 of the Social Secu-10
rity Act (42 U.S.C. 1395x) is amended— 11
(1) in subsection (s)(2)— 12
(A) in subparagraph (JJ), by striking the 13
semicolon at the end and inserting ‘‘; and’’; and 14
(B) by adding at the end the following new 15
subparagraph: 16
‘‘(KK) peripheral artery disease screening tests 17
furnished to at-risk beneficiaries (as such terms are 18
defined in subsection (nnn)).’’; and 19
(2) by adding at the end the following new sub-20
section: 21
‘‘(nnn) P
ERIPHERALARTERYDISEASESCREENING 22
T
EST; AT-RISKBENEFICIARY.—(1) The term ‘peripheral 23
artery disease screening test’ means— 24
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‘‘(A) noninvasive physiologic studies of extrem-1
ity arteries (commonly referred to as ankle-brachial 2
index testing); 3
‘‘(B) arterial duplex scans of lower extremity 4
arteries vascular; and 5
‘‘(C) such other items and services as the Sec-6
retary determines, in consultation with relevant 7
stakeholders, to be appropriate for screening for pe-8
ripheral artery disease for at-risk beneficiaries. 9
‘‘(2) The term ‘at-risk beneficiary’ means an indi-10
vidual entitled to, or enrolled for, benefits under part A 11
and enrolled for benefits under part B— 12
‘‘(A) who is 65 years of age or older; 13
‘‘(B) who is at least 50 years of age but not 14
older than 64 years of age with risk factors for ath-15
erosclerosis (such as diabetes mellitus, a history of 16
smoking, hyperlipidemia, and hypertension) or a 17
family history of peripheral artery disease; 18
‘‘(C) who is younger than 50 years of age with 19
diabetes mellitus and one additional risk factor for 20
atherosclerosis; or 21
‘‘(D) with a known atherosclerotic disease in 22
another vascular bed such as coronary, carotid, sub-23
clavian, renal, or mesenteric artery stenosis, or ab-24
dominal aortic aneurysm. 25
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‘‘(3) The Secretary shall, in consultation with appro-1
priate organizations, establish standards regarding the 2
frequency for peripheral artery disease screening tests de-3
scribed in subsection (s)(2)(KK) for purposes of coverage 4
under this title.’’. 5
(b) I
NCLUSION OFPERIPHERALARTERYDISEASE 6
S
CREENINGTESTS ININITIALPREVENTIVEPHYSICAL 7
E
XAMINATION.—Section 1861(ww)(2) of the Social Secu-8
rity Act (42 U.S.C. 1395x(ww)(2)) is amended— 9
(1) in subparagraph (N), by moving the mar-10
gins of such subparagraph 2 ems to the left; 11
(2) by redesignating subparagraph (O) as sub-12
paragraph (P); and 13
(3) by inserting after subparagraph (N) the fol-14
lowing new subparagraph: 15
‘‘(O) Peripheral artery disease screening tests 16
furnished to at risk-beneficiaries (as such terms are 17
defined in subsection (nnn)).’’. 18
(c) P
AYMENT.— 19
(1) I
N GENERAL.—Section 1833(a) of the So-20
cial Security Act (42 U.S.C. 1395l(a)) is amended— 21
(A) in paragraph (1)— 22
(i) in subparagraph (N), by inserting 23
‘‘and other than peripheral artery disease 24
screening tests furnished to at-risk bene-25
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ficiaries (as such terms are defined in sec-1
tion 1861(nnn))’’ after ‘‘other than person-2
alized prevention plan services (as defined 3
in section 1861(hhh)(1))’’; 4
(ii) by striking ‘‘and’’ before ‘‘(HH)’’; 5
and 6
(iii) by adding at the end the fol-7
lowing: ‘‘and (II) with respect to peripheral 8
artery disease screening tests furnished to 9
at-risk beneficiaries (as such terms are de-10
fined in section 1861(nnn)), the amount 11
paid shall be 100 percent of the lesser of 12
