Home > 106th Congressional Bills > S. 1685 (is) To authorize the Golden Spike/Crossroads of the West National Heritage Area. [Introduced in Senate] ...S. 1685 (is) To authorize the Golden Spike/Crossroads of the West National Heritage Area. [Introduced in Senate] ...
108th CONGRESS
1st Session
S. 1684
To amend the Public Health Service Act and Employee Retirement Income
Security Act of 1974 to require that group and individual health
insurance coverage and group health plans provide coverage for a
minimum hospital stay for mastectomies and lymph node dissections
performed for the treatment of breast cancer.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
September 30 (legislative day, September 29), 2003
Ms. Landrieu (for herself, Mrs. Murray, and Mr. Corzine) introduced the
following bill; which was read twice and referred to the Committee on
Health, Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To amend the Public Health Service Act and Employee Retirement Income
Security Act of 1974 to require that group and individual health
insurance coverage and group health plans provide coverage for a
minimum hospital stay for mastectomies and lymph node dissections
performed for the treatment of breast cancer.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Breast Cancer Patient Protection Act
of 2003''.
SEC. 2. COVERAGE OF MINIMUM HOSPITAL STAY FOR CERTAIN BREAST CANCER
TREATMENT.
(a) Group Health Plans.--
(1) Public health service act amendments.--(A) Subpart 2 of
part A of title XXVII of the Public Health Service Act is
amended by adding at the end the following new section:
``SEC. 2707. STANDARDS RELATING TO BENEFITS FOR CERTAIN BREAST CANCER
TREATMENT.
``(a) Requirements for Minimum Hospital Stay Following Mastectomy
or Lymph Node Dissection.--
``(1) In general.--A group health plan, and a health
insurance issuer offering group health insurance coverage, may
not--
``(A) except as provided in paragraph (2)--
``(i) restrict benefits for any hospital
length of stay in connection with a mastectomy
for the treatment of breast cancer to less than
48 hours, or
``(ii) restrict benefits for any hospital
length of stay in connection with a lymph node
dissection for the treatment of breast cancer
to less than 24 hours, or
``(B) require that a provider obtain authorization
from the plan or the issuer for prescribing any length
of stay required under subparagraph (A) (without regard
to paragraph (2)).
``(2) Exception.--Paragraph (1)(A) shall not apply in
connection with any group health plan or health insurance
issuer in any case in which the decision to discharge the woman
involved prior to the expiration of the minimum length of stay
otherwise required under paragraph (1)(A) is made by an
attending provider in consultation with the woman.
``(b) Prohibitions.--A group health plan, and a health insurance
issuer offering group health insurance coverage in connection with a
group health plan, may not--
``(1) deny to a woman eligibility, or continued
eligibility, to enroll or to renew coverage under the terms of
the plan, solely for the purpose of avoiding the requirements
of this section;
``(2) provide monetary payments or rebates to women to
encourage such women to accept less than the minimum
protections available under this section;
``(3) penalize or otherwise reduce or limit the
reimbursement of an attending provider because such provider
provided care to an individual participant or beneficiary in
accordance with this section;
``(4) provide incentives (monetary or otherwise) to an
attending provider to induce such provider to provide care to
an individual participant or beneficiary in a manner
inconsistent with this section; or
``(5) subject to subsection (c)(3), restrict benefits for
any portion of a period within a hospital length of stay
required under subsection (a) in a manner which is less
favorable than the benefits provided for any preceding portion
of such stay.
``(c) Rules of Construction.--
``(1) Nothing in this section shall be construed to require
a woman who is a participant or beneficiary--
``(A) to undergo a mastectomy or lymph node
dissection in a hospital; or
``(B) to stay in the hospital for a fixed period of
time following a mastectomy or lymph node dissection.
``(2) This section shall not apply with respect to any
group health plan, or any group health insurance coverage
offered by a health insurance issuer, which does not provide
benefits for hospital lengths of stay in connection with a
mastectomy or lymph node dissection for the treatment of breast
cancer.
