I
106TH CONGRESS
1ST SESSION H. R. 383
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
JANUARY 19, 1999
Mrs. 
KELLY introduced the following bill; which was referred to the Com-
mittee on Commerce, and in addition to the Committees on Ways and
Means, and Education and the Workforce, for a period to be subsequently
determined by the Speaker, in each case for consideration of such provi-
sions as fall within the jurisdiction of the committee concerned
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
secondary 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 Health and
Cancer Rights Act of 1999’’.
SEC. 2. FINDINGS.
Congress finds that—
(1) the offering and operation of health plans
affect commerce among the States;
(2) health care providers located in a State
serve patients who reside in the State and patients
who reside in other States; and
(3) in order to provide for uniform treatment of
health care providers and patients among the States,
it is necessary to cover health plans operating in 1
State as well as health plans operating among the
several States.
SEC. 3. 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 (29 U.S.C. 1185 et seq.), as amended by sec-
tion 902(a) of the Women’s Health and Cancer Rights Act
of 1998, is amended by inserting after section 713 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
treatment of breast cancer is provided for a period
of time as is determined by the attending physician,
in consultation with the patient, to be medically ap-
propriate following—
‘‘(A) a mastectomy;
‘‘(B) a lumpectomy; or
‘‘(C) a lymph node dissection for the treat-
ment of breast cancer.
‘‘(2) EXCEPTION.—Nothing in this section shall
be construed as requiring the provision of inpatient
coverage if the attending physician and patient de-
termine that a shorter period of hospital stay is
medically 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.—A group health plan, and a health in-
surance issuer providing health insurance coverage in con-
nection with a group health plan shall provide notice to
each participant and beneficiary under such plan regard-
ing the coverage required by this section in accordance
with regulations promulgated by the Secretary. Such no-
tice shall be in writing and prominently positioned in any
literature or correspondence made available or distributed
by the plan or issuer and shall be transmitted—
‘‘(1) in the next mailing made by the plan or
issuer to the participant or beneficiary;
‘‘(2) as part of any yearly informational packet
sent to the participant or beneficiary; or
‘‘(3) not later than January 1, 2000;
whichever is earlier.
‘‘(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 the patient determines
not to seek such a consultation.
‘‘(e) PROHIBITION ON PENALTIES OR INCENTIVES.—
A group health plan, and a health insurance issuer provid-
ing 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).’’.
(b) CLERICAL AMENDMENT.—The table of contents
in section 1 of the Employee Retirement Income Security
Act of 1974 (29 U.S.C. 1001 note), as amended by section
902(b) of the Women’s Health and Cancer Rights Act of
1998, 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.
(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 BARGAIN-
ING AGREEMENTS.—In the case of a group health
plan maintained pursuant to 1 or more collective
bargaining agreements between employee representa-
tives 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 begin-
ning 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, 2000.
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. AMENDMENTS TO THE PUBLIC HEALTH SERVICE
ACT RELATING TO THE GROUP MARKET.
(a) GROUP MARKET.—Subpart 2 of part A of title
XXVII of the Public Health Service Act (42 U.S.C.
300gg–4 et seq.), as amended by section 903(a) of the
Women’s Health and Cancer Rights Act of 1998, is
amended by inserting after section 2706 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
treatment of breast cancer is provided for a period
of time as is determined by the attending physician,
in consultation with the patient, to be medically ap-
propriate following—
‘‘(A) a mastectomy;
‘‘(B) a lumpectomy; or
‘‘(C) a lymph node dissection for the treat-
ment of breast cancer.
‘‘(2) EXCEPTION.—Nothing in this section shall
be construed as requiring the provision of inpatient
coverage if the attending physician and patient de-
termine that a shorter period of hospital stay is
medically 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.—A group health plan, and a health in-
surance issuer providing health insurance coverage in con-
nection with a group health plan shall provide notice to
each participant and beneficiary under such plan regard-
ing the coverage required by this section in accordance
with regulations promulgated by the Secretary. Such no-
tice shall be in writing and prominently positioned in any
literature or correspondence made available or distributed
by the plan or issuer and shall be transmitted—
‘‘(1) in the next mailing made by the plan or
issuer to the participant or beneficiary;
‘‘(2) as part of any yearly informational packet
sent to the participant or beneficiary; or
‘‘(3) not later than January 1, 2000;
whichever is earlier.
