108th CONGRESS
1st Session
H. R. 1886
To amend the Public Health Service Act and Employee Retirement Income
Security Act of 1974 to require that group and individual health insurance
coverage and group health plans provide coverage for a minimum hospital stay
for mastectomies and lymph node dissections performed for the treatment of
breast cancer.
IN THE HOUSE OF REPRESENTATIVES
April 30, 2003
Ms. DELAURO (for herself, Mr. ABERCROMBIE, Mr. ACKERMAN, Ms. BALDWIN, Ms.
BERKLEY, Mr. BERRY, Mr. BISHOP of New York, Mr. BLUMENAUER, Ms. BORDALLO,
Mr. BOSWELL, Mr. BOUCHER, Mr. BOYD, Mr. BRADY of Pennsylvania, Ms. CORRINE
BROWN of Florida, Mr. BROWN of Ohio, Mrs. CAPPS, Mr. CAPUANO, Ms. CARSON of
Indiana, Mr. CASE, Mrs. CHRISTENSEN, Mr. CLAY, Mr. COOPER, Mr. COSTELLO, Mr.
CROWLEY, Mr. CUMMINGS, Mr. DAVIS of Illinois, Mr. DELAHUNT, Mr. DEUTSCH, Mr.
DICKS, Mr. DINGELL, Mr. DOYLE, Mr. EMANUEL, Mr. ENGEL, Mr. ETHERIDGE, Mr.
EVANS, Mr. FARR, Mr. FATTAH, Mr. FOLEY, Mr. FORD, Mr. FRANK of Massachusetts,
Mr. FROST, Mr. GORDON, Mr. GREEN of Texas, Mr. GRIJALVA, Mr. GUTIERREZ, Ms.
HARMAN, Ms. HART, Mr. HINCHEY, Mr. HINOJOSA, Mr. HOEFFEL, Mr. HOLDEN, Mr.
HOLT, Mr. HONDA, Mr. INSLEE, Mr. ISRAEL, Ms. JACKSON-LEE of Texas, Mr. JEFFERSON,
Ms. EDDIE BERNICE JOHNSON of Texas, Ms. KAPTUR, Mr. KENNEDY of Rhode Island,
Mr. KILDEE, Mr. KING of New York, Mr. KLECZKA, Mr. LANGEVIN, Mr. LANTOS, Mr.
LARSEN of Washington, Mr. LARSON of Connecticut, Ms. LEE, Mr. LEVIN, Mr. LOBIONDO,
Mrs. LOWEY, Mr. LYNCH, Ms. MCCARTHY of Missouri, Mrs. MCCARTHY of New York,
Ms. MCCOLLUM, Mr. MCDERMOTT, Mr. MCGOVERN, Mr. MCHUGH, Mr. MCINTYRE, Mr. MCNULTY,
Mrs. MALONEY, Mr. MARKEY, Mr. MATSUI, Mr. MEEHAN, Mr. MENENDEZ, Mr. MICHAUD,
Ms. MILLENDER-MCDONALD, Mr. GEORGE MILLER of California, Mr. MORAN of Virginia,
Mr. MURTHA, Mr. NADLER, Mrs. NAPOLITANO, Ms. NORTON, Mr. OBERSTAR, Mr. OLVER,
Mr. OWENS, Mr. PALLONE, Mr. PASTOR, Mr. PAYNE, Mr. REYES, Ms. ROS-LEHTINEN,
Mr. ROSS, Mr. ROTHMAN, Ms. ROYBAL-ALLARD, Mr. RUSH, Mr. RYAN of Ohio, Ms.
LORETTA SANCHEZ of California, Mr. SANDLIN, Ms. SCHAKOWSKY, Mr. SCHIFF, Mr.
SERRANO, Mr. SHERMAN, Mr. SIMMONS, Ms. SLAUGHTER, Mr. SMITH of New Jersey,
Mr. SNYDER, Mr. STRICKLAND, Mrs. TAUSCHER, Mr. TAYLOR of Mississippi, Mr.
