IB 
Union Calendar No. 564 
110TH CONGRESS 
2D SESSION 
H. R. 758 
[Report No. 110–868, Part I] 
To require that health plans provide coverage for a minimum hospital stay 
for mastectomies, lumpectomies, and lymph node dissection for the treat-
ment of breast cancer and coverage for secondary consultations. 
IN THE HOUSE OF REPRESENTATIVES 
JANUARY 31, 2007 
Ms. DELAURO (for herself, Mr. ACKERMAN, Mr. ALLEN, Mr. BACA, Ms. 
BALDWIN, Ms. BERKLEY, Mr. BERMAN, Mr. BERRY, Mr. BISHOP of 
Georgia, Mr. BISHOP of New York, Mr. BLUMENAUER, Ms. BORDALLO, 
Mr. BOSWELL, Mr. BOUCHER, Mr. BURTON of Indiana, Mr. CAPUANO, 
Ms. CARSON, Mr. CHANDLER, Mrs. CHRISTENSEN, Mr. CLAY, Mr. 
CLEAVER, Mr. CONYERS, Mr. COOPER, Mr. CROWLEY, Mrs. JO ANN 
DAVIS of Virginia, Mr. LINCOLN DAVIS of Tennessee, Mrs. DAVIS of 
California, Mr. DEFAZIO, Ms. DEGETTE, Mr. DICKS, Mr. DINGELL, Mr. 
DOGGETT, Mr. DOYLE, Mr. EMANUEL, Mr. ENGEL, Ms. ESHOO, Mr. 
FARR, Mr. FATTAH, Mr. FRANK of Massachusetts, Mr. GERLACH, Mrs. 
GILLIBRAND, Mr. GONZALEZ, Mr. AL GREEN of Texas, Mr. GENE 
GREEN of Texas, Mr. GRIJALVA, Mr. GUTIERREZ, Mr. HALL of Texas, 
Ms. HARMAN, Mr. HIGGINS, Mr. HINCHEY, Mr. HINOJOSA, Ms. HIRONO, 
Mr. HOLDEN, Mr. HOLT, Ms. HOOLEY, Mr. INSLEE, Mr. ISRAEL, Mr. 
JACKSON of Illinois, Ms. JACKSON-LEE of Texas, Mr. JEFFERSON, Ms. 
EDDIE BERNICE JOHNSON of Texas, Mr. KANJORSKI, Mr. KENNEDY, 
Mr. KILDEE, Ms. KILPATRICK of Michigan, Mr. KIND, Mr. KUCINICH, 
Mr. LARSEN of Washington, Mr. LARSON of Connecticut, Ms. LEE, Mr. 
LEVIN, Mr. LEWIS of Georgia, Mr. LOBIONDO, Ms. ZOE LOFGREN of 
California, Mrs. LOWEY, Mr. LYNCH, Mrs. MALONEY of New York, Mr. 
MARKEY, Ms. MATSUI, Mrs. MCCARTHY of New York, Ms. MCCOLLUM 
of Minnesota, Mr. MCDERMOTT, Mr. MCGOVERN, Mr. MCHUGH, Mr. 
MCINTYRE, Mr. MCNULTY, Mr. MEEHAN, Ms. MILLENDER-MCDONALD, 
Mr. MILLER of North Carolina, Mr. GEORGE MILLER of California, Mr. 
MOORE of Kansas, Mr. MORAN of Virginia, Mrs. NAPOLITANO, Mr. 
OLVER, Mr. PAYNE, Mr. PRICE of North Carolina, Mr. REYES, Mr. 
ROSS, Mr. ROTHMAN, Ms. ROYBAL-ALLARD, Mr. RYAN of Ohio, Ms. 
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LINDA T. SA´NCHEZ of California, Ms. SCHAKOWSKY, Mr. SCHIFF, Mr. 
SCOTT of Georgia, Mr. SCOTT of Virginia, Mr. SERRANO, Mr. SHAYS, Mr. 
SHERMAN, Ms. SLAUGHTER, Ms. SOLIS, Mr. SPRATT, Mr. STARK, Mr. 
STUPAK, Mrs. TAUSCHER, Mr. TAYLOR, Mr. THOMPSON of California, 
Mr. TIERNEY, Mr. TOWNS, Mr. UDALL of Colorado, Ms. VELA´ZQUEZ, 
Ms. WASSERMAN SCHULTZ, Mr. WEINER, Mr. WOLF, Ms. WOOLSEY, Mr. 