‘‘(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 the patient determines
not to seek such a consultation.
‘‘(e) PROHIBITION ON PENALTIES OR INCENTIVES.—
A group health plan, and a health insurance issuer provid-
ing 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).’’.
(b) 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 BARGAIN-
ING AGREEMENTS.—In the case of a group health
plan maintained pursuant to 1 or more collective
bargaining agreements between employee representa-
tives 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 begin-
ning 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, 2000.
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. 5. 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 (42 U.S.C.
300gg–51 et seq.), as amended by section 903(b) of the
Women’s Health and Cancer Rights Act of 1998, is
amended by inserting after section 2752 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.
‘‘The provisions of section 2707 shall apply to health
insurance coverage offered by a health insurance issuer
in the individual 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) EFFECTIVE DATE.—The amendment 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. 6. AMENDMENTS TO THE INTERNAL REVENUE CODE
OF 1986.
(a) IN GENERAL.—Chapter 100 of the Internal Reve-
nue Code of 1986 (relating to group health plan port-
ability, access, and renewability requirements) is amended
by inserting after section 9803 the following new section:
‘‘SEC. 9804. 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 treatment
of breast cancer is provided for a period of time as
is determined by the attending physician, in con-
sultation with the patient, to be medically appro-
priate following—
‘‘(A) a mastectomy;
‘‘(B) a lumpectomy; or
‘‘(C) a lymph node dissection for the treat-
ment of breast cancer.
‘‘(2) EXCEPTION.—Nothing in this section shall
be construed as requiring the provision of inpatient
coverage if the attending physician and patient de-
termine that a shorter period of hospital stay is
medically 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) NOTICE.—A group health plan shall provide no-
tice to each participant and beneficiary under such plan
regarding the coverage required by this section in accord-
ance with regulations promulgated by the Secretary. Such
notice shall be in writing and prominently positioned in
any literature or correspondence made available or distrib-
uted by the plan and shall be transmitted—
‘‘(1) in the next mailing made by the plan to
the participant or beneficiary;
‘‘(2) as part of any yearly informational packet
sent to the participant or beneficiary; or
‘‘(3) not later than January 1, 2000;
whichever is earlier.
‘‘(d) 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 the patient determines
not to seek such a consultation.
‘‘(e) 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).’’.
(b) CONFORMING AMENDMENTS.—
(1) The heading for subtitle K of such Code is
amended to read as follows:
‘‘Subtitle K—Group Health Plan
Portability, Access, Renewabil-
ity, and Other Requirements’’.
(2) The heading for chapter 100 of such Code
is amended to read as follows:
‘‘CHAPTER 100—GROUP HEALTH PLAN PORT-
ABILITY, 
ACCESS, 
RENEWABILITY, 
AND
OTHER REQUIREMENTS’’.
(3) Section 4980D(a) of such Code is amended
by striking ‘‘and renewability’’ and inserting ‘‘renew-
ability, and other’’.
(c) CLERICAL AMENDMENTS.—
(1) The table of contents for chapter 100 of
such Code is amended by inserting after the item re-
lating to section 9803 the following new item:
‘‘Sec. 9804. Required coverage for minimum hospital stay for mastectomies and
lymph node dissections for the treatment of breast cancer, and
coverage for secondary consultations.
(2) The item relating to subtitle K in the table
of subtitles for such Code is amended by striking
‘‘and renewability’’ and inserting ‘‘renewability, and
other’’.
(3) The item relating to chapter 100 in the
table of chapters for subtitle K of such Code is
amended by striking ‘‘and renewability’’ and insert-
ing ‘‘renewability, and other’’.
(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 BARGAIN-
ING AGREEMENTS.—In the case of a group health
plan maintained pursuant to 1 or more collective
bargaining agreements between employee representa-
tives 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 begin-
ning 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, 2000.
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.
Æ