HB 0639

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 an effective date.
9
10	Be It Enacted by the Legislature of the State of Florida:
11
12	Section 1.  This act may be cited as the "Mary B. Hooks
13	Act."
14	Section 2.  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 which provides coverage for
21	breast cancer treatment may not limit inpatient hospital
22	coverage for lymph node dissections or mastectomies to any
23	period that is less than that determined by the treating
24	physician to be medically necessary in accordance with
25	prevailing medical standards and after consultation with the
26	insured patient.
27	(2)  Any health insurance policy that provides coverage for
28	lymph node dissections or mastectomies under subsection (1) must
29	also provide coverage for outpatient postsurgical followup care
30	in keeping with prevailing medical standards by a licensed
31	health care professional qualified to provide postsurgical
32	mastectomy care. The treating physician, after consultation with
33	the insured patient, may choose that the outpatient care be
34	provided at the most medically appropriate setting, which may
35	include the hospital, treating physician's office, outpatient
36	center, or home of the insured patient.
37	(4)(a)  This section does not require an insured patient to
38	have a lymph node dissection or the mastectomy in the hospital
39	or stay in the hospital for a fixed period of time following a
40	lymph node dissection or the mastectomy.
41	Section 3.  Subsections (1) and (2) and paragraph (a) of
42	subsection (4) of section 627.66121, Florida Statutes, are
43	amended to read:
44	627.66121  Coverage for length of stay and outpatient
45	postsurgical care.--
46	(1)  Any group, blanket, or franchise accident or health
47	insurance policy that is issued, amended, delivered, or renewed
48	in this state which provides coverage for breast cancer
49	treatment may not limit inpatient hospital coverage for lymph
50	node dissections or mastectomies to any period that is less than
51	that determined by the treating physician to be medically
52	necessary in accordance with prevailing medical standards and
53	after consultation with the insured patient.
54	(2)  Any group, blanket, or franchise accident or health
55	insurance policy that provides coverage for lymph node
56	dissections or mastectomies under subsection (1) must also
57	provide coverage for outpatient postsurgical followup care in
58	keeping with prevailing medical standards by a licensed health
59	care professional qualified to provide postsurgical mastectomy
60	care. The treating physician, after consultation with the
61	insured patient, may choose that the outpatient care be provided
62	at the most medically appropriate setting, which may include the
63	hospital, treating physician's office, outpatient center, or
64	home of the insured patient.
65	(4)(a)  This section does not require an insured patient to
66	have a lymph node dissection or the mastectomy in the hospital
67	or stay in the hospital for a fixed period of time following a
68	lymph node dissection or the mastectomy.
69	Section 4.  Paragraphs (a) and (c) of subsection (31) of
70	section 641.31, Florida Statutes, are amended to read:
71	641.31  Health maintenance contracts.--
72	(31)(a)  Health maintenance contracts that provide
73	coverage, benefits, or services for breast cancer treatment may
74	not limit inpatient hospital coverage for lymph node dissections
75	or mastectomies to any period that is less than that determined
76	by the treating physician under contract with the health
77	maintenance organization to be medically necessary in accordance
78	with prevailing medical standards and after consultation with
79	the covered patient. Such contract must also provide coverage
80	for outpatient postsurgical followup care in keeping with
81	prevailing medical standards by a licensed health care
82	professional under contract with the health maintenance
83	organization qualified to provide postsurgical mastectomy care.
84	The treating physician under contract with the health
85	maintenance organization, after consultation with the covered
86	patient, may choose that the outpatient care be provided at the
87	most medically appropriate setting, which may include the
88	hospital, treating physician's office, outpatient center, or
89	home of the covered patient.
90	(c)1.  This subsection does not require a covered patient
91	to have a lymph node dissection or the mastectomy in the
92	hospital or stay in the hospital for a fixed period of time
93	following a lymph node dissection or the mastectomy.
94	2.  This subsection does not prevent a contract from
95	imposing deductibles, coinsurance, or other cost sharing in
96	relation to benefits pursuant to this subsection, except that
97	such cost sharing shall not exceed cost sharing with other
98	benefits.
99	Section 5.  This act shall take effect July 1, 2005.

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