I 

110TH CONGRESS 

1ST SESSION H. R. 119 

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

for mastectomies, lumpectomies, and lymph node dissection for the treatment of breast cancer and coverage for secondary consultations. 

IN THE HOUSE OF REPRESENTATIVES 

JANUARY 4, 2007 

Mrs. JO ANN DAVIS of Virginia introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to 

the Committees on Education and Labor 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, lumpectomies, 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, 

3 SECTION 1. SHORT TITLE. 

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

5 Protection Act of 2007’’. 


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1 SEC. 2. FINDINGS. 

2 Congress finds that— 

3 (1) the offering and operation of health plans 

4 affect commerce among the States; 

5 (2) health care providers located in a State 

6 serve patients who reside in the State and patients 

7 who reside in other States; and 

8 (3) in order to provide for uniform treatment of 

9 health care providers and patients among the States, 

10 it is necessary to cover health plans operating in 1 

11 State as well as health plans operating among the 

12 several States. 

13 SEC. 3. AMENDMENTS TO THE EMPLOYEE RETIREMENT IN14 COME SECURITY ACT OF 1974. 

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

16 B of title I of the Employee Retirement Income Security 

17 Act of 1974 (29 U.S.C. 1185 et seq.) is amended by add18 ing at the end the following: 

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

20 STAY FOR MASTECTOMIES, LUMPECTOMIES, 

21 AND LYMPH NODE DISSECTIONS FOR THE 

22 TREATMENT OF BREAST CANCER AND COV23 ERAGE FOR SECONDARY CONSULTATIONS. 

24 ‘‘(a) INPATIENT CARE.— 

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

26 health insurance issuer providing health insurance 


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1 coverage in connection with a group health plan, 

2 that provides medical and surgical benefits shall en3 sure that inpatient (and in the case of a 

4 lumpectomy, outpatient) coverage and radiation 

5 therapy is provided for breast cancer treatment. 

6 Such plan or coverage may not— 

7 ‘‘(A) except as provided for in paragraph 

8 (2)— 

9 ‘‘(i) restrict benefits for any hospital 

10 length of stay in connection with a mastec11 tomy or breast conserving surgery (such as 

12 a lumpectomy) for the treatment of breast 

13 cancer to less than 48 hours; or 

14 ‘‘(ii) restrict benefits for any hospital 

15 length of stay in connection with a lymph 

16 node dissection for the treatment of breast 

17 cancer to less than 24 hours; or 

18 ‘‘(B) require that a provider obtain author19 ization from the plan or the issuer for pre20 scribing any length of stay required under sub21 paragraph (A) (without regard to paragraph 

22 (2)). 

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

24 be construed as requiring the provision of inpatient 

25 coverage if the attending physician and patient deVerDate Aug 31 2005 07:39 Jan 10, 2007 Jkt 059200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H119.IH H119

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1 termine that either a shorter period of hospital stay, 

2 or outpatient treatment, is medically appropriate. 

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

4 In implementing the requirements of this section, a group 

5 health plan, and a health insurance issuer providing health 

6 insurance coverage in connection with a group health plan, 

7 may not modify the terms and conditions of coverage 

8 based on the determination by a participant or beneficiary 

9 to request less than the minimum coverage required under 

10 subsection (a). 

11 ‘‘(c) NOTICE.—A group health plan, and a health in12 surance issuer providing health insurance coverage in con13 nection with a group health plan shall provide notice to 

14 each participant and beneficiary under such plan regard15 ing the coverage required by this section in accordance 

16 with regulations promulgated by the Secretary. Such no17 tice shall be in writing and prominently positioned in any 

18 literature or correspondence made available or distributed 

19 by the plan or issuer and shall be transmitted— 

20 ‘‘(1) in the next mailing made by the plan or 

21 issuer to the participant or beneficiary; or 

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

23 sent to the participant or beneficiary; 

24 whichever is earlier. 

