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Q: SECTION 1. SHORT TITLE.

This Act may be cited as the ''Breast Cancer Patient Protection Act
of 1997''.

SEC. 2. COVERAGE OF MINIMUM HOSPITAL STAY FOR CERTAIN BREAST CANCER
TREATMENT.

(a) Group Health Plans.--
(1) Public health service act amendments.--
(A) In general.--Subpart 2 of part A of title XXVII
of the Public Health Service Act, as amended by section
703(a) of Public Law 104-204, is amended by adding at
the end the following new section:

''SEC. 2706. STANDARDS RELATING TO BENEFITS FOR CERTAIN BREAST CANCER
TREATMENT.

''(a) Requirements for Minimum Hospital Stay Following Mastectomy
or Lymph Node Dissection.--
''(1) In general.--A group health plan, and a health
insurance issuer offering group health insurance coverage, may
not--
''(A) except as provided in paragraph (2)--
''(i) restrict benefits for any hospital
length of stay in connection with a mastectomy
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 authorization
from the plan or the issuer for prescribing any length
of stay required under subparagraph (A) (without regard
to paragraph (2)).
''(2) Exception.--Paragraph (1)(A) shall not apply in
connection with any group health plan or health insurance
issuer in any case in which the decision to discharge the woman
involved prior to the expiration of the minimum length of stay
otherwise required under paragraph (1)(A) is made by an
attending provider in consultation with the woman.
''(b) Prohibitions.--A group health plan, and a health insurance
issuer offering group health insurance coverage in connection with a
group health plan, may not--
''(1) deny to a woman eligibility, or continued
eligibility, to enroll or to renew coverage under the terms of
the plan, solely for the purpose of avoiding the requirements
of this section;
''(2) provide monetary payments or rebates to women to
encourage such women to accept less than the minimum
protections available under this section;
''(3) penalize or otherwise reduce or limit the
reimbursement of an attending provider because such provider
provided care to an individual participant or beneficiary in
accordance with this section;
''(4) provide incentives (monetary or otherwise) to an
attending provider to induce such provider to provide care to
an individual participant or beneficiary in a manner
inconsistent with this section; or
''(5) subject to subsection (c)(3), restrict benefits for
any portion of a period within a hospital length of stay
required under subsection (a) in a manner which is less
favorable than the benefits provided for any preceding portion
of such stay.
''(c) Rules of Construction.--
''(1) Nothing in this section shall be construed to require
a woman who is a participant or beneficiary--
''(A) to undergo a mastectomy or lymph node
dissection in a hospital; or
''(B) to stay in the hospital for a fixed period of
time following a mastectomy or lymph node dissection.
''(2) This section shall not apply with respect to any
group health plan, or any group health insurance coverage
offered by a health insurance issuer, which does not provide
benefits for hospital lengths of stay in connection with a mastectomy
or lymph node dissection for the treatment of breast cancer.
''(3) Nothing in this section shall be construed as
preventing a group health plan or issuer from imposing
deductibles, coinsurance, or other cost-sharing in relation to
benefits for hospital lengths of stay in connection with a
mastectomy or lymph node dissection for the treatment of breast
cancer under the plan (or under health insurance coverage
offered in connection with a group health plan), except that
such coinsurance or other cost-sharing for any portion of a
period within a hospital length of stay required under
subsection (a) may not be greater than such coinsurance or
cost-sharing for any preceding portion of such stay.
''(d) Notice.--A group health plan under this part shall comply
with the notice requirement under section 713(d) 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.
''(e) Level and Type of Reimbursements.--Nothing in this section
shall be construed to prevent a group health plan or a health insurance
issuer offering group health insurance coverage from negotiating the
level and type of reimbursement with a provider for care provided in
accordance with this section.
''(f) Preemption; Exception for Health Insurance Coverage in
Certain States.--
''(1) In general.--The requirements of this section shall
not apply with respect to health insurance coverage if there is
a State law (as defined in section 2723(d)(1)) for a State that
regulates such coverage that is described in any of the
following subparagraphs:
''(A) 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 treatment of
breast cancer.
''(B) 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.
''(2) Construction.--Section 2723(a)(1) shall not be
construed as superseding a State law described in paragraph
(1).''.
(B) Conforming amendment.--Section 2723(c) of such
Act (42 U.S.C. 300gg-23(c)), as amended by section
604(b)(2) of Public Law 104-204, is amended by striking
''section 2704'' and inserting ''sections 2704 and
2706''.
(2) ERISA amendments.--
(A) In general.--Subpart B of part 7 of subtitle B
of title I of the Employee Retirement Income Security
Act of 1974, as amended by section 702(a) of Public Law
104-204, is amended by adding at the end the following
new section:

''SEC. 713. STANDARDS RELATING TO BENEFITS FOR CERTAIN BREAST CANCER
TREATMENT.

