I
105TH CONGRESS
1ST SESSION
H. R. 135
To amend the Public Health Service Act and Employee Retirement Income
Security Act of 1974 to require that group and individual health insur-
ance 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 HOUSE OF REPRESENTATIVES
JANUARY 7, 1997
Ms. DELAURO (for herself, Mr. DINGELL, Mrs. ROUKEMA, Mr. ACKERMAN,
Mr. BARRETT of Wisconsin, Mr. BENTSEN, Ms. BROWN of Florida, Mr.
BROWN of Ohio, Mrs. CLAYTON, Mr. CLEMENT, Mr. CONYERS, Mr.
DEFAZIO, Ms. ESHOO, Mr. EVANS, Mr. FALEOMAVAEGA, Mr. FARR of
California, Mr. FOGLIETTA, Mr. FOX of Pennsylvania, Mr. FRANK of
Massachusetts, Mr. FROST, Mr. GEJDENSON, Mr. GONZALEZ, Mr. GOR-
DON, Mr. GREEN, Mr. HINCHEY, Mr. KENNEDY of Rhode Island, Mrs.
KENNELLY of Connecticut, Mr. KILDEE, Mr. LAFALCE, Mrs. LOWEY,
Mr. MCDERMOTT, Mrs. MALONEY of New York, Mrs. MEEK of Florida,
Mrs. MINK of Hawaii, Mr. MORAN of Virginia, Mrs. MORELLA, Mr. MUR-
THA, Mr. NADLER, Ms. NORTON, Mr. OBERSTAR, Mr. OLVER, Mr.
OWENS, Mr. PALLONE, Mr. PAYNE, Ms. PELOSI, Mr. QUINN, Mr. RA-
HALL, Ms. RIVERS, Mr. SANDERS, Ms. SLAUGHTER, Mr. TOWNS, Ms.
VELA´ZQUEZ, Mr. ROMERO-BARCELO´, Mr. KENNEDY of Massachusetts,
and Mr. MATSUI) introduced the following bill; which was referred to the
Committee on Commerce, and in addition to the Committee on Education
and the Workforce, 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 amend the Public Health Service Act and Employee Re-
tirement Income Security Act of 1974 to require that
group and individual health insurance coverage and
group health plans provide coverage for a minimum hos-
pital stay for mastectomies and lymph node dissections
performed for the treatment of breast cancer.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Breast Cancer Patient
Protection Act of 1997’’.
SEC. 2. COVERAGE OF MINIMUM HOSPITAL STAY FOR CER-
TAIN BREAST CANCER TREATMENT.
(a) GROUP HEALTH PLANS.—
(1) PUBLIC
HEALTH
SERVICE
ACT
AMEND-
MENTS.—(A) Subpart 2 of part A of title XXVII of
the Public Health Service Act, as amended by sec-
tion 703(a) of Public Law 104–204, is amended by
adding at the end the following new section:
‘‘SEC. 2706. STANDARDS RELATING TO BENEFITS FOR CER-
TAIN BREAST CANCER TREATMENT.
‘‘(a) REQUIREMENTS FOR MINIMUM HOSPITAL STAY
FOLLOWING MASTECTOMY
OR LYMPH NODE DISSEC-
TION.—
‘‘(1) IN GENERAL.—A group health plan, and a
health insurance issuer offering group health insur-
ance coverage, may not—
‘‘(A) except as provided in paragraph
(2)—
‘‘(i) restrict benefits for any hospital
length of stay in connection with a mastec-
tomy for the treatment of breast cancer to
less than 48 hours, or
‘‘(ii) restrict benefits for any hospital
length of stay in connection with a lymph
node dissection for the treatment of breast
cancer to less than 24 hours, or
‘‘(B) require that a provider obtain author-
ization from the plan or the issuer for prescrib-
ing any length of stay required under subpara-
graph (A) (without regard to paragraph (2)).
‘‘(2) EXCEPTION.—Paragraph (1)(A) shall not
apply in connection with any group health plan or
health insurance issuer in any case in which the de-
cision to discharge the woman involved prior to the
expiration of the minimum length of stay otherwise
required under paragraph (1)(A) is made by an at-
tending provider in consultation with the woman.
‘‘(b) PROHIBITIONS.—A group health plan, and a
health insurance issuer offering group health insurance
coverage in connection with a group health plan, may
not—
‘‘(1) deny to a woman eligibility, or continued
eligibility, to enroll or to renew coverage under the
terms of the plan, solely for the purpose of avoiding
the requirements of this section;
‘‘(2) provide monetary payments or rebates to
women to encourage such women to accept less than
the minimum protections available under this sec-
tion;
‘‘(3) penalize or otherwise reduce or limit the
reimbursement of an attending provider because
such provider provided care to an individual partici-
pant or beneficiary in accordance with this section;
‘‘(4) provide incentives (monetary or otherwise)
to an attending provider to induce such provider to
provide care to an individual participant or bene-
ficiary in a manner inconsistent with this section; or
‘‘(5) subject to subsection (c)(3), restrict bene-
fits for any portion of a period within a hospital
length of stay required under subsection (a) in a
manner which is less favorable than the benefits pro-
vided for any preceding portion of such stay.