TIERNEY, Mr. TOWNS, Mr. THOMPSON of Mississippi, Mr. THOMPSON of California,
Mrs. JONES of Ohio, Mr. UDALL of New Mexico, Mr. VITTER, Ms. WATERS, Mr. WATT,
Mr. WEXLER, and Ms. WOOLSEY) introduced the following bill; which was referred
to the Committee on Energy and Commerce, and in addition to the Committee
on Education and the Workforce, for a period to be subsequently determined
by the Speaker, in each case for consideration of such provisions as fall
within the jurisdiction of the committee concerned
A BILL
To amend the Public Health Service Act and Employee Retirement Income
Security Act of 1974 to require that group and individual health insurance
coverage and group health plans provide coverage for a minimum hospital stay
for mastectomies and lymph node dissections performed for the treatment of
breast cancer.
Be it enacted by the Senate and House of Representatives of the United
States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the `Breast Cancer Patient Protection Act of 2003'.
SEC. 2. COVERAGE OF MINIMUM HOSPITAL STAY FOR CERTAIN BREAST CANCER TREATMENT.
(1) PUBLIC HEALTH SERVICE ACT AMENDMENTS- (A) Subpart 2 of part A of title
XXVII of the Public Health Service Act is amended by adding at the end the
following new section:
`SEC. 2707. STANDARDS RELATING TO BENEFITS FOR CERTAIN BREAST CANCER TREATMENT.
`(a) REQUIREMENTS FOR MINIMUM HOSPITAL STAY FOLLOWING MASTECTOMY OR LYMPH
NODE DISSECTION-
`(1) IN GENERAL- A group health plan, and a health insurance issuer offering
group health insurance coverage, may not--
`(A) except as provided in paragraph (2)--
`(i) restrict benefits for any hospital length of stay in connection
with a mastectomy for the treatment of breast cancer to less than 48
hours, or
`(ii) restrict benefits for any hospital length of stay in connection
with a lymph node dissection for the treatment of breast cancer to less
than 24 hours, or
`(B) require that a provider obtain authorization from the plan or the
issuer for prescribing any length of stay required under subparagraph
(A) (without regard to paragraph (2)).
`(2) EXCEPTION- Paragraph (1)(A) shall not apply in connection with any
group health plan or health insurance issuer in any case in which the decision
to discharge the woman involved prior to the expiration of the minimum length
of stay otherwise required under paragraph (1)(A) is made by an attending
provider in consultation with the woman.
`(b) PROHIBITIONS- A group health plan, and a health insurance issuer offering
group health insurance coverage in connection with a group health plan, may
not--
`(1) deny to a woman eligibility, or continued eligibility, to enroll or
to renew coverage under the terms of the plan, solely for the purpose of
avoiding the requirements of this section;
`(2) provide monetary payments or rebates to women to encourage such women
to accept less than the minimum protections available under this section;
`(3) penalize or otherwise reduce or limit the reimbursement of an attending
provider because such provider provided care to an individual participant
or beneficiary in accordance with this section;
`(4) provide incentives (monetary or otherwise) to an attending provider
to induce such provider to provide care to an individual participant or
beneficiary in a manner inconsistent with this section; or
`(5) subject to subsection (c)(3), restrict benefits for any portion of
a period within a hospital length of stay required under subsection (a)
in a manner which is less favorable than the benefits provided for any preceding
portion of such stay.
`(c) RULES OF CONSTRUCTION-
`(1) Nothing in this section shall be construed to require a woman who is
a participant or beneficiary--
`(A) to undergo a mastectomy or lymph node dissection in a hospital; or
`(B) to stay in the hospital for a fixed period of time following a mastectomy
or lymph node dissection.
`(2) This section shall not apply with respect to any group health plan,
or any group health insurance coverage offered by a health insurance issuer,
which does not provide benefits for hospital lengths of stay in connection
with a mastectomy or lymph node dissection for the treatment of breast cancer.
`(3) Nothing in this section shall be construed as preventing a group health
plan or issuer from imposing deductibles, coinsurance, or other cost-sharing
in relation to benefits for hospital lengths of stay in connection with
a mastectomy or lymph node dissection for the treatment of breast cancer
under the plan (or under health insurance coverage offered in connection
with a group health plan), except that such coinsurance or other cost-sharing
for any portion of a period within a hospital length of stay required under
subsection (a) may not be greater than such coinsurance or cost-sharing
for any preceding portion of such stay.
`(d) NOTICE- A group health plan under this part shall comply with the notice
requirement under section 713(d) of the Employee Retirement Income Security
Act of 1974 with respect to the requirements of this section as if such section
applied to such plan.
`(e) LEVEL AND TYPE OF REIMBURSEMENTS- Nothing in this section shall be construed
to prevent a group health plan or a health insurance issuer offering group
health insurance coverage from negotiating the level and type of reimbursement
with a provider for care provided in accordance with this section.