25 ‘‘(d) SECONDARY CONSULTATIONS.— 


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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 coverage with respect to medical and 

5 surgical services provided in relation to the diagnosis 

6 and treatment of cancer shall ensure that full cov7 erage is provided for secondary consultations by spe8 cialists in the appropriate medical fields (including 

9 pathology, radiology, and oncology) to confirm or re10 fute such diagnosis. Such plan or issuer shall ensure 

11 that full coverage is provided for such secondary 

12 consultation whether such consultation is based on a 

13 positive or negative initial diagnosis. In any case in 

14 which the attending physician certifies in writing 

15 that services necessary for such a secondary con16 sultation are not sufficiently available from special17 ists operating under the plan with respect to whose 

18 services coverage is otherwise provided under such 

19 plan or by such issuer, such plan or issuer shall en20 sure that coverage is provided with respect to the 

21 services necessary for the secondary consultation 

22 with any other specialist selected by the attending 

23 physician for such purpose at no additional cost to 

24 the individual beyond that which the individual 


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1 would have paid if the specialist was participating in 

2 the network of the plan. 

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

4 shall be construed as requiring the provision of sec5 ondary consultations where the patient determines 

6 not to seek such a consultation. 

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

8 A group health plan, and a health insurance issuer pro9 viding health insurance coverage in connection with a 

10 group health plan, may not— 

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

12 reimbursement of a provider or specialist because 

13 the provider or specialist provided care to a partici14 pant or beneficiary in accordance with this section; 

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

16 physician or specialist to induce the physician or 

17 specialist to keep the length of inpatient stays of pa18 tients following a mastectomy, lumpectomy, or a 

19 lymph node dissection for the treatment of breast 

20 cancer below certain limits or to limit referrals for 

21 secondary consultations; 

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

23 physician or specialist to induce the physician or 

24 specialist to refrain from referring a participant or 

25 beneficiary for a secondary consultation that would 


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1 otherwise be covered by the plan or coverage in2 volved under subsection (d); or 

3 ‘‘(4) deny to a woman eligibility, or continued 

4 eligibility, to enroll or to renew coverage under the 

5 terms of the plan or coverage solely for the purpose 

6 of avoiding the requirements of this section.’’. 

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

8 in section 1 of the Employee Retirement Income Security 

9 Act of 1974 is amended by inserting after the item relat10 ing to section 713 the following: 

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

lumpectomies, and lymph node dissections for the treatment of 

breast cancer and coverage for secondary consultations.’’. 

11 (c) EFFECTIVE DATES.— 

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

13 this section shall apply with respect to plan years be14 ginning on or after the date that is 90 days after 

15 the date of enactment of this Act. 

16 (2) SPECIAL RULE FOR COLLECTIVE BAR17 GAINING AGREEMENTS.—In the case of a group 

18 health plan maintained pursuant to 1 or more collec19 tive bargaining agreements between employee rep20 resentatives and 1 or more employers ratified before 

21 the date of enactment of this Act, the amendments 

22 made by this section shall not apply to plan years 

23 beginning before the date on which the last collective 

24 bargaining agreements relating to the plan termiVerDate Aug 31 2005 07:39 Jan 10, 2007 Jkt 059200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H119.IH H119

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1 nates (determined without regard to any extension 

2 thereof agreed to after the date of enactment of this 

3 Act). For purposes of this paragraph, any plan 

4 amendment made pursuant to a collective bargaining 

5 agreement relating to the plan which amends the 

6 plan solely to conform to any requirement added by 

7 this section shall not be treated as a termination of 

8 such collective bargaining agreement. 

9 SEC. 4. AMENDMENTS TO THE PUBLIC HEALTH SERVICE 

10 ACT RELATING TO THE GROUP MARKET. 

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

12 XXVII of the Public Health Service Act (42 U.S.C. 

13 300gg–4 et seq.) is amended by adding at the end the 

14 following: 

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

16 STAY FOR MASTECTOMIES, LUMPECTOMIES, 

17 AND LYMPH NODE DISSECTIONS FOR THE 

18 TREATMENT OF BREAST CANCER AND COV19 ERAGE FOR SECONDARY CONSULTATIONS. 

20 ‘‘(a) INPATIENT CARE.— 

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

22 health insurance issuer providing health insurance 

23 coverage in connection with a group health plan, 

24 that provides medical and surgical benefits shall en25 sure that inpatient (and in the case of a 


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1 lumpectomy, outpatient) coverage and radiation 

2 therapy is provided for breast cancer treatment. 

