Senate Bill sb1172e2
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SB 1172 Second Engrossed
1 A bill to be entitled
2 An act relating to breast cancer treatment;
3 amending s. 627.42395, F.S.; including certain
4 amino-acid-based formulas within requirements
5 concerning optional coverage for formulas;
6 providing a short title; amending ss.
7 627.64171, 627.66121, and 641.31, F.S.;
8 including lymph node dissections under
9 provisions prescribing the length of hospital
10 stay relating to a mastectomy and the
11 outpatient postsurgical followup care which
12 specified health insurers and health
13 maintenance organizations must cover; limiting
14 application; providing an effective date.
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16 Be It Enacted by the Legislature of the State of Florida:
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18 Section 1. This act may be cited as the "Mary B. Hooks
19 Act."
20 Section 2. Subsections (1) and (2) and paragraph (a)
21 of subsection (4) of section 627.64171, Florida Statutes, are
22 amended to read:
23 627.64171 Coverage for length of stay and outpatient
24 postsurgical care.--
25 (1) Any health insurance policy that is issued,
26 amended, delivered, or renewed in this state which provides
27 coverage for breast cancer treatment may not limit inpatient
28 hospital coverage for lymph node dissections or mastectomies
29 to any period that is less than that determined by the
30 treating physician to be medically necessary in accordance
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SB 1172 Second Engrossed
1 with prevailing medical standards and after consultation with
2 the insured patient.
3 (2) Any health insurance policy that provides coverage
4 for lymph node dissections or mastectomies under subsection
5 (1) must also provide coverage for outpatient postsurgical
6 followup care in keeping with prevailing medical standards by
7 a licensed health care professional qualified to provide
8 postsurgical lymph node dissection or mastectomy care. The
9 treating physician, after consultation with the insured
10 patient, may choose that the outpatient care be provided at
11 the most medically appropriate setting, which may include the
12 hospital, treating physician's office, outpatient center, or
13 home of the insured patient.
14 (4)(a) This section does not require an insured
15 patient to have a lymph node dissection or the mastectomy in
16 the hospital or stay in the hospital for a fixed period of
17 time following the lymph node dissection or mastectomy.
18 Section 3. Subsections (1) and (2) and paragraph (a)
19 of subsection (4) of section 627.66121, Florida Statutes, are
20 amended to read:
21 627.66121 Coverage for length of stay and outpatient
22 postsurgical care.--
23 (1) Any group, blanket, or franchise accident or
24 health insurance policy that is issued, amended, delivered, or
25 renewed in this state which provides coverage for breast
26 cancer treatment may not limit inpatient hospital coverage for
27 lymph node dissections or mastectomies to any period that is
28 less than that determined by the treating physician to be
29 medically necessary in accordance with prevailing medical
30 standards and after consultation with the insured patient.
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SB 1172 Second Engrossed
1 (2) Any group, blanket, or franchise accident or
2 health insurance policy that provides coverage for lymph node
3 dissections or mastectomies under subsection (1) must also
4 provide coverage for outpatient postsurgical followup care in
5 keeping with prevailing medical standards by a licensed health
6 care professional qualified to provide postsurgical lymph node
7 dissection or mastectomy care. The treating physician, after
8 consultation with the insured patient, may choose that the
9 outpatient care be provided at the most medically appropriate
10 setting, which may include the hospital, treating physician's
11 office, outpatient center, or home of the insured patient.
12 (4)(a) This section does not require an insured
13 patient to have a lymph node dissection or the mastectomy in
14 the hospital or stay in the hospital for a fixed period of
15 time following the lymph node dissection or mastectomy.
16 Section 4. Paragraphs (a) and (c) of subsection (31)
17 of section 641.31, Florida Statutes, are amended to read:
18 641.31 Health maintenance contracts.--
19 (31)(a) Health maintenance contracts that provide
20 coverage, benefits, or services for breast cancer treatment
21 may not limit inpatient hospital coverage for lymph node
22 dissections or mastectomies to any period that is less than
23 that determined by the treating physician under contract with
24 the health maintenance organization to be medically necessary
25 in accordance with prevailing medical standards and after
26 consultation with the covered patient. Such contract must also
27 provide coverage for outpatient postsurgical followup care in
28 keeping with prevailing medical standards by a licensed health
29 care professional under contract with the health maintenance
30 organization qualified to provide postsurgical lymph node
31 dissection or mastectomy care. The treating physician under
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SB 1172 Second Engrossed
1 contract with the health maintenance organization, after
2 consultation with the covered patient, may choose that the
3 outpatient care be provided at the most medically appropriate
4 setting, which may include the hospital, treating physician's
5 office, outpatient center, or home of the covered patient.
6 (c)1. This subsection does not require a covered
7 patient to have a lymph node dissection or the mastectomy in
8 the hospital or stay in the hospital for a fixed period of
9 time following the lymph node dissection or mastectomy.
10 2. This subsection does not prevent a contract from
11 imposing deductibles, coinsurance, or other cost sharing in
12 relation to benefits pursuant to this subsection, except that
13 such cost sharing shall not exceed cost sharing with other
14 benefits.
15 Section 5. This act shall take effect July 1, 2007.
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