Senate Bill sb1172

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    Florida Senate - 2007                                  SB 1172

    By Senator Joyner





    18-1284-07                                              See HB

  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 which

  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

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    Florida Senate - 2007                                  SB 1172
    18-1284-07                                              See HB




 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 the lymph node dissection or 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

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






    Florida Senate - 2007                                  SB 1172
    18-1284-07                                              See HB




 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 the lymph node dissection or 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.

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






    Florida Senate - 2007                                  SB 1172
    18-1284-07                                              See HB




 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 the lymph node dissection or 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, 2007.

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