SENATE AMENDMENT
    Bill No. CS for SB 1092
    Amendment No. ___   Barcode 142382
                            CHAMBER ACTION
              Senate                               House
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       04/16/2004 11:45 AM         .                    
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11  Senator Lynn moved the following amendment:
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13         Senate Amendment (with title amendment) 
14         Delete everything after the enacting clause
15  
16  and insert:  
17         Section 1.  Subsections (1) and (2) and paragraph (a)
18  of subsection (4) of section 627.64171, Florida Statutes, are
19  amended to read:
20         627.64171  Coverage for length of stay and outpatient
21  postsurgical care.--
22         (1)  Any health insurance policy that is issued,
23  amended, delivered, or renewed in this state which provides
24  coverage for breast cancer treatment may not limit inpatient
25  hospital coverage for lymph-node dissections or mastectomies
26  to any period that is less than that determined by the
27  treating physician to be medically necessary in accordance
28  with prevailing medical standards and after consultation with
29  the insured patient.
30         (2)  Any health insurance policy that provides coverage
31  for mastectomies under subsection (1) must also provide
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    5:34 PM   04/15/04                              s1092c1c-07k0a

SENATE AMENDMENT Bill No. CS for SB 1092 Amendment No. ___ Barcode 142382 1 coverage for outpatient postsurgical followup care in keeping 2 with prevailing medical standards by a licensed health care 3 professional qualified to provide postsurgical mastectomy 4 care. The treating physician, after consultation with the 5 insured patient, may choose that the outpatient care be 6 provided at the most medically appropriate setting, which may 7 include the hospital, treating physician's office, outpatient 8 center, or home of the insured patient. 9 (4)(a) This section does not require an insured 10 patient to have a lymph-node dissection or a the mastectomy in 11 the hospital or stay in the hospital for a fixed period of 12 time following a lymph-node dissection or a the mastectomy. 13 Section 2. Subsections (1) and (2) and paragraph (a) 14 of subsection (4) of section 627.66121, Florida Statutes, are 15 amended to read: 16 627.66121 Coverage for length of stay and outpatient 17 postsurgical care.-- 18 (1) Any group, blanket, or franchise accident or 19 health insurance policy that is issued, amended, delivered, or 20 renewed in this state which provides coverage for breast 21 cancer treatment may not limit inpatient hospital coverage for 22 lymph-node dissections or mastectomies to any period that is 23 less than that determined by the treating physician to be 24 medically necessary in accordance with prevailing medical 25 standards and after consultation with the insured patient. 26 (2) Any group, blanket, or franchise accident or 27 health insurance policy that provides coverage for 28 mastectomies under subsection (1) must also provide coverage 29 for outpatient postsurgical followup care in keeping with 30 prevailing medical standards by a licensed health care 31 professional qualified to provide postsurgical mastectomy 2 5:34 PM 04/15/04 s1092c1c-07k0a
SENATE AMENDMENT Bill No. CS for SB 1092 Amendment No. ___ Barcode 142382 1 care. The treating physician, after consultation with the 2 insured patient, may choose that the outpatient care be 3 provided at the most medically appropriate setting, which may 4 include the hospital, treating physician's office, outpatient 5 center, or home of the insured patient. 6 (4)(a) This section does not require an insured 7 patient to have a lymph-node dissection or a the mastectomy in 8 the hospital or stay in the hospital for a fixed period of 9 time following a lymph-node dissection or a the mastectomy. 10 Section 3. Paragraphs (a) and (c) of subsection (31) 11 of section 641.31, Florida Statutes, are amended to read: 12 641.31 Health maintenance contracts.-- 13 (31)(a) Health maintenance contracts that provide 14 coverage, benefits, or services for breast cancer treatment 15 may not limit inpatient hospital coverage for lymph-node 16 dissections or mastectomies to any period that is less than 17 that determined by the treating physician under contract with 18 the health maintenance organization to be medically necessary 19 in accordance with prevailing medical standards and after 20 consultation with the covered patient. Such contract must also 21 provide coverage for outpatient postsurgical followup care in 22 keeping with prevailing medical standards by a licensed health 23 care professional under contract with the health maintenance 24 organization qualified to provide postsurgical mastectomy 25 care. The treating physician under contract with the health 26 maintenance organization, after consultation with the covered 27 patient, may choose that the outpatient care be provided at 28 the most medically appropriate setting, which may include the 29 hospital, treating physician's office, outpatient center, or 30 home of the covered patient. 31 (c)1. This subsection does not require a covered 3 5:34 PM 04/15/04 s1092c1c-07k0a
SENATE AMENDMENT Bill No. CS for SB 1092 Amendment No. ___ Barcode 142382 1 patient to have a lymph-node dissection or a the mastectomy in 2 the hospital or stay in the hospital for a fixed period of 3 time following a lymph-node dissection or a the mastectomy. 4 2. This subsection does not prevent a contract from 5 imposing deductibles, coinsurance, or other cost sharing in 6 relation to benefits pursuant to this subsection, except that 7 such cost sharing shall not exceed cost sharing with other 8 benefits. 9 Section 4. The Legislature finds that it is of the 10 utmost public importance that quality mammography services and 11 other diagnostic tools remain available to detect and treat 12 breast cancer. The Office of Program Policy Analysis and 13 Government Accountability shall study issues relating to the 14 availability utilization, quality, and cost of mammography 15 services in all facilities performing mammography. The study 16 shall include, but need not be limited to, examining the 17 following factors that impact availability utilization, 18 quality, and cost: reimbursement fees, copayment fees paid by 19 patients, incidence of lawsuits filed, equipment and liability 20 insurance costs, equipment maintenance and calibration, 21 staffing requirements and training, type and number of 22 facilities performing mammography, facilities surveyed by the 23 Bureau of Radiation Control of the Department of Health, 24 population density of females aged 40 and older in each 25 county, and other factors that relate to the demand and 26 availability of mammography services. The Office of Program 27 Policy Analysis and Government Accountability shall complete 28 its study and submit its report to the Legislature by February 29 15, 2005. 30 Section 5. This act shall take effect July 1, 2005. 31 4 5:34 PM 04/15/04 s1092c1c-07k0a
SENATE AMENDMENT Bill No. CS for SB 1092 Amendment No. ___ Barcode 142382 1 ================ T I T L E A M E N D M E N T =============== 2 And the title is amended as follows: 3 Delete everything before the enacting clause 4 5 and insert: 6 A bill to be entitled 7 An act relating to breast cancer treatment; 8 amending ss. 627.64171, 627.66121, and 641.31, 9 F.S.; providing requirements for the length of 10 hospital stay relating to a lymph-node 11 dissection which specified health insurers and 12 health maintenance organizations must cover; 13 limiting application; directing the Office of 14 Program Policy Analysis and Government 15 Accountability to study mammography and report 16 to the Legislature; providing an effective 17 date. 18 19 20 21 22 23 24 25 26 27 28 29 30 31 5 5:34 PM 04/15/04 s1092c1c-07k0a