HB 59

1	A bill to be entitled
2	An act relating to breast cancer treatment; providing a
3	short title; 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 and the outpatient postsurgical
7	followup care which specified health insurers and health
8	maintenance organizations must cover; limiting
9	application; providing an effective date.
10
11	Be It Enacted by the Legislature of the State of Florida:
12
13	Section 1.  This act may be cited as the "Mary B. Hooks
14	Act."
15	Section 2.  Subsections (1) and (2) and paragraph (a) of
16	subsection (4) of section 627.64171, Florida Statutes, are
17	amended to read:
18	627.64171  Coverage for length of stay and outpatient
19	postsurgical care.--
20	(1)  Any health insurance policy that is issued, amended,
21	delivered, or renewed in this state which provides coverage for
22	breast cancer treatment may not limit inpatient hospital
23	coverage for lymph node dissections or mastectomies to any
24	period that is less than that determined by the treating
25	physician to be medically necessary in accordance with
26	prevailing medical standards and after consultation with the
27	insured patient.
28	(2)  Any health insurance policy that provides coverage for
29	lymph node dissections or mastectomies under subsection (1) must
30	also provide coverage for outpatient postsurgical followup care
31	in keeping with prevailing medical standards by a licensed
32	health care professional qualified to provide postsurgical lymph
33	node dissection or mastectomy care. The treating physician,
34	after consultation with the insured patient, may choose that the
35	outpatient care be provided at the most medically appropriate
36	setting, which may include the hospital, treating physician's
37	office, outpatient center, or home of the insured patient.
38	(4)(a)  This section does not require an insured patient to
39	have a lymph node dissection or the mastectomy in the hospital
40	or stay in the hospital for a fixed period of time following a
41	lymph node dissection or the mastectomy.
42	Section 3.  Subsections (1) and (2) and paragraph (a) of
43	subsection (4) of section 627.66121, Florida Statutes, are
44	amended to read:
45	627.66121  Coverage for length of stay and outpatient
46	postsurgical care.--
47	(1)  Any group, blanket, or franchise accident or health
48	insurance policy that is issued, amended, delivered, or renewed
49	in this state which provides coverage for breast cancer
50	treatment may not limit inpatient hospital coverage for lymph
51	node dissections or mastectomies to any period that is less than
52	that determined by the treating physician to be medically
53	necessary in accordance with prevailing medical standards and
54	after consultation with the insured patient.
55	(2)  Any group, blanket, or franchise accident or health
56	insurance policy that provides coverage for lymph node
57	dissections or mastectomies under subsection (1) must also
58	provide coverage for outpatient postsurgical followup care in
59	keeping with prevailing medical standards by a licensed health
60	care professional qualified to provide postsurgical lymph node
61	dissection or mastectomy care. The treating physician, after
62	consultation with the insured patient, may choose that the
63	outpatient care be provided at the most medically appropriate
64	setting, which may include the hospital, treating physician's
65	office, outpatient center, or home of the insured patient.
66	(4)(a)  This section does not require an insured patient to
67	have a lymph node dissection or the mastectomy in the hospital
68	or stay in the hospital for a fixed period of time following a
69	lymph node dissection or the mastectomy.
70	Section 4.  Paragraphs (a) and (c) of subsection (31) of
71	section 641.31, Florida Statutes, are amended to read:
72	641.31  Health maintenance contracts.--
73	(31)(a)  Health maintenance contracts that provide
74	coverage, benefits, or services for breast cancer treatment may
75	not limit inpatient hospital coverage for lymph node dissections
76	or mastectomies to any period that is less than that determined
77	by the treating physician under contract with the health
78	maintenance organization to be medically necessary in accordance
79	with prevailing medical standards and after consultation with
80	the covered patient. Such contract must also provide coverage
81	for outpatient postsurgical followup care in keeping with
82	prevailing medical standards by a licensed health care
83	professional under contract with the health maintenance
84	organization qualified to provide postsurgical lymph node
85	dissection or mastectomy care. The treating physician under
86	contract with the health maintenance organization, after
87	consultation with the covered patient, may choose that the
88	outpatient care be provided at the most medically appropriate
89	setting, which may include the hospital, treating physician's
90	office, outpatient center, or home of the covered patient.
91	(c)1.  This subsection does not require a covered patient
92	to have a lymph node dissection or the mastectomy in the
93	hospital or stay in the hospital for a fixed period of time
94	following a lymph node dissection or the mastectomy.
95	2.  This subsection does not prevent a contract from
96	imposing deductibles, coinsurance, or other cost sharing in
97	relation to benefits pursuant to this subsection, except that
98	such cost sharing shall not exceed cost sharing with other
99	benefits.
100	Section 5.  This act shall take effect July 1, 2006.

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