I
107TH CONGRESS
1ST SESSION
H. R. 1485
To require that health plans provide coverage for a minimum hospital stay
for mastectomies and lymph node dissection for the treatment of breast
cancer and coverage for secondary consultations.
IN THE HOUSE OF REPRESENTATIVES
APRIL 4, 2001
Mr. LOBIONDO introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce, and in addition to the Committees on
Education and the Workforce, 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 con-
cerned
A BILL
To require that health plans provide coverage for a minimum
hospital stay for mastectomies and lymph node dissection
for the treatment of breast cancer and coverage for sec-
ondary consultations.
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 ‘‘Women’s Cancer Re-
covery Act of 2001’’.
SEC. 2. AMENDMENTS TO THE EMPLOYEE RETIREMENT IN-
COME SECURITY ACT OF 1974.
(a) IN GENERAL.—Subpart B of part 7 of subtitle
B of title I of the Employee Retirement Income Security
Act of 1974 is amended by adding at the end the following
new section:
‘‘SEC. 714. REQUIRED COVERAGE FOR MINIMUM HOSPITAL
STAY FOR MASTECTOMIES AND LYMPH NODE
DISSECTIONS 
FOR 
THE 
TREATMENT 
OF
BREAST CANCER AND COVERAGE FOR SEC-
ONDARY CONSULTATIONS.
‘‘(a) INPATIENT CARE.—
‘‘(1) IN GENERAL.—A group health plan, and a
health insurance issuer providing health insurance
coverage in connection with a group health plan,
that provides medical and surgical benefits shall en-
sure that inpatient coverage with respect to the sur-
gical treatment of breast cancer (including a mastec-
tomy, lumpectomy, or lymph node dissection for the
treatment of breast cancer) is provided for a period
of time as is determined by the attending physician,
in the physician’s professional judgment consistent
with generally accepted principles of professional
medical practice, in consultation with the patient, to
be medically necessary or appropriate.
‘‘(2) EXCEPTION.—Nothing in this section shall
be construed as requiring the provision of inpatient
coverage if the attending physician in consultation
with the patient determines that a shorter period of
hospital stay is medically necessary or appropriate.
‘‘(b) PROHIBITION ON CERTAIN MODIFICATIONS.—
In implementing the requirements of this section, a group
health plan, and a health insurance issuer providing health
insurance coverage in connection with a group health plan,
may not modify the terms and conditions of coverage
based on the determination by a participant or beneficiary
to request less than the minimum coverage required under
subsection (a).
‘‘(c) NOTICE REQUIREMENT.—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 require-
ments under the plan; except that the summary descrip-
tion required to be provided under the last sentence of sec-
tion 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 and
shall be made available at the time of initial coverage and
at any time upon request of a participant or beneficiary.
‘‘(d) SECONDARY CONSULTATIONS.—
‘‘(1) IN GENERAL.—A group health plan, and a
health insurance issuer providing health insurance
coverage in connection with a group health plan,
that provides coverage with respect to medical and
surgical services provided in relation to the diagnosis
and treatment of cancer shall ensure that full cov-
erage is provided for secondary consultations by spe-
cialists in the appropriate medical fields (including
pathology, radiology, and oncology) to confirm or re-
fute such diagnosis. Such plan or issuer shall ensure
that full coverage is provided for such secondary
consultation whether such consultation is based on a
positive or negative initial diagnosis. In any case in
which the attending physician certifies in writing
that services necessary for such a secondary con-
sultation are not sufficiently available from special-
ists operating under the plan with respect to whose
services coverage is otherwise provided under such
plan or by such issuer, such plan or issuer shall en-
sure that coverage is provided with respect to the
services necessary for the secondary consultation
with any other specialist selected by the attending
physician for such purpose at no additional cost to
the individual beyond that which the individual
would have paid if the specialist was participating
in the network of the plan.