the actual charge for the services or the 13
amount determined under the payment 14
basis determined under section 1848;’’; 15
and 16
(B) in paragraph (2)— 17
(i) in subparagraph (G), by striking 18
‘‘and’’ at the end; 19
(ii) in subparagraph (H), by striking 20
the semicolon at the end and inserting ‘‘; 21
and’’; and 22
(iii) by inserting after subparagraph 23
(H) the following new subparagraph: 24
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‘‘(I) with respect to peripheral artery disease 1
screening tests (as defined in paragraph (1) of sec-2
tion 1861(nnn)) furnished by an outpatient depart-3
ment of a hospital to at-risk beneficiaries (as defined 4
in paragraph (2) of such section), the amount deter-5
mined under paragraph (1)(II);’’. 6
(2) N
O DEDUCTIBLE.—Section 1833(b) of the 7
Social Security Act (42 U.S.C. 1395l(b)) is amend-8
ed, in the first sentence— 9
(A) by striking ‘‘, and’’ before ‘‘(13)’’; and 10
(B) by inserting before the period at the 11
end the following: ‘‘, and (14) such deductible 12
shall not apply with respect to peripheral artery 13
disease screening tests furnished to at-risk 14
beneficiaries (as such terms are defined in sec-15
tion 1861(nnn))’’. 16
(3) E
XCLUSION FROM PROSPECTIVE PAYMENT 17
SYSTEM FOR HOSPITAL OUTPATIENT DEPARTMENT 18
SERVICES.—Section 1833(t)(1)(B)(iv) of the Social 19
Security Act (42 U.S.C. 1395l(t)(1)(B)(iv)) is 20
amended— 21
(A) by striking ‘‘, or personalized’’ and in-22
serting ‘‘, personalized’’; and 23
(B) by inserting ‘‘, or peripheral artery 24
disease screening tests furnished to at-risk 25
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beneficiaries (as such terms are defined in sec-1
tion 1861(nnn))’’ after ‘‘personalized prevention 2
plan services (as defined in section 3
1861(hhh)(1))’’. 4
(4) C
ONFORMING AMENDMENT .—Section 5
1848(j)(3) of the Social Security Act (42 U.S.C. 6
1395w–4(j)(3)) is amended by striking ‘‘(2)(FF) 7
(including administration of the health risk assess-8
ment),’’ and inserting ‘‘(2)(FF) (including adminis-9
tration of the health risk assessment), (2)(KK),’’. 10
(d) E
XCLUSIONFROMCOVERAGE ANDMEDICARE AS 11
S
ECONDARYPAYER FORTESTSPERFORMEDMOREFRE-12
QUENTLYTHANALLOWED.—Section 1862(a)(1) of the 13
Social Security Act (42 U.S.C. 1395y(a)(1)) is amended— 14
(1) in subparagraph (O), by striking ‘‘and’’ at 15
the end; 16
(2) in subparagraph (P), by striking the semi-17
colon at the end and inserting ‘‘, and’’; and 18
(3) by adding at the end the following new sub-19
paragraph: 20
‘‘(Q) in the case of peripheral artery disease 21
screening tests furnished to at-risk beneficiaries (as 22
such terms are defined in section 1861(nnn)), which 23
are performed more frequently than is covered under 24
such section;’’. 25
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(e) AUTHORITYTOMODIFY ORELIMINATECOV-1
ERAGE OF CERTAINPREVENTIVESERVICES.—Section 2
1834(n) of the Social Security Act (42 U.S.C. 1395m(n)) 3
is amended— 4
(1) by redesignating subparagraphs (A) and 5
(B) of paragraph (1) as clauses (i) and (ii), respec-6
tively, and moving the margins of such clauses, as 7
so redesignated, 2 ems to the right; 8
(2) by redesignating paragraphs (1) and (2) as 9
subparagraphs (A) and (B), respectively, and mov-10
ing the margins of such subparagraphs, as so redes-11
ignated, 2 ems to the right; 12
(3) by striking ‘‘C
ERTAINPREVENTIVESERV-13
ICES’’ and all that follows through ‘‘any other provi-14
sion of this title’’ and inserting: ‘‘C
ERTAINPREVEN-15
TIVESERVICES.— 16