‘‘(c) RULES OF CONSTRUCTION.—
‘‘(1) Nothing in this section shall be construed
to require a woman who is a participant or bene-
ficiary—
‘‘(A) to undergo a mastectomy or lymph
node dissection in a hospital; or
of breast cancer, that the hospital length of
stay for such care is left to the decision of (or
required to be made by) the attending provider
in consultation with the woman involved.
‘‘(2) CONSTRUCTION.—Section 2723(a)(1) shall
not be construed as superseding a State law de-
scribed in paragraph (1).’’.
(B) Section 2723(c) of such Act (42 U.S.C.
300gg–23(c)), as amended by section 604(b)(2) of
Public Law 104–204, is amended by striking ‘‘sec-
tion 2704’’ and inserting ‘‘sections 2704 and 2706’’.
(2) ERISA AMENDMENTS.—(A) Subpart B of
part 7 of subtitle B of title I of the Employee Re-
tirement Income Security Act of 1974, as amended
by section 702(a) of Public Law 104–204, is amend-
ed by adding at the end the following new section:
‘‘SEC. 713. STANDARDS RELATING TO BENEFITS FOR CER-
TAIN BREAST CANCER TREATMENT.
‘‘(a) REQUIREMENTS FOR MINIMUM HOSPITAL STAY
FOLLOWING MASTECTOMY
OR LYMPH NODE DISSEC-
TION.—
‘‘(1) IN GENERAL.—A group health plan, and a
health insurance issuer offering group health insur-
ance coverage, may not—
‘‘(A) except as provided in paragraph
(2)—
‘‘(i) restrict benefits for any hospital
length of stay in connection with a mastec-
tomy for the treatment of breast cancer to
less than 48 hours, or
‘‘(ii) restrict benefits for any hospital
length of stay in connection with a lymph
node dissection for the treatment of breast
cancer to less than 24 hours, or
‘‘(B) require that a provider obtain author-
ization from the plan or the issuer for prescrib-
ing any length of stay required under subpara-
graph (A) (without regard to paragraph (2)).
‘‘(2) EXCEPTION.—Paragraph (1)(A) shall not
apply in connection with any group health plan or
health insurance issuer in any case in which the de-
cision to discharge the woman involved prior to the
expiration of the minimum length of stay otherwise
required under paragraph (1)(A) is made by an at-
tending provider in consultation with the woman.
‘‘(b) PROHIBITIONS.—A group health plan, and a
health insurance issuer offering group health insurance
coverage in connection with a group health plan, may
not—
‘‘(1) deny to a woman eligibility, or continued
eligibility, to enroll or to renew coverage under the
terms of the plan, solely for the purpose of avoiding
the requirements of this section;
‘‘(2) provide monetary payments or rebates to
women to encourage such women to accept less than
the minimum protections available under this sec-
tion;
‘‘(3) penalize or otherwise reduce or limit the
reimbursement of an attending provider because
such provider provided care to an individual partici-
pant or beneficiary in accordance with this section;
‘‘(4) provide incentives (monetary or otherwise)
to an attending provider to induce such provider to
provide care to an individual participant or bene-
ficiary in a manner inconsistent with this section; or
‘‘(5) subject to subsection (c)(3), restrict bene-
fits for any portion of a period within a hospital
length of stay required under subsection (a) in a
manner which is less favorable than the benefits pro-
vided for any preceding portion of such stay.
‘‘(c) RULES OF CONSTRUCTION.—
‘‘(1) Nothing in this section shall be construed
to require a woman who is a participant or bene-
ficiary—
‘‘(A) to undergo a mastectomy or lymph
node dissection in a hospital; or
‘‘(B) to stay in the hospital for a fixed pe-
riod of time following a mastectomy or lymph
node dissection.
‘‘(2) This section shall not apply with respect to
any group health plan, or any group health insur-
ance coverage offered by a health insurance issuer,
which does not provide benefits for hospital lengths
of stay in connection with a mastectomy or lymph
node dissection for the treatment of breast cancer.
‘‘(3) Nothing in this section shall be construed
as preventing a group health plan or issuer from im-
posing deductibles, coinsurance, or other cost-shar-
ing in relation to benefits for hospital lengths of stay
in connection with a mastectomy or lymph node dis-
section for the treatment of breast cancer under the
plan (or under health insurance coverage offered in
connection with a group health plan), except that
such coinsurance or other cost-sharing for any por-
tion of a period within a hospital length of stay re-
quired under subsection (a) may not be greater than
such coinsurance or cost-sharing for any preceding
portion of such stay.
