I 

108TH CONGRESS 

1ST SESSION H. R. 1886

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 HOUSE OF REPRESENTATIVES 

APRIL 30, 2003

Ms. DELAURO (for herself, Mr. ABERCROMBIE, Mr. ACKERMAN, Ms. BALDWIN, Ms. BERKLEY, Mr. BERRY, Mr. BISHOP of New York, Mr. 

BLUMENAUER, Ms. BORDALLO, Mr. BOSWELL, Mr. BOUCHER, Mr. 

BOYD, Mr. BRADY of Pennsylvania, Ms. CORRINE BROWN of Florida, Mr. 

BROWN of Ohio, Mrs. CAPPS, Mr. CAPUANO, Ms. CARSON of Indiana, Mr. 

CASE, Mrs. CHRISTENSEN, Mr. CLAY, Mr. COOPER, Mr. COSTELLO, Mr. 

CROWLEY, Mr. CUMMINGS, Mr. DAVIS of Illinois, Mr. DELAHUNT, Mr. 

DEUTSCH, Mr. DICKS, Mr. DINGELL, Mr. DOYLE, Mr. EMANUEL, Mr. 

ENGEL, Mr. ETHERIDGE, Mr. EVANS, Mr. FARR, Mr. FATTAH, Mr. 

FOLEY, Mr. FORD, Mr. FRANK of Massachusetts, Mr. FROST, Mr. GORDON, Mr. GREEN of Texas, Mr. GRIJALVA, Mr. GUTIERREZ, Ms. HARMAN, Ms. HART, Mr. HINCHEY, Mr. HINOJOSA, Mr. HOEFFEL, Mr. 

HOLDEN, Mr. HOLT, Mr. HONDA, Mr. INSLEE, Mr. ISRAEL, Ms. JACKSON-LEE of Texas, Mr. JEFFERSON, Ms. EDDIE BERNICE JOHNSON of 

Texas, Ms. KAPTUR, Mr. KENNEDY of Rhode Island, Mr. KILDEE, Mr. 

KING of New York, Mr. KLECZKA, Mr. LANGEVIN, Mr. LANTOS, Mr. 

LARSEN of Washington, Mr. LARSON of Connecticut, Ms. LEE, Mr. 

LEVIN, Mr. LOBIONDO, Mrs. LOWEY, Mr. LYNCH, Ms. MCCARTHY of 

Missouri, Mrs. MCCARTHY of New York, Ms. MCCOLLUM, Mr. 

MCDERMOTT, Mr. MCGOVERN, Mr. MCHUGH, Mr. MCINTYRE, Mr. 

MCNULTY, Mrs. MALONEY, Mr. MARKEY, Mr. MATSUI, Mr. MEEHAN, 

Mr. MENENDEZ, Mr. MICHAUD, Ms. MILLENDER-MCDONALD, Mr. 

GEORGE MILLER of California, Mr. MORAN of Virginia, Mr. MURTHA, 

Mr. NADLER, Mrs. NAPOLITANO, Ms. NORTON, Mr. OBERSTAR, Mr. 

OLVER, Mr. OWENS, Mr. PALLONE, Mr. PASTOR, Mr. PAYNE, Mr. 

REYES, Ms. ROS-LEHTINEN, Mr. ROSS, Mr. ROTHMAN, Ms. ROYBAL-ALLARD, Mr. RUSH, Mr. RYAN of Ohio, Ms. LORETTA SANCHEZ of California, Mr. SANDLIN, Ms. SCHAKOWSKY, Mr. SCHIFF, Mr. SERRANO, Mr. 

SHERMAN, Mr. SIMMONS, Ms. SLAUGHTER, Mr. SMITH of New Jersey, 

Mr. SNYDER, Mr. STRICKLAND, Mrs. TAUSCHER, Mr. TAYLOR of Mis-
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•HR 1886 IH 

sissippi, Mr. TIERNEY, Mr. TOWNS, Mr. THOMPSON of Mississippi, Mr. 

