I 

108TH CONGRESS 

1ST SESSION H. R. 1448

To require that health plans provide coverage for a minimum hospital stay 

for mastectomies and lymph node dissection for the treatment of breast 

cancer and coverage for secondary consultations. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 26, 2003

Mr. LOBIONDO (for himself, Mrs. MYRICK, Mr. SMITH of New Jersey, Mr. 

PAYNE, Mr. CONYERS, Mr. FROST, Mrs. MCCARTHY of New York, Ms. 

HOOLEY of Oregon, Mr. WYNN, Mrs. JO ANN DAVIS of Virginia, Mr. 

MCINTYRE, Mr. BACA, Mrs. CAPPS, Mr. MCHUGH, Mr. OBERSTAR, and 

Mrs. MALONEY) introduced the following bill; which was referred to the 

Committee on Energy and Commerce, and in addition to the Committees 

on Education and the Workforce, and 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 jurisdiction of the committee 

concerned 

A BILL

To require that health plans provide coverage for a minimum 

hospital stay for mastectomies and lymph node dissection 

for the treatment of breast cancer and coverage for secondary consultations.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,
2

•HR 1448 IH 

1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Women’s Cancer Re3 covery Act of 2003’’. 

4 SEC. 2. AMENDMENTS TO THE EMPLOYEE RETIREMENT IN5 COME SECURITY ACT OF 1974. 

6 (a) IN GENERAL.—Subpart B of part 7 of subtitle 

7 B of title I of the Employee Retirement Income Security 

8 Act of 1974 is amended by adding at the end the following 

9 new section:

10 ‘‘SEC. 714. REQUIRED COVERAGE FOR MINIMUM HOSPITAL 

11 STAY FOR MASTECTOMIES AND LYMPH NODE 

12 DISSECTIONS FOR THE TREATMENT OF 

13 BREAST CANCER AND COVERAGE FOR SEC14 ONDARY CONSULTATIONS. 

15 ‘‘(a) INPATIENT CARE.—

16 ‘‘(1) IN GENERAL.—A group health plan, and a 

17 health insurance issuer providing health insurance 

18 coverage in connection with a group health plan, 

19 that provides medical and surgical benefits shall en20 sure that inpatient coverage with respect to the sur21 gical treatment of breast cancer (including a mastec22 tomy, lumpectomy, or lymph node dissection for the 

23 treatment of breast cancer) is provided for a period 

24 of time as is determined by the attending physician, 

25 in the physician’s professional judgment consistent 

26 with generally accepted principles of professional 
3

•HR 1448 IH 

1 medical practice, in consultation with the patient, to 

2 be medically necessary or appropriate. 

3 ‘‘(2) EXCEPTION.—Nothing in this section shall 

4 be construed as requiring the provision of inpatient 

5 coverage if the attending physician in consultation 

6 with the patient determines that a shorter period of 

7 hospital stay is medically necessary or appropriate. 

8 ‘‘(b) PROHIBITION ON CERTAIN MODIFICATIONS.—

9 In implementing the requirements of this section, a group 

10 health plan, and a health insurance issuer providing health 

11 insurance coverage in connection with a group health plan, 

12 may not modify the terms and conditions of coverage 

13 based on the determination by a participant or beneficiary 

14 to request less than the minimum coverage required under 

15 subsection (a). 

16 ‘‘(c) NOTICE REQUIREMENT.—The imposition of the 

17 requirements of this section shall be treated as a material 

18 modification in the terms of the plan described in section 

19 102(a)(1), for purposes of assuring notice of such require20 ments under the plan; except that the summary descrip21 tion required to be provided under the last sentence of sec22 tion 104(b)(1) with respect to such modification shall be 

23 provided by not later than 60 days after the first day of 

24 the first plan year in which such requirements apply and 
4

•HR 1448 IH 

1 shall be made available at the time of initial coverage and 

2 at any time upon request of a participant or beneficiary. 

