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104TH CONGRESS

2D SESSION H. R. 4296

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

for mastectomies and lymph node disection for the treatment of breast cancer.

IN THE HOUSE OF REPRESENTATIVES

SEPTEMBER 28, 1996

Ms. DELAURO (for herself, Mr. DINGELL, Mr. SANDERS, Mr. COSTELLO, Mr.

FOGLIETTA, Mr. MORAN, Mrs. LOWEY, Mr. PALLONE, Mrs. MEEK of

Florida, Mr. LOBIONDO, Ms. PELOSI, Mr. NADLER, Ms. ESHOO, Mrs.

MALONEY, Ms. NORTON, Mrs. CLAYTON, and Ms. SLAUGHTER) introduced the following bill; which was referred to the Committee on Commerce

A BILL

To require that health plans provide coverage for a minimum

hospital stay for mastectomies and lymph node disection

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 1996’’.
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1 SEC. 2. REQUIRED COVERAGE FOR MINIMUM HOSPITAL

2 STAY FOR MASTECTOMIES AND LYMPH NODE

3 DISECTIONS FOR THE TREATMENT OF

4 BREAST CANCER.

5 (a) IN GENERAL.—A health plan that provides medi6 cal and surgical benefits with respect to the treatment of

7 breast cancer shall ensure that coverage is provided for

8 not less than 48 hours of inpatient care following a mas9 tectomy and not less than 24 hours of inpatient care fol10 lowing a lymph node disection for the treatment of breast

11 cancer.

12 (b) EXCEPTION.—Nothing in this section shall be

13 construed as requiring the provision of inpatient coverage

14 where the attending physician and patient determine that

15 a shorter period of hospital stay is appropriate.

16 (c) PROHIBITION.—In implementing the require17 ments of this section, a health plan may not modify the

18 terms and conditions of coverage based on the determina19 tion by an enrollee to request less than the minimum cov20 erage required under subsection (a).

21 (d) NOTICE.—A health plan shall provide notice to

22 each enrollee under such plan regarding the coverage re23 quired by this section in accordance with regulations pro24 mulgated by the Secretary of Health and Human Services.

25 Such notice shall be in writing and prominently positioned
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1 in any literature or correspondence made available or dis2 tributed by the health plan and shall be transmitted—

3 (1) in the next mailing made by the plan to the

4 employee;

5 (2) as part of any yearly informational packet

6 sent to the enrollee; or

7 (3) not later than January 1, 1997;

8 whichever is earlier.

9 (e) HEALTH PLAN.—

10 (1) IN GENERAL.—As used in this Act, the

11 term ‘‘health plan’’ means any plan or arrangement

12 which provides, or pays the cost of, health benefits.

13 (2) EXCLUSIONS.—Such term does not include

14 the following, or any combination thereof:

15 (A) Coverage only for accidental death or

16 dismemberment.

17 (B) Coverage providing wages or payments

18 in lieu of wages for any period during which the

19 employee is absent from work on account of

20 sickness or injury.

21 (C) A Medicare supplemental policy (as de22 fined in section 1882(g)(1) of the Social Secu23 rity Act).

24 (D) Coverage issued as a supplement to li25 ability insurance.
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1 (E) Worker’s compensation or similar in2 surance.

3 (F) Automobile medical-payment insur4 ance.

5 (G) A long-term care policy, including a

6 nursing home fixed indemnity policy (unless the

7 Secretary determines that such a policy pro8 vides sufficiently comprehensive coverage of a

9 benefit so that it should be treated as a health

10 plan).

11 (H) Such other plan or arrangement as the

12 Secretary of Health and Human Services deter13 mines is not a health plan.

14 (3) CERTAIN PLANS INCLUDED.—Such term in15 cludes any plan or arrangement not described in any

16 subparagraph of paragraph (2) which provides for

17 benefit payments, on a periodic basis, for—

18 (A) a specified disease or illness, or

19 (B) period of hospitalization,

20 without regard to the costs incurred or services ren21 dered during the period to which the payments re22 late.
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1 SEC. 3. EFFECTIVE DATE.

2 The provisions of section 2 shall apply to all health

3 plans offered, sold, issued, renewed, in effect, or operated

4 after the date of the enactment of this Act.

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