THOMPSON of California, Mrs. JONES of Ohio, Mr. UDALL of New Mexico, Mr. VITTER, Ms. WATERS, Mr. WATT, Mr. WEXLER, and Ms. WOOLSEY) introduced the following bill; which was referred to the Committee 

on Energy and Commerce, and in addition to the Committee on Education and the Workforce, 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 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.

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Breast Cancer Patient 

5 Protection Act of 2003’’. 

6 SEC. 2. COVERAGE OF MINIMUM HOSPITAL STAY FOR CER7 TAIN BREAST CANCER TREATMENT. 

8 (a) GROUP HEALTH PLANS.—

9 (1) PUBLIC HEALTH SERVICE ACT AMEND10 MENTS.—(A) Subpart 2 of part A of title XXVII of 

11 the Public Health Service Act is amended by adding 

12 at the end the following new section: 
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•HR 1886 IH 

1 ‘‘SEC. 2707. STANDARDS RELATING TO BENEFITS FOR CER2 TAIN BREAST CANCER TREATMENT. 

3 ‘‘(a) REQUIREMENTS FOR MINIMUM HOSPITAL STAY

4 FOLLOWING MASTECTOMY OR LYMPH NODE DISSEC5 TION.—

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

7 health insurance issuer offering group health insur8 ance coverage, may not—

9 ‘‘(A) except as provided in paragraph 

10 (2)—

11 ‘‘(i) restrict benefits for any hospital 

12 length of stay in connection with a mastec13 tomy for the treatment of breast cancer to 

14 less than 48 hours, or 

15 ‘‘(ii) restrict benefits for any hospital 

16 length of stay in connection with a lymph 

17 node dissection for the treatment of breast 

18 cancer to less than 24 hours, or 

19 ‘‘(B) require that a provider obtain author20 ization from the plan or the issuer for pre21 scribing any length of stay required under sub22 paragraph (A) (without regard to paragraph 

23 (2)). 

24 ‘‘(2) EXCEPTION.—Paragraph (1)(A) shall not 

25 apply in connection with any group health plan or 

26 health insurance issuer in any case in which the de-
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•HR 1886 IH 

1 cision to discharge the woman involved prior to the 

2 expiration of the minimum length of stay otherwise 

3 required under paragraph (1)(A) is made by an at4 tending provider in consultation with the woman. 

5 ‘‘(b) PROHIBITIONS.—A group health plan, and a 

6 health insurance issuer offering group health insurance 

7 coverage in connection with a group health plan, may 

8 not—

9 ‘‘(1) deny to a woman eligibility, or continued 

10 eligibility, to enroll or to renew coverage under the 

11 terms of the plan, solely for the purpose of avoiding 

12 the requirements of this section; 

13 ‘‘(2) provide monetary payments or rebates to 

14 women to encourage such women to accept less than 

15 the minimum protections available under this sec16 tion; 

17 ‘‘(3) penalize or otherwise reduce or limit the 

18 reimbursement of an attending provider because 

19 such provider provided care to an individual partici20 pant or beneficiary in accordance with this section; 

21 ‘‘(4) provide incentives (monetary or otherwise) 

22 to an attending provider to induce such provider to 

23 provide care to an individual participant or bene24 ficiary in a manner inconsistent with this section; or 
5

•HR 1886 IH 

1 ‘‘(5) subject to subsection (c)(3), restrict bene2 fits for any portion of a period within a hospital 

3 length of stay required under subsection (a) in a 

4 manner which is less favorable than the benefits pro5 vided for any preceding portion of such stay. 

6 ‘‘(c) RULES OF CONSTRUCTION.—

7 ‘‘(1) Nothing in this section shall be construed 

8 to require a woman who is a participant or bene9 ficiary—

10 ‘‘(A) to undergo a mastectomy or lymph 

11 node dissection in a hospital; or 

12 ‘‘(B) to stay in the hospital for a fixed pe13 riod of time following a mastectomy or lymph 

14 node dissection. 