3 ‘‘(d) SECONDARY CONSULTATIONS.—

4 ‘‘(1) IN GENERAL.—A group health plan, and a 

5 health insurance issuer providing health insurance 

6 coverage in connection with a group health plan, 

7 that provides coverage with respect to medical and 

8 surgical services provided in relation to the diagnosis 

9 and treatment of cancer shall ensure that full cov10 erage is provided for secondary consultations by spe11 cialists in the appropriate medical fields (including 

12 pathology, radiology, and oncology) to confirm or re13 fute such diagnosis. Such plan or issuer shall ensure 

14 that full coverage is provided for such secondary 

15 consultation whether such consultation is based on a 

16 positive or negative initial diagnosis. In any case in 

17 which the attending physician certifies in writing 

18 that services necessary for such a secondary con19 sultation are not sufficiently available from special20 ists operating under the plan with respect to whose 

21 services coverage is otherwise provided under such 

22 plan or by such issuer, such plan or issuer shall en23 sure that coverage is provided with respect to the 

24 services necessary for the secondary consultation 

25 with any other specialist selected by the attending 
5

•HR 1448 IH 

1 physician for such purpose at no additional cost to 

2 the individual beyond that which the individual 

3 would have paid if the specialist was participating in 

4 the network of the plan. 

5 ‘‘(2) EXCEPTION.—Nothing in paragraph (1) 

6 shall be construed as requiring the provision of sec7 ondary consultations where there is a financial rela8 tionship (including an ownership or investment in9 terest or compensation arrangement) between the 

10 specialist and the attending physician or where the 

11 patient determines not to seek such a consultation. 

12 ‘‘(e) PROHIBITION ON PENALTIES OR INCENTIVES.—

13 A group health plan, and a health insurance issuer pro14 viding health insurance coverage in connection with a 

15 group health plan, may not—

16 ‘‘(1) penalize or otherwise reduce or limit the 

17 reimbursement of a provider or specialist because 

18 the provider or specialist provided care to a partici19 pant or beneficiary in accordance with this section; 

20 ‘‘(2) provide financial or other incentives to a 

21 physician or specialist to induce the physician or 

22 specialist to keep the length of inpatient stays of pa23 tients following a mastectomy, lumpectomy, or a 

24 lymph node dissection for the treatment of breast 
6

•HR 1448 IH 

1 cancer below certain limits or to limit referrals for 

2 secondary consultations; or

3 ‘‘(3) provide financial or other incentives to a 

4 physician or specialist to induce the physician or 

5 specialist to refrain from referring a participant or 

6 beneficiary for a secondary consultation that would 

7 otherwise be covered by the plan or coverage in8 volved under subsection (d). 

9 ‘‘(f) PREEMPTION; EXCEPTION FOR HEALTH INSUR10 ANCE COVERAGE IN CERTAIN STATES.—

11 ‘‘(1) IN GENERAL.—The requirements of this 

12 section shall not apply with respect to health insur13 ance coverage if there is a State law (as defined in 

14 section 731(d)(1)) for a State that regulates such 

15 coverage that is described in any of the following 

16 subparagraphs: 

17 ‘‘(A) Such State law requires such cov18 erage to provide for at least a 48-hour hospital 

19 length of stay following a mastectomy per20 formed for treatment of breast cancer and at 

21 least a 24-hour hospital length of stay following 

22 a lymph node dissection for treatment of breast 

23 cancer. 

24 ‘‘(B) Such State law requires, in connec25 tion with such coverage for surgical treatment 
7

•HR 1448 IH 

1 of breast cancer, that the hospital length of 

2 stay for such care is left to the decision of (or 

3 required to be made by) the attending provider 

4 in consultation with the woman involved. 

5 ‘‘(2) CONSTRUCTION.—Section 731(a)(1) shall 

6 not be construed as superseding a State law de7 scribed in paragraph (1).’’. 

8 (b) CONFORMING AMENDMENT.—Section 731(c) of 

9 such Act (29 U.S.C. 1191(c)) is amended by striking ‘‘sec10 tion 711’’ and inserting ‘‘sections 711 and 714’’. 