3 Such plan or coverage may not— 

4 ‘‘(A) except as provided for in paragraph 

5 (2)— 

6 ‘‘(i) restrict benefits for any hospital 

7 length of stay in connection with a mastec8 tomy or breast conserving surgery (such as 

9 a lumpectomy) for the treatment of breast 

10 cancer to less than 48 hours; or 

11 ‘‘(ii) restrict benefits for any hospital 

12 length of stay in connection with a lymph 

13 node dissection for the treatment of breast 

14 cancer to less than 24 hours; or 

15 ‘‘(B) require that a provider obtain author16 ization from the plan or the issuer for pre17 scribing any length of stay required under sub18 paragraph (A) (without regard to paragraph 

19 (2)). 

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

21 be construed as requiring the provision of inpatient 

22 coverage if the attending physician and patient de23 termine that either a shorter period of hospital stay, 

24 or outpatient treatment, is medically appropriate. 


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

2 In implementing the requirements of this section, a group 

3 health plan, and a health insurance issuer providing health 

4 insurance coverage in connection with a group health plan, 

5 may not modify the terms and conditions of coverage 

6 based on the determination by a participant or beneficiary 

7 to request less than the minimum coverage required under 

8 subsection (a). 

9 ‘‘(c) NOTICE.—A group health plan, and a health in10 surance issuer providing health insurance coverage in con11 nection with a group health plan shall provide notice to 

12 each participant and beneficiary under such plan regard13 ing the coverage required by this section in accordance 

14 with regulations promulgated by the Secretary. Such no15 tice shall be in writing and prominently positioned in any 

16 literature or correspondence made available or distributed 

17 by the plan or issuer and shall be transmitted— 

18 ‘‘(1) in the next mailing made by the plan or 

19 issuer to the participant or beneficiary; or 

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

21 sent to the participant or beneficiary; 

22 whichever is earlier. 

23 ‘‘(d) SECONDARY CONSULTATIONS.— 

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

25 health insurance issuer providing health insurance 


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1 coverage in connection with a group health plan that 

2 provides coverage with respect to medical and sur3 gical services provided in relation to the diagnosis 

4 and treatment of cancer shall ensure that full cov5 erage is provided for secondary consultations by spe6 cialists in the appropriate medical fields (including 

7 pathology, radiology, and oncology) to confirm or re8 fute such diagnosis. Such plan or issuer shall ensure 

9 that full coverage is provided for such secondary 

10 consultation whether such consultation is based on a 

11 positive or negative initial diagnosis. In any case in 

12 which the attending physician certifies in writing 

13 that services necessary for such a secondary con14 sultation are not sufficiently available from special15 ists operating under the plan with respect to whose 

16 services coverage is otherwise provided under such 

17 plan or by such issuer, such plan or issuer shall en18 sure that coverage is provided with respect to the 

19 services necessary for the secondary consultation 

20 with any other specialist selected by the attending 

21 physician for such purpose at no additional cost to 

22 the individual beyond that which the individual 

23 would have paid if the specialist was participating in 

24 the network of the plan. 


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

2 shall be construed as requiring the provision of sec3 ondary consultations where the patient determines 

4 not to seek such a consultation. 

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

6 A group health plan, and a health insurance issuer pro7 viding health insurance coverage in connection with a 

8 group health plan, may not— 

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

10 reimbursement of a provider or specialist because 

11 the provider or specialist provided care to a partici12 pant or beneficiary in accordance with this section; 

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

14 physician or specialist to induce the physician or 

15 specialist to keep the length of inpatient stays of pa16 tients following a mastectomy, lumpectomy, or a 

17 lymph node dissection for the treatment of breast 

18 cancer below certain limits or to limit referrals for 

19 secondary consultations; 

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

21 physician or specialist to induce the physician or 

22 specialist to refrain from referring a participant or 

23 beneficiary for a secondary consultation that would 

24 otherwise be covered by the plan or coverage in25 volved under subsection (d); or 


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

2 eligibility, to enroll or to renew coverage under the 

3 terms of the plan or coverage solely for the purpose 

4 of avoiding the requirements of this section.’’. 

