SENATE AMENDMENT
Bill No. CS for SB 560, 1st Eng.
Amendment No. ___ Barcode 470424
CHAMBER ACTION
Senate House
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04/27/2004 03:46 PM .
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11 Senator Lynn moved the following amendment:
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13 Senate Amendment (with title amendment)
14 On page 29, between lines 29 and 30,
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16 insert:
17 Section 17. 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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SENATE AMENDMENT
Bill No. CS for SB 560, 1st Eng.
Amendment No. ___ Barcode 470424
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 18. 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
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11:57 AM 04/27/04 s0560c1c-0720a
SENATE AMENDMENT
Bill No. CS for SB 560, 1st Eng.
Amendment No. ___ Barcode 470424
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 19. 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
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SENATE AMENDMENT
Bill No. CS for SB 560, 1st Eng.
Amendment No. ___ Barcode 470424
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.
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10 (Redesignate subsequent sections.)
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14 And the title is amended as follows:
15 On page 3, line 17, after the semicolon,
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17 insert:
18 amending ss. 627.64171, 627.66121, and 641.31,
19 F.S.; providing requirements for the length of
20 hospital stay relating to a lymph-node
21 dissection which specified health insurers and
22 health maintenance organizations must cover;
23 limiting application; directing the Office of
24 Program Policy Analysis and Government
25 Accountability to study mammography and report
26 to the Legislature;
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