II 

108TH CONGRESS 

1ST SESSION S. 1730

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 SENATE OF THE UNITED STATES 

OCTOBER 14, 2003

Ms. SNOWE (for herself, Mrs. MURRAY, Mr. BIDEN, and Mrs. FEINSTEIN) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions 

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 ‘‘Women’s Health and 

5 Cancer Rights Act of 2003’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds that—
2

•S 1730 IS 

1 (1) the offering and operation of health plans 

2 affect commerce among the States; 

3 (2) health care providers located in a State 

4 serve patients who reside in the State and patients 

5 who reside in other States; and 

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

7 health care providers and patients among the States, 

8 it is necessary to cover health plans operating in 1 

9 State as well as health plans operating among the 

10 several States. 

11 SEC. 3. AMENDMENTS TO THE EMPLOYEE RETIREMENT IN12 COME SECURITY ACT OF 1974. 

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

14 B of title I of the Employee Retirement Income Security 

15 Act of 1974 (29 U.S.C. 1185 et seq.) is amended by add16 ing at the end the following:

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

18 STAY FOR MASTECTOMIES, LUMPECTOMIES, 

19 AND LYMPH NODE DISSECTIONS FOR THE 

20 TREATMENT OF BREAST CANCER AND COV21 ERAGE FOR SECONDARY CONSULTATIONS. 

22 ‘‘(a) INPATIENT CARE.—

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

24 health insurance issuer providing health insurance 

25 coverage in connection with a group health plan, 
3

•S 1730 IS 

1 that provides medical and surgical benefits shall en2 sure that inpatient (and in the case of a 

3 lumpectomy, outpatient) coverage and radiation 

4 therapy is provided for breast cancer treatment and 

5 that inpatient coverage with respect to the treatment 

6 of breast cancer is provided for a period of time as 

7 is determined by the attending physician, in con8 sultation with the patient, to be medically appro9 priate following—

10 ‘‘(A) a mastectomy; 

11 ‘‘(B) breast conserving surgery (such as a 

12 lumpectomy, whether performed on an inpatient 

13 or outpatient basis) as well as radiation treat14 ment; or 

15 ‘‘(C) a lymph node dissection for the treat16 ment of breast cancer. 

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

18 be construed as requiring the provision of inpatient 

19 coverage if the attending physician and patient de20 termine that a shorter period of hospital stay is 

21 medically appropriate.

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

23 In implementing the requirements of this section, a group 

24 health plan, and a health insurance issuer providing health 

25 insurance coverage in connection with a group health plan, 
4

•S 1730 IS 

1 may not modify the terms and conditions of coverage 

2 based on the determination by a participant or beneficiary 

3 to request less than the minimum coverage required under 

4 subsection (a). 

5 ‘‘(c) NOTICE.—A group health plan, and a health in6 surance issuer providing health insurance coverage in con7 nection with a group health plan shall provide notice to 

8 each participant and beneficiary under such plan regard9 ing the coverage required by this section in accordance 

10 with regulations promulgated by the Secretary. Such no11 tice shall be in writing and prominently positioned in any 

12 literature or correspondence made available or distributed 

13 by the plan or issuer and shall be transmitted—

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

15 issuer to the participant or beneficiary; 

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

17 sent to the participant or beneficiary; or 

18 ‘‘(3) not later than January 1, 2004; 

19 whichever is earlier. 

20 ‘‘(d) SECONDARY CONSULTATIONS.—

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 coverage with respect to medical and 

25 surgical services provided in relation to the diagnosis 
5

•S 1730 IS 

1 and treatment of cancer shall ensure that full cov2 erage is provided for secondary consultations by spe3 cialists in the appropriate medical fields (including 

4 pathology, radiology, and oncology) to confirm or re5 fute such diagnosis. Such plan or issuer shall ensure 

6 that full coverage is provided for such secondary 

7 consultation whether such consultation is based on 

8 a positive or negative initial diagnosis. In any case 

9 in which the attending physician certifies in writing 

10 that services necessary for such a secondary con11 sultation are not sufficiently available from special12 ists operating under the plan with respect to whose 

13 services coverage is otherwise provided under such 

14 plan or by such issuer, such plan or issuer shall en15 sure that coverage is provided with respect to the 

16 services necessary for the secondary consultation 

17 with any other specialist selected by the attending 

18 physician for such purpose at no additional cost to 

19 the individual beyond that which the individual 

20 would have paid if the specialist was participating 

21 in the network of the plan. 

