Breast Cancer Patient Protection Act of 1997

Summary: Breast Cancer Patient Protection Act of 1997 - Amends the Public Health Service Act to prohibit group health plans and health insurance issuers offering group health insurance coverage, with regard to hospital stays in connection with breast cancer treatment, from:  (1) covering less than 48 hours after mastectomies or less than 24 hours after lymph node dissections; or (2) requiring plan or issuer authorization for prescribing any length of stay.  Prohibits:  (1) denying eligibility, enrollment, or renewal to avoid these requirements; (2) providing payments or rebates to women; or (3) penalizing or providing incentives to providers.   Applies the same requirements to issuers in the individual market.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Breast Cancer Patient Protection Act 
of 1997''.

SEC. 2. COVERAGE OF MINIMUM HOSPITAL STAY FOR CERTAIN BREAST CANCER 
              TREATMENT.

    (a) Group Health Plans.--
            (1) Public health service act amendments.--
                    (A) In general.--Subpart 2 of part A of title XXVII 
                of the Public Health Service Act, as amended by section 
                703(a) of Public Law 104-204, is amended by adding at 
                the end the following new section:

``SEC. 2706. 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) Conforming amendment.--Section 2723(c) of such 
                Act (42 U.S.C. 300gg-23(c)), as amended by section 
                604(b)(2) of Public Law 104-204, is amended by striking 
                ``section 2704'' and inserting ``sections 2704 and 
                2706''.
            (2) ERISA amendments.--
                    (A) In general.--Subpart B of part 7 of subtitle B 
                of title I of the Employee Retirement Income Security 
                Act of 1974, as amended by section 702(a) of Public Law 
                104-204, is amended by adding at the end the following 
                new section:

``SEC. 713. 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) Conforming amendments.--
                            (i) Section 731(c) of such Act (29 U.S.C. 
                        1191(c)), as amended by section 603(b)(1) of 
                        Public Law 104-204, is amended by striking 
                        ``section 711'' and inserting ``sections 711 
                        and 713''.
                            (ii) Section 732(a) of such Act (29 U.S.C. 
                        1191a(a)), as amended by section 603(b)(2) of 
                        Public Law 104-204, is amended by striking 
                        ``section 711'' and inserting ``sections 711 
                        and 713''.
                            (iii) The table of contents in section 1 of 
                        such Act is amended by inserting after the item 
relating to section 712 the following new item:

``Sec. 713. Standards relating to benefits for certain breast cancer 
                            treatment.''.
    (b) Individual Health Insurance.--
            (1) In general.--Part B of title XXVII of the Public Health 
        Service Act, as amended by section 605(a) of Public Law 104-
        204, is amended by inserting after section 2751 the following 
        new section:

``SEC. 2752. STANDARDS RELATING TO BENEFITS FOR CERTAIN BREAST CANCER 
              TREATMENT.

    ``(a) In General.--The provisions of section 2706 (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 
it applies to health insurance coverage offered by a health insurance 
issuer in connection with a group health plan in the small or large 
group market.
    ``(b) Notice.--A health insurance issuer 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 
referred to in subsection (a) as if such section applied to such issuer 
and such issuer were a group health plan.
    ``(c) 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 2762(a) shall not be construed 
        as superseding a State law described in paragraph (1).''.
            (2) Conforming amendment.--Section 2762(b)(2) of such Act 
        (42 U.S.C. 300gg-62(b)(2)), as added by section 605(b)(3)(B) of 
        Public Law 104-204, is amended by striking ``section 2751'' and 
        inserting ``sections 2751 and 2752''.
    (c) Effective Dates.--
            (1) Group market.--The amendments made by subsection (a) 
        shall apply with respect to group health plans for plan years 
        beginning on or after January 1, 1998.
            (2) Individual market.--The amendment made by subsection 
        (b) shall apply with respect to health insurance coverage 
        offered, sold, issued, renewed, in effect, or operated in the 
        individual market on or after such date.