11 (c) CLERICAL AMENDMENT.—The table of contents 

12 in section 1 of such Act is amended by inserting after the 

13 item relating to section 713 the following new item:

‘‘Sec. 714. Required coverage for minimum hospital stay for mastectomies and 

lymph node dissections for the treatment of breast cancer and 

coverage for secondary consultations.’’.

14 (d) EFFECTIVE DATES.—

15 (1) IN GENERAL.—The amendments made by 

16 this section shall apply with respect to plan years be17 ginning on or after the date of enactment of this 

18 Act. 

19 (2) SPECIAL RULE FOR COLLECTIVE BAR20 GAINING AGREEMENTS.—In the case of a group 

21 health plan maintained pursuant to 1 or more collec22 tive bargaining agreements between employee rep23 resentatives and 1 or more employers ratified before 

24 the date of enactment of this Act, the amendments 
8

•HR 1448 IH 

1 made by this section shall not apply to plan years 

2 beginning before the later of—

3 (A) the date on which the last collective 

4 bargaining agreements relating to the plan ter5 minates (determined without regard to any ex6 tension thereof agreed to after the date of en7 actment of this Act), or 

8 (B) January 1, 2004. 

9 For purposes of subparagraph (A), any plan amend10 ment made pursuant to a collective bargaining 

11 agreement relating to the plan which amends the 

12 plan solely to conform to any requirement added by 

13 this section shall not be treated as a termination of 

14 such collective bargaining agreement. 

15 SEC. 3. AMENDMENTS TO THE PUBLIC HEALTH SERVICE 

16 ACT RELATING TO THE GROUP MARKET. 

17 (a) IN GENERAL.—Subpart 2 of part A of title 

18 XXVII of the Public Health Service Act is amended by 

19 adding at the end the following new section:

20 ‘‘SEC. 2707. REQUIRED COVERAGE FOR MINIMUM HOSPITAL 

21 STAY FOR MASTECTOMIES AND LYMPH NODE 

22 DISSECTIONS FOR THE TREATMENT OF 

23 BREAST CANCER AND COVERAGE FOR SEC24 ONDARY CONSULTATIONS. 

25 ‘‘(a) INPATIENT CARE.—
9

•HR 1448 IH 

1 ‘‘(1) IN GENERAL.—A group health plan, and a 

2 health insurance issuer providing health insurance 

3 coverage in connection with a group health plan, 

4 that provides medical and surgical benefits shall en5 sure that inpatient coverage with respect to the sur6 gical treatment of breast cancer (including a mastec7 tomy, lumpectomy, or lymph node dissection for the 

8 treatment of breast cancer) is provided for a period 

9 of time as is determined by the attending physician, 

10 in the physician’s professional judgment consistent 

11 with generally accepted principles of professional 

12 medical practice, in consultation with the patient, to 

13 be medically necessary or appropriate. 

14 ‘‘(2) EXCEPTION.—Nothing in this section shall 

15 be construed as requiring the provision of inpatient 

16 coverage if the attending physician in consultation 

17 with the patient determines that a shorter period of 

18 hospital stay is medically necessary or appropriate. 

19 ‘‘(b) PROHIBITION ON CERTAIN MODIFICATIONS.—

20 In implementing the requirements of this section, a group 

21 health plan, and a health insurance issuer providing health 

22 insurance coverage in connection with a group health plan, 

23 may not modify the terms and conditions of coverage 

24 based on the determination by a participant or beneficiary 
10

•HR 1448 IH 

1 to request less than the minimum coverage required under 

2 subsection (a).

3 ‘‘(c) NOTICE REQUIREMENT.—A group health plan 

4 under this part shall comply with the notice requirement 

5 under section 714(c) of the Employee Retirement Income 

6 Security Act of 1974 with respect to the requirements of 

7 this section as if such section applied to such plan. 

