I

106TH CONGRESS

1ST SESSION H. R. 116

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

JANUARY 6, 1999

Ms. DELAURO (for herself, Mr. DINGELL, Mrs. ROUKEMA, Ms. ESHOO, Mr.

HASTINGS of Florida, Mrs. MEEK of Florida, Ms. SANCHEZ, Mr. WYNN,

Mr. MASCARA, Mr. KILDEE, Mr. BURTON of Indiana, Mr. GEJDENSON,

Mr. MALONEY of Connecticut, Mr. SHAYS, Mr. KLECZKA, Mrs. MALONEY

of New York, Ms. LEE, Mr. MORAN of Virginia, Mr. MCINTYRE, Mr.

DIXON, Mr. FRANK of Massachusetts, Mr. DELAHUNT, Mr. SHERMAN,

Mr. ROMERO-BARCELO ́, Mr. ANDREWS, Mrs. MINK of Hawaii, Mr. FILNER, Mr. TURNER, Mr. SANDLIN, Mrs. MORELLA, Mr. STRICKLAND, Mr.

DEUTSCH, Mr. PALLONE, Mr. EDWARDS, Mr. RANGEL, Mr. DOOLEY of

California, Mr. BOUCHER, Mr. COYNE, Mr. BROWN of Ohio, Mr. BENTSEN, Mr. BOYD, Mr. MEEHAN, Mr. SERRANO, Mrs. LOWEY, Mr. HINCHEY, Mr. COOKSEY, Mr. BALDACCI, Mr. FALEOMAVAEGA, Mr. PRICE of

North Carolina, Mr. DAVIS of Illinois, Ms. PELOSI, Mr. MCNULTY, Mr.

TIERNEY, Ms. KILPATRICK, Mr. TOWNS, Mr. BARRETT of Wisconsin, Mr.

HILLIARD, Ms. DANNER, Mrs. CLAYTON, Mr. HORN, Mr. WOLF, Mr. LUTHER, Mr. FARR of California, Mr. HOYER, Mr. FROST, Mr. KUCINICH,

Mr. RAHALL, Mr. RODRIGUEZ, Mr. BONIOR, Mrs. CAPPS, Mr. GUTIERREZ, Ms. NORTON, Ms. MILLENDER-MCDONALD, Mr. FORD, Mrs. THURMAN, Mr. DEFAZIO, Mr. ETHERIDGE, Mr. GEPHARDT, Ms. KAPTUR, Mr.

LAFALCE, Ms. SLAUGHTER, Mr. MATSUI, Mr. GEORGE MILLER of California, Mr. BRADY of Pennsylvania, Mr. KING, Mr. LEWIS of Georgia,

Mr. MCGOVERN, Mrs. MCCARTHY of New York, Mr. BERRY, Mr. WALSH,

Ms. MCCARTHY of Missouri, Ms. VELA ́ZQUEZ, Mr. BLAGOJEVICH, Mr.

BOEHLERT, Ms. MCKINNEY, Mr. QUINN, Mr. ACKERMAN, Mr. OLVER,

Mr. STUPAK, Ms. ROYBAL-ALLARD, Mr. PASCRELL, and Ms. STABENOW)

introduced the following bill; which was referred to the Committee on

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
2

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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 1999’’.

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:

13 ‘‘SEC. 2707. STANDARDS RELATING TO BENEFITS FOR CER14 TAIN BREAST CANCER TREATMENT.

15 ‘‘(a) REQUIREMENTS FOR MINIMUM HOSPITAL STAY

16 FOLLOWING MASTECTOMY OR LYMPH NODE DISSEC17 TION.—
3

•HR 116 IH

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

2 health insurance issuer offering group health insur3 ance coverage, may not—

4 ‘‘(A) except as provided in paragraph

5 (2)—

6 ‘‘(i) restrict benefits for any hospital

7 length of stay in connection with a mastec8 tomy for the treatment of breast cancer to

9 less than 48 hours, or

10 ‘‘(ii) restrict benefits for any hospital

11 length of stay in connection with a lymph

12 node dissection for the treatment of breast

13 cancer to less than 24 hours, or

14 ‘‘(B) require that a provider obtain author15 ization from the plan or the issuer for prescrib16 ing any length of stay required under subpara17 graph (A) (without regard to paragraph (2)).

