No-Cost Screening to Prevent Amputations

Summary#

This bill, the Amputation Reduction and Compassion (ARC) Act of 2025, would make screening for peripheral artery disease (PAD) a covered, no-cost preventive service under Medicare and Medicaid for people the law calls “at‑risk.” It also creates a federal PAD education program, requires new quality measures and reporting to reduce nontraumatic major lower‑limb amputations, and directs a pilot model to test amputation‑prevention programs. The Medicare coverage rules would start for services furnished on or after January 1, 2026.

Key changes:

• Medicare: Adds PAD screening tests (for example, ankle‑brachial index testing and arterial duplex scans) as covered preventive services for defined at‑risk beneficiaries and removes cost‑sharing and the Part B deductible for those tests. The bill requires the Health and Human Services (HHS) Secretary to set how often tests are covered.
• Medicaid: Adds PAD screening to the list of Medicaid‑covered services for at‑risk enrollees and bars cost‑sharing for those tests; the Secretary will set frequency standards for coverage.
• Education: Directs the CDC, working with CMS and others, to run a PAD education program and authorizes $6 million per year for FY2026–2030.
• Quality measures: Requires HHS to develop and test quality measures for nontraumatic major lower‑limb amputation that use appropriate PAD screening and to add those measures into Medicare quality and payment programs within 18 months.
• Pilot model: Directs the Medicare Innovation Center to test voluntary programs at hospitals and surgical centers to prevent nontraumatic major amputations, focusing on screening, treatment, care coordination, and risk management.

What it means for you#

• Medicare beneficiaries (who meet the bill’s “at‑risk” definition):

  • Could get PAD screening (for example, ankle‑brachial index or leg arterial duplex) without copayments or Part B deductible when provided on or after Jan 1, 2026.
  • The bill defines “at‑risk” as people 65+, people 50–64 with risk factors (like diabetes, smoking, high cholesterol, high blood pressure, or family history), people under 50 with diabetes plus one other risk factor, and people with known atherosclerotic disease elsewhere (for example, coronary or carotid disease).
  • Doctors and clinics may increase offering or recommending these tests because they are covered with no out‑of‑pocket cost for eligible patients.

• Medicaid enrollees (meeting the same at‑risk definition):

  • States must cover PAD screening tests for at‑risk enrollees and may not impose cost‑sharing for those tests.
  • States will need to follow federal standards the Secretary sets on how often screening is covered.

• Health care providers and hospitals:

  • Medicare will pay 100% of the lesser of the actual charge or the amount under the physician fee schedule for covered PAD screening tests; outpatient hospital departments will be paid under that rule rather than included in the hospital outpatient prospective payment system.
  • Providers will face new reporting and quality measures tied to preventing major lower‑limb amputations; those measures can affect payments through existing Medicare programs.
  • Some providers may participate in the Innovation Center pilot to receive support or payments for comprehensive amputation‑prevention programs.

• Public health and the general public:

  • CDC will run education and outreach about PAD and amputation prevention with federal funding.
  • Over time, screening and education could increase diagnosis of PAD and awareness of related heart and stroke risks.

Expenses#

Estimated public cost: The bill authorizes $6,000,000 per year for FY2026–2030 for the CDC education program.

• Direct federal authorization: $6 million per year for PAD education (FY2026–2030).
• Other fiscal impacts (Medicare and Medicaid payment increases, state costs for Medicaid coverage, administrative costs to implement new quality measures and reporting, potential increased use of diagnostic tests and downstream treatments) are not estimated in the bill text.
• No publicly available information on total federal or state cost changes is included in the provided material.

Proponents' View#

• The bill appears intended to reduce preventable limb amputations and related deaths by finding PAD earlier. Supporters may argue:
  • PAD is common and often unrecognized; targeted screening can find disease earlier.
  • Screening is described in the bill as cost‑effective and could enable treatments (including revascularization) and care that reduce amputations and cardiac risk.
  • Removing cost‑sharing removes a financial barrier for people at higher risk, including groups with higher amputation rates (the bill cites racial and ethnic disparities).
  • Education, quality measures, and pilot programs together could improve coordination of care and encourage use of evidence‑based treatments.

Opponents' View#

• The bill does not include a fiscal estimate for Medicare and Medicaid coverage changes, so budget impacts are unclear. One concern is:
  • Expanding no‑cost screening could increase the number of tests and downstream procedures, raising Medicare and Medicaid spending; the bill does not provide cost estimates or budget offsets.
• The bill leaves several key details to the Secretary (for example, how often tests are covered and what additional screening items may be included), so:
  • It is unclear how strictly frequency rules will limit repeat testing to avoid overuse.
• Implementing new quality measures and reporting into multiple Medicare programs will require administrative work for HHS and providers; timing and workload effects are uncertain.
• While the bill promotes alternative treatments such as revascularization, increased treatment rates bring their own medical risks and costs; the bill does not detail safeguards, patient selection criteria, or long‑term outcome tracking beyond the quality measure requirement.