‘‘(1) I
N GENERAL.—Notwithstanding any other 17
provision of this title’’; and 18
(4) by adding at the end the following new 19
paragraph: 20
‘‘(2) I
NAPPLICABILITY.—The Secretarial au-21
thority described in paragraph (1) shall not apply 22
with respect to preventive services described in sec-23
tion 1861(ww)(2)(O).’’. 24
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(f) EFFECTIVEDATE.—The amendments made by 1
this section shall apply with respect to items and services 2
furnished on or after January 1, 2026. 3
SEC. 4. MEDICAID COVERAGE OF PERIPHERAL ARTERY 4
DISEASE SCREENING TESTS FURNISHED TO 5
AT-RISK BENEFICIARIES WITHOUT IMPOSI-6
TION OF COST-SHARING REQUIREMENTS. 7
(a) I
NGENERAL.—Section 1905 of the Social Secu-8
rity Act (42 U.S.C. 1396d) is amended— 9
(1) in subsection (a)— 10
(A) in paragraph (31), by striking ‘‘and’’ 11
at the end; 12
(B) by redesignating paragraph (32) as 13
paragraph (33); and 14
(C) by inserting after paragraph (31) the 15
following new paragraph: 16
‘‘(32) peripheral artery disease screening tests 17
furnished to at-risk beneficiaries (as such terms are 18
defined in subsection (kk)); and’’; and 19
(2) by adding at the end the following new sub-20
section: 21
‘‘(kk) P
ERIPHERALARTERYDISEASESCREENING 22
T
EST; AT-RISKBENEFICIARY.— 23
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‘‘(1) PERIPHERAL ARTERY DISEASE SCREENING 1
TEST.—The term ‘peripheral artery disease screen-2
ing test’ means— 3
‘‘(A) noninvasive physiologic studies of ex-4
tremity arteries (commonly referred to as ankle- 5
brachial index testing); 6
‘‘(B) arterial duplex scans of lower extrem-7
ity arteries vascular; and 8
‘‘(C) such other items and services as the 9
Secretary determines, in consultation with rel-10
evant stakeholders, to be appropriate for 11
screening for peripheral artery disease for at- 12
risk beneficiaries. 13
‘‘(2) A
T-RISK BENEFICIARY.—The term ‘at-risk 14
beneficiary’ means an individual enrolled under a 15
State plan (or a waiver of such plan)— 16
‘‘(A) who is 65 years of age or older; 17
‘‘(B) who is at least 50 years of age but 18
not older than 64 years of age with risk factors 19
for atherosclerosis (such as diabetes mellitus, a 20
history of smoking, hyperlipidemia, and hyper-21
tension) or a family history of peripheral artery 22
disease; 23
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‘‘(C) who is younger than 50 years of age 1
with diabetes mellitus and one additional risk 2
factor for atherosclerosis; or 3
‘‘(D) with a known atherosclerotic disease 4
in another vascular bed such as coronary, ca-5
rotid, subclavian, renal, or mesenteric artery 6
stenosis, or abdominal aortic aneurysm. 7
‘‘(3) F
REQUENCY.—The Secretary shall, in con-8
sultation with appropriate organizations, establish 9
standards regarding the frequency for peripheral ar-10
tery disease screening tests described in subsection 11
(a)(31) for purposes of coverage under a State plan 12
under this title.’’. 13
(b) N
OCOSTSHARING.— 14
(1) I
N GENERAL.—Subsections (a)(2) and 15
(b)(2) of section 1916 of the Social Security Act (42 16
U.S.C. 1396o) are each amended— 17
(A) in subparagraph (I), by striking ‘‘or’’ 18
at the end; 19
(B) in subparagraph (J), by striking ‘‘; 20
and’’ and inserting ‘‘, or’’; and 21
(C) by adding at the end the following new 22
subparagraph: 23
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‘‘(K) peripheral artery disease screening 1
tests furnished to at-risk beneficiaries (as such 2
terms are defined in section 1905(kk)); and’’. 3