``(3) Nothing in this section shall be construed as
preventing a group health plan or issuer from imposing
deductibles, coinsurance, or other cost-sharing in relation to
benefits for hospital lengths of stay in connection with a
mastectomy or lymph node dissection for the treatment of breast
cancer under the plan (or under health insurance coverage
offered in connection with a group health plan), except that
such coinsurance or other cost-sharing for any portion of a
period within a hospital length of stay required under
subsection (a) may not be greater than such coinsurance or
cost-sharing for any preceding portion of such stay.
``(d) Notice.--A group health plan under this part shall comply
with the notice requirement under section 713(d) of the Employee
Retirement Income Security Act of 1974 with respect to the requirements
of this section as if such section applied to such plan.
``(e) Level and Type of Reimbursements.--Nothing in this section
shall be construed to prevent a group health plan or a health insurance
issuer offering group health insurance coverage from negotiating the
level and type of reimbursement with a provider for care provided in
accordance with this section.
``(f) Preemption; Exception for Health Insurance Coverage in
Certain States.--
``(1) In general.--The requirements of this section shall
not apply with respect to health insurance coverage if there is
a State law (as defined in section 2723(d)(1)) for a State that
regulates such coverage that is described in any of the
following subparagraphs:
``(A) Such State law requires such coverage to
provide for at least a 48-hour hospital length of stay
following a mastectomy performed for treatment of
breast cancer and at least a 24-hour hospital length of
stay following a lymph node dissection for treatment of
breast cancer.
``(B) Such State law requires, in connection with
such coverage for surgical treatment of breast cancer,
that the hospital length of stay for such care is left
to the decision of (or required to be made by) the
attending provider in consultation with the woman
involved.
``(2) Construction.--Section 2723(a)(1) shall not be
construed as superseding a State law described in paragraph
(1).''.
(B) Section 2723(c) of such Act (42 U.S.C. 300gg-23(c)) is
amended by striking ``section 2704'' and inserting ``sections
2704 and 2707''.
(2) ERISA amendments.--(A) Subpart B of part 7 of subtitle
B of title I of the Employee Retirement Income Security Act of
1974 is amended by adding at the end the following new section:
``SEC. 714. STANDARDS RELATING TO BENEFITS FOR CERTAIN BREAST CANCER
TREATMENT.
``(a) Requirements for Minimum Hospital Stay Following Mastectomy
or Lymph Node Dissection.--
``(1) In general.--A group health plan, and a health
insurance issuer offering group health insurance coverage, may
not--
``(A) except as provided in paragraph (2)--
``(i) restrict benefits for any hospital
length of stay in connection with a mastectomy
for the treatment of breast cancer to less than
48 hours, or
``(ii) restrict benefits for any hospital
length of stay in connection with a lymph node
dissection for the treatment of breast cancer
to less than 24 hours, or
``(B) require that a provider obtain authorization
from the plan or the issuer for prescribing any length
of stay required under subparagraph (A) (without regard
to paragraph (2)).
``(2) Exception.--Paragraph (1)(A) shall not apply in
connection with any group health plan or health insurance
issuer in any case in which the decision to discharge the woman
involved prior to the expiration of the minimum length of stay
otherwise required under paragraph (1)(A) is made by an
attending provider in consultation with the woman.
``(b) Prohibitions.--A group health plan, and a health insurance
issuer offering group health insurance coverage in connection with a
group health plan, may not--
``(1) deny to a woman eligibility, or continued
eligibility, to enroll or to renew coverage under the terms of
the plan, solely for the purpose of avoiding the requirements
of this section;
``(2) provide monetary payments or rebates to women to
encourage such women to accept less than the minimum
protections available under this section;
``(3) penalize or otherwise reduce or limit the
reimbursement of an attending provider because such provider
provided care to an individual participant or beneficiary in
accordance with this section;
``(4) provide incentives (monetary or otherwise) to an
attending provider to induce such provider to provide care to
an individual participant or beneficiary in a manner
inconsistent with this section; or
``(5) subject to subsection (c)(3), restrict benefits for
any portion of a period within a hospital length of stay
required under subsection (a) in a manner which is less
favorable than the benefits provided for any preceding portion
of such stay.