`(f) PREEMPTION; EXCEPTION FOR HEALTH INSURANCE COVERAGE IN CERTAIN STATES-
`(1) IN GENERAL- The requirements of this section shall not apply with respect
to health insurance coverage if there is a State law (as defined in section
2723(d)(1)) for a State that regulates such coverage that is described in
any of the following subparagraphs:
`(A) Such State law requires such coverage to provide for at least a 48-hour
hospital length of stay following a mastectomy performed for treatment
of breast cancer and at least a 24-hour hospital length of stay following
a lymph node dissection for treatment of breast cancer.
`(B) Such State law requires, in connection with such coverage for surgical
treatment of breast cancer, that the hospital length of stay for such
care is left to the decision of (or required to be made by) the attending
provider in consultation with the woman involved.
`(2) CONSTRUCTION- Section 2723(a)(1) shall not be construed as superseding
a State law described in paragraph (1).'.
(B) Section 2723(c) of such Act (42 U.S.C. 300gg-23(c)) is amended by striking
`section 2704' and inserting `sections 2704 and 2707'.
(2) ERISA AMENDMENTS- (A) Subpart B of part 7 of subtitle B of title I of
the Employee Retirement Income Security Act of 1974 is amended by adding
at the end the following new section:
`SEC. 714. STANDARDS RELATING TO BENEFITS FOR CERTAIN BREAST CANCER TREATMENT.
`(a) REQUIREMENTS FOR MINIMUM HOSPITAL STAY FOLLOWING MASTECTOMY OR LYMPH
NODE DISSECTION-
`(1) IN GENERAL- A group health plan, and a health insurance issuer offering
group health insurance coverage, may not--
`(A) except as provided in paragraph (2)--
`(i) restrict benefits for any hospital length of stay in connection
with a mastectomy for the treatment of breast cancer to less than 48
hours, or
`(ii) restrict benefits for any hospital length of stay in connection
with a lymph node dissection for the treatment of breast cancer to less
than 24 hours, or
`(B) require that a provider obtain authorization from the plan or the
issuer for prescribing any length of stay required under subparagraph
(A) (without regard to paragraph (2)).
`(2) EXCEPTION- Paragraph (1)(A) shall not apply in connection with any
group health plan or health insurance issuer in any case in which the decision
to discharge the woman involved prior to the expiration of the minimum length
of stay otherwise required under paragraph (1)(A) is made by an attending
provider in consultation with the woman.
`(b) PROHIBITIONS- A group health plan, and a health insurance issuer offering
group health insurance coverage in connection with a group health plan, may
not--
`(1) deny to a woman eligibility, or continued eligibility, to enroll or
to renew coverage under the terms of the plan, solely for the purpose of
avoiding the requirements of this section;
`(2) provide monetary payments or rebates to women to encourage such women
to accept less than the minimum protections available under this section;
`(3) penalize or otherwise reduce or limit the reimbursement of an attending
provider because such provider provided care to an individual participant
or beneficiary in accordance with this section;
`(4) provide incentives (monetary or otherwise) to an attending provider
to induce such provider to provide care to an individual participant or
beneficiary in a manner inconsistent with this section; or
`(5) subject to subsection (c)(3), restrict benefits for any portion of
a period within a hospital length of stay required under subsection (a)
in a manner which is less favorable than the benefits provided for any preceding
portion of such stay.
`(c) RULES OF CONSTRUCTION-
`(1) Nothing in this section shall be construed to require a woman who is
a participant or beneficiary--
`(A) to undergo a mastectomy or lymph node dissection in a hospital; or
`(B) to stay in the hospital for a fixed period of time following a mastectomy
or lymph node dissection.
`(2) This section shall not apply with respect to any group health plan,
or any group health insurance coverage offered by a health insurance issuer,
which does not provide benefits for hospital lengths of stay in connection
with a mastectomy or lymph node dissection for the treatment of breast cancer.
`(3) Nothing in this section shall be construed as preventing a group health
plan or issuer from imposing deductibles, coinsurance, or other cost-sharing
in relation to benefits for hospital lengths of stay in connection with
a mastectomy or lymph node dissection for the treatment of breast cancer
under the plan (or under health insurance coverage offered in connection
with a group health plan), except that such coinsurance or other cost-sharing
for any portion of a period within a hospital length of stay required under
subsection (a) may not be greater than such coinsurance or cost-sharing
for any preceding portion of such stay.