‘‘(2) EXCEPTION.—Nothing in paragraph (1)
shall be construed as requiring the provision of sec-
ondary consultations where there is a financial rela-
tionship (including an ownership or investment in-
terest or compensation arrangement) between the
specialist and the attending physician or where the
patient determines not to seek such a consultation.
‘‘(e) PROHIBITION ON PENALTIES OR INCENTIVES.—
A group health plan, and a health insurance issuer pro-
viding health insurance coverage in connection with a
group health plan, may not—
‘‘(1) penalize or otherwise reduce or limit the
reimbursement of a provider or specialist because
the provider or specialist provided care to a partici-
pant or beneficiary in accordance with this section;
‘‘(2) provide financial or other incentives to a
physician or specialist to induce the physician or
specialist to keep the length of inpatient stays of pa-
tients following a mastectomy, lumpectomy, or a
lymph node dissection for the treatment of breast
cancer below certain limits or to limit referrals for
secondary consultations; or
‘‘(3) provide financial or other incentives to a
physician or specialist to induce the physician or
specialist to refrain from referring a participant or
beneficiary for a secondary consultation that would
otherwise be covered by the plan or coverage in-
volved under subsection (d).
‘‘(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) CONFORMING AMENDMENT.—Section 731(c) of
such Act (29 U.S.C. 1191(c)) is amended by striking ‘‘sec-
tion 711’’ and inserting ‘‘sections 711 and 714’’.
(c) CLERICAL AMENDMENT.—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. Required coverage for minimum hospital stay for mastectomies and
lymph node dissections for the treatment of breast cancer and
coverage for secondary consultations.’’.
(d) EFFECTIVE DATES.—
(1) IN GENERAL.—The amendments made by
this section shall apply with respect to plan years be-
ginning on or after the date of enactment of this
Act.
(2) SPECIAL
RULE
FOR
COLLECTIVE
BAR-
GAINING
AGREEMENTS.—In the case of a group
health plan maintained pursuant to 1 or more collec-
tive bargaining agreements between employee rep-
resentatives and 1 or more employers ratified before
the date of enactment of this Act, the amendments
made by this section shall not apply to plan years
beginning before the later of—
(A) the date on which the last collective
bargaining agreements relating to the plan ter-
minates (determined without regard to any ex-
tension thereof agreed to after the date of en-
actment of this Act), or
(B) January 1, 2002.
For purposes of subparagraph (A), any plan amend-
ment made pursuant to a collective bargaining
agreement relating to the plan which amends the
plan solely to conform to any requirement added by
this section shall not be treated as a termination of
such collective bargaining agreement.
SEC. 3. AMENDMENTS TO THE PUBLIC HEALTH SERVICE
ACT RELATING TO THE GROUP MARKET.
(a) IN GENERAL.—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:
‘‘SEC. 2707. REQUIRED COVERAGE FOR MINIMUM HOSPITAL
STAY FOR MASTECTOMIES AND LYMPH NODE
DISSECTIONS 
FOR 
THE 
TREATMENT 
OF
BREAST CANCER AND COVERAGE FOR SEC-
ONDARY CONSULTATIONS.
‘‘(a) INPATIENT CARE.—
‘‘(1) IN GENERAL.—A group health plan, and a
health insurance issuer providing health insurance
coverage in connection with a group health plan,
that provides medical and surgical benefits shall en-
sure that inpatient coverage with respect to the sur-
gical treatment of breast cancer (including a mastec-
tomy, lumpectomy, or lymph node dissection for the
treatment of breast cancer) is provided for a period
of time as is determined by the attending physician,
in the physician’s professional judgment consistent
with generally accepted principles of professional
medical practice, in consultation with the patient, to
be medically necessary or appropriate.
‘‘(2) EXCEPTION.—Nothing in this section shall
be construed as requiring the provision of inpatient
coverage if the attending physician in consultation
with the patient determines that a shorter period of
hospital stay is medically necessary or appropriate.