8 ‘‘(d) SECONDARY CONSULTATIONS.—

9 ‘‘(1) IN GENERAL.—A group health plan, and a 

10 health insurance issuer providing health insurance 

11 coverage in connection with a group health plan that 

12 provides coverage with respect to medical and sur13 gical services provided in relation to the diagnosis 

14 and treatment of cancer shall ensure that full cov15 erage is provided for secondary consultations by spe16 cialists in the appropriate medical fields (including 

17 pathology, radiology, and oncology) to confirm or re18 fute such diagnosis. Such plan or issuer shall ensure 

19 that full coverage is provided for such secondary 

20 consultation whether such consultation is based on a 

21 positive or negative initial diagnosis. In any case in 

22 which the attending physician certifies in writing 

23 that services necessary for such a secondary con24 sultation are not sufficiently available from special25 ists operating under the plan with respect to whose 
11

•HR 1448 IH 

1 services coverage is otherwise provided under such 

2 plan or by such issuer, such plan or issuer shall en3 sure that coverage is provided with respect to the 

4 services necessary for the secondary consultation 

5 with any other specialist selected by the attending 

6 physician for such purpose at no additional cost to 

7 the individual beyond that which the individual 

8 would have paid if the specialist was participating in 

9 the network of the plan. 

10 ‘‘(2) EXCEPTION.—Nothing in paragraph (1) 

11 shall be construed as requiring the provision of sec12 ondary consultations where there is a financial rela13 tionship (including an ownership or investment in14 terest or compensation arrangement) between the 

15 specialist and the attending physician or where the 

16 patient determines not to seek such a consultation. 

17 ‘‘(e) PROHIBITION ON PENALTIES OR INCENTIVES.—

18 A group health plan, and a health insurance issuer pro19 viding health insurance coverage in connection with a 

20 group health plan, may not—

21 ‘‘(1) penalize or otherwise reduce or limit the 

22 reimbursement of a provider or specialist because 

23 the provider or specialist provided care to a partici24 pant or beneficiary in accordance with this section; 
12

•HR 1448 IH 

1 ‘‘(2) provide financial or other incentives to a 

2 physician or specialist to induce the physician or 

3 specialist to keep the length of inpatient stays of pa4 tients following a mastectomy, lumpectomy, or a 

5 lymph node dissection for the treatment of breast 

6 cancer below certain limits or to limit referrals for 

7 secondary consultations; or 

8 ‘‘(3) provide financial or other incentives to a 

9 physician or specialist to induce the physician or 

10 specialist to refrain from referring a participant or 

11 beneficiary for a secondary consultation that would 

12 otherwise be covered by the plan or coverage in13 volved under subsection (d). 

14 ‘‘(f) EXCEPTION FOR HEALTH INSURANCE COV15 ERAGE IN CERTAIN STATES.—

16 ‘‘(1) IN GENERAL.—The requirements of this 

17 section shall not apply with respect to health insur18 ance coverage if there is a State law (as defined in 

19 section 2723(d)(1) of the Public Health Service Act) 

20 for a State that regulates such coverage that is de21 scribed in any of the following subparagraphs: 

22 ‘‘(A) Such State law requires such cov23 erage to provide for at least a 48-hour hospital 

24 length of stay following a mastectomy per25 formed for treatment of breast cancer and at 
13

•HR 1448 IH 

1 least a 24-hour hospital length of stay following 

2 a lymph node dissection for treatment of breast 

3 cancer. 

4 ‘‘(B) Such State law requires, in connec5 tion with such coverage for surgical treatment 

6 of breast cancer, that the hospital length of 

7 stay for such care is left to the decision of (or 

8 required to be made by) the attending provider 

9 in consultation with the woman involved. 

10 ‘‘(2) CONSTRUCTION.—Section 2723(a)(1) shall 

11 not be construed as superseding a State law de12 scribed in paragraph (1).’’. 

