II 

108TH CONGRESS 

1ST SESSION S. 1684

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 SENATE OF THE UNITED STATES 

SEPTEMBER 30 (legislative day, SEPTEMBER 29), 2003

Ms. LANDRIEU (for herself, Mrs. MURRAY, and Mr. CORZINE) introduced the 

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

Health, Education, Labor, and Pensions 

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 2003’’. 
2

•S 1684 IS 

1 SEC. 2. COVERAGE OF MINIMUM HOSPITAL STAY FOR CER2 TAIN BREAST CANCER TREATMENT. 

3 (a) GROUP HEALTH PLANS.—

4 (1) PUBLIC HEALTH SERVICE ACT AMEND5 MENTS.—(A) Subpart 2 of part A of title XXVII of 

6 the Public Health Service Act is amended by adding 

7 at the end the following new section: 

8 ‘‘SEC. 2707. STANDARDS RELATING TO BENEFITS FOR CER9 TAIN BREAST CANCER TREATMENT. 

10 ‘‘(a) REQUIREMENTS FOR MINIMUM HOSPITAL STAY

11 FOLLOWING MASTECTOMY OR LYMPH NODE DISSEC12 TION.—

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

14 health insurance issuer offering group health insur15 ance coverage, may not—

16 ‘‘(A) except as provided in paragraph 

17 (2)—

18 ‘‘(i) restrict benefits for any hospital 

19 length of stay in connection with a mastec20 tomy for the treatment of breast cancer to 

21 less than 48 hours, or 

22 ‘‘(ii) restrict benefits for any hospital 

23 length of stay in connection with a lymph 

24 node dissection for the treatment of breast 

25 cancer to less than 24 hours, or 
3

•S 1684 IS 

1 ‘‘(B) require that a provider obtain author2 ization from the plan or the issuer for pre3 scribing any length of stay required under sub4 paragraph (A) (without regard to paragraph 

5 (2)). 

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

7 apply in connection with any group health plan or 

8 health insurance issuer in any case in which the de9 cision to discharge the woman involved prior to the 

10 expiration of the minimum length of stay otherwise 

11 required under paragraph (1)(A) is made by an at12 tending provider in consultation with the woman. 

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

14 health insurance issuer offering group health insurance 

15 coverage in connection with a group health plan, may 

16 not—

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

18 eligibility, to enroll or to renew coverage under the 

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

20 the requirements of this section; 

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

22 women to encourage such women to accept less than 

23 the minimum protections available under this sec24 tion; 
4

•S 1684 IS 

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

2 reimbursement of an attending provider because 

3 such provider provided care to an individual partici4 pant or beneficiary in accordance with this section; 

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

6 to an attending provider to induce such provider to 

7 provide care to an individual participant or bene8 ficiary in a manner inconsistent with this section; or 

9 ‘‘(5) subject to subsection (c)(3), restrict bene10 fits for any portion of a period within a hospital 

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

12 manner which is less favorable than the benefits pro13 vided for any preceding portion of such stay. 

14 ‘‘(c) RULES OF CONSTRUCTION.—

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

16 to require a woman who is a participant or bene17 ficiary—

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

19 node dissection in a hospital; or 

20 ‘‘(B) to stay in the hospital for a fixed pe21 riod of time following a mastectomy or lymph 

22 node dissection. 

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

24 any group health plan, or any group health insur25 ance coverage offered by a health insurance issuer, 
5

•S 1684 IS 

1 which does not provide benefits for hospital lengths 

2 of stay in connection with a mastectomy or lymph 

3 node dissection for the treatment of breast cancer. 

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

5 as preventing a group health plan or issuer from im6 posing deductibles, coinsurance, or other cost-shar7 ing in relation to benefits for hospital lengths of stay 

8 in connection with a mastectomy or lymph node dis9 section for the treatment of breast cancer under the 

10 plan (or under health insurance coverage offered in 

11 connection with a group health plan), except that 

12 such coinsurance or other cost-sharing for any por13 tion of a period within a hospital length of stay re14 quired under subsection (a) may not be greater than 

15 such coinsurance or cost-sharing for any preceding 

16 portion of such stay. 