‘‘(b) PROHIBITION ON CERTAIN MODIFICATIONS.—
In implementing the requirements of this section, a group
health plan, and a health insurance issuer providing health
insurance coverage in connection with a group health plan,
may not modify the terms and conditions of coverage
based on the determination by a participant or beneficiary
to request less than the minimum coverage required under
subsection (a).
‘‘(c) NOTICE REQUIREMENT.—A group health plan
under this part shall comply with the notice requirement
under section 714(c) 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.
‘‘(d) SECONDARY CONSULTATIONS.—
‘‘(1) IN GENERAL.—A group health plan, and a
health insurance issuer providing health insurance
coverage in connection with a group health plan that
provides coverage with respect to medical and sur-
gical services provided in relation to the diagnosis
and treatment of cancer shall ensure that full cov-
erage is provided for secondary consultations by spe-
cialists in the appropriate medical fields (including
pathology, radiology, and oncology) to confirm or re-
fute such diagnosis. Such plan or issuer shall ensure
that full coverage is provided for such secondary
consultation whether such consultation is based on a
positive or negative initial diagnosis. In any case in
which the attending physician certifies in writing
that services necessary for such a secondary con-
sultation are not sufficiently available from special-
ists operating under the plan with respect to whose
services coverage is otherwise provided under such
plan or by such issuer, such plan or issuer shall en-
sure that coverage is provided with respect to the
services necessary for the secondary consultation
with any other specialist selected by the attending
physician for such purpose at no additional cost to
the individual beyond that which the individual
would have paid if the specialist was participating in
the network of the plan.
‘‘(2) EXCEPTION.—Nothing in paragraph (1)
shall be construed as requiring the provision of sec-
ondary consultations where there is a financial rela-
tionship (including an ownership or investment in-
terest or compensation arrangement) between the
specialist and the attending physician or where the
patient determines not to seek such a consultation.
‘‘(e) PROHIBITION ON PENALTIES OR INCENTIVES.—
A group health plan, and a health insurance issuer pro-
viding health insurance coverage in connection with a
group health plan, may not—
‘‘(1) penalize or otherwise reduce or limit the
reimbursement of a provider or specialist because
the provider or specialist provided care to a partici-
pant or beneficiary in accordance with this section;
‘‘(2) provide financial or other incentives to a
physician or specialist to induce the physician or
specialist to keep the length of inpatient stays of pa-
tients following a mastectomy, lumpectomy, or a
lymph node dissection for the treatment of breast
cancer below certain limits or to limit referrals for
secondary consultations; or
‘‘(3) provide financial or other incentives to a
physician or specialist to induce the physician or
specialist to refrain from referring a participant or
beneficiary for a secondary consultation that would
otherwise be covered by the plan or coverage in-
volved under subsection (d).
‘‘(f) EXCEPTION
FOR HEALTH INSURANCE COV-
ERAGE 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) of the Public Health Service Act)
for a State that regulates such coverage that is de-
scribed 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) CONFORMING AMENDMENT.—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’’.
(c) EFFECTIVE DATES.—
(1) IN GENERAL.—The amendments made by
this section shall apply to group health plans for
plan years beginning on or after the date of enact-
ment of this Act.
(2) SPECIAL
RULE
FOR
COLLECTIVE
BAR-
GAINING
AGREEMENTS.—In the case of a group
health plan maintained pursuant to 1 or more collec-
tive bargaining agreements between employee rep-
resentatives and 1 or more employers ratified before
the date of enactment of this Act, the amendments
made by this section shall not apply to plan years
beginning before the later of—
(A) the date on which the last collective
bargaining agreements relating to the plan ter-
minates (determined without regard to any ex-
tension thereof agreed to after the date of en-
actment of this Act), or
(B) January 1, 2002.
For purposes of subparagraph (A), any plan amend-
ment made pursuant to a collective bargaining
agreement relating to the plan which amends the
plan solely to conform to any requirement added by
this section shall not be treated as a termination of
such collective bargaining agreement.