WYNN, Mr. CARNEY, and Mr. WEXLER) introduced the following bill; 
which was referred to the Committee on Energy and Commerce, and in 
addition to the Committees on Ways and Means and Education and 
Labor, for a period to be subsequently determined by the Speaker, in 
each case for consideration of such provisions as fall within the jurisdic-
tion of the committee concerned 
SEPTEMBER 23, 2008 
Reported from the Committee on Committee on Energy and Commerce with 
an amendment 
[Strike out all after the enacting clause and insert the part printed in italic] 
SEPTEMBER 23, 2008 
Additional sponsors: Mrs. BOYDA of Kansas, Mr. WATT, Mr. VAN HOLLEN, 
Mr. MELANCON, Mr. ETHERIDGE, Mr. PASCRELL, Mr. MACK, Mr. OBER-
STAR, Mr. GILCHREST, Mr. FRELINGHUYSEN, Mrs. CAPPS, Mr. WAMP, 
Ms. KAPTUR, Mr. COHEN, Ms. ROS-LEHTINEN, Mr. LOEBSACK, Mr. PAS-
TOR, Mr. MICHAUD, Mr. ALTMIRE, Mr. UPTON, Mr. FORTUN˜O, Mr. ED-
WARDS, Mr. GORDON of Tennessee, Mr. SNYDER, Mr. SAXTON, Mr. 
KAGEN, Mr. SMITH of Washington, Mr. ELLISON, Ms. MOORE of Wis-
consin, Mr. PETERSON of Minnesota, Mr. CARDOZA, Mr. ALEXANDER, 
Mr. HASTINGS of Florida, Mr. CUMMINGS, Mr. RUPPERSBERGER, Mr. 
COURTNEY, Mr. MORAN of Kansas, Mr. BARROW, Mr. DELAHUNT, Mr. 
ISSA, Mr. ABERCROMBIE, Mr. MURPHY of Connecticut, Mr. SPACE, Mr. 
LANGEVIN, Mr. BOREN, Ms. NORTON, Mr. MEEKS of New York, Mr. 
RANGEL, Mr. NADLER, Mr. MCCOTTER, Mr. ENGLISH of Pennsylvania, 
Mr. MURTHA, Mr. ORTIZ, Mr. WALSH of New York, Mr. DAVIS of Ken-
tucky, Mr. BOYD of Florida, Mr. BRADY of Pennsylvania, Mr. LANTOS, 
Mr. SKELTON, Mr. SALAZAR, Mr. MCNERNEY, Mr. BAIRD, Mr. LEWIS 
of Kentucky, Mr. COSTELLO, Mr. FILNER, Mr. GOODE, Mrs. JONES of 
Ohio, Mr. JONES of North Carolina, Mr. SESTAK, Mr. HARE, Mr. RUSH, 
Mr. HONDA, Mr. ROGERS of Michigan, Mr. LATHAM, Mr. RODRIGUEZ, 
Mr. PLATTS, Ms. SCHWARTZ, Mrs. MYRICK, Ms. CASTOR, Mr. SIRES, Ms. 
HERSETH SANDLIN, Ms. CLARKE, Mr. BECERRA, Ms. WATSON, Mr. 
BUTTERFIELD, Mr. WELCH of Vermont, Ms. SUTTON, Mr. CUELLAR, Ms. 
BEAN, Ms. TSONGAS, Mr. WITTMAN of Virginia, Mr. CARSON, Mr. SAR-
BANES, Mr. ROSKAM, Mr. SOUDER, and Ms. SHEA-PORTER 
SEPTEMBER 23, 2008 
Committees on Ways and Means and Education and Labor discharged; com-
mitted to the Committee of the Whole House on the State of the Union 
and ordered to be printed 
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[For text of introduced bill, see copy of bill as introduced on January 31, 2007] 
A BILL 
To require that health plans provide coverage for a minimum 
hospital stay for mastectomies, lumpectomies, 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 ‘‘Breast Cancer Patient 
Protection Act of 2008’’. 
SEC. 2. FINDINGS. 
Congress finds that— 
(1) the offering and operation of health plans af-
fect commerce among the States; 
(2) health care providers located in a State serve 
patients who reside in the State and patients who re-
side in other States; 
(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; 
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(4) currently, 20 States mandate minimum hos-
pital stay coverage after a patient undergoes a mas-
tectomy; 
(5) according to the American Cancer Society, 
there were 40,954 deaths due to breast cancer in 
women in 2004; 
(6) according to the American Cancer Society, 
there are currently over 2.0 million women living in 
the United States who have been treated for breast 
cancer; and 
(7) according to the American Cancer Society, a 
woman in the United States has a 1 in 8 chance of 
developing invasive breast cancer in her lifetime. 