''(a) Requirements for Minimum Hospital Stay Following Mastectomy
or Lymph Node Dissection.--
''(1) In general.--A group health plan, and a health
insurance issuer offering group health insurance coverage, may
not--
''(A) except as provided in paragraph (2)--
''(i) restrict benefits for any hospital
length of stay in connection with a mastectomy
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 authorization
from the plan or the issuer for prescribing any length
of stay required under subparagraph (A) (without regard
to paragraph (2)).
''(2) Exception.--Paragraph (1)(A) shall not apply in
connection with any group health plan or health insurance
issuer in any case in which the decision to discharge the woman
involved prior to the expiration of the minimum length of stay
otherwise required under paragraph (1)(A) is made by an
attending provider in consultation with the woman.
''(b) Prohibitions.--A group health plan, and a health insurance
issuer offering group health insurance coverage in connection with a
group health plan, may not--
''(1) deny to a woman eligibility, or continued
eligibility, to enroll or to renew coverage under the terms of
the plan, solely for the purpose of avoiding the requirements of this
section;
''(2) provide monetary payments or rebates to women to
encourage such women to accept less than the minimum
protections available under this section;
''(3) penalize or otherwise reduce or limit the
reimbursement of an attending provider because such provider
provided care to an individual participant or beneficiary in
accordance with this section;
''(4) provide incentives (monetary or otherwise) to an
attending provider to induce such provider to provide care to
an individual participant or beneficiary in a manner
inconsistent with this section; or
''(5) subject to subsection (c)(3), restrict benefits for
any portion of a period within a hospital length of stay
required under subsection (a) in a manner which is less
favorable than the benefits provided for any preceding portion
of such stay.
''(c) Rules of Construction.--
''(1) Nothing in this section shall be construed to require
a woman who is a participant or beneficiary--
''(A) to undergo a mastectomy or lymph node
dissection in a hospital; or
''(B) to stay in the hospital for a fixed period of
time following a mastectomy or lymph node dissection.
''(2) This section shall not apply with respect to any
group health plan, or any group health insurance coverage
offered by a health insurance issuer, which does not provide
benefits for hospital lengths of stay in connection with a
mastectomy or lymph node dissection for the treatment of breast
cancer.
''(3) Nothing in this section shall be construed as
preventing a group health plan or issuer from imposing
deductibles, coinsurance, or other cost-sharing in relation to
benefits for hospital lengths of stay in connection with a
mastectomy or lymph node dissection for the treatment of breast
cancer under the plan (or under health insurance coverage
offered in connection with a group health plan), except that
such coinsurance or other cost-sharing for any portion of a
period within a hospital length of stay required under
subsection (a) may not be greater than such coinsurance or
cost-sharing for any preceding portion of such stay.
''(d) Notice Under Group Health Plan.--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 requirements under the plan;
except that the summary description required to be provided under the
last sentence of section 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.
''(e) Level and Type of Reimbursements.--Nothing in this section
shall be construed to prevent a group health plan or a health insurance
issuer offering group health insurance coverage from negotiating the
level and type of reimbursement with a provider for care provided in
accordance with this section.
''(f) Preemption; Exception for Health Insurance Coverage in
Certain States.--
''(1) In general.--The requirements of this section shall
not apply with respect to health insurance 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 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 treatment of
breast cancer.
''(B) 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.
''(2) Construction.--Section 731(a)(1) shall not be
construed as superseding a State law described in paragraph
(1).''.
(B) Conforming amendments.--
(i) Section 731(c) of such Act (29 U.S.C.
1191(c)), as amended by section 603(b)(1) of
Public Law 104-204, is amended by striking
''section 711'' and inserting ''sections 711
and 713''.
(ii) Section 732(a) of such Act (29 U.S.C.
1191a(a)), as amended by section 603(b)(2) of
Public Law 104-204, is amended by striking
''section 711'' and inserting ''sections 711
and 713''.
(iii) The table of contents in section 1 of
such Act is amended by inserting after the item
relating to section 712 the following new item:

''Sec. 713. Standards relating to benefits for certain breast cancer
treatment.''.
(b) Individual Health Insurance.--
(1) In general.--Part B of title XXVII of the Public Health
Service Act, as amended by section 605(a) of Public Law 104-
204, is amended by inserting after section 2751 the following
new section:

''SEC. 2752. STANDARDS RELATING TO BENEFITS FOR CERTAIN BREAST CANCER
TREATMENT.

''(a) In General.--The provisions of section 2706 (other than
subsection (d)) shall apply to health insurance coverage offered by a
health insurance issuer in the individual market in the same manner as
it applies 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) Notice.--A health insurance issuer under this part shall
comply with the notice requirement under section 713(d) of the Employee
Retirement Income Security Act of 1974 with respect to the requirements
referred to in subsection (a) as if such section applied to such issuer
and such issuer were a group health plan.
''(c) Preemption; Exception for Health Insurance Coverage in
Certain States.--
''(1) In general.--The requirements of this section shall
not apply with respect to health insurance coverage if there is
a State law (as defined in section 2723(d)(1)) for a State that
regulates such coverage that is described in any of the
following subparagraphs:
''(A) 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 treatment of
breast cancer.
''(B) 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.
''(2) Construction.--Section 2762(a) shall not be construed
as superseding a State law described in paragraph (1).''.
(2) Conforming amendment.--Section 2762(b)(2) of such Act
(42 U.S.C. 300gg-62(b)(2)), as added by section 605(b)(3)(B) of
Public Law 104-204, is amended by striking ''section 2751'' and
inserting ''sections 2751 and 2752''.
(c) Effective Dates.--
(1) Group market.--The amendments made by subsection (a)
shall apply with respect to group health plans for plan years
beginning on or after January 1, 1998.
(2) Individual market.--The amendment made by subsection
(b) shall apply with respect to health insurance coverage
offered, sold, issued, renewed, in effect, or operated in the
individual market on or after such date.
A:
Breast Cancer Patient Protection Act of 1997 - Amends the Public Health Service Act to prohibit group health plans and health insurance issuers offering group health insurance coverage, with regard to hospital stays in connection with breast cancer treatment, from: (1) covering less than 48 hours after mastectomies or less than 24 hours after lymph node dissections; or (2) requiring plan or issuer authorization for prescribing any length of stay. Prohibits: (1) denying eligibility, enrollment, or renewal to avoid these requirements; (2) providing payments or rebates to women; or (3) penalizing or providing incentives to providers. Applies the same requirements to issuers in the individual market.