SB 431 - Breast Cancer Patient Care Act - provide

First Reader Summary

A bill to amend Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to insurance generally, so as to provide for a short title; to provide for legislative findings; to provide definitions; to require health insurers to provide coverage for a minimum of inpatient care following a mastectomy or lymph node dissection; to provide for coverage by insurers of postmastectomy and postlymph node dissectomy care.

Marable, Richard O (52nd) Dean, Nathan (31st) Madden, Eddie M (47th)
Status Summary HC: Ins SC: H&HS LA: 03/13/98 H - Favorably Reported (CS/FA )
Page Numbers - 1/ 2/ 3/ 4/ 5
Code Sections - 33-24-70/ 33-24-71/ 33-24-72/ 33-24-73/ 33-24-74
Senate Action House
1/14/98 Read 1st time 2/13/98
2/6/98 Favorably Reported 3/13/98
Sub Committee Amend/Sub
2/9/98 Read 2nd Time 2/16/98
2/12/98 Read 3rd Time
2/12/98 Passed/Adopted
CS/FA Comm/Floor Amend/Sub

SB 431 98                                        SB431/CSFA/3 
 
      SENATE BILL 431 
 
      By:  Senators Marable of the 52nd, Dean of the 31st, 
           Madden of the 47th and others 
 
                        A BILL TO BE ENTITLED 
                               AN ACT 
 
 
  1- 1  To amend Chapter 24 of Title 33 of the Official Code of 
  1- 2  Georgia Annotated, relating to insurance generally, so as to 
  1- 3  provide for a short title; to provide for legislative 
  1- 4  findings; to provide definitions; to require health insurers 
  1- 5  to make available coverage for a minimum of inpatient care 
  1- 6  following a mastectomy or lymph node dissection; to provide 
  1- 7  for coverage by insurers of postmastectomy and postlymph 
  1- 8  node dissectomy care; to require that certain information be 
  1- 9  provided; to provide for regulations to be issued by the 
  1-10  Commissioner of Insurance; to provide for notice to 
  1-11  policyholders; to prohibit certain actions by insurers; to 
  1-12  provide for applicability; to provide for adjustment of 
  1-13  current contracts; to provide for related matters; to 
  1-14  provide for an effective date; to repeal conflicting laws; 
  1-15  and for other purposes. 
 
  1-16       BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA: 
 
  1-17                           SECTION 1. 
 
  1-18  Chapter 24 of Title 33 of the Official Code of Georgia 
  1-19  Annotated, relating to insurance generally, is amended by 
  1-20  adding at the end a new article to read as follows: 
 
 
 
  1-21    33-24-70. 
 
  1-22    This article shall be known and may be cited as the 
  1-23    'Breast Cancer Patient Care Act.' 
 
  1-24    33-24-71. 
 
  1-25    The General Assembly finds and declares that: 
 
  1-26      (1) Whereas, until recently health care insurers covered 
  1-27      costs of hospital stays of a patient who had undergone a 
  1-28      mastectomy or lymph node dissection until that patient 
  1-29      was discharged by a physician.  Now some insurers are 
  1-30      making mastectomies and lymph node dissections an 
 
 
 
 
                                 -1- 
 
 
 
  2- 1      outpatient procedure and refusing to pay for any 
  2- 2      hospital inpatient care following the procedure; 
 
  2- 3      (2) There is sufficient scientific data to question the 
  2- 4      safety and appropriateness of such treatment of breast 
  2- 5      cancer patients; and 
 
  2- 6      (3) The length of postmastectomy or postlymph node 
  2- 7      dissection inpatient stay should be a clinical decision 
  2- 8      made by a physician based on the unique characteristics 
  2- 9      of the patient and the surgery involved. 
 
  2-10    33-24-72. 
 
  2-11    (a) As used in this Code section, the term: 
 
  2-12      (1)'Attending provider' means a person licensed to 
  2-13      practice medicine pursuant to Chapter 34 of Title 43. 
 
  2-14      (2) 'Health benefit policy' means any individual or 
  2-15      group plan, policy, or contract for health care services 
  2-16      issued, delivered, issued for delivery, or renewed in 
  2-17      this state, including, but not limited to, those 
  2-18      contracts executed by the State of Georgia on behalf of 
  2-19      indigents and on behalf of state employees under Article 
  2-20      1 of Chapter 18 of Title 45, by a health care 
  2-21      corporation, health maintenance organization, preferred 
  2-22      provider organization, accident and sickness insurer, 
  2-23      fraternal benefit society, hospital service corporation, 
  2-24      medical service corporation, or other insurer or similar 
  2-25      entity. 
 
  2-26      (3) 'Insurer' means an accident and sickness insurer, 
  2-27      fraternal benefit society, hospital service corporation, 
  2-28      medical service corporation, health care corporation, 
  2-29      health maintenance organization, managed care plan other 
  2-30      than a dental plan, or any similar entity authorized to 
  2-31      issue contracts under this title and also means any 
  2-32      state program funded under Title XIX of the federal 
  2-33      Social Security Act, 42 U.S.C.A. Section 1396 et seq., 
  2-34      and any other publicly funded state health care program. 
 
  2-35      (4) 'Lymph node dissection' means the removal of a part 
  2-36      of the lymph node system under the arm using general 
  2-37      anesthesia as part of a diagnostic process that is used 
  2-38      to evaluate the spread of cancer and to determine the 
  2-39      need for further treatment. 
 
