Short title; findings

(a)

Short title

This Act may be cited as the Post-Prostate Cancer Treatment Equity Act of 2007. (b)

Findings

Congress finds the following: (1)Prostate cancer will strike about one in six men during their lifetime. (2)Many of these men will have a prostatectomy and about half of those will experience significant complications. (3)For some 6,000 of these men annually reconstructive prosthetic urology surgery is their only option to address these complications. (4)Medicare covers reconstructive prosthetic urology surgery, as does two-third of private health benefits coverage. However, about one-third of private health benefits coverage does not cover this surgery. (5)To address a similar concern with respect to breast cancer, Congress enacted the Women’s Health and Cancer Rights Act of 1998 that requires private health benefits coverage to provide coverage for reconstructive surgery following mastectomies. (6)Men should have a right to access to reconstructive surgery following a prostatectomy just as women have the right to access to reconstructive surgery following a mastectomy.

Amendments to the Employee Retirement Income Security Act of 1974

(a)

In general

Subpart B of part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1185 et seq.) is amended by adding at the end the following new section:

714.

Required coverage for reconstructive prosthetic urology surgery following prostate cancer treatment

(a)

In general

A group health plan, and a health insurance issuer providing health insurance coverage in connection with a group health plan, that provides medical and surgical benefits with respect to prostate cancer treatment shall provide, in a case of a participant or beneficiary who is receiving benefits in connection with such prostate cancer treatment, coverage for— (1)all stages of reconstructive prosthetic urology surgery; and (2)prostheses and physical complications of prostatectomy;

in a manner determined in consultation with the attending physician and the patient. Such coverage may be subject to annual deductibles and coinsurance provisions as may be deemed appropriate and as are consistent with those established for other benefits under the plan or coverage. Written notice of the availability of such coverage shall be delivered to the participant upon enrollment and annually thereafter.

(b)

Notice

A group health plan, and a health insurance issuer providing health insurance coverage in connection with a group health plan shall provide notice to each participant and beneficiary under such plan regarding the coverage required by this section in accordance with regulations promulgated by the Secretary. Such notice shall be in writing and prominently positioned in any literature or correspondence made available or distributed by the plan or issuer and shall be transmitted— (1)in the next mailing made by the plan or issuer to the participant or beneficiary; (2)as part of any yearly informational packet sent to the participant or beneficiary; or (3)not later than January 1, 2008;

whichever is earlier.

(c)

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 patient eligibility or continued eligibility, to enroll or to renew coverage under the terms of the plan, solely for the purposes of avoiding the requirements of this section; and (2)penalize or otherwise reduce or limit the reimbursement of an attending provider, or 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. (d)

Rule of construction

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. (e)

Preemption, relation to state laws

(1)

In general

Nothing in this section shall be construed to preempt any State law in effect on the date of enactment of this section with respect to health insurance coverage that requires coverage of at least the coverage of reconstructive prosthetic urology surgery otherwise required in this section. (2)

ERISA

Nothing in this section shall be construed to affect or modify the provisions of section 514 with respect to group health plans.

(b)

Clerical amendment

The table of contents in section 1 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1001 note) is amended by inserting after the item relating to section 713 the following new item:

Sec. 714. Required coverage for reconstructive prosthetic urology surgery following prostate cancer treatment.

(c)

Effective dates

(1)

In general

The amendments made by this section shall apply with respect to plan years beginning on or after the first day of the sixth month beginning after the date of the enactment of this Act. (2)

Special rule for collective bargaining agreements

In the case of a group health plan maintained pursuant to 1 or more collective bargaining agreements between employee representative and 1 or more employers, any plan amendment made pursuant to a collective bargaining agreement relating to the plan which amends the plan solely to conform to any requirement added by this section shall not be treated as a termination of such collective bargaining agreement.

Amendments to the Public Health Service Act

(a)

Group market

Subpart 2 of part A of title XXVII of the Public Health Service Act (42 U.S.C. 300gg-4 et seq.) is amended by adding at the end the following new section:

2707.

Required coverage for reconstructive prosthetic urology surgery following prostate cancer treatment

The provisions of section 714 of the Employee Retirement Income Security Act of 1974 shall apply to group health plans, and health insurance issuers providing health insurance coverage in connection with group health plans, as if included in this subpart.

(b)

Individual market

Subpart 3 of part B of title XXVII of the Public Health Service Act (42 U.S.C. 300gg–51 et seq.) is amended by adding at the end the following new section:

2753.

Required coverage for reconstructive prosthetic urology surgery following prostate cancer treatment

The provisions of section 2707 of the title shall apply to health insurance coverage offered by a health insurance issuer in the individual market in the same manner as they apply to health insurance coverage offered by a health insurance issuer in connection with a group health plan in the small or large group market.

(c)

Effective dates

(1)

Group plans

(A)

In general

The amendment made by subsection (a) shall apply to group health plans for plan years beginning on or after the first day of the sixth month beginning after the date of the enactment of this Act. (B)

Special rule for collective bargaining agreement

In the case of a group health plan maintained pursuant to 1 or more collective bargaining agreements between employee representatives and 1 or more employers, any plan amendment made pursuant to a collective bargaining agreement relating to the plan which amends the plan solely to conform to any requirement added by the amendment made by subsection (a) shall not be treated as a termination of such collective bargaining agreement. (2)

Individual plans

The amendment 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 the first day of the sixth month beginning after the date of the enactment of this Act.