`(d) NOTICE UNDER GROUP HEALTH PLAN- The imposition of the requirements of
this section shall be treated as a material modification in the terms of the
plan described in section 102(a)(1), for purposes of assuring notice of such
requirements under the plan; except that the summary description required
to be provided under the last sentence of section 104(b)(1) with respect to
such modification shall be provided by not later than 60 days after the first
day of the first plan year in which such requirements apply.
`(e) LEVEL AND TYPE OF REIMBURSEMENTS- Nothing in this section shall be construed
to prevent a group health plan or a health insurance issuer offering group
health insurance coverage from negotiating the level and type of reimbursement
with a provider for care provided in accordance with this section.
`(f) PREEMPTION; EXCEPTION FOR HEALTH INSURANCE COVERAGE IN CERTAIN STATES-
`(1) IN GENERAL- The requirements of this section shall not apply with respect
to health insurance coverage if there is a State law (as defined in section
731(d)(1)) for a State that regulates such coverage that is described in
any of the following subparagraphs:
`(A) Such State law requires such coverage to provide for at least a 48-hour
hospital length of stay following a mastectomy performed for treatment
of breast cancer and at least a 24-hour hospital length of stay following
a lymph node dissection for treatment of breast cancer.
`(B) Such State law requires, in connection with such coverage for surgical
treatment of breast cancer, that the hospital length of stay for such
care is left to the decision of (or required to be made by) the attending
provider in consultation with the woman involved.
`(2) CONSTRUCTION- Section 731(a)(1) shall not be construed as superseding
a State law described in paragraph (1).'.
(B) Section 731(c) of such Act (29 U.S.C. 1191(c)) is amended by striking
`section 711' and inserting `sections 711 and 714'.
(C) Section 732(a) of such Act (29 U.S.C. 1191a(a)) is amended by striking
`section 711' and inserting `sections 711 and 714'.
(D) The table of contents in section 1 of such Act is amended by inserting
after the item relating to section 713 the following new item:
`Sec. 714. Standards relating to benefits for certain breast cancer treatment.'.
(b) INDIVIDUAL HEALTH INSURANCE- (1) Part B of title XXVII of the Public Health
Service Act is amended by inserting after section 2752 the following new section:
`SEC. 2753. STANDARDS RELATING TO BENEFITS FOR CERTAIN BREAST CANCER TREATMENT.
`(a) IN GENERAL- The provisions of section 2707 (other than subsection (d))
shall apply to health insurance coverage offered by a health insurance issuer
in the individual market in the same manner as it applies to health insurance
coverage offered by a health insurance issuer in connection with a group health
plan in the small or large group market.
`(b) NOTICE- A health insurance issuer under this part shall comply with the
notice requirement under section 714(d) of the Employee Retirement Income
Security Act of 1974 with respect to the requirements referred to in subsection
(a) as if such section applied to such issuer and such issuer were a group
health plan.
`(c) PREEMPTION; EXCEPTION FOR HEALTH INSURANCE COVERAGE IN CERTAIN STATES-
`(1) IN GENERAL- The requirements of this section shall not apply with respect
to health insurance coverage if there is a State law (as defined in section
2723(d)(1)) for a State that regulates such coverage that is described in
any of the following subparagraphs:
`(A) Such State law requires such coverage to provide for at least a 48-hour
hospital length of stay following a mastectomy performed for treatment
of breast cancer and at least a 24-hour hospital length of stay following
a lymph node dissection for treatment of breast cancer.
`(B) Such State law requires, in connection with such coverage for surgical
treatment of breast cancer, that the hospital length of stay for such
care is left to the decision of (or required to be made by) the attending
provider in consultation with the woman involved.
`(2) CONSTRUCTION- Section 2762(a) shall not be construed as superseding
a State law described in paragraph (1).'.
(2) Section 2762(b)(2) of such Act (42 U.S.C. 300gg-62(b)(2)) is amended by
striking `section 2751' and inserting `sections 2751 and 2753'.
(c) EFFECTIVE DATES- (1) The amendments made by subsection (a) shall apply
with respect to group health plans for plan years beginning on or after January
1, 2004.
(2) The amendments made by subsection (b) shall apply with respect to health
insurance coverage offered, sold, issued, renewed, in effect, or operated
in the individual market on or after such date.
END