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

19 apply in connection with any group health plan or

20 health insurance issuer in any case in which the de21 cision to discharge the woman involved prior to the

22 expiration of the minimum length of stay otherwise

23 required under paragraph (1)(A) is made by an at24 tending provider in consultation with the woman.
4

•HR 116 IH

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

2 health insurance issuer offering group health insurance

3 coverage in connection with a group health plan, may

4 not—

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

6 eligibility, to enroll or to renew coverage under the

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

8 the requirements of this section;

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

10 women to encourage such women to accept less than

11 the minimum protections available under this sec12 tion;

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

14 reimbursement of an attending provider because

15 such provider provided care to an individual partici16 pant or beneficiary in accordance with this section;

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

18 to an attending provider to induce such provider to

19 provide care to an individual participant or bene20 ficiary in a manner inconsistent with this section; or

21 ‘‘(5) subject to subsection (c)(3), restrict bene22 fits for any portion of a period within a hospital

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

24 manner which is less favorable than the benefits pro25 vided for any preceding portion of such stay.
5

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1 ‘‘(c) RULES OF CONSTRUCTION.—

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

3 to require a woman who is a participant or

4 beneficiary—

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

6 node dissection in a hospital; or

7 ‘‘(B) to stay in the hospital for a fixed pe8 riod of time following a mastectomy or lymph

9 node dissection.

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

11 any group health plan, or any group health insur12 ance coverage offered by a health insurance issuer,

13 which does not provide benefits for hospital lengths

14 of stay in connection with a mastectomy or lymph

15 node dissection for the treatment of breast cancer.

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

17 as preventing a group health plan or issuer from im18 posing deductibles, coinsurance, or other cost-shar19 ing in relation to benefits for hospital lengths of stay

20 in connection with a mastectomy or lymph node dis21 section for the treatment of breast cancer under the

22 plan (or under health insurance coverage offered in

23 connection with a group health plan), except that

24 such coinsurance or other cost-sharing for any por25 tion of a period within a hospital length of stay re-
6

•HR 116 IH

1 quired under subsection (a) may not be greater than

2 such coinsurance or cost-sharing for any preceding

3 portion of such stay.

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

5 shall comply with the notice requirement under section

6 713(d) of the Employee Retirement Income Security Act

7 of 1974 with respect to the requirements of this section

8 as if such section applied to such plan.

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

10 Nothing in this section shall be construed to prevent a

11 group health plan or a health insurance issuer offering

12 group health insurance coverage from negotiating the level

13 and type of reimbursement with a provider for care pro14 vided in accordance with this section.

15 ‘‘(f) PREEMPTION; EXCEPTION FOR HEALTH INSUR16 ANCE COVERAGE IN CERTAIN STATES.—

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

18 section shall not apply with respect to health insur19 ance coverage if there is a State law (as defined in

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

21 coverage that is described in any of the following

22 subparagraphs:

23 ‘‘(A) Such State law requires such cov24 erage to provide for at least a 48-hour hospital

25 length of stay following a mastectomy per-
7

•HR 116 IH

1 formed for treatment of breast cancer and at

2 least a 24-hour hospital length of stay following

3 a lymph node dissection for treatment of breast

4 cancer.

5 ‘‘(B) Such State law requires, in connec6 tion with such coverage for surgical treatment

7 of breast cancer, that the hospital length of

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

9 required to be made by) the attending provider

10 in consultation with the woman involved.

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

12 not be construed as superseding a State law de13 scribed in paragraph (1).’’.

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

15 300gg–23(c)) is amended by striking ‘‘section 2704’’

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

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

18 part 7 of subtitle B of title I of the Employee Re19 tirement Income Security Act of 1974 is amended by

20 adding at the end the following new section:

21 ‘‘SEC. 714. STANDARDS RELATING TO BENEFITS FOR CER22 TAIN BREAST CANCER TREATMENT.

23 ‘‘(a) REQUIREMENTS FOR MINIMUM HOSPITAL STAY

24 FOLLOWING MASTECTOMY OR LYMPH NODE DISSEC25 TION.—
8

•HR 116 IH

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

2 health insurance issuer offering group health insur3 ance coverage, may not—

4 ‘‘(A) except as provided in paragraph

5 (2)—

6 ‘‘(i) restrict benefits for any hospital

7 length of stay in connection with a mastec8 tomy for the treatment of breast cancer to

9 less than 48 hours, or

10 ‘‘(ii) restrict benefits for any hospital

11 length of stay in connection with a lymph

12 node dissection for the treatment of breast

13 cancer to less than 24 hours, or

14 ‘‘(B) require that a provider obtain author15 ization from the plan or the issuer for prescrib16 ing any length of stay required under subpara17 graph (A) (without regard to paragraph (2)).

