HB 0519 2004
1	A bill to be entitled
2	An act relating to breast cancer treatment; amending ss.
3	627.64171, 627.66121, and 641.31, F.S.; revising
4	provisions prescribing the length of hospital stay
5	relating to a mastectomy which specified health insurers
6	and health maintenance organizations must cover; providing
7	requirements for the length of hospital stay relating to a
8	lymph-node dissection which specified health insurers and
9	health maintenance organizations must cover; limiting
10	application; providing an effective date.
11
12	Be It Enacted by the Legislature of the State of Florida:
13
14	Section 1. Subsections (1) and (2) and paragraph (a) of
15	subsection (4) of section 627.64171, Florida Statutes, are
16	amended to read:
17	627.64171 Coverage for length of stay and outpatient
18	postsurgical care.--
19	(1) Any health insurance policy that is issued, amended,
20	delivered, or renewed in this state and which provides medical
21	and surgical benefits coverage for breast cancer treatmentmay
22	not limit inpatient hospital coverage:
23	(a) For a lymph-node dissection for treatment of breast
24	cancer, to a period that is less than 24 hours of hospital care
25	immediately following the lymph-node dissection; or
26	(b) For a mastectomy, mastectomies to a anyperiod that is
27	less than that determined by the treating physician, after
28	consultation with the insured patient,to be medically necessary
29	in accordance with prevailing medical standards, or 48 hours
30	following such a mastectomy, whichever period is longer and
31	after consultation with the insured patient.
32	(2) Any health insurance policy that provides coverage for
33	mastectomies under paragraph (1)(b) subsection (1)must also
34	provide coverage for outpatient postsurgical followup care in
35	keeping with prevailing medical standards by a licensed health
36	care professional qualified to provide postsurgical mastectomy
37	care. The treating physician, after consultation with the
38	insured patient, may choose that the outpatient care be provided
39	at the most medically appropriate setting, which may include the
40	hospital, treating physician's office, outpatient center, or
41	home of the insured patient.
42	(4)(a) This section does not require an insured patient to
43	have a lymph-node dissection or themastectomy in the hospital
44	or stay in the hospital for a fixed period of time following a
45	lymph-node dissection or themastectomy.
46	Section 2. Subsections (1) and (2) and paragraph (a) of
47	subsection (4) of section 627.66121, Florida Statutes, are
48	amended to read:
49	627.66121 Coverage for length of stay and outpatient
50	postsurgical care.--
51	(1) Any group, blanket, or franchise accident or health
52	insurance policy that is issued, amended, delivered, or renewed
53	in this state and which provides medical and surgical benefits
54	coverage for breast cancer treatmentmay not limit inpatient
55	hospital coverage:
56	(a) For a lymph-node dissection for treatment of breast
57	cancer, to a period that is less than 24 hours of hospital care
58	immediately following the lymph-node dissection; or
59	(b) For a mastectomy, mastectomies to a anyperiod that is
60	less than that determined by the treating physician, after
61	consultation with the insured patient,to be medically necessary
62	in accordance with prevailing medical standards, or 48 hours
63	following such a mastectomy, whichever period is longer and
64	after consultation with the insured patient.
65	(2) Any group, blanket, or franchise accident or health
66	insurance policy that provides coverage for mastectomies under
67	paragraph (1)(b) subsection (1)must also provide coverage for
68	outpatient postsurgical followup care in keeping with prevailing
69	medical standards by a licensed health care professional
70	qualified to provide postsurgical mastectomy care. The treating
71	physician, after consultation with the insured patient, may
72	choose that the outpatient care be provided at the most
73	medically appropriate setting, which may include the hospital,
74	treating physician's office, outpatient center, or home of the
75	insured patient.
76	(4)(a) This section does not require an insured patient to
77	have a lymph-node dissection or themastectomy in the hospital
78	or stay in the hospital for a fixed period of time following a
79	lymph-node dissection or themastectomy.
80	Section 3. Paragraphs (a) and (c) of subsection (31) of
81	section 641.31, Florida Statutes, are amended to read:
82	641.31 Health maintenance contracts.--
83	(31)(a) Health maintenance contracts that provide medical
84	and surgical benefits coverage, benefits, or services for breast
85	cancer treatment may not limit inpatient hospital coverage:
86	1. For a lymph-node dissection for treatment of breast
87	cancer, to a period that is less than 24 hours of hospital care
88	immediately following the lymph-node dissection; or
89	2. For a mastectomy, mastectomies to a anyperiod that is
90	less than that determined by the treating physician under
91	contract with the health maintenance organization, after
92	consultation with the covered patient,to be medically necessary
93	in accordance with prevailing medical standards, or 48 hours
94	following such a mastectomy, whichever period is longer and
95	after consultation with the covered patient.
96
97	A Such contract that provides coverage for mastectomiesmust
98	also provide coverage for outpatient postsurgical followup care
99	in keeping with prevailing medical standards by a licensed
100	health care professional under contract with the health
101	maintenance organization qualified to provide postsurgical
102	mastectomy care. The treating physician under contract with the
103	health maintenance organization, after consultation with the
104	covered patient, may choose that the outpatient care be provided
105	at the most medically appropriate setting, which may include the
106	hospital, treating physician's office, outpatient center, or
107	home of the covered patient.
108	(c)1. This subsection does not require a covered patient
109	to have a lymph-node dissection or themastectomy in the
110	hospital or stay in the hospital for a fixed period of time
111	following a lymph-node dissection or themastectomy.
112	2. This subsection does not prevent a contract from
113	imposing deductibles, coinsurance, or other cost sharing in
114	relation to benefits pursuant to this subsection, except that
115	such cost sharing shall not exceed cost sharing with other
116	benefits.
117	Section 4. This act shall take effect July 1, 2004.