  2-40      (5)'Mastectomy' means surgical removal of one or both 
  2-41      breasts. 
 
 
 
                                 -2- 
 
 
 
  3- 1    (b) Every health benefit policy that provides surgical 
  3- 2    benefits for mastectomies that is delivered, issued, 
  3- 3    executed, or renewed in this state or approved for 
  3- 4    issuance or renewal in this state by the Commissioner on 
  3- 5    or after July 1, 1998, shall make available as a part of 
  3- 6    the policy or as an optional endorsement to the policy 
  3- 7    coverage in a licensed health care facility for a length 
  3- 8    of stay determined to be medically appropriate for the 
  3- 9    patient as determined by the attending provider in 
  3-10    consultation with the patient, provided that coverage is 
  3-11    not less than 48 hours of inpatient care following a 
  3-12    simple mastectomy and 72 hours of inpatient care following 
  3-13    a modified radical mastectomy. 
 
  3-14    (c) Every health benefit policy that provides surgical 
  3-15    benefits for lymph node dissection that is delivered, 
  3-16    issued, executed, or renewed in this state or approved for 
  3-17    issuance or renewal in this state by the Commissioner on 
  3-18    or after July 1, 1998, shall make available as a part of 
  3-19    the policy or as an optional endorsement to the policy 
  3-20    coverage in a licensed health care facility for a length 
  3-21    of stay determined to be medically appropriate for the 
  3-22    patient as determined by the attending provider in 
  3-23    consultation with the patient, provided that such coverage 
  3-24    is not less than 24 hours of inpatient care following the 
  3-25    lymph node dissection. 
 
  3-26    (d) Any decision to shorten the length of stay to less 
  3-27    than that provided under subsection (b) or (c) of this 
  3-28    Code section shall be made by the attending provider after 
  3-29    conferring with the breast cancer patient. 
 
  3-30    (e) If an attending provider discharges a simple 
  3-31    mastectomy patient in less than 48 hours, a modified 
  3-32    radical mastectomy patient in less than 72 hours, or a 
  3-33    lymph node dissection patient in less than 24 hours, 
  3-34    coverage shall be made available for up to two follow-up 
  3-35    visits, provided that the first such visit shall occur 
  3-36    within 48 hours of discharge.  Such visits shall be 
  3-37    conducted by a physician, a physician's assistant, or a 
  3-38    registered professional nurse with experience and training 
  3-39    in postsurgical care.  After conferring with the 
  3-40    mastectomy patient, the health care provider shall 
  3-41    determine whether the initial visit will be conducted at 
  3-42    the patient's home or at the health care provider's 
  3-43    office.  Thereafter, the health care provider shall confer 
  3-44    with the patient and determine whether a second visit is 
 
 
 
                                 -3- 
 
 
 
  4- 1    appropriate, and, if appropriate, where such visit shall 
  4- 2    be conducted. If no early discharge occurs, coverage shall 
  4- 3    be made available for follow-up visits which are medically 
  4- 4    necessary as determined by the attending provider. 
 
  4- 5    (f) Prior to discharge from the health care facility, an 
  4- 6    attending provider shall inform the mastectomy or lymph 
  4- 7    node dissection patient of all community and hospital 
  4- 8    based programs, agencies, or institutions which provide 
  4- 9    assistance to breast cancer victims who need physical 
  4-10    assistance or psychological and emotional counseling. 
 
  4-11    (g) The Commissioner shall adopt rules and regulations 
  4-12    necessary to implement the provisions of this Code 
  4-13    section. 
 
  4-14    (h) Every insurer shall provide notice to policyholders 
  4-15    regarding the coverage made available by this Code section 
  4-16    and any rules and regulations promulgated by the 
  4-17    Commissioner relating to this Code section.  The notice 
  4-18    shall be in writing and prominently positioned in any of 
  4-19    the following literature: 
 
  4-20      (1) The next mailing to the policyholder; 
 
  4-21      (2) The yearly informational packets sent to the 
  4-22      policyholder; or 
 
  4-23      (3) Other literature mailed before January 1, 1999. 
 
  4-24    (i) No insurer covered under this Code section shall 
  4-25    deselect, terminate the services of, require additional 
  4-26    utilization review, reduce capitation payment, or 
  4-27    otherwise penalize an attending provider or other health 
  4-28    care provider who orders care consistent with the 
  4-29    provisions of this Code section.  For purposes of this 
  4-30    subsection, the term 'health care provider' shall be 
  4-31    defined to include the attending provider and hospital. 
 
  4-32    33-24-73. 
 
  4-33    All contracts relating to the provision of health care 
  4-34    services in effect on July 1, 1998, shall be appropriately 
  4-35    adjusted to reflect any change in services made available 
  4-36    as required by this article. 
 
  4-37    33-24-74. 
 
  4-38    The provisions of this article shall not be construed to 
  4-39    apply to or in any way affect the provisions of the 
  4-40    federal Employee's Retirement Income Security Act." 
 
 
 
                                 -4- 
 
 
 
  5- 1                           SECTION 2. 
 
  5- 2  This Act shall become effective on July 1, 1998. 
 
  5- 3                           SECTION 3. 
 
  5- 4  All laws and parts of laws in conflict with this Act are 
  5- 5  repealed. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                 -5- 

Clerk of the House
Robert E. Rivers, Jr., Clerk
Last Updated on 04/20/98

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