STATEMENT TO

 

SENATE COMMITTEE SUBSTITUTE FOR

SENATE, No. 3202

 

with Senate Floor Amendments

(Proposed by Senator LAGANA)

 

ADOPTED: MARCH 14, 2019


 

      These amendments provide that the notice provided to patients under the bill will include the patient’s right to seek a consultation and obtain reconstructive surgery from a board-certified or board-eligible plastic surgeon that provides breast reconstructive services, regardless of whether the plastic surgeon is affiliated with the general hospital or a health care provider network.  As introduced, the bill only provided for notice concerning a board-certified plastic surgeon.

      The amendments also provide that contract between a carrier and a health care provider for network participation will not contain any provision that prohibits a health care provider from making recommendations to a covered person to a board-certified or board-eligible plastic surgeon, regardless of network affiliation, who provides the full scope of breast reconstructive services necessary and appropriate to the patient’s treatment, provided that the primary consideration when making such recommendations would be the patient's clinical needs, as determined by the patient’s treating physician. As introduced, the bill also included referrals in this provision.  The amendments provide that other considerations when making such recommendations may include the plastic surgeon’s training, expertise, availability, and accessibility to the patient.  The amendments also provide that a carrier cannot deny requests to approve the medical necessity for reconstructive surgery or related services based solely on the network status or hospital affiliation of the plastic surgeon that will perform the reconstructive surgery and related services.