Florida Senate - 2008 (Reformatted) SB 448
By Senator Joyner
18-00028-08 2008448__
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A bill to be entitled
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An act relating to breast cancer treatment; providing a
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641.31, F.S.; including lymph node dissections under
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provisions prescribing the length of hospital stay
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relating to a mastectomy and the outpatient postsurgical
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followup care that specified health insurers and health
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maintenance organizations must cover; limiting
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application; providing an effective date.
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Be It Enacted by the Legislature of the State of Florida:
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Section 1. This act may be cited as the "Mary B. Hooks
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Act."
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Section 2. Subsections (1) and (2) and paragraph (a) of
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subsection (4) of section 627.64171, Florida Statutes, are
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amended to read:
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627.64171 Coverage for length of stay and outpatient
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postsurgical care.--
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(1) Any health insurance policy that is issued, amended,
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delivered, or renewed in this state which provides coverage for
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breast cancer treatment may not limit inpatient hospital coverage
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for lymph node dissections or mastectomies to any period that is
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less than that determined by the treating physician to be
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medically necessary in accordance with prevailing medical
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standards and after consultation with the insured patient.
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(2) Any health insurance policy that provides coverage for
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lymph node dissections or mastectomies under subsection (1) must
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also provide coverage for outpatient postsurgical followup care
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in keeping with prevailing medical standards by a licensed health
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care professional qualified to provide postsurgical lymph node
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dissection or mastectomy care. The treating physician, after
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consultation with the insured patient, may choose that the
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outpatient care be provided at the most medically appropriate
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setting, which may include the hospital, treating physician's
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office, outpatient center, or home of the insured patient.
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(4)(a) This section does not require an insured patient to
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have a lymph node dissection or the mastectomy in the hospital or
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stay in the hospital for a fixed period of time following the
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lymph node dissection or mastectomy.
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Section 3. Subsections (1) and (2) and paragraph (a) of
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subsection (4) of section 627.66121, Florida Statutes, are
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amended to read:
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627.66121 Coverage for length of stay and outpatient
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postsurgical care.--
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(1) Any group, blanket, or franchise accident or health
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insurance policy that is issued, amended, delivered, or renewed
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in this state which provides coverage for breast cancer treatment
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may not limit inpatient hospital coverage for lymph node
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dissections or mastectomies to any period that is less than that
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determined by the treating physician to be medically necessary in
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accordance with prevailing medical standards and after
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consultation with the insured patient.
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(2) Any group, blanket, or franchise accident or health
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insurance policy that provides coverage for lymph node
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dissections or mastectomies under subsection (1) must also
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provide coverage for outpatient postsurgical followup care in
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keeping with prevailing medical standards by a licensed health
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care professional qualified to provide postsurgical lymph node
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dissection or mastectomy care. The treating physician, after
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consultation with the insured patient, may choose that the
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outpatient care be provided at the most medically appropriate
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setting, which may include the hospital, treating physician's
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office, outpatient center, or home of the insured patient.
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(4)(a) This section does not require an insured patient to
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have a lymph node dissection or the mastectomy in the hospital or
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stay in the hospital for a fixed period of time following the
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lymph node dissection or mastectomy.
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Section 4. Paragraphs (a) and (c) of subsection (31) of
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section 641.31, Florida Statutes, are amended to read:
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641.31 Health maintenance contracts.--
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(31)(a) Health maintenance contracts that provide coverage,
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benefits, or services for breast cancer treatment may not limit
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inpatient hospital coverage for lymph node dissections or
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mastectomies to any period that is less than that determined by
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the treating physician under contract with the health maintenance
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organization to be medically necessary in accordance with
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prevailing medical standards and after consultation with the
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covered patient. Such contract must also provide coverage for
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outpatient postsurgical followup care in keeping with prevailing
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medical standards by a licensed health care professional under
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contract with the health maintenance organization qualified to
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provide postsurgical lymph node dissection or mastectomy care.
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The treating physician under contract with the health maintenance
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organization, after consultation with the covered patient, may
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choose that the outpatient care be provided at the most medically
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appropriate setting, which may include the hospital, treating
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physician's office, outpatient center, or home of the covered
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patient.
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(c)1. This subsection does not require a covered patient to
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have a lymph node dissection or the mastectomy in the hospital or
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stay in the hospital for a fixed period of time following the
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lymph node dissection or mastectomy.
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2. This subsection does not prevent a contract from
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imposing deductibles, coinsurance, or other cost sharing in
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relation to benefits pursuant to this subsection, except that
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such cost sharing shall not exceed cost sharing with other
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benefits.
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Section 5. This act shall take effect July 1, 2008.
CODING: Words stricken are deletions; words underlined are additions.