13 (b) CONFORMING AMENDMENT.—Section 2723(c) of 

14 such Act (42 U.S.C. 300gg–23(c)) is amended by striking 

15 ‘‘section 2704’’ and inserting ‘‘sections 2704 and 2707’’. 

16 (c) EFFECTIVE DATES.—

17 (1) IN GENERAL.—The amendments made by 

18 this section shall apply to group health plans for 

19 plan years beginning on or after the date of enact20 ment of this Act. 

21 (2) SPECIAL RULE FOR COLLECTIVE BAR22 GAINING AGREEMENTS.—In the case of a group 

23 health plan maintained pursuant to 1 or more collec24 tive bargaining agreements between employee rep25 resentatives and 1 or more employers ratified before 
14

•HR 1448 IH 

1 the date of enactment of this Act, the amendments 

2 made by this section shall not apply to plan years 

3 beginning before the later of—

4 (A) the date on which the last collective 

5 bargaining agreements relating to the plan ter6 minates (determined without regard to any ex7 tension thereof agreed to after the date of en8 actment of this Act), or 

9 (B) January 1, 2004. 

10 For purposes of subparagraph (A), any plan amend11 ment made pursuant to a collective bargaining 

12 agreement relating to the plan which amends the 

13 plan solely to conform to any requirement added by 

14 this section shall not be treated as a termination of 

15 such collective bargaining agreement. 

16 SEC. 4. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT 

17 RELATING TO THE INDIVIDUAL MARKET. 

18 (a) IN GENERAL.—Subpart 3 of part B of title 

19 XXVII of the Public Health Service Act is amended by 

20 adding at the end the following new section: 
15

•HR 1448 IH 

1 ‘‘SEC. 2753. REQUIRED COVERAGE FOR MINIMUM HOSPITAL 

2 STAY FOR MASTECTOMIES AND LYMPH NODE 

3 DISSECTIONS FOR THE TREATMENT OF 

4 BREAST CANCER AND SECONDARY CON5 SULTATIONS. 

6 ‘‘(a) IN GENERAL.—The provisions of section 2707 

7 (other than subsection (c)) shall apply to health insurance 

8 coverage offered by a health insurance issuer in the indi9 vidual market in the same manner as they apply to health 

10 insurance coverage offered by a health insurance issuer 

11 in connection with a group health plan in the small or 

12 large group market. 

13 ‘‘(b) REQUIREMENT.—A health insurance issuer 

14 under this part shall comply with the notice requirement 

15 under section 714(c) of the Employee Retirement Income 

16 Security Act of 1974 with respect to the requirements re17 ferred to in subsection (a) as if such section applied to 

18 such issuer and such issuer were a group health plan. 

19 ‘‘(c) EXCEPTION FOR HEALTH INSURANCE COV20 ERAGE IN CERTAIN STATES.—

21 ‘‘(1) IN GENERAL.—The requirements of this 

22 section shall not apply with respect to health insur23 ance coverage if there is a State law (as defined in 

24 section 2723(d)(1) of the Public Health Service Act) 

25 for a State that regulates such coverage that is de26 scribed in any of the following subparagraphs: 
16

•HR 1448 IH 

1 ‘‘(A) Such State law requires such cov2 erage to provide for at least a 48-hour hospital 

3 length of stay following a mastectomy per4 formed for treatment of breast cancer and at 

5 least a 24-hour hospital length of stay following 

6 a lymph node dissection for treatment of breast 

7 cancer. 

8 ‘‘(B) Such State law requires, in connec9 tion with such coverage for surgical treatment 

10 of breast cancer, that the hospital length of 

11 stay for such care is left to the decision of (or 

12 required to be made by) the attending provider 

13 in consultation with the woman involved. 

14 ‘‘(2) CONSTRUCTION.—Section 2762(a) shall 

15 not be construed as superseding a State law de16 scribed in paragraph (1).’’. 

17 (b) CONFORMING AMENDMENT.—Section 2762(b)(2) 

18 of such Act (42 U.S.C. 300gg–62(b)(2)) is amended by 

19 striking ‘‘section 2751’’ and inserting ‘‘sections 2751 and 

20 2753’’. 