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

23 shall be construed as requiring the provision of sec24 ondary consultations where the patient determines 

25 not to seek such a consultation. 
6

•S 1730 IS 

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

2 A group health plan, and a health insurance issuer pro3 viding health insurance coverage in connection with a 

4 group health plan, may not—

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

6 reimbursement of a provider or specialist because

7 the provider or specialist provided care to a partici8 pant or beneficiary in accordance with this section;

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

10 physician or specialist to induce the physician or 

11 specialist to keep the length of inpatient stays of pa12 tients following a mastectomy, lumpectomy, or a 

13 lymph node dissection for the treatment of breast 

14 cancer below certain limits or to limit referrals for 

15 secondary consultations; or 

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

17 physician or specialist to induce the physician or 

18 specialist to refrain from referring a participant or 

19 beneficiary for a secondary consultation that would 

20 otherwise be covered by the plan or coverage in21 volved under subsection (d).’’. 

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

23 in section 1 of the Employee Retirement Income Security 

24 Act of 1974 is amended by inserting after the item relat25 ing to section 713 the following:
7

•S 1730 IS 

‘‘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.’’.

1 (c) EFFECTIVE DATES.—

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

3 this section shall apply with respect to plan years be4 ginning on or after the date of enactment of this 

5 Act. 

6 (2) SPECIAL RULE FOR COLLECTIVE BAR7 GAINING AGREEMENTS.—In the case of a group 

8 health plan maintained pursuant to 1 or more collec9 tive bargaining agreements between employee rep10 resentatives and 1 or more employers ratified before 

11 the date of enactment of this Act, the amendments 

12 made by this section shall not apply to plan years 

13 beginning before the later of—

14 (A) the date on which the last collective 

15 bargaining agreements relating to the plan ter16 minates (determined without regard to any ex17 tension thereof agreed to after the date of en18 actment of this Act), or 

19 (B) January 1, 2004. 

20 For purposes of subparagraph (A), any plan amend21 ment made pursuant to a collective bargaining 

22 agreement relating to the plan which amends the 

23 plan solely to conform to any requirement added by 
8

•S 1730 IS 

1 this section shall not be treated as a termination of 

2 such collective bargaining agreement.

3 SEC. 4. AMENDMENTS TO THE PUBLIC HEALTH SERVICE 

4 ACT RELATING TO THE GROUP MARKET. 

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

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

7 300gg–4 et seq.) is amended by adding at the end the 

8 following:

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

10 STAY FOR MASTECTOMIES, LUMPECTOMIES, 

11 AND LYMPH NODE DISSECTIONS FOR THE 

12 TREATMENT OF BREAST CANCER AND COV13 ERAGE FOR SECONDARY CONSULTATIONS. 

14 ‘‘(a) INPATIENT CARE.—

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

16 health insurance issuer providing health insurance 

17 coverage in connection with a group health plan, 

18 that provides medical and surgical benefits shall en19 sure that inpatient (and in the case of a 

20 lumpectomy, outpatient) coverage and radiation 

21 therapy is provided for breast cancer treatment and 

22 that inpatient coverage with respect to the treatment 

23 of breast cancer is provided for a period of time as 

24 is determined by the attending physician, in con-
9

•S 1730 IS 

1 sultation with the patient, to be medically appro2 priate following—

3 ‘‘(A) a mastectomy; 

4 ‘‘(B) breast conserving surgery (such as a 

5 lumpectomy, whether performed on an inpatient 

6 or outpatient basis) as well as radiation treat7 ment; or 

8 ‘‘(C) a lymph node dissection for the treat9 ment of breast cancer. 

