I 
108TH CONGRESS 
1ST SESSION H. R. 1886
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 
APRIL 30, 2003
Ms. DELAURO (for herself, Mr. ABERCROMBIE, Mr. ACKERMAN, Ms. BALD-
WIN, Ms. BERKLEY, Mr. BERRY, Mr. BISHOP of New York, Mr. 
BLUMENAUER, Ms. BORDALLO, Mr. BOSWELL, Mr. BOUCHER, Mr. 
BOYD, Mr. BRADY of Pennsylvania, Ms. CORRINE BROWN of Florida, Mr. 
BROWN of Ohio, Mrs. CAPPS, Mr. CAPUANO, Ms. CARSON of Indiana, Mr. 
CASE, Mrs. CHRISTENSEN, Mr. CLAY, Mr. COOPER, Mr. COSTELLO, Mr. 
CROWLEY, Mr. CUMMINGS, Mr. DAVIS of Illinois, Mr. DELAHUNT, Mr. 
DEUTSCH, Mr. DICKS, Mr. DINGELL, Mr. DOYLE, Mr. EMANUEL, Mr. 
ENGEL, Mr. ETHERIDGE, Mr. EVANS, Mr. FARR, Mr. FATTAH, Mr. 
FOLEY, Mr. FORD, Mr. FRANK of Massachusetts, Mr. FROST, Mr. GOR-
DON, Mr. GREEN of Texas, Mr. GRIJALVA, Mr. GUTIERREZ, Ms. HAR-
MAN, Ms. HART, Mr. HINCHEY, Mr. HINOJOSA, Mr. HOEFFEL, Mr. 
HOLDEN, Mr. HOLT, Mr. HONDA, Mr. INSLEE, Mr. ISRAEL, Ms. JACK-
SON-LEE of Texas, Mr. JEFFERSON, Ms. EDDIE BERNICE JOHNSON of 
Texas, Ms. KAPTUR, Mr. KENNEDY of Rhode Island, Mr. KILDEE, Mr. 
KING of New York, Mr. KLECZKA, Mr. LANGEVIN, Mr. LANTOS, Mr. 
LARSEN of Washington, Mr. LARSON of Connecticut, Ms. LEE, Mr. 
LEVIN, Mr. LOBIONDO, Mrs. LOWEY, Mr. LYNCH, Ms. MCCARTHY of 
Missouri, Mrs. MCCARTHY
of New York, Ms. MCCOLLUM, Mr. 
MCDERMOTT, Mr. MCGOVERN, Mr. MCHUGH, Mr. MCINTYRE, Mr. 
MCNULTY, Mrs. MALONEY, Mr. MARKEY, Mr. MATSUI, Mr. MEEHAN, 
Mr. MENENDEZ, Mr. MICHAUD, Ms. MILLENDER-MCDONALD, Mr. 
GEORGE MILLER of California, Mr. MORAN of Virginia, Mr. MURTHA, 
Mr. NADLER, Mrs. NAPOLITANO, Ms. NORTON, Mr. OBERSTAR, Mr. 
OLVER, Mr. OWENS, Mr. PALLONE, Mr. PASTOR, Mr. PAYNE, Mr. 
REYES, Ms. ROS-LEHTINEN, Mr. ROSS, Mr. ROTHMAN, Ms. ROYBAL-AL-
LARD, Mr. RUSH, Mr. RYAN of Ohio, Ms. LORETTA SANCHEZ of Cali-
fornia, Mr. SANDLIN, Ms. SCHAKOWSKY, Mr. SCHIFF, Mr. SERRANO, Mr. 
SHERMAN, Mr. SIMMONS, Ms. SLAUGHTER, Mr. SMITH of New Jersey, 
Mr. SNYDER, Mr. STRICKLAND, Mrs. TAUSCHER, Mr. TAYLOR of Mis-
sissippi, Mr. TIERNEY, Mr. TOWNS, Mr. THOMPSON of Mississippi, Mr. 
THOMPSON of California, Mrs. JONES of Ohio, Mr. UDALL of New Mex-
ico, Mr. VITTER, Ms. WATERS, Mr. WATT, Mr. WEXLER, and Ms. WOOL-
SEY) introduced the following bill; which was referred to the Committee 
on Energy and Commerce, and in addition to the Committee on Edu-
cation and the Workforce, for a period to be subsequently determined by 
the Speaker, in each case for consideration of such provisions as fall with-
in 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 2003’’. 
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 is amended by adding 
at the end the following new section:
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.—A group health plan under this part 
shall comply with the notice requirement under section 
713(d) of the Employee Retirement Income Security Act 
of 1974 with respect to the requirements of this section 
as if such section applied to such plan.
‘‘(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 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 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)) is amended by striking ‘‘section 2704’’ 
and inserting ‘‘sections 2704 and 2707’’. 
(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 is amended by 
adding at the end the following new section:
‘‘SEC. 714. 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 pre-
scribing any length of stay required under sub-
paragraph (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)) is amended by striking ‘‘section 711’’ and 
inserting ‘‘sections 711 and 714’’. 
(C) Section 732(a) of such Act (29 U.S.C. 
1191a(a)) is amended by striking ‘‘section 711’’ and 
inserting ‘‘sections 711 and 714’’. 
(D) The table of contents in section 1 of such 
Act is amended by inserting after the item relating 
to section 713 the following new item:
‘‘Sec. 714. 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 is amend-
ed by inserting after section 2752 the following new sec-
tion: 
‘‘SEC. 2753. STANDARDS RELATING TO BENEFITS FOR CER-
TAIN BREAST CANCER TREATMENT. 
‘‘(a) IN GENERAL.—The provisions of section 2707 
(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 714(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)) is amended by striking ‘‘section 2751’’ 
and inserting ‘‘sections 2751 and 2753’’. 
(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, 
2004. 
(2) The amendments made by subsection (b) shall 
apply with respect to health insurance coverage offered, 
sold, issued, renewed, in effect, or operated in the indi-
vidual market on or after such date.
Æ