|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.
Page Numbers -
||Read 1st time
||Read 2nd Time
||Read 3rd Time
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
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:
1-22 This article shall be known and may be cited as the
1-23 'Breast Cancer Patient Care Act.'
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
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.
2-11 (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
2-26 (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
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
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
4-14 (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.
4-33 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.
4-38 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."
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.
Clerk of the House
Robert E. Rivers, Jr., Clerk
Last Updated on 04/20/98