SENATE COMMITTEE SUBSTITUTE FOR

SENATE, No. 3202

STATE OF NEW JERSEY

218th LEGISLATURE

  ADOPTED JANUARY 17, 2019

 


 

Sponsored by:

Senator  JOSEPH A. LAGANA

District 38 (Bergen and Passaic)

Senator  VIN GOPAL

District 11 (Monmouth)

 

Co-Sponsored by:

Senators Codey and Brown

 

 

 

 

SYNOPSIS

     Requires hospitals to provide breast cancer patients with information concerning reconstructive surgery; prohibits certain provisions in managed care plan contracts.

 

CURRENT VERSION OF TEXT

     Substitute as adopted by the Senate Health, Human Services and Senior Citizens Committee.

  

 

 

 


An Act concerning breast cancer and supplementing Title 26 of the Revised Statutes.

 

     Be It Enacted by the Senate and General Assembly of the State of New Jersey:

 

     1.    Each general hospital licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.) that provides surgical services for the treatment of breast cancer, the breast cancer gene, or other breast abnormality, including, but not limited to, mastectomy surgery, lymph node dissection, or lumpectomy, shall ensure that each patient receiving treatment for breast cancer is provided with written notice of:  (1) the patient’s right to seek a consultation with a board-certified plastic surgeon of the patient’s choosing who provides breast reconstructive services, regardless of whether the plastic surgeon is affiliated with the general hospital or a health care provider network, concerning the patient’s treatment options during and after the provision of surgical services, including the use of a prosthesis and the option of undergoing reconstructive surgery during or after the provision of surgical services for the treatment of breast cancer, the breast cancer gene, or other breast abnormality; (2) the patient’s right to obtain reconstructive surgery from a board-certified  plastic surgeon who provides