An Act To Assist Persons with Breast Cancer
Maine Legislature, Session 127, LD 0359
Senate Amendment SA_B_S144 (Senate)
Amends: 24 MRSA §2320-C, 24-A MRSA §2745-C, 24-A MRSA §2837-C, 24-A MRSA §4237

SENATE AMENDMENT" 6" to H.P. 246, L.n. 359, Bill, "An Act To Assist 
Persons with Breast Cancer" 
Amend the bill by striking out everything after the enacting clause and before the 
II 
summary and inserting the following: 
'Sec. 1. 24 MRSA §2320-C, sub-§l, as enacted by PL 1997, c. 408, §2 and 
affected by § 8, is amended to read: 
1. r npatient care. All individual and group nonprofit hospital and medical services 
plan contracts providing coverage for medical and surgical benefits must ensure that 
inpatient coverage with respect to the treatment of breast cancer is provided for a period 
of time determined by the attending physician, after providing notice to the patient 
regarding the coverage required by this subsection and in consultation with the patient, to 
be medically appropriate following a mastectomy, a lumpectomy or a lymph node 
dissection for the treatment of breast cancer. 
Nothing in this subsection may be construed to require the provision of inpatient 
coverage if the attending physician and patient determine that a shorter period of hospital 
stay is appropriate. 
In implementing the requirements of this subsection, an individual and group nonprofit 
hospital and medical services plan contract may not modify the tenus and conditions of 
coverage based on the detennination by any enrollee to request less than the minimum 
coverage required under this subsection. 
All individual and group nonprofit hospital and medical services plan contracts must 
provide written notice to each enrollee under the contract regarding the coverage required 
by this subsection. 
The notice must be prominently positioned in any literature or 
correspondence made available or distributed by the plan and must be transmitted in thc 
next mailing made by the plan to the enrollee or as part of any yearly infonuation packet 
sent to the enrollee, whichever is earlier. The notice must also be made available to any 
physician participating in the insurer's provider network. 
Sec. 2. 24-A MRSA §2745-C, sub-§l, as enacted by PL 1997, c. 408, §4 and 
affected by §8, is amended to read: 
SENA TE AMENDMENT 
SENATE AMENDMENT" C> "to H.P. 246, L.D. 359 
1. Inpatient care. All individual health policies providing covemge [or medical and 
surgical benefits, except accidental injUlY, specified disease, hospital indemnity, 
Medicare supplement, long-term care and other limited benefit health insurance policies 
and contracts, must ensure that inpatient coverage with respect to the treatment of breast 
cancer is provided for a pcriod of time detel111ined by the attending physician, after 
providing notice to the patient regarding the coverage required by this subsection and in 
consultation with the patient, to be medically appropriate following a mastectomy, a 
lumpectomy or a lymph node dissection for the treatment of breast cancer. 
Nothing in this subsection may be constmed to reqllire the provision of inpatient 
coverage if the attending physician and patient determine that a shorter period of hospital 
stay is appropriate. 
In implementing the requirements of this subsection, an individual health policy may not 
modify the tenus and conditions of coverage based on the detenuination by any enrollee 
to request less than the minimum coverage required under this subsection. 
All individual health policies must provide written notice to each enrollee under the 
contract regarding the coverage required by this subsection. 
The notice must be 
prominently positioned in any literature or correspondence made available or distributed 
by the plan and must be transmitted in the next mailing made by the plan to the enrollee 
or as part of any yearly information packet sent to the enrollee, whichever is earlier. The 
notice must also be made available to any physician participating in the insurer's provider 
network. 
Sec. 3. 24-A MRSA §2837-C, sub-§l, as enacted by PL 1997, c. 408, §6 and 
affected by §8, is amended to read: 
1. Inpatient care. All group health policies providing coverage for medical and 
surgical benefits, except accidental injury, specified disease, hospital indemnity, 
Medicare supplement, long-term care and other limited benefit health insurance policies 
and contracts, must ensure that inpatient coverage with respect to the treatment of breast 
cancer is provided for a period of time detenuined by the attending physician, after 
providing notice to the patient regarding the coverage required by this subsection and in 
consultation with the patient, to be medically appropriate following a mastectomy, a 
lumpectomyor a lymph node dissection for the treatment of breast cancer. 
Nothing in this subsection may be constmed to require the provision of inpatient 
coverage if the attending physician and patient detenuine that a shorter period of hospital 
stay is appropriate. 
In implementing the requirements of this subsection, a group health policy may not 
modify the tenus and conditions of coverage based on the detenuination by any enrollee 
to request less than the minimum coverage reqllired under this subsection. 
All group health policies must provide written notice to each enrollee under the contract 
regarding the coverage required by this subsection. 
The notice must be prominently 
positioned in any literature or correspondence made available or distributed by the plan 
and must be transmitted in the next mailing made by the plan to the enrollee or as part of 
any yearly infonuation packet sent to the enrollee, whichever is earlier. The notice must 
also be made available to any physician participating in the insurer's provider network. 
SENATE AMENDMENT 
SENATE AMENDMENT" 6" to H.P. 246, L,D. JS9 
Sec. 4. 24-A MRSA §4237, sub-§l, as cnacted by PL 1997, c. 408, §7 and 
affected by §8, is amended to read: 
1. Inpatient care. All individual and group coverage subject to this chapter that 
provides coverage for medical and surgical bcnefits must ensure that inpatient coverage 
with respect to the treatmcnt of breast cancer is provided for a period of time determined 
by the attending physician, after providing notice to the patient regarding the coverage 
required by this subsection and in consultation with the patient, to be medically 
appropriate following a mastectomy, a lumpectomy or a lymph node dissection for the 
treatment of breast cancer. 
Nothing in this subsection may be construed to require the provision of inpatient 
coverage if the attending physician and patient determine that a shorter period of hospital 
stay is appropriate. 
In implementing the requirements of this subsection, an individual or group coverage 
contract may not modify the terms and conditions of coverage based on the determination 
by any enrollee to request less than the minimum coverage required under this subsection. 
All individual and group coverage subject to this subsection must provide written notice 
to each enrollee under the contract regarding the coverage required by this subsection. 
The notice musl be prominently positioned in any literature or correspondence made 
available or distributed by the plan and must be transmitted in the next mailing made by 
the plan to the enrollee or as part of any yearly information packet sent to the cnrollee, 
whichever is earlier. 
The notice must also be made available to any physician 
participating in the insurer's provider network. 
Sec. 5. Application. The requirements of this Act apply to all policies, contracts 
and certificates executed, delivered, issued for delivery, continued or renewed in this 
State on or after January 1,2016. For purposes of this Act, all contracts are deemed to be 
renewed no later than the next yearly anniversary ofthe contract date.' 
SUMMARY 
This amendment strikes the bill and requires carriers to provide written notice 
regarding the requirements for inpatient coverage following treatment of breast cancer to 
physicians participating in the carrier's provider network and requiring attending 
physicians to provide a similar notice to patients when consulting with patients about 
breast cancer treatment. The amendment strikes the provisions in the bill requiring that 
inpatient coverage be provided for a hospital stay of no less than 48 hours following a 
mastectomy or lumpectomy or no less than 24 ours following a lymph node dissection. 
SPONSOREDBY:~~~~~~~~~~~~-L_ 
COUNTY: Somerset 
SENA TE AMENDMENT