[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4296 Introduced in House (IH)]







104th CONGRESS
  2d Session
                                H. R. 4296

 To require that health plans provide coverage for a minimum hospital 
  stay for mastectomies and lymph node disection for the treatment of 
                             breast cancer.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 28, 1996

 Ms. DeLauro (for herself, Mr. Dingell, Mr. Sanders, Mr. Costello, Mr. 
 Foglietta, Mr. Moran, Mrs. Lowey, Mr. Pallone, Mrs. Meek of Florida, 
  Mr. LoBiondo, Ms. Pelosi, Mr. Nadler, Ms. Eshoo, Mrs. Maloney, Ms. 
Norton, Mrs. Clayton, and Ms. Slaughter) introduced the following bill; 
            which was referred to the Committee on Commerce

_______________________________________________________________________

                                 A BILL


 
 To require that health plans provide coverage for a minimum hospital 
  stay for mastectomies and lymph node disection 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 1996''.

SEC. 2. REQUIRED COVERAGE FOR MINIMUM HOSPITAL STAY FOR MASTECTOMIES 
              AND LYMPH NODE DISECTIONS FOR THE TREATMENT OF BREAST 
              CANCER.

    (a) In General.--A health plan that provides medical and surgical 
benefits with respect to the treatment of breast cancer shall ensure 
that coverage is provided for not less than 48 hours of inpatient care 
following a mastectomy and not less than 24 hours of inpatient care 
following a lymph node disection for the treatment of breast cancer.
    (b) Exception.--Nothing in this section shall be construed as 
requiring the provision of inpatient coverage where the attending 
physician and patient determine that a shorter period of hospital stay 
is appropriate.
    (c) Prohibition.--In implementing the requirements of this section, 
a health plan may not modify the terms and conditions of coverage based 
on the determination by an enrollee to request less than the minimum 
coverage required under subsection (a).
    (d) Notice.--A health plan shall provide notice to each enrollee 
under such plan regarding the coverage required by this section in 
accordance with regulations promulgated by the Secretary of Health and 
Human Services. Such notice shall be in writing and prominently 
positioned in any literature or correspondence made available or 
distributed by the health plan and shall be transmitted--
            (1) in the next mailing made by the plan to the employee;
            (2) as part of any yearly informational packet sent to the 
        enrollee; or
            (3) not later than January 1, 1997;
whichever is earlier.
    (e) Health Plan.--
            (1) In general.--As used in this Act, the term ``health 
        plan'' means any plan or arrangement which provides, or pays 
        the cost of, health benefits.
            (2) Exclusions.--Such term does not include the following, 
        or any combination thereof:
                    (A) Coverage only for accidental death or 
                dismemberment.
                    (B) Coverage providing wages or payments in lieu of 
                wages for any period during which the employee is 
                absent from work on account of sickness or injury.
                    (C) A Medicare supplemental policy (as defined in 
                section 1882(g)(1) of the Social Security Act).
                    (D) Coverage issued as a supplement to liability 
                insurance.
                    (E) Worker's compensation or similar insurance.
                    (F) Automobile medical-payment insurance.
                    (G) A long-term care policy, including a nursing 
                home fixed indemnity policy (unless the Secretary 
                determines that such a policy provides sufficiently 
                comprehensive coverage of a benefit so that it should 
                be treated as a health plan).
                    (H) Such other plan or arrangement as the Secretary 
                of Health and Human Services determines is not a health 
                plan.
            (3) Certain plans included.--Such term includes any plan or 
        arrangement not described in any subparagraph of paragraph (2) 
        which provides for benefit payments, on a periodic basis, for--
                    (A) a specified disease or illness, or
                    (B) period of hospitalization,
        without regard to the costs incurred or services rendered 
        during the period to which the payments relate.

SEC. 3. EFFECTIVE DATE.

    The provisions of section 2 shall apply to all health plans 
offered, sold, issued, renewed, in effect, or operated after the date 
of the enactment of this Act.
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