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.) is amended by adding at 
the end the following: 
‘‘SEC. 714. REQUIRED COVERAGE FOR MINIMUM HOSPITAL 
STAY FOR MASTECTOMIES, LUMPECTOMIES, 
AND LYMPH NODE DISSECTIONS FOR THE 
TREATMENT OF BREAST CANCER AND COV-
ERAGE FOR SECONDARY CONSULTATIONS. 
‘‘(a) INPATIENT CARE.— 
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‘‘(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 ensure 
that inpatient (and in the case of a lumpectomy, out-
patient) coverage and radiation therapy is provided 
for breast cancer treatment. Such plan or coverage 
may not— 
‘‘(A) except as provided for in paragraph 
(2)— 
‘‘(i) restrict benefits for any hospital 
length of stay in connection with a mastec-
tomy or breast conserving surgery (such as 
a lumpectomy) 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)). 
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‘‘(2) EXCEPTION.—Nothing in this section shall 
be construed as requiring the provision of inpatient 
coverage if the attending physician and patient deter-
mine that either a shorter period of hospital stay, or 
outpatient treatment, 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 re-
quest less than the minimum coverage required under sub-
section (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 regarding 
the coverage required by this section in accordance with reg-
ulations promulgated by the Secretary. Such notice 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; or 
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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 pro-
viding health insurance coverage in connection with a 
group health plan, may not— 
‘‘(1) penalize or otherwise reduce or limit the re-
imbursement of a provider or specialist because the 
provider or specialist provided care to a participant 
or beneficiary in accordance with this section; 
‘‘(2) provide financial or other incentives to a 
physician or specialist to induce the physician or spe-
cialist to keep the length of inpatient stays of patients 
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; 
‘‘(3) provide financial or other incentives to a 
physician or specialist to induce the physician or spe-
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cialist to refrain from referring a participant or bene-
ficiary for a secondary consultation that would other-
wise be covered by the plan or coverage involved 
under subsection (d); or 
‘‘(4) deny to a woman eligibility, or continued 
eligibility, to enroll or to renew coverage under the 
terms of the plan or coverage solely for the purpose 
of avoiding the requirements of this section.’’. 
(b) CLERICAL AMENDMENT.—The table of contents in 
section 1 of the Employee Retirement Income Security Act 
of 1974 is amended by inserting after the item relating to 
section 713 the following: 
‘‘Sec. 714. Required coverage for minimum hospital stay for mastectomies, 
lumpectomies, 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 that is 90 days after the 
date of enactment of this Act. 
(2) SPECIAL RULE FOR COLLECTIVE BARGAINING 
AGREEMENTS.—In the case of a group health plan 
maintained pursuant to 1 or more collective bar-
gaining agreements between employee representatives 
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 
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the date on which the last collective bargaining agree-
ments relating to the plan terminates (determined 
without regard to any extension thereof agreed to 
after the date of enactment of this Act). For purposes 
of this paragraph, any plan amendment made pursu-
ant 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) IN GENERAL.—Subpart 2 of part A of title XXVII 
of the Public Health Service Act (42 U.S.C. 300gg–4 et seq.) 
is amended by adding at the end the following: 
‘‘SEC. 2707. REQUIRED COVERAGE FOR MINIMUM HOSPITAL 
STAY FOR MASTECTOMIES, LUMPECTOMIES, 
AND LYMPH NODE DISSECTIONS FOR THE 
TREATMENT OF BREAST CANCER AND COV-
ERAGE FOR SECONDARY 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 ensure 
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that inpatient (and in the case of a lumpectomy, out-
patient) coverage and radiation therapy is provided 
for breast cancer treatment. Such plan or coverage 
may not— 
‘‘(A) insofar as the attending physician, in 
consultation with the patient, determines it to be 
medically necessary— 
‘‘(i) restrict benefits for any hospital 
length of stay in connection with a mastec-
tomy or breast conserving surgery (such as 
a lumpectomy) 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 this 
paragraph. 
‘‘(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 either a shorter pe-
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riod of hospital stay, or outpatient treatment, 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 re-
quest less than the minimum coverage required under sub-
section (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 regarding 
the coverage required by this section in accordance with reg-
ulations promulgated by the Secretary. Such notice 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; or 
‘‘(2) as part of any yearly informational packet 
sent to the participant or beneficiary; 
whichever is earlier. 
‘‘(d) SECONDARY CONSULTATIONS.— 
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‘‘(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 coverage 
is provided for secondary consultations by specialists 
in the appropriate medical fields (including pathol-
ogy, radiology, and oncology) to confirm or refute 
such diagnosis. Such plan or issuer shall ensure that 
full coverage is provided for such secondary consulta-
tion whether such consultation is based on a positive 
or negative initial diagnosis. In any case in which 
the attending physician certifies in writing that serv-
ices necessary for such a secondary consultation are 
not sufficiently available from specialists 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 ensure 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. 