15 ‘‘(2) This section shall not apply with respect to 

16 any group health plan, or any group health insur17 ance coverage offered by a health insurance issuer, 

18 which does not provide benefits for hospital lengths 

19 of stay in connection with a mastectomy or lymph 

20 node dissection for the treatment of breast cancer. 

21 ‘‘(3) Nothing in this section shall be construed 

22 as preventing a group health plan or issuer from im23 posing deductibles, coinsurance, or other cost-shar24 ing in relation to benefits for hospital lengths of stay 

25 in connection with a mastectomy or lymph node dis-
6

•HR 1886 IH 

1 section for the treatment of breast cancer under the 

2 plan (or under health insurance coverage offered in 

3 connection with a group health plan), except that 

4 such coinsurance or other cost-sharing for any por5 tion of a period within a hospital length of stay re6 quired under subsection (a) may not be greater than 

7 such coinsurance or cost-sharing for any preceding 

8 portion of such stay. 

9 ‘‘(d) NOTICE.—A group health plan under this part 

10 shall comply with the notice requirement under section 

11 713(d) of the Employee Retirement Income Security Act 

12 of 1974 with respect to the requirements of this section 

13 as if such section applied to such plan.

14 ‘‘(e) LEVEL AND TYPE OF REIMBURSEMENTS.—

15 Nothing in this section shall be construed to prevent a 

16 group health plan or a health insurance issuer offering 

17 group health insurance coverage from negotiating the level 

18 and type of reimbursement with a provider for care pro19 vided in accordance with this section.

20 ‘‘(f) PREEMPTION; EXCEPTION FOR HEALTH INSUR21 ANCE COVERAGE IN CERTAIN STATES.—

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

23 section shall not apply with respect to health insur24 ance coverage if there is a State law (as defined in 

25 section 2723(d)(1)) for a State that regulates such 
7

•HR 1886 IH 

1 coverage that is described in any of the following 

2 subparagraphs: 

3 ‘‘(A) Such State law requires such cov4 erage to provide for at least a 48-hour hospital 

5 length of stay following a mastectomy per6 formed for treatment of breast cancer and at 

7 least a 24-hour hospital length of stay following 

8 a lymph node dissection for treatment of breast 

9 cancer. 

10 ‘‘(B) Such State law requires, in connec11 tion with such coverage for surgical treatment 

12 of breast cancer, that the hospital length of 

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

14 required to be made by) the attending provider 

15 in consultation with the woman involved. 

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

17 not be construed as superseding a State law de18 scribed in paragraph (1).’’. 

19 (B) Section 2723(c) of such Act (42 U.S.C. 

20 300gg–23(c)) is amended by striking ‘‘section 2704’’ 

21 and inserting ‘‘sections 2704 and 2707’’. 

22 (2) ERISA AMENDMENTS.—(A) Subpart B of 

23 part 7 of subtitle B of title I of the Employee Re24 tirement Income Security Act of 1974 is amended by 

25 adding at the end the following new section: 
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•HR 1886 IH 

1 ‘‘SEC. 714. STANDARDS RELATING TO BENEFITS FOR CER2 TAIN BREAST CANCER TREATMENT. 

3 ‘‘(a) REQUIREMENTS FOR MINIMUM HOSPITAL STAY

4 FOLLOWING MASTECTOMY OR LYMPH NODE DISSEC5 TION.—

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

7 health insurance issuer offering group health insur8 ance coverage, may not—

9 ‘‘(A) except as provided in paragraph 

10 (2)—

11 ‘‘(i) restrict benefits for any hospital 

12 length of stay in connection with a mastec13 tomy for the treatment of breast cancer to 

14 less than 48 hours, or 

15 ‘‘(ii) restrict benefits for any hospital 

16 length of stay in connection with a lymph 

17 node dissection for the treatment of breast 

18 cancer to less than 24 hours, or 

19 ‘‘(B) require that a provider obtain author20 ization from the plan or the issuer for pre21 scribing any length of stay required under sub22 paragraph (A) (without regard to paragraph 

23 (2)). 