SEC. 4. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT
RELATING TO THE INDIVIDUAL MARKET.
(a) IN GENERAL.—Subpart 3 of part B of title
XXVII of the Public Health Service Act is amended by
adding at the end the following new section:
‘‘SEC. 2753. REQUIRED COVERAGE FOR MINIMUM HOSPITAL
STAY FOR MASTECTOMIES AND LYMPH NODE
DISSECTIONS 
FOR 
THE 
TREATMENT 
OF
BREAST 
CANCER 
AND 
SECONDARY 
CON-
SULTATIONS.
‘‘(a) IN GENERAL.—The provisions of section 2707
(other than subsection (c)) shall apply to health insurance
coverage offered by a health insurance issuer in the indi-
vidual market in the same manner as they apply 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) REQUIREMENT.—A health insurance issuer
under this part shall comply with the notice requirement
under section 714(c) of the Employee Retirement Income
Security Act of 1974 with respect to the requirements re-
ferred to in subsection (a) as if such section applied to
such issuer and such issuer were a group health plan.
‘‘(c) EXCEPTION
FOR HEALTH INSURANCE COV-
ERAGE 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) of the Public Health Service Act)
for a State that regulates such coverage that is de-
scribed 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).’’.
(b) CONFORMING AMENDMENT.—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 DATE.—The amendments made by
this section shall apply with respect to health insurance
coverage offered, sold, issued, renewed, in effect, or oper-
ated in the individual market on or after the date of enact-
ment of this Act.
SEC. 5. AMENDMENTS TO THE INTERNAL REVENUE CODE
OF 1986.
(a) IN GENERAL.—Subchapter B of chapter 100 of
the Internal Revenue Code of 1986 (relating to other re-
quirements) is amended by inserting after section 9812
the following new section:
‘‘SEC. 9813. REQUIRED COVERAGE FOR MINIMUM HOSPITAL
STAY FOR MASTECTOMIES AND LYMPH NODE
DISSECTIONS 
FOR 
THE 
TREATMENT 
OF
BREAST CANCER AND COVERAGE FOR SEC-
ONDARY CONSULTATIONS.
‘‘(a) INPATIENT CARE.—
‘‘(1) IN GENERAL.—A group health plan that
provides medical and surgical benefits shall ensure
that inpatient coverage with respect to the surgical
treatment of breast cancer (including a mastectomy,
lumpectomy, or lymph node dissection for the treat-
ment of breast cancer) is provided for a period of
time as is determined by the attending physician, in
the physician’s professional judgment consistent with
generally accepted principles of professional medical
practice, in consultation with the patient, to be
medically necessary or appropriate.
‘‘(2) EXCEPTION.—Nothing in this section shall
be construed as requiring the provision of inpatient
coverage if the attending physician in consultation
with the patient determines that a shorter period of
hospital stay is medically necessary or appropriate.
‘‘(b) PROHIBITION ON CERTAIN MODIFICATIONS.—
In implementing the requirements of this section, a group
health plan may not modify the terms and conditions of
coverage based on the determination by a participant or
beneficiary to request less than the minimum coverage re-
quired under subsection (a).
‘‘(c) SECONDARY CONSULTATIONS.—
‘‘(1) IN GENERAL.—A group health plan that
provides coverage with respect to medical and sur-
gical services provided in relation to the diagnosis
and treatment of cancer shall ensure that full cov-
erage is provided for secondary consultations by spe-
cialists in the appropriate medical fields (including
pathology, radiology, and oncology) to confirm or re-
fute such diagnosis. Such plan or issuer shall ensure
that full coverage is provided for such secondary
consultation whether such consultation is based on a
positive or negative initial diagnosis. In any case in
which the attending physician certifies in writing
that services necessary for such a secondary con-
sultation are not sufficiently available from special-
ists operating under the plan with respect to whose
services coverage is otherwise provided under such
plan or by such issuer, such plan or issuer shall en-
sure that coverage is provided with respect to the
services necessary for the secondary consultation
with any other specialist selected by the attending
physician for such purpose at no additional cost to
the individual beyond that which the individual
would have paid if the specialist was participating
in the network of the plan.