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

11 be construed as requiring the provision of inpatient 

12 coverage if the attending physician and patient de13 termine that a shorter period of hospital stay is 

14 medically appropriate.

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

16 In implementing the requirements of this section, a group 

17 health plan, and a health insurance issuer providing health 

18 insurance coverage in connection with a group health plan, 

19 may not modify the terms and conditions of coverage 

20 based on the determination by a participant or beneficiary 

21 to request less than the minimum coverage required under 

22 subsection (a). 

23 ‘‘(c) NOTICE.—A group health plan, and a health in24 surance issuer providing health insurance coverage in con25 nection with a group health plan shall provide notice to 
10

•S 1730 IS 

1 each participant and beneficiary under such plan regard2 ing the coverage required by this section in accordance 

3 with regulations promulgated by the Secretary. Such no4 tice shall be in writing and prominently positioned in any 

5 literature or correspondence made available or distributed 

6 by the plan or issuer and shall be transmitted—

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

8 issuer to the participant or beneficiary; 

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

10 sent to the participant or beneficiary; or 

11 ‘‘(3) not later than January 1, 2004; 

12 whichever is earlier. 

13 ‘‘(d) SECONDARY CONSULTATIONS.—

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

15 health insurance issuer providing health insurance 

16 coverage in connection with 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 
11

•S 1730 IS 

1 a positive or negative initial diagnosis. In any case 

2 in 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 

14 in 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 OR INCENTIVES.—

20 A group health plan, and a health insurance issuer pro21 viding health insurance coverage in connection with a 

22 group health plan, may not—

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

24 reimbursement of a provider or specialist because 
12

•S 1730 IS 

1 the provider or specialist provided care to a partici2 pant or beneficiary in accordance with this section; 

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

4 physician or specialist to induce the physician or 

5 specialist to keep the length of inpatient stays of pa6 tients following a mastectomy, lumpectomy, or a 

7 lymph node dissection for the treatment of breast 

8 cancer below certain limits or to limit referrals for 

9 secondary consultations; or 

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

11 physician or specialist to induce the physician or 

12 specialist to refrain from referring a participant or 

13 beneficiary for a secondary consultation that would 

14 otherwise be covered by the plan or coverage in15 volved under subsection (d).’’. 

16 (b) EFFECTIVE DATES.—

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

18 this section shall apply to group health plans for 

19 plan years beginning on or after the date of enact20 ment of this Act. 

21 (2) SPECIAL RULE FOR COLLECTIVE BAR22 GAINING AGREEMENTS.—In the case of a group 

23 health plan maintained pursuant to 1 or more collec24 tive bargaining agreements between employee rep25 resentatives and 1 or more employers ratified before 
13

•S 1730 IS 

1 the date of enactment of this Act, the amendments 

2 made by this section shall not apply to plan years 

3 beginning before the later of—

4 (A) the date on which the last collective 

5 bargaining agreements relating to the plan ter6 minates (determined without regard to any ex7 tension thereof agreed to after the date of en8 actment of this Act), or 

9 (B) January 1, 2004. 

10 For purposes of subparagraph (A), any plan amend11 ment made pursuant to a collective bargaining 

12 agreement relating to the plan which amends the 

13 plan solely to conform to any requirement added by 

14 this section shall not be treated as a termination of 

15 such collective bargaining agreement. 

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

17 RELATING TO THE INDIVIDUAL MARKET. 

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

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

20 300gg–11 et seq.) is amended— 

21 (1) by adding after section 2752 the following: 
14

•S 1730 IS 

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

2 STAY FOR MASTECTOMIES, LUMPECTOMIES, 

3 AND LYMPH NODE DISSECTIONS FOR THE 

4 TREATMENT OF BREAST CANCER AND SEC5 ONDARY CONSULTATIONS. 

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

7 insurance coverage offered by a health insurance issuer 

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

9 to health insurance coverage offered by a health insurance 

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

11 or large group market.’’; and 

12 (2) by redesignating such subpart 3 as subpart 

13 2. 