21 (c) EFFECTIVE DATE.—The amendments made by 

22 this section shall apply with respect to health insurance 

23 coverage offered, sold, issued, renewed, in effect, or oper24 ated in the individual market on or after the date of enact25 ment of this Act. 
17

•HR 1448 IH 

1 SEC. 5. AMENDMENTS TO THE INTERNAL REVENUE CODE 

2 OF 1986. 

3 (a) IN GENERAL.—Subchapter B of chapter 100 of 

4 the Internal Revenue Code of 1986 (relating to other re5 quirements) is amended by inserting after section 9812 

6 the following new section:

7 ‘‘SEC. 9813. REQUIRED COVERAGE FOR MINIMUM HOSPITAL 

8 STAY FOR MASTECTOMIES AND LYMPH NODE 

9 DISSECTIONS FOR THE TREATMENT OF 

10 BREAST CANCER AND COVERAGE FOR SEC11 ONDARY CONSULTATIONS. 

12 ‘‘(a) INPATIENT CARE.—

13 ‘‘(1) IN GENERAL.—A group health plan that 

14 provides medical and surgical benefits shall ensure 

15 that inpatient coverage with respect to the surgical 

16 treatment of breast cancer (including a mastectomy, 

17 lumpectomy, or lymph node dissection for the treat18 ment of breast cancer) is provided for a period of 

19 time as is determined by the attending physician, in 

20 the physician’s professional judgment consistent with 

21 generally accepted principles of professional medical 

22 practice, in consultation with the patient, to be 

23 medically necessary or appropriate. 

24 ‘‘(2) EXCEPTION.—Nothing in this section shall 

25 be construed as requiring the provision of inpatient 

26 coverage if the attending physician in consultation 
18

•HR 1448 IH 

1 with the patient determines that a shorter period of 

2 hospital stay is medically necessary or appropriate. 

3 ‘‘(b) PROHIBITION ON CERTAIN MODIFICATIONS.—

4 In implementing the requirements of this section, a group 

5 health plan may not modify the terms and conditions of 

6 coverage based on the determination by a participant or 

7 beneficiary to request less than the minimum coverage re8 quired under subsection (a). 

9 ‘‘(c) SECONDARY CONSULTATIONS.—

10 ‘‘(1) IN GENERAL.—A group health plan that 

11 provides coverage with respect to medical and sur12 gical services provided in relation to the diagnosis 

13 and treatment of cancer shall ensure that full cov14 erage is provided for secondary consultations by spe15 cialists in the appropriate medical fields (including 

16 pathology, radiology, and oncology) to confirm or re17 fute such diagnosis. Such plan or issuer shall ensure 

18 that full coverage is provided for such secondary 

19 consultation whether such consultation is based on a 

20 positive or negative initial diagnosis. In any case in 

21 which the attending physician certifies in writing 

22 that services necessary for such a secondary con23 sultation are not sufficiently available from special24 ists operating under the plan with respect to whose 

25 services coverage is otherwise provided under such 
19

•HR 1448 IH 

1 plan or by such issuer, such plan or issuer shall en2 sure that coverage is provided with respect to the 

3 services necessary for the secondary consultation 

4 with any other specialist selected by the attending 

5 physician for such purpose at no additional cost to 

6 the individual beyond that which the individual

7 would have paid if the specialist was participating 

8 in the network of the plan. 

9 ‘‘(2) EXCEPTION.—Nothing in paragraph (1) 

10 shall be construed as requiring the provision of sec11 ondary consultations where there is a financial rela12 tionship (including an ownership or investment in13 terest or compensation arrangement) between the 

14 specialist and the attending physician or where the 

15 patient determines not to seek such a consultation. 