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

18 shall comply with the notice requirement under section 

19 713(d) of the Employee Retirement Income Security Act 

20 of 1974 with respect to the requirements of this section 

21 as if such section applied to such plan.

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

23 Nothing in this section shall be construed to prevent a 

24 group health plan or a health insurance issuer offering 

25 group health insurance coverage from negotiating the level 
6

•S 1684 IS 

1 and type of reimbursement with a provider for care pro2 vided in accordance with this section.

3 ‘‘(f) PREEMPTION; EXCEPTION FOR HEALTH INSUR4 ANCE COVERAGE IN CERTAIN STATES.—

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

6 section shall not apply with respect to health insur7 ance coverage if there is a State law (as defined in 

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

9 coverage that is described in any of the following 

10 subparagraphs: 

11 ‘‘(A) Such State law requires such cov12 erage to provide for at least a 48-hour hospital 

13 length of stay following a mastectomy per14 formed for treatment of breast cancer and at 

15 least a 24-hour hospital length of stay following 

16 a lymph node dissection for treatment of breast 

17 cancer. 

18 ‘‘(B) Such State law requires, in connec19 tion with such coverage for surgical treatment 

20 of breast cancer, that the hospital length of 

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

22 required to be made by) the attending provider 

23 in consultation with the woman involved. 
7

•S 1684 IS 

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

2 not be construed as superseding a State law de3 scribed in paragraph (1).’’. 

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

5 300gg–23(c)) is amended by striking ‘‘section 2704’’ 

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

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

8 part 7 of subtitle B of title I of the Employee Re9 tirement Income Security Act of 1974 is amended by 

10 adding at the end the following new section: 

11 ‘‘SEC. 714. STANDARDS RELATING TO BENEFITS FOR CER12 TAIN BREAST CANCER TREATMENT. 

13 ‘‘(a) REQUIREMENTS FOR MINIMUM HOSPITAL STAY

14 FOLLOWING MASTECTOMY OR LYMPH NODE DISSEC15 TION.—

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

17 health insurance issuer offering group health insur18 ance coverage, may not—

19 ‘‘(A) except as provided in paragraph 

20 (2)—

21 ‘‘(i) restrict benefits for any hospital 

22 length of stay in connection with a mastec23 tomy for the treatment of breast cancer to 

24 less than 48 hours, or 
8

•S 1684 IS 

1 ‘‘(ii) restrict benefits for any hospital 

2 length of stay in connection with a lymph 

3 node dissection for the treatment of breast 

4 cancer to less than 24 hours, or 

5 ‘‘(B) require that a provider obtain author6 ization from the plan or the issuer for pre7 scribing any length of stay required under sub8 paragraph (A) (without regard to paragraph 

9 (2)). 

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

11 apply in connection with any group health plan or 

12 health insurance issuer in any case in which the de13 cision to discharge the woman involved prior to the 

14 expiration of the minimum length of stay otherwise 

15 required under paragraph (1)(A) is made by an at16 tending provider in consultation with the woman. 

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

18 health insurance issuer offering group health insurance 

19 coverage in connection with a group health plan, may 

20 not—

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

22 eligibility, to enroll or to renew coverage under the 

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

24 the requirements of this section; 
9

•S 1684 IS 

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

2 women to encourage such women to accept less than 

3 the minimum protections available under this sec4 tion; 

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

6 reimbursement of an attending provider because 

7 such provider provided care to an individual partici8 pant or beneficiary in accordance with this section; 

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

10 to an attending provider to induce such provider to 

11 provide care to an individual participant or bene12 ficiary in a manner inconsistent with this section; or 

13 ‘‘(5) subject to subsection (c)(3), restrict bene14 fits for any portion of a period within a hospital 

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

16 manner which is less favorable than the benefits pro17 vided for any preceding portion of such stay. 

18 ‘‘(c) RULES OF CONSTRUCTION.—

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

20 to require a woman who is a participant or bene21 ficiary—

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

23 node dissection in a hospital; or
10

•S 1684 IS 

1 ‘‘(B) to stay in the hospital for a fixed pe2 riod of time following a mastectomy or lymph 

3 node dissection. 

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

5 any group health plan, or any group health insur6 ance coverage offered by a health insurance issuer, 

7 which does not provide benefits for hospital lengths 

8 of stay in connection with a mastectomy or lymph 

9 node dissection for the treatment of breast cancer. 