‘‘(2) EXCEPTION.—Nothing in paragraph (1)
shall be construed as requiring the provision of sec-
ondary consultations where there is a financial rela-
tionship (including an ownership or investment in-
terest or compensation arrangement) between the
specialist and the attending physician or where the
patient determines not to seek such a consultation.
‘‘(d) PROHIBITION ON PENALTIES.—A group health
plan may not—
‘‘(1) penalize or otherwise reduce or limit the
reimbursement of a provider or specialist because
the provider or specialist provided care to a partici-
pant or beneficiary in accordance with this section;
‘‘(2) provide financial or other incentives to a
physician or specialist to induce the physician or
specialist to keep the length of inpatient stays of pa-
tients following a mastectomy, lumpectomy, or a
lymph node dissection for the treatment of breast
cancer below certain limits or to limit referrals for
secondary consultations; or
‘‘(3) provide financial or other incentives to a
physician or specialist to induce the physician or
specialist to refrain from referring a participant or
beneficiary for a secondary consultation that would
otherwise be covered by the plan involved under sub-
section (d).
‘‘(e) EXCEPTION
FOR HEALTH INSURANCE COV-
ERAGE IN CERTAIN STATES.—The requirements of this
section shall not apply with respect to health insurance
coverage if there is a State law (including a decision, rule,
regulation, or other State action having the effect of law)
for a State that regulates such coverage that is described
in any of the following paragraphs:
‘‘(1) Such State law requires such coverage to
provide for at least a 48-hour hospital length of stay
following a mastectomy performed for treatment of
breast cancer and at least a 24-hour hospital length
of stay following a lymph node dissection for treat-
ment of breast cancer.
‘‘(2) Such State law requires, in connection
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.’’.
(b) CLERICAL AMENDMENT.—The table of sections
for such subchapter is amended by adding at the end the
following new item:
‘‘Sec. 9813. Required coverage for minimum hospital stay for mastectomies and
lymph node dissections for the treatment of breast cancer and
coverage for secondary consultations.’’.
(c) EFFECTIVE DATES.—
(1) IN GENERAL.—The amendments made by
this section shall apply with respect to plan years be-
ginning on or after the date of enactment of this
Act.
(2) SPECIAL
RULE
FOR
COLLECTIVE
BAR-
GAINING
AGREEMENTS.—In the case of a group
health plan maintained pursuant to 1 or more collec-
tive bargaining agreements between employee rep-
resentatives and 1 or more employers ratified before
the date of enactment of this Act, the amendments
made by this section shall not apply to plan years
beginning before the later of—
(A) the date on which the last collective
bargaining agreements relating to the plan ter-
minates (determined without regard to any ex-
tension thereof agreed to after the date of en-
actment of this Act), or
(B) January 1, 2002.
For purposes of subparagraph (A), any plan amend-
ment made pursuant to a collective bargaining
agreement relating to the plan which amends the
plan solely to conform to any requirement added by
this section shall not be treated as a termination of
such collective bargaining agreement.
SEC. 6. COORDINATION OF ADMINISTRATION.
The Secretary of Labor, the Secretary of the Treas-
ury, and the Secretary of Health and Human Services
shall ensure, through the execution of an interagency
memorandum of understanding among such Secretaries,
that—
(1) regulations, rulings, and interpretations
issued by such Secretaries relating to the same mat-
ter over which two or more such Secretaries have re-
sponsibility under the provisions of this Act (and the
amendments made thereby) are administered so as
to have the same effect at all times; and
(2) coordination of policies relating to enforcing
the same requirements through such Secretaries in
order to have a coordinated enforcement strategy
that avoids duplication of enforcement efforts and
assigns priorities in enforcement.
Æ