5 (b) EFFECTIVE DATES.— 

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

7 this section shall apply to group health plans for 

8 plan years beginning on or after 90 days after the 

9 date of enactment of this Act. 

10 (2) SPECIAL RULE FOR COLLECTIVE BAR11 GAINING AGREEMENTS.—In the case of a group 

12 health plan maintained pursuant to 1 or more collec13 tive bargaining agreements between employee rep14 resentatives and 1 or more employers ratified before 

15 the date of enactment of this Act, the amendments 

16 made by this section shall not apply to plan years 

17 beginning before the date on which the last collective 

18 bargaining agreements relating to the plan termi19 nates (determined without regard to any extension 

20 thereof agreed to after the date of enactment of this 

21 Act). For purposes of this paragraph, any plan 

22 amendment made pursuant to a collective bargaining 

23 agreement relating to the plan which amends the 

24 plan solely to conform to any requirement added by 


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1 this section shall not be treated as a termination of 

2 such collective bargaining agreement. 

3 SEC. 5. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT 

4 RELATING TO THE INDIVIDUAL MARKET. 

5 (a) IN GENERAL.—The first subpart 3 of part B of 

6 title XXVII of the Public Health Service Act (42 U.S.C. 

7 300gg–11 et seq.) is amended— 

8 (1) by adding after section 2752 the following: 

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

10 STAY FOR MASTECTOMIES, LUMPECTOMIES, 

11 AND LYMPH NODE DISSECTIONS FOR THE 

12 TREATMENT OF BREAST CANCER AND SEC13 ONDARY CONSULTATIONS. 

14 ‘‘The provisions of section 2707 shall apply to health 

15 insurance coverage offered by a health insurance issuer 

16 in the individual market in the same manner as they apply 

17 to health insurance coverage offered by a health insurance 

18 issuer in connection with a group health plan in the small 

19 or large group market.’’; and 

20 (2) by redesignating such subpart 3 as subpart 

21 2. 

22 (b) EFFECTIVE DATE.—The amendment made by 

23 this section shall apply with respect to health insurance 

24 coverage offered, sold, issued, renewed, in effect, or operVerDate Aug 31 2005 07:39 Jan 10, 2007 Jkt 059200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\H119.IH H119

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1 ated in the individual market on or after the date of enact2 ment of this Act. 

3 SEC. 6. AMENDMENTS TO THE INTERNAL REVENUE CODE 

4 OF 1986. 

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

6 the Internal Revenue Code of 1986 is amended— 

7 (1) in the table of sections, by inserting after 

8 the item relating to section 9812 the following: 

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

lumpectomies, and lymph node dissections for the treatment of 

breast cancer and coverage for secondary consultations.’’; 

9 and 

10 (2) by inserting after section 9812 the fol11 lowing: 

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

13 STAY FOR MASTECTOMIES, LUMPECTOMIES, 

14 AND LYMPH NODE DISSECTIONS FOR THE 

15 TREATMENT OF BREAST CANCER AND COV16 ERAGE FOR SECONDARY CONSULTATIONS. 

17 ‘‘(a) INPATIENT CARE.— 

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

19 provides medical and surgical benefits shall ensure 

20 that inpatient (and in the case of a lumpectomy, 

21 outpatient) coverage and radiation therapy is pro22 vided for breast cancer treatment. Such plan may 

23 not— 


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1 ‘‘(A) except as provided for in paragraph 

2 (2)— 

3 ‘‘(i) restrict benefits for any hospital 

4 length of stay in connection with a mastec5 tomy or breast conserving surgery (such as 

6 a lumpectomy) for the treatment of breast 

7 cancer to less than 48 hours; or 

8 ‘‘(ii) restrict benefits for any hospital 

9 length of stay in connection with a lymph 

10 node dissection for the treatment of breast 

11 cancer to less than 24 hours; or 

12 ‘‘(B) require that a provider obtain author13 ization from the plan for prescribing any length 

14 of stay required under subparagraph (A) (with15 out regard to paragraph (2)). 