(2) A
PPLICATION TO ALTERNATIVE COST SHAR -4
ING.—Section 1916A(b)(3)(B) of the Social Security 5
Act (42 U.S.C. 1396o–1(b)(3)(B)) is amended by 6
adding at the end the following new clause: 7
‘‘(xv) Peripheral artery disease screen-8
ing tests furnished to at-risk beneficiaries 9
(as such terms are defined in section 10
1905(kk)).’’. 11
(c) C
ONFORMINGAMENDMENTS.— 12
(1) Section 1902(nn)(3) of the Social Security 13
Act (42 U.S.C. 1396a(nn)(3)) is amended by strik-14
ing ‘‘following paragraph (31)’’ and inserting ‘‘fol-15
lowing paragraph (32)’’. 16
(2) Section 1905(a) of the Social Security Act 17
(42 U.S.C. 1396d(a)) is amended by striking ‘‘fol-18
lowing paragraph (31)’’ and inserting ‘‘following 19
paragraph (32)’’. 20
SEC. 5. DEVELOPMENT AND IMPLEMENTATION OF QUALITY 21
MEASURES. 22
(a) D
EVELOPMENT.—The Secretary of Health and 23
Human Services (referred to in this section as the ‘‘Sec-24
retary’’) shall, in consultation with relevant stakeholders, 25
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develop quality measures for nontraumatic, lower-limb, 1
major amputation that utilize appropriate diagnostic 2
screening (including peripheral artery disease screening) 3
in order to encourage alternative treatments (including 4
revascularization) in lieu of such an amputation. 5
(b) I
MPLEMENTATION.—Not later than 18 months 6
after the date of enactment of this Act, the Secretary shall 7
complete appropriate testing and validation of the meas-8
ures developed under subsection (a) and shall incorporate 9
such measures in quality reporting programs for appro-10
priate providers of services and suppliers under the Medi-11
care program under title XVIII of the Social Security Act 12
(42 U.S.C. 1395 et seq.), including for purposes of— 13
(1) the merit-based incentive payment system 14
under section 1848(q) of such Act (42 U.S.C. 15
1395w–4(q)); 16
(2) incentive payments for participation in eligi-17
ble alternative payment models under section 18
1833(z) of such Act (42 U.S.C. 1395l(z)); 19
(3) the shared savings program under section 20
1899 of such Act (42 U.S.C. 1395jjj); 21
(4) models under section 1115A of such Act 22
(42 U.S.C. 1315a); and 23
(5) such other payment systems or models as 24
the Secretary may specify. 25
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SEC. 6. AMPUTATION PREVENTION PILOT PROGRAM. 1
(a) I
NGENERAL.—Section 1115A(b)(2)(B) of the 2
Social Security Act (42 U.S.C. 1315a(b)(2)(B)) is amend-3
ed by adding at the end the following new clause: 4
‘‘(xxviii) Promoting voluntary, non-5
traumatic lower-limb major amputation 6
prevention programs at hospitals, ambula-7
tory surgical centers, and office-based cen-8
ters that will increase access to amputation 9
prevention services, reduce amputation 10
rates, and reduce costs to such hospitals, 11
surgical centers, and office-based centers, 12
through— 13
‘‘(I) patient risk modification and 14
management; 15
‘‘(II) early screening and detec-16
tion and surveillance; 17
‘‘(III) testing and treatment for 18
peripheral artery disease; and 19
‘‘(IV) improved care coordination 20
for individuals at high risk for ampu-21
tation.’’. 22
(b) T
ESTING OFMODEL.—Not later than 18 months 23
after the date of the enactment of this Act, the Deputy 24
Administrator and Director of the Center for Medicare 25
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and Medicaid Innovation shall test the model described 1
under subsection (a). 2
Æ
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