24 ‘‘(2) EXCEPTION.—Paragraph (1)(A) shall not 

25 apply in connection with any group health plan or 

26 health insurance issuer in any case in which the de-
9

•HR 1886 IH 

1 cision to discharge the woman involved prior to the 

2 expiration of the minimum length of stay otherwise 

3 required under paragraph (1)(A) is made by an at4 tending provider in consultation with the woman. 

5 ‘‘(b) PROHIBITIONS.—A group health plan, and a 

6 health insurance issuer offering group health insurance 

7 coverage in connection with a group health plan, may 

8 not—

9 ‘‘(1) deny to a woman eligibility, or continued 

10 eligibility, to enroll or to renew coverage under the 

11 terms of the plan, solely for the purpose of avoiding 

12 the requirements of this section; 

13 ‘‘(2) provide monetary payments or rebates to 

14 women to encourage such women to accept less than 

15 the minimum protections available under this sec16 tion; 

17 ‘‘(3) penalize or otherwise reduce or limit the 

18 reimbursement of an attending provider because 

19 such provider provided care to an individual partici20 pant or beneficiary in accordance with this section; 

21 ‘‘(4) provide incentives (monetary or otherwise) 

22 to an attending provider to induce such provider to 

23 provide care to an individual participant or bene24 ficiary in a manner inconsistent with this section; or 
10

•HR 1886 IH 

1 ‘‘(5) subject to subsection (c)(3), restrict bene2 fits for any portion of a period within a hospital 

3 length of stay required under subsection (a) in a 

4 manner which is less favorable than the benefits pro5 vided for any preceding portion of such stay. 

6 ‘‘(c) RULES OF CONSTRUCTION.—

7 ‘‘(1) Nothing in this section shall be construed 

8 to require a woman who is a participant or bene9 ficiary—

10 ‘‘(A) to undergo a mastectomy or lymph 

11 node dissection in a hospital; or

12 ‘‘(B) to stay in the hospital for a fixed pe13 riod of time following a mastectomy or lymph 

14 node dissection. 

15 ‘‘(2) This section shall not apply with respect to 

16 any group health plan, or any group health insur17 ance coverage offered by a health insurance issuer, 

18 which does not provide benefits for hospital lengths 

19 of stay in connection with a mastectomy or lymph 

20 node dissection for the treatment of breast cancer. 

21 ‘‘(3) Nothing in this section shall be construed 

22 as preventing a group health plan or issuer from im23 posing deductibles, coinsurance, or other cost-shar24 ing in relation to benefits for hospital lengths of stay 

25 in connection with a mastectomy or lymph node dis-
11

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1 section for the treatment of breast cancer under the 

2 plan (or under health insurance coverage offered in 

3 connection with a group health plan), except that 

4 such coinsurance or other cost-sharing for any por5 tion of a period within a hospital length of stay re6 quired under subsection (a) may not be greater than 

7 such coinsurance or cost-sharing for any preceding 

8 portion of such stay. 

9 ‘‘(d) NOTICE UNDER GROUP HEALTH PLAN.—The 

10 imposition of the requirements of this section shall be 

11 treated as a material modification in the terms of the plan 

12 described in section 102(a)(1), for purposes of assuring 

13 notice of such requirements under the plan; except that 

14 the summary description required to be provided under the 

15 last sentence of section 104(b)(1) with respect to such 

16 modification shall be provided by not later than 60 days 

17 after the first day of the first plan year in which such 

18 requirements apply. 

19 ‘‘(e) LEVEL AND TYPE OF REIMBURSEMENTS.—

20 Nothing in this section shall be construed to prevent a 

21 group health plan or a health insurance issuer offering 

22 group health insurance coverage from negotiating the level 

23 and type of reimbursement with a provider for care pro24 vided in accordance with this section.
12

•HR 1886 IH 

1 ‘‘(f) PREEMPTION; EXCEPTION FOR HEALTH INSUR2 ANCE COVERAGE IN CERTAIN STATES.—

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

4 section shall not apply with respect to health insur5 ance coverage if there is a State law (as defined in 

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

7 coverage that is described in any of the following 

8 subparagraphs: 

9 ‘‘(A) Such State law requires such cov10 erage to provide for at least a 48-hour hospital 

11 length of stay following a mastectomy per12 formed for treatment of breast cancer and at 

13 least a 24-hour hospital length of stay following 

14 a lymph node dissection for treatment of breast 

15 cancer. 

