HB 0029

1	A bill to be entitled
2	An act relating to breast cancer treatment; providing a
3	popular name; amending ss. 627.64171, 627.66121, and
4	641.31, F.S.; including lymph node dissections under
5	provisions prescribing the length of hospital stay
6	relating to a mastectomy which specified health insurers
7	and health maintenance organizations must cover; limiting
8	application; providing legislative findings; requiring the
9	Office of Program Policy Analysis and Government
10	Accountability to study certain issues relating to
11	mammography services; providing study requirements;
12	requiring a report to the Legislature; providing an
13	effective date.
14
15	Be It Enacted by the Legislature of the State of Florida:
16
17	Section 1.  This act may be cited as the "Mary B. Hooks
18	Act."
19	Section 2.  Subsections (1) and (2) and paragraph (a) of
20	subsection (4) of section 627.64171, Florida Statutes, are
21	amended to read:
22	627.64171  Coverage for length of stay and outpatient
23	postsurgical care.--
24	(1)  Any health insurance policy that is issued, amended,
25	delivered, or renewed in this state which provides coverage for
26	breast cancer treatment may not limit inpatient hospital
27	coverage for lymph node dissections or mastectomies to any
28	period that is less than that determined by the treating
29	physician to be medically necessary in accordance with
30	prevailing medical standards and after consultation with the
31	insured patient.
32	(2)  Any health insurance policy that provides coverage for
33	lymph node dissections or mastectomies under subsection (1) must
34	also provide coverage for outpatient postsurgical followup care
35	in keeping with prevailing medical standards by a licensed
36	health care professional qualified to provide postsurgical
37	mastectomy care. The treating physician, after consultation with
38	the insured patient, may choose that the outpatient care be
39	provided at the most medically appropriate setting, which may
40	include the hospital, treating physician's office, outpatient
41	center, or home of the insured patient.
42	(4)(a)  This section does not require an insured patient to
43	have a lymph node dissection or the mastectomy in the hospital
44	or stay in the hospital for a fixed period of time following a
45	lymph node dissection or the mastectomy.
46	Section 3.  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 which provides coverage for breast cancer
54	treatment may not limit inpatient hospital coverage for lymph
55	node dissections or mastectomies to any period that is less than
56	that determined by the treating physician to be medically
57	necessary in accordance with prevailing medical standards and
58	after consultation with the insured patient.
59	(2)  Any group, blanket, or franchise accident or health
60	insurance policy that provides coverage for lymph node
61	dissections or mastectomies under subsection (1) must also
62	provide coverage for outpatient postsurgical followup care in
63	keeping with prevailing medical standards by a licensed health
64	care professional qualified to provide postsurgical mastectomy
65	care. The treating physician, after consultation with the
66	insured patient, may choose that the outpatient care be provided
67	at the most medically appropriate setting, which may include the
68	hospital, treating physician's office, outpatient center, or
69	home of the insured patient.
70	(4)(a)  This section does not require an insured patient to
71	have a lymph node dissection or the mastectomy in the hospital
72	or stay in the hospital for a fixed period of time following a
73	lymph node dissection or the mastectomy.
74	Section 4.  Paragraphs (a) and (c) of subsection (31) of
75	section 641.31, Florida Statutes, are amended to read:
76	641.31  Health maintenance contracts.--
77	(31)(a)  Health maintenance contracts that provide
78	coverage, benefits, or services for breast cancer treatment may
79	not limit inpatient hospital coverage for lymph node dissections
80	or mastectomies to any period that is less than that determined
81	by the treating physician under contract with the health
82	maintenance organization to be medically necessary in accordance
83	with prevailing medical standards and after consultation with
84	the covered patient. Such contract must also provide coverage
85	for outpatient postsurgical followup care in keeping with
86	prevailing medical standards by a licensed health care
87	professional under contract with the health maintenance
88	organization qualified to provide postsurgical mastectomy care.
89	The treating physician under contract with the health
90	maintenance organization, after consultation with the covered
91	patient, may choose that the outpatient care be provided at the
92	most medically appropriate setting, which may include the
93	hospital, treating physician's office, outpatient center, or
94	home of the covered patient.
95	(c)1.  This subsection does not require a covered patient
96	to have a lymph node dissection or the mastectomy in the
97	hospital or stay in the hospital for a fixed period of time
98	following a lymph node dissection or the mastectomy.
99	2.  This subsection does not prevent a contract from
100	imposing deductibles, coinsurance, or other cost sharing in
101	relation to benefits pursuant to this subsection, except that
102	such cost sharing shall not exceed cost sharing with other
103	benefits.
104	Section 5.  The Legislature finds that it is of the utmost
105	public importance that quality mammography services and other
106	diagnostic tools remain available to detect and treat breast
107	cancer. The Office of Program Policy Analysis and Government
108	Accountability shall study issues relating to the availability,
109	utilization, quality, and cost of mammography services in all
110	facilities performing mammography. The study shall include, but
111	not be limited to, examining the following factors which impact
112	availability, utilization, quality, and cost: reimbursement
113	fees, copayment fees paid by patients, closed claim data
114	retained by the Office of Insurance Regulation relating to the
115	failure to diagnose breast cancer, equipment and liability
116	insurance costs, equipment maintenance and calibration, staffing
117	requirements and training, type and number of facilities
118	performing mammography, facilities surveyed by the Department of
119	Health, Bureau of Radiation Control, population density of
120	females aged 40 and older in each county in this state, the
121	average wait time for diagnostic and screening mammograms, and
122	other factors which relate to the demand and availability of
123	mammography services. The Office of Program Policy Analysis and
124	Government Accountability shall complete its study and submit a
125	report to the President of the Senate and the Speaker of the
126	House of Representatives by February 15, 2006.
127	Section 6.  This act shall take effect July 1, 2005.

CODING: Words stricken are deletions; words underlined are additions.