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

19 apply in connection with any group health plan or

20 health insurance issuer in any case in which the de21 cision to discharge the woman involved prior to the

22 expiration of the minimum length of stay otherwise

23 required under paragraph (1)(A) is made by an at24 tending provider in consultation with the woman.
9

•HR 116 IH

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

2 health insurance issuer offering group health insurance

3 coverage in connection with a group health plan, may

4 not—

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

6 eligibility, to enroll or to renew coverage under the

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

8 the requirements of this section;

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

10 women to encourage such women to accept less than

11 the minimum protections available under this sec12 tion;

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

14 reimbursement of an attending provider because

15 such provider provided care to an individual partici16 pant or beneficiary in accordance with this section;

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

18 to an attending provider to induce such provider to

19 provide care to an individual participant or bene20 ficiary in a manner inconsistent with this section; or

21 ‘‘(5) subject to subsection (c)(3), restrict bene22 fits for any portion of a period within a hospital

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

24 manner which is less favorable than the benefits pro25 vided for any preceding portion of such stay.
10

•HR 116 IH

1 ‘‘(c) RULES OF CONSTRUCTION.—

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

3 to require a woman who is a participant or

4 beneficiary—

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

6 node dissection in a hospital; or

7 ‘‘(B) to stay in the hospital for a fixed pe8 riod of time following a mastectomy or lymph

9 node dissection.

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

11 any group health plan, or any group health insur12 ance coverage offered by a health insurance issuer,

13 which does not provide benefits for hospital lengths

14 of stay in connection with a mastectomy or lymph

15 node dissection for the treatment of breast cancer.

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

17 as preventing a group health plan or issuer from im18 posing deductibles, coinsurance, or other cost-shar19 ing in relation to benefits for hospital lengths of stay

20 in connection with a mastectomy or lymph node dis21 section for the treatment of breast cancer under the

22 plan (or under health insurance coverage offered in

23 connection with a group health plan), except that

24 such coinsurance or other cost-sharing for any por25 tion of a period within a hospital length of stay re-
11

•HR 116 IH

1 quired under subsection (a) may not be greater than

2 such coinsurance or cost-sharing for any preceding

3 portion of such stay.

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

5 imposition of the requirements of this section shall be

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

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

8 notice of such requirements under the plan; except that

9 the summary description required to be provided under the

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

11 modification shall be provided by not later than 60 days

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

13 requirements apply.

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 731(d)(1)) for a State that regulates such
12

•HR 116 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 731(a)(1) shall

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

19 (B) Section 731(c) of such Act (29 U.S.C.

20 1191(c)), as amended by section 603(b)(1) of Public

21 Law 104–204, is amended by striking ‘‘section 711’’

22 and inserting ‘‘sections 711 and 714’’.

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

24 1191a(a)), as amended by section 603(b)(2) of Pub-
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•HR 116 IH

1 lic Law 104–204, is amended by striking ‘‘section

2 711’’ and inserting ‘‘sections 711 and 714’’.

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

4 Act is amended by inserting after the item relating

5 to section 713 the following new item:

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

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

7 of title XXVII of the Public Health Service Act is amend8 ed by inserting after section 2752 the following new sec9 tion:

10 ‘‘SEC. 2753. STANDARDS RELATING TO BENEFITS FOR CER11 TAIN BREAST CANCER TREATMENT.

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

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

14 coverage offered by a health insurance issuer in the indi15 vidual market in the same manner as it applies to health

16 insurance coverage offered by a health insurance issuer

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

18 large group market.

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

20 part shall comply with the notice requirement under sec21 tion 714(d) of the Employee Retirement Income Security

22 Act of 1974 with respect to the requirements referred to

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

24 and such issuer were a group health plan.
14

•HR 116 IH

1 ‘‘(c) 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 2723(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 2762(a) shall

23 not be construed as superseding a State law de24 scribed in paragraph (1).’’.
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1 (2) Section 2762(b)(2) of such Act (42 U.S.C.

2 300gg–62(b)(2)), as added by section 605(b)(3)(B) of

3 Public Law 104–204, is amended by striking ‘‘section

4 2751’’ and inserting ‘‘sections 2751 and 2753’’.

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

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

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

8 2000.

9 (2) The amendment made by subsection (b) shall

10 apply with respect to health insurance coverage offered,

11 sold, issued, renewed, in effect, or operated in the individ12 ual market on or after such date.

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