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‘‘(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 pro-
viding health insurance coverage in connection with a 
group health plan, may not— 
‘‘(1) penalize or otherwise reduce or limit the re-
imbursement of a provider or specialist because the 
provider or specialist provided care to a participant 
or beneficiary in accordance with this section; 
‘‘(2) provide financial or other incentives to a 
physician or specialist to induce the physician or spe-
cialist to keep the length of inpatient stays of patients 
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; 
‘‘(3) provide financial or other incentives to a 
physician or specialist to induce the physician or spe-
cialist to refrain from referring a participant or bene-
ficiary for a secondary consultation that would other-
wise be covered by the plan or coverage involved 
under subsection (d); or 
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‘‘(4) deny to a woman eligibility, or continued 
eligibility, to enroll or to renew coverage under the 
terms of the plan or coverage solely for the purpose 
of avoiding the requirements of this section.’’. 
(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 90 days after the date of 
enactment of this Act. 
(2) SPECIAL RULE FOR COLLECTIVE BARGAINING 
AGREEMENTS.—In the case of a group health plan 
maintained pursuant to 1 or more collective bar-
gaining agreements between employee representatives 
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 date on which the last collective bargaining agree-
ments relating to the plan terminates (determined 
without regard to any extension thereof agreed to 
after the date of enactment of this Act). For purposes 
of this paragraph, any plan amendment made pursu-
ant 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 
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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 2 of part B of title XXVII 
of the Public Health Service Act (42 U.S.C. 300gg–51 et 
seq.) is amended by adding at the end the following new 
section: 
‘‘SEC. 2754. REQUIRED COVERAGE FOR MINIMUM HOSPITAL 
STAY FOR MASTECTOMIES, LUMPECTOMIES, 
AND LYMPH NODE DISSECTIONS FOR THE 
TREATMENT OF BREAST CANCER AND SEC-
ONDARY CONSULTATIONS. 
‘‘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 operated in the 
individual market on or after the date of enactment of this 
Act. 
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SEC. 6. AMENDMENTS TO THE INTERNAL REVENUE CODE 
OF 1986. 
(a) IN GENERAL.—Subchapter B of chapter 100 of the 
Internal Revenue Code of 1986 is amended— 
(1) in the table of sections, by inserting after the 
item relating to section 9812 the following: 
‘‘Sec. 9813. Required coverage for minimum hospital stay for mastectomies, 
lumpectomies, and lymph node dissections for the treatment of 
breast cancer and coverage for secondary consultations.’’; 
and 
(2) by inserting after section 9812 the following: 
‘‘SEC. 9813. REQUIRED COVERAGE FOR MINIMUM HOSPITAL 
STAY FOR MASTECTOMIES, LUMPECTOMIES, 
AND LYMPH NODE DISSECTIONS FOR THE 
TREATMENT OF BREAST CANCER AND COV-
ERAGE FOR SECONDARY CONSULTATIONS. 
‘‘(a) INPATIENT CARE.— 
‘‘(1) IN GENERAL.—A group health plan that 
provides medical and surgical benefits shall ensure 
that inpatient (and in the case of a lumpectomy, out-
patient) coverage and radiation therapy is provided 
for breast cancer treatment. Such plan may not— 
‘‘(A) except as provided for in paragraph 
(2)— 
‘‘(i) restrict benefits for any hospital 
length of stay in connection with a mastec-
tomy or breast conserving surgery (such as 
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a lumpectomy) 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 for prescribing any length 
of stay required under subparagraph (A) (with-
out regard to paragraph (2)). 
‘‘(2) EXCEPTION.—Nothing in this section shall 
be construed as requiring the provision of inpatient 
coverage if the attending physician and patient deter-
mine that either a shorter period of hospital stay, or 
outpatient treatment, 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 
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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; or 
‘‘(2) as part of any yearly informational packet 
sent to the participant or beneficiary; 
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 coverage 
is provided for secondary consultations by specialists 
in the appropriate medical fields (including pathol-
ogy, radiology, and oncology) to confirm or refute 
such diagnosis. Such plan or issuer shall ensure that 
full coverage is provided for such secondary consulta-
tion whether such consultation is based on a positive 
or negative initial diagnosis. In any case in which 
the attending physician certifies in writing that serv-
ices necessary for such a secondary consultation are 
not sufficiently available from specialists operating 
under the plan with respect to whose services coverage 
is otherwise provided under such plan or by such 
VerDate Aug 31 2005 
04:16 Sep 24, 2008
Jkt 069200
PO 00000
Frm 00019
Fmt 6652
Sfmt 6203
E:\BILLS\H758.RH
H758
jbell on PROD1PC69 with BILLS