‘‘(d) NOTICE UNDER GROUP HEALTH PLAN.—The
imposition of the requirements of this section shall be
treated as a material modification in the terms of the plan
described in section 102(a)(1), for purposes of assuring
notice of such requirements under the plan; except that
the summary description required to be provided under the
last sentence of section 104(b)(1) with respect to such
modification shall be provided by not later than 60 days
after the first day of the first plan year in which such
requirements apply.
‘‘(e) LEVEL
AND TYPE
OF REIMBURSEMENTS.—
Nothing in this section shall be construed to prevent a
group health plan or a health insurance issuer offering
group health insurance coverage from negotiating the level
and type of reimbursement with a provider for care pro-
vided in accordance with this section.
‘‘(f) PREEMPTION; EXCEPTION FOR HEALTH INSUR-
ANCE COVERAGE IN CERTAIN STATES.—
‘‘(1) IN GENERAL.—The requirements of this
section shall not apply with respect to health insur-
ance coverage if there is a State law (as defined in
section 731(d)(1)) for a State that regulates such
coverage that is described in any of the following
subparagraphs:
‘‘(A) Such State law requires such cov-
erage to provide for at least a 48-hour hospital
length of stay following a mastectomy per-
formed for treatment of breast cancer and at
least a 24-hour hospital length of stay following
a lymph node dissection for treatment of breast
cancer.
‘‘(B) Such State law requires, in connec-
tion with such coverage for surgical treatment
of breast cancer, that the hospital length of
stay for such care is left to the decision of (or
required to be made by) the attending provider
in consultation with the woman involved.
‘‘(2) CONSTRUCTION.—Section 731(a)(1) shall
not be construed as superseding a State law de-
scribed in paragraph (1).’’.
(B) Section 731(c) of such Act (29 U.S.C.
1191(c)), as amended by section 603(b)(1) of Public
Law 104–204, is amended by striking ‘‘section 711’’
and inserting ‘‘sections 711 and 713’’.
(C) Section 732(a) of such Act (29 U.S.C.
1191a(a)), as amended by section 603(b)(2) of Pub-
lic Law 104–204, is amended by striking ‘‘section
711’’ and inserting ‘‘sections 711 and 713’’.
(D) The table of contents in section 1 of such
Act is amended by inserting after the item relating
to section 712 the following new item:
‘‘Sec. 713. Standards relating to benefits for certain breast cancer treatment.’’.
(b) INDIVIDUAL HEALTH INSURANCE.—(1) Part B
of title XXVII of the Public Health Service Act, as amend-
ed by section 605(a) of Public Law 104–204, is amended
by inserting after section 2751 the following new section:
‘‘SEC. 2752. STANDARDS RELATING TO BENEFITS FOR CER-
TAIN BREAST CANCER TREATMENT.
‘‘(a) IN GENERAL.—The provisions of section 2706
(other than subsection (d)) shall apply to health insurance
coverage offered by a health insurance issuer in the indi-
vidual market in the same manner as it applies to health
insurance coverage offered by a health insurance issuer
in connection with a group health plan in the small or
large group market.
‘‘(b) NOTICE.—A health insurance issuer under this
part shall comply with the notice requirement under sec-
tion 713(d) of the Employee Retirement Income Security
Act of 1974 with respect to the requirements referred to
in subsection (a) as if such section applied to such issuer
and such issuer were a group health plan.
‘‘(c) PREEMPTION; EXCEPTION FOR HEALTH INSUR-
ANCE COVERAGE IN CERTAIN STATES.—
‘‘(1) IN GENERAL.—The requirements of this
section shall not apply with respect to health insur-
ance coverage if there is a State law (as defined in
section 2723(d)(1)) for a State that regulates such
coverage that is described in any of the following
subparagraphs:
‘‘(A) Such State law requires such cov-
erage to provide for at least a 48-hour hospital
length of stay following a mastectomy per-
formed for treatment of breast cancer and at
least a 24-hour hospital length of stay following
a lymph node dissection for treatment of breast
cancer.
‘‘(B) Such State law requires, in connec-
tion with such coverage for surgical treatment
of breast cancer, that the hospital length of
stay for such care is left to the decision of (or
required to be made by) the attending provider
in consultation with the woman involved.
‘‘(2) CONSTRUCTION.—Section 2762(a) shall
not be construed as superseding a State law de-
scribed in paragraph (1).’’.
(2) Section 2762(b)(2) of such Act (42 U.S.C.
300gg–62(b)(2)), as added by section 605(b)(3)(B) of
Public Law 104–204, is amended by striking ‘‘section
2751’’ and inserting ‘‘sections 2751 and 2752’’.
(c) EFFECTIVE DATES.—(1) The amendments made
by subsection (a) shall apply with respect to group health
plans for plan years beginning on or after January 1,
1998.
(2) The amendment made by subsection (b) shall
apply with respect to health insurance coverage offered,
sold, issued, renewed, in effect, or operated in the individ-
ual market on or after such date.
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