16 ‘‘(B) Such State law requires, in connec17 tion with such coverage for surgical treatment 

18 of breast cancer, that the hospital length of 

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

20 required to be made by) the attending provider 

21 in consultation with the woman involved. 

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

23 not be construed as superseding a State law de24 scribed in paragraph (1).’’. 
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1 (B) Section 731(c) of such Act (29 U.S.C. 

2 1191(c)) is amended by striking ‘‘section 711’’ and 

3 inserting ‘‘sections 711 and 714’’. 

4 (C) Section 732(a) of such Act (29 U.S.C. 

5 1191a(a)) is amended by striking ‘‘section 711’’ and 

6 inserting ‘‘sections 711 and 714’’. 

7 (D) The table of contents in section 1 of such 

8 Act is amended by inserting after the item relating 

9 to section 713 the following new item:

‘‘Sec. 714. Standards relating to benefits for certain breast cancer treatment.’’.

10 (b) INDIVIDUAL HEALTH INSURANCE.—(1) Part B 

11 of title XXVII of the Public Health Service Act is amend12 ed by inserting after section 2752 the following new sec13 tion: 

14 ‘‘SEC. 2753. STANDARDS RELATING TO BENEFITS FOR CER15 TAIN BREAST CANCER TREATMENT. 

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

17 (other than subsection (d)) shall apply to health insurance 

18 coverage offered by a health insurance issuer in the indi19 vidual market in the same manner as it applies to health 

20 insurance coverage offered by a health insurance issuer 

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

22 large group market. 

23 ‘‘(b) NOTICE.—A health insurance issuer under this 

24 part shall comply with the notice requirement under sec25 tion 714(d) of the Employee Retirement Income Security 
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1 Act of 1974 with respect to the requirements referred to 

2 in subsection (a) as if such section applied to such issuer 

3 and such issuer were a group health plan. 

4 ‘‘(c) PREEMPTION; EXCEPTION FOR HEALTH INSUR5 ANCE COVERAGE IN CERTAIN STATES.—

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

7 section shall not apply with respect to health insur8 ance coverage if there is a State law (as defined in 

9 section 2723(d)(1)) for a State that regulates such 

10 coverage that is described in any of the following 

11 subparagraphs: 

12 ‘‘(A) Such State law requires such cov13 erage to provide for at least a 48-hour hospital 

14 length of stay following a mastectomy per15 formed for treatment of breast cancer and at 

16 least a 24-hour hospital length of stay following 

17 a lymph node dissection for treatment of breast 

18 cancer. 

19 ‘‘(B) Such State law requires, in connec20 tion with such coverage for surgical treatment 

21 of breast cancer, that the hospital length of 

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

23 required to be made by) the attending provider 

24 in consultation with the woman involved. 
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1 ‘‘(2) CONSTRUCTION.—Section 2762(a) shall 

2 not be construed as superseding a State law de3 scribed in paragraph (1).’’. 

4 (2) Section 2762(b)(2) of such Act (42 U.S.C. 

5 300gg–62(b)(2)) is amended by striking ‘‘section 2751’’ 

6 and inserting ‘‘sections 2751 and 2753’’. 

7 (c) EFFECTIVE DATES.—(1) The amendments made 

8 by subsection (a) shall apply with respect to group health 

9 plans for plan years beginning on or after January 1, 

10 2004. 

11 (2) The amendments made by subsection (b) shall 

12 apply with respect to health insurance coverage offered, 

13 sold, issued, renewed, in effect, or operated in the indi14 vidual market on or after such date.

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