16 ‘‘(d) PROHIBITION ON PENALTIES.—A group health 

17 plan may not—

18 ‘‘(1) penalize or otherwise reduce or limit the 

19 reimbursement of a provider or specialist because 

20 the provider or specialist provided care to a partici21 pant or beneficiary in accordance with this section; 

22 ‘‘(2) provide financial or other incentives to a 

23 physician or specialist to induce the physician or 

24 specialist to keep the length of inpatient stays of pa25 tients following a mastectomy, lumpectomy, or a 
20

•HR 1448 IH 

1 lymph node dissection for the treatment of breast 

2 cancer below certain limits or to limit referrals for 

3 secondary consultations; or 

4 ‘‘(3) provide financial or other incentives to a 

5 physician or specialist to induce the physician or 

6 specialist to refrain from referring a participant or 

7 beneficiary for a secondary consultation that would 

8 otherwise be covered by the plan involved under sub9 section (d). 

10 ‘‘(e) EXCEPTION FOR HEALTH INSURANCE COV11 ERAGE IN CERTAIN STATES.—The requirements of this 

12 section shall not apply with respect to health insurance 

13 coverage if there is a State law (including a decision, rule, 

14 regulation, or other State action having the effect of law) 

15 for a State that regulates such coverage that is described 

16 in any of the following paragraphs: 

17 ‘‘(1) Such State law requires such coverage to 

18 provide for at least a 48-hour hospital length of stay 

19 following a mastectomy performed for treatment of 

20 breast cancer and at least a 24-hour hospital length 

21 of stay following a lymph node dissection for treat22 ment of breast cancer. 

23 ‘‘(2) Such State law requires, in connection 

24 with such coverage for surgical treatment of breast 

25 cancer, that the hospital length of stay for such care 
21

•HR 1448 IH 

1 is left to the decision of (or required to be made by) 

2 the attending provider in consultation with the 

3 woman involved.’’. 

4 (b) CLERICAL AMENDMENT.—The table of sections 

5 for such subchapter is amended by adding at the end the 

6 following new item:

‘‘Sec. 9813. Required coverage for minimum hospital stay for mastectomies and 

lymph node dissections for the treatment of breast cancer and 

coverage for secondary consultations.’’.

7 (c) EFFECTIVE DATES.—

8 (1) IN GENERAL.—The amendments made by 

9 this section shall apply with respect to plan years be10 ginning on or after the date of enactment of this 

11 Act. 

12 (2) SPECIAL RULE FOR COLLECTIVE BAR13 GAINING AGREEMENTS.—In the case of a group 

14 health plan maintained pursuant to 1 or more collec15 tive bargaining agreements between employee rep16 resentatives and 1 or more employers ratified before 

17 the date of enactment of this Act, the amendments 

18 made by this section shall not apply to plan years 

19 beginning before the later of—

20 (A) the date on which the last collective 

21 bargaining agreements relating to the plan ter22 minates (determined without regard to any ex23 tension thereof agreed to after the date of en24 actment of this Act), or 
22

•HR 1448 IH 

1 (B) January 1, 2004. 

2 For purposes of subparagraph (A), any plan amend3 ment made pursuant to a collective bargaining 

4 agreement relating to the plan which amends the 

5 plan solely to conform to any requirement added by 

6 this section shall not be treated as a termination of 

7 such collective bargaining agreement. 

8 SEC. 6. COORDINATION OF ADMINISTRATION. 

9 The Secretary of Labor, the Secretary of the Treas10 ury, and the Secretary of Health and Human Services 

11 shall ensure, through the execution of an interagency 

12 memorandum of understanding among such Secretaries, 

13 that—

14 (1) regulations, rulings, and interpretations 

15 issued by such Secretaries relating to the same mat16 ter over which two or more such Secretaries have re17 sponsibility under the provisions of this Act (and the 

18 amendments made thereby) are administered so as 

19 to have the same effect at all times; and 

20 (2) coordination of policies relating to enforcing 

21 the same requirements through such Secretaries in 

22 order to have a coordinated enforcement strategy 

23 that avoids duplication of enforcement efforts and 

24 assigns priorities in enforcement.

Æ