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

11 as preventing a group health plan or issuer from im12 posing deductibles, coinsurance, or other cost-shar13 ing in relation to benefits for hospital lengths of stay 

14 in connection with a mastectomy or lymph node dis15 section for the treatment of breast cancer under the 

16 plan (or under health insurance coverage offered in 

17 connection with a group health plan), except that 

18 such coinsurance or other cost-sharing for any por19 tion of a period within a hospital length of stay re20 quired under subsection (a) may not be greater than 

21 such coinsurance or cost-sharing for any preceding 

22 portion of such stay. 

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

24 imposition of the requirements of this section shall be 

25 treated as a material modification in the terms of the plan 
11

•S 1684 IS 

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

2 notice of such requirements under the plan; except that 

3 the summary description required to be provided under the 

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

5 modification shall be provided by not later than 60 days

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

7 requirements apply. 

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

9 Nothing in this section shall be construed to prevent a 

10 group health plan or a health insurance issuer offering 

11 group health insurance coverage from negotiating the level 

12 and type of reimbursement with a provider for care pro13 vided in accordance with this section.

14 ‘‘(f) PREEMPTION; EXCEPTION FOR HEALTH INSUR15 ANCE COVERAGE IN CERTAIN STATES.—

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

17 section shall not apply with respect to health insur18 ance coverage if there is a State law (as defined in 

19 section 731(d)(1)) for a State that regulates such 

20 coverage that is described in any of the following 

21 subparagraphs: 

22 ‘‘(A) Such State law requires such cov23 erage to provide for at least a 48-hour hospital 

24 length of stay following a mastectomy per25 formed for treatment of breast cancer and at 
12

•S 1684 IS 

1 least a 24-hour hospital length of stay following 

2 a lymph node dissection for treatment of breast 

3 cancer. 

4 ‘‘(B) Such State law requires, in connec5 tion with such coverage for surgical treatment 

6 of breast cancer, that the hospital length of 

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

8 required to be made by) the attending provider 

9 in consultation with the woman involved. 

10 ‘‘(2) CONSTRUCTION.—Section 731(a)(1) shall 

11 not be construed as superseding a State law de12 scribed in paragraph (1).’’. 

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

14 1191(c)) is amended by striking ‘‘section 711’’ and 

15 inserting ‘‘sections 711 and 714’’. 

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

17 1191a(a)) is amended by striking ‘‘section 711’’ and 

18 inserting ‘‘sections 711 and 714’’. 

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

20 Act is amended by inserting after the item relating 

21 to section 713 the following new item:

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

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

23 of title XXVII of the Public Health Service Act is amend24 ed by inserting after section 2752 the following new sec25 tion: 
13

•S 1684 IS 

1 ‘‘SEC. 2753. STANDARDS RELATING TO BENEFITS FOR CER2 TAIN BREAST CANCER TREATMENT. 

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

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

5 coverage offered by a health insurance issuer in the indi6 vidual market in the same manner as it applies to health 

7 insurance coverage offered by a health insurance issuer 

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

9 large group market. 

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

11 part shall comply with the notice requirement under sec12 tion 714(d) of the Employee Retirement Income Security 

13 Act of 1974 with respect to the requirements referred to 

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

15 and such issuer were a group health plan. 

16 ‘‘(c) PREEMPTION; EXCEPTION FOR HEALTH INSUR17 ANCE COVERAGE IN CERTAIN STATES.—

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

19 section shall not apply with respect to health insur20 ance coverage if there is a State law (as defined in 

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

22 coverage that is described in any of the following 

23 subparagraphs: 

24 ‘‘(A) Such State law requires such cov25 erage to provide for at least a 48-hour hospital 

26 length of stay following a mastectomy per-
14

•S 1684 IS 

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 2762(a) shall 

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

14 (2) Section 2762(b)(2) of such Act (42 U.S.C. 

15 300gg–62(b)(2)) is amended by striking ‘‘section 2751’’ 

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

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

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

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

20 2004. 

21 (2) The amendments made by subsection (b) shall 

22 apply with respect to health insurance coverage offered, 

23 sold, issued, renewed, in effect, or operated in the indi24 vidual market on or after such date.

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