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

17 be construed as requiring the provision of inpatient 

18 coverage if the attending physician and patient de19 termine that either a shorter period of hospital stay, 

20 or outpatient treatment, is medically appropriate. 

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

22 In implementing the requirements of this section, a group 

23 health plan may not modify the terms and conditions of 

24 coverage based on the determination by a participant or 


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1 beneficiary to request less than the minimum coverage re2 quired under subsection (a). 

3 ‘‘(c) NOTICE.—A group health plan shall provide no4 tice to each participant and beneficiary under such plan 

5 regarding the coverage required by this section in accord6 ance with regulations promulgated by the Secretary. Such 

7 notice shall be in writing and prominently positioned in 

8 any literature or correspondence made available or distrib9 uted by the plan and shall be transmitted— 

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

11 the participant or beneficiary; or 

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

13 sent to the participant or beneficiary; 

14 whichever is earlier. 

15 ‘‘(d) SECONDARY CONSULTATIONS.— 

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

17 provides coverage with respect to medical and sur18 gical services provided in relation to the diagnosis 

19 and treatment of cancer shall ensure that full cov20 erage is provided for secondary consultations by spe21 cialists in the appropriate medical fields (including 

22 pathology, radiology, and oncology) to confirm or re23 fute such diagnosis. Such plan or issuer shall ensure 

24 that full coverage is provided for such secondary 

25 consultation whether such consultation is based on a 


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1 positive or negative initial diagnosis. In any case in 

2 which the attending physician certifies in writing 

3 that services necessary for such a secondary con4 sultation are not sufficiently available from special5 ists operating under the plan with respect to whose 

6 services coverage is otherwise provided under such 

7 plan or by such issuer, such plan or issuer shall en8 sure that coverage is provided with respect to the 

9 services necessary for the secondary consultation 

10 with any other specialist selected by the attending 

11 physician for such purpose at no additional cost to 

12 the individual beyond that which the individual 

13 would have paid if the specialist was participating in 

14 the network of the plan. 

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

16 shall be construed as requiring the provision of sec17 ondary consultations where the patient determines 

18 not to seek such a consultation. 

19 ‘‘(e) PROHIBITION ON PENALTIES.—A group health 

20 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; 


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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; 

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 involved under sub13 section (d); or 

14 ‘‘(4) deny to a woman eligibility, or continued 

15 eligibility, to enroll or to renew coverage under the 

16 terms of the plan solely for the purpose of avoiding 

17 the requirements of this section.’’. 

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

19 for chapter 100 of such Code is amended by inserting after 

20 the item relating to section 9812 the following: 

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

lumpectomies, and lymph node dissections for the treatment of 

breast cancer and coverage for secondary consultations.’’. 

21 (c) EFFECTIVE DATES.— 

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

23 this section shall apply with respect to plan years beVerDate Aug 31 2005 07:39 Jan 10, 2007 Jkt 059200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\H119.IH H119

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1 ginning on or after the date of enactment of this 

2 Act. 

3 (2) SPECIAL RULE FOR COLLECTIVE BAR4 GAINING AGREEMENTS.—In the case of a group 

5 health plan maintained pursuant to 1 or more collec6 tive bargaining agreements between employee rep7 resentatives and 1 or more employers ratified before 

8 the date of enactment of this Act, the amendments 

9 made by this section shall not apply to plan years 

10 beginning before the date on which the last collective 

11 bargaining agreements relating to the plan termi12 nates (determined without regard to any extension 

13 thereof agreed to after the date of enactment of this 

14 Act). For purposes of this paragraph, any plan 

15 amendment made pursuant to a collective bargaining 

16 agreement relating to the plan which amends the 

17 plan solely to conform to any requirement added by 

18 this section shall not be treated as a termination of 

19 such collective bargaining agreement. 

Æ 


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