``(c) Rules of Construction.--
``(1) Nothing in this section shall be construed to require
a woman who is a participant or beneficiary--
``(A) to undergo a mastectomy or lymph node
dissection in a hospital; or
``(B) to stay in the hospital for a fixed period of
time following a mastectomy or lymph node dissection.
``(2) This section shall not apply with respect to any
group health plan, or any group health insurance coverage
offered by a health insurance issuer, which does not provide
benefits for hospital lengths of stay in connection with a
mastectomy or lymph node dissection for the treatment of breast
cancer.
``(3) Nothing in this section shall be construed as
preventing a group health plan or issuer from imposing
deductibles, coinsurance, or other cost-sharing in relation to
benefits for hospital lengths of stay in connection with a
mastectomy or lymph node dissection for the treatment of breast
cancer under the plan (or under health insurance coverage
offered in connection with a group health plan), except that
such coinsurance or other cost-sharing for any portion of a
period within a hospital length of stay required under
subsection (a) may not be greater than such coinsurance or
cost-sharing for any preceding portion of such stay.
``(d) Notice Under Group Health Plan.--The imposition of the
requirements of this section shall be treated as a material
modification in the terms of the plan described in section 102(a)(1),
for purposes of assuring notice of such requirements under the plan;
except that the summary description required to be provided under the
last sentence of section 104(b)(1) with respect to such modification
shall be provided by not later than 60 days after the first day of the
first plan year in which such requirements apply.
``(e) Level and Type of Reimbursements.--Nothing in this section
shall be construed to prevent a group health plan or a health insurance
issuer offering group health insurance coverage from negotiating the
level and type of reimbursement with a provider for care provided in
accordance with this section.
``(f) Preemption; Exception for Health Insurance Coverage in
Certain States.--
``(1) In general.--The requirements of this section shall
not apply with respect to health insurance coverage if there is
a State law (as defined in section 731(d)(1)) for a State that
regulates such coverage that is described in any of the
following subparagraphs:
``(A) Such State law requires such coverage to
provide for at least a 48-hour hospital length of stay
following a mastectomy performed for treatment of
breast cancer and at least a 24-hour hospital length of
stay following a lymph node dissection for treatment of
breast cancer.
``(B) Such State law requires, in connection with
such coverage for surgical treatment of breast cancer,
that the hospital length of stay for such care is left
to the decision of (or required to be made by) the
attending provider in consultation with the woman
involved.
``(2) Construction.--Section 731(a)(1) shall not be
construed as superseding a State law described in paragraph
(1).''.
(B) Section 731(c) of such Act (29 U.S.C. 1191(c)) is
amended by striking ``section 711'' and inserting ``sections
711 and 714''.
(C) Section 732(a) of such Act (29 U.S.C. 1191a(a)) is
amended by striking ``section 711'' and inserting ``sections
711 and 714''.
(D) The table of contents in section 1 of such Act is
amended by inserting after the item relating to section 713 the
following new item:
``Sec. 714. Standards relating to benefits for certain breast cancer
treatment.''.
(b) Individual Health Insurance.--(1) Part B of title XXVII of the
Public Health Service Act is amended by inserting after section 2752
the following new section:
``SEC. 2753. STANDARDS RELATING TO BENEFITS FOR CERTAIN BREAST CANCER
TREATMENT.
``(a) In General.--The provisions of section 2707 (other than
subsection (d)) shall apply to health insurance coverage offered by a
health insurance issuer in the individual market in the same manner as
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