II

106TH CONGRESS

1ST SESSION S. 1679

To amend the Internal Revenue Code of 1986 to implement enforcement

of the Women’s Health and Cancer Rights Act of 1998.

IN THE SENATE OF THE UNITED STATES

OCTOBER 1, 1999

Mr. BIDEN (for himself, Mr. KERRY, and Ms. MIKULSKI) introduced the

following bill; which was read twice and referred to the Committee on Finance

A BILL

To amend the Internal Revenue Code of 1986 to implement

enforcement of the Women’s Health and Cancer Rights

Act of 1998.

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 Reconstruction

5 Implementation Act of 1999’’.

6 SEC. 2. REQUIRED COVERAGE FOR RECONSTRUCTIVE SUR7 GERY FOLLOWING MASTECTOMIES.

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

9 the Internal Revenue Code of 1986 (relating to other re-
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1 quirements) is amended by adding at the end the fol2 lowing:

3 ‘‘SEC. 9813. REQUIRED COVERAGE FOR RECONSTRUCTIVE

4 SURGERY FOLLOWING MASTECTOMIES.

5 ‘‘(a) RECONSTRUCTIVE SURGERY.—A group health

6 plan that provides medical and surgical benefits with re7 spect to a mastectomy shall ensure that, in a case in which

8 a mastectomy patient elects breast reconstruction, cov9 erage is provided for—

10 ‘‘(1) all stages of reconstruction of the breast

11 on which the mastectomy has been performed, and

12 ‘‘(2) surgery and reconstruction of the other

13 breast to produce a symmetrical appearance;

14 in the manner determined by the attending physician and

15 the patient to be appropriate, and consistent with any fee

16 schedule contained in the plan.

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

18 In implementing the requirements of this section, a group

19 health plan may not modify the terms and conditions of

20 coverage based on the determination by a participant or

21 beneficiary to request less than the minimum coverage re22 quired under subsection (a).

23 ‘‘(c) NOTICE.—A group health plan shall provide no24 tice to each participant and beneficiary under such plan

25 regarding the coverage required by this section in accord-
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1 ance with regulations promulgated by the Secretary. Such

2 notice shall be in writing and prominently positioned in

3 any literature or correspondence made available or distrib4 uted by the plan and shall be transmitted—

5 ‘‘(1) in the next mailing made by the plan to

6 the participant or beneficiary,

7 ‘‘(2) as part of any yearly informational packet

8 sent to the participant or beneficiary, or

9 ‘‘(3) not later than January 1, 2002;

10 whichever is earlier.

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

12 plan may not penalize or otherwise reduce or limit the re13 imbursement of a provider or specialist because the pro14 vider or specialist provided care to a participant or bene15 ficiary in accordance with this section.’’.

16 (b) CLERICAL AMENDMENT.—The table of contents

17 for subchapter B of chapter 100 of the Internal Revenue

18 Code of 1986 is amended by adding at the end the fol19 lowing:

‘‘Sec. 9813. Required coverage for reconstructive surgery following

mastectomies.’’.

20 (c) EFFECTIVE DATES.—

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

22 this section shall apply with respect to plan years be23 ginning on or after the date of enactment of this

24 Act.
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1 (2) SPECIAL RULE FOR COLLECTIVE BAR2 GAINING AGREEMENTS.—In the case of a group

3 health plan maintained pursuant to 1 or more collec4 tive bargaining agreements between employee rep5 resentatives and 1 or more employers ratified before

6 the date of enactment of this Act, the amendments

7 made by this section shall not apply to plan years

8 beginning before the later of—

9 (A) the date on which the last collective

10 bargaining agreements relating to the plan ter11 minates (determined without regard to any ex12 tension thereof agreed to after the date of en13 actment of this Act), or

14 (B) January 1, 2002.

15 For purposes of subparagraph (A), any plan amend16 ment made pursuant to a collective bargaining

17 agreement relating to the plan which amends the

18 plan solely to conform to any requirement added by

19 this section shall not be treated as a termination of

20 such collective bargaining agreement.

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