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

15 this section shall apply with respect to health insurance 

16 coverage offered, sold, issued, renewed, in effect, or oper17 ated in the individual market on or after the date of enact18 ment of this Act. 

19 SEC. 6. AMENDMENTS TO THE INTERNAL REVENUE CODE 

20 OF 1986. 

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

22 the Internal Revenue Code of 1986 is amended—

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

24 the item relating to section 9812 the following:
15

•S 1730 IS 

‘‘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.’’; and

1 (2) by inserting after section 9812 the fol2 lowing:

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

4 STAY FOR MASTECTOMIES, LUMPECTOMIES, 

5 AND LYMPH NODE DISSECTIONS FOR THE 

6 TREATMENT OF BREAST CANCER AND COV7 ERAGE FOR SECONDARY CONSULTATIONS. 

8 ‘‘(a) INPATIENT CARE.—

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

10 provides medical and surgical benefits shall ensure 

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

12 outpatient) coverage and radiation therapy is pro13 vided for breast cancer treatment and that inpatient 

14 coverage with respect to the treatment of breast can15 cer is provided for a period of time as is determined 

16 by the attending physician, in consultation with the 

17 patient, to be medically appropriate following—

18 ‘‘(A) a mastectomy; 

19 ‘‘(B) breast conserving surgery (such as a 

20 lumpectomy, whether performed on an inpatient 

21 or outpatient basis) as well as radiation treat22 ment; or 
16

•S 1730 IS 

1 ‘‘(C) a lymph node dissection for the treat2 ment of breast cancer. 

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

4 be construed as requiring the provision of inpatient 

5 coverage if the attending physician and patient de6 termine that a shorter period of hospital stay is 

7 medically appropriate.

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

9 In implementing the requirements of this section, a group 

10 health plan may not modify the terms and conditions of 

11 coverage based on the determination by a participant or 

12 beneficiary to request less than the minimum coverage re13 quired under subsection (a).

14 ‘‘(c) NOTICE.—A group health plan shall provide no15 tice to each participant and beneficiary under such plan 

16 regarding the coverage required by this section in accord17 ance with regulations promulgated by the Secretary. Such 

18 notice shall be in writing and prominently positioned in 

19 any literature or correspondence made available or distrib20 uted by the plan and shall be transmitted—

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

22 the participant or beneficiary; 

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

24 sent to the participant or beneficiary; or 

25 ‘‘(3) not later than January 1, 2004; 
17

•S 1730 IS 

1 whichever is earlier. 

2 ‘‘(d) SECONDARY CONSULTATIONS.—

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

4 provides coverage with respect to medical and sur5 gical 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 
18

•S 1730 IS 

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.—A group health 

8 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; or 

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 involved under sub25 section (d).’’. 
19

•S 1730 IS 

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

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

3 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.’’.

4 (c) EFFECTIVE DATES.—

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

6 this section shall apply with respect to plan years be7 ginning on or after the date of enactment of this 

8 Act. 

9 (2) SPECIAL RULE FOR COLLECTIVE BAR10 GAINING AGREEMENTS.—In the case of a group 

11 health plan maintained pursuant to 1 or more collec12 tive bargaining agreements between employee rep13 resentatives and 1 or more employers ratified before 

14 the date of enactment of this Act, the amendments 

15 made by this section shall not apply to plan years 

16 beginning before the later of—

17 (A) the date on which the last collective 

18 bargaining agreements relating to the plan ter19 minates (determined without regard to any ex20 tension thereof agreed to after the date of en21 actment of this Act), or 

22 (B) January 1, 2004. 

23 For purposes of subparagraph (A), any plan amend24 ment made pursuant to a collective bargaining 
20

•S 1730 IS 

1 agreement relating to the plan which amends the 

2 plan solely to conform to any requirement added by 

3 this section shall not be treated as a termination of 

4 such collective bargaining agreement.

Æ