An Act To Assist Persons with Breast Cancer
Maine Legislature, Session 127, LD 0359
Committee: Insurance and Financial Services
Sponsors: LONGSTAFF, BREEN, BECK, BROOKS, DUNPHY, ESPLING, LUCHINI, NADEAU, SAUCIER, ALFOND
Amends: 24 MRSA §2320-C, 24-A MRSA §2745-C, 24-A MRSA §2837-C, 24-A MRSA §4237

Legislative Document 
No. 359 
H.P. 246 
House of Representatives, February 12, 2015 
An Act To Assist Persons with Breast Cancer 
Reference to the Committee on Insurance and Financial Services suggested and ordered 
printed. 
ROBERT B. HUNT 
Clerk 
Presented by Representative LONGSTAFF of Waterville. 
Cosponsored by Senator BREEN of Cumberland and 
Representatives: BECK of Waterville, BROOKS of Lewiston, DUNPHY of Old Town, 
ESPLING of New Gloucester, LUCHINI of Ellsworth, NADEAU of Winslow, SAUCIER of 
Presque Isle, Senator: ALFOND of Cumberland. 
Be it enacted by the People of the State of Maine as follows: 
Sec. 1.  24 MRSA §2320-C, sub-§1, as enacted by PL 1997, c. 408, §2 and 
affected by §8, is amended to read: 
1.  Inpatient 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 hospital stay of no less than 48 hours insofar as the attending 
physician, in consultation with the patient, determines it to be medically appropriate 
following a mastectomy, or a lumpectomy or for a hospital stay of no less than 24 hours 
insofar as the attending physician, in consultation with the patient, determines it to be 
medically appropriate following 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 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 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 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. 
Sec. 2.  24-A MRSA §2745-C, sub-§1, as enacted by PL 1997, c. 408, §4 and 
affected by §8, is amended to read: 
1.  Inpatient care. All individual 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 determined by hospital stay of no less than 48 
hours insofar as the attending physician, in consultation with the patient, determines it to 
be medically appropriate following a mastectomy, or a lumpectomy or for a hospital stay 
of no less than 24 hours insofar as the attending physician, in consultation with the 
patient, determines it to be medically appropriate following 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 health policy 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 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. 
Sec. 3.  24-A MRSA §2837-C, sub-§1, 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 determined by hospital stay of no less than 48 
hours insofar as the attending physician, in consultation with the patient, determines it to 
be medically appropriate following a mastectomy, or a lumpectomy or for a hospital stay 
of no less than 24 hours insofar as the attending physician, in consultation with the 
patient, determines it to be medically appropriate following 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, a group health policy 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 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 information packet sent to the enrollee, whichever is earlier. 
Sec. 4.  24-A MRSA §4237, sub-§1, as enacted 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 benefits must ensure that inpatient coverage 
with respect to the treatment of breast cancer is provided for a period of time determined 
by hospital stay of no less than 48 hours insofar as the attending physician, in 
consultation with the patient, determines it to be medically appropriate following a 
mastectomy, or a lumpectomy or for a hospital stay of no less than 24 hours insofar as the 
attending physician, in consultation with the patient, determines it to be medically 
appropriate following 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 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. 
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 of the contract date. 
SUMMARY 
This bill provides that individual and group health insurance policies must ensure that 
inpatient coverage with respect to breast cancer treatment is provided for a hospital stay 
of no less than 48 hours insofar as the attending physician, in consultation with the 
patient, determines it to be medically appropriate following a mastectomy or lumpectomy 
or of no less than 24 hours following a lymph node dissection. Under current law, the 
minimum hospital stay is not prescribed but must be provided for a period of time 
determined to be medically appropriate by the attending physician in consultation with 
the patient.