Senate Bill sb1178
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2006 SB 1178
By Senator Wise
5-826-06 See HB 59
1 A bill to be entitled
2 An act relating to breast cancer treatment;
3 providing a short title; amending ss.
4 627.64171, 627.66121, and 641.31, F.S.;
5 including lymph node dissections under
6 provisions prescribing the length of hospital
7 stay relating to a mastectomy and the
8 outpatient postsurgical followup care that
9 specified health insurers and health
10 maintenance organizations must cover; limiting
11 application; providing an effective date.
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13 Be It Enacted by the Legislature of the State of Florida:
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15 Section 1. This act may be cited as the "Mary B. Hooks
16 Act."
17 Section 2. 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 lymph node dissections or mastectomies under subsection
1
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2006 SB 1178
5-826-06 See HB 59
1 (1) must also provide coverage for outpatient postsurgical
2 followup care in keeping with prevailing medical standards by
3 a licensed health care professional qualified to provide
4 postsurgical lymph node dissection or mastectomy care. The
5 treating physician, after consultation with the insured
6 patient, may choose that the outpatient care be provided at
7 the most medically appropriate setting, which may include the
8 hospital, treating physician's office, outpatient center, or
9 home of the insured patient.
10 (4)(a) This section does not require an insured
11 patient to have a lymph node dissection or the mastectomy in
12 the hospital or stay in the hospital for a fixed period of
13 time following a lymph node dissection or the mastectomy.
14 Section 3. Subsections (1) and (2) and paragraph (a)
15 of subsection (4) of section 627.66121, Florida Statutes, are
16 amended to read:
17 627.66121 Coverage for length of stay and outpatient
18 postsurgical care.--
19 (1) Any group, blanket, or franchise accident or
20 health insurance policy that is issued, amended, delivered, or
21 renewed in this state which provides coverage for breast
22 cancer treatment may not limit inpatient hospital coverage for
23 lymph node dissections or mastectomies to any period that is
24 less than that determined by the treating physician to be
25 medically necessary in accordance with prevailing medical
26 standards and after consultation with the insured patient.
27 (2) Any group, blanket, or franchise accident or
28 health insurance policy that provides coverage for lymph node
29 dissections or mastectomies under subsection (1) must also
30 provide coverage for outpatient postsurgical followup care in
31 keeping with prevailing medical standards by a licensed health
2
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2006 SB 1178
5-826-06 See HB 59
1 care professional qualified to provide postsurgical lymph node
2 dissection or mastectomy care. The treating physician, after
3 consultation with the insured patient, may choose that the
4 outpatient care be provided at the most medically appropriate
5 setting, which may include the hospital, treating physician's
6 office, outpatient center, or home of the insured patient.
7 (4)(a) This section does not require an insured
8 patient to have a lymph node dissection or the mastectomy in
9 the hospital or stay in the hospital for a fixed period of
10 time following a lymph node dissection or the mastectomy.
11 Section 4. Paragraphs (a) and (c) of subsection (31)
12 of section 641.31, Florida Statutes, are amended to read:
13 641.31 Health maintenance contracts.--
14 (31)(a) Health maintenance contracts that provide
15 coverage, benefits, or services for breast cancer treatment
16 may not limit inpatient hospital coverage for lymph node
17 dissections or mastectomies to any period that is less than
18 that determined by the treating physician under contract with
19 the health maintenance organization to be medically necessary
20 in accordance with prevailing medical standards and after
21 consultation with the covered patient. Such contract must also
22 provide coverage for outpatient postsurgical followup care in
23 keeping with prevailing medical standards by a licensed health
24 care professional under contract with the health maintenance
25 organization qualified to provide postsurgical lymph node
26 dissection or mastectomy care. The treating physician under
27 contract with the health maintenance organization, after
28 consultation with the covered patient, may choose that the
29 outpatient care be provided at the most medically appropriate
30 setting, which may include the hospital, treating physician's
31 office, outpatient center, or home of the covered patient.
3
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2006 SB 1178
5-826-06 See HB 59
1 (c)1. This subsection does not require a covered
2 patient to have a lymph node dissection or the mastectomy in
3 the hospital or stay in the hospital for a fixed period of
4 time following a lymph node dissection or the mastectomy.
5 2. This subsection does not prevent a contract from
6 imposing deductibles, coinsurance, or other cost sharing in
7 relation to benefits pursuant to this subsection, except that
8 such cost sharing shall not exceed cost sharing with other
9 benefits.
10 Section 5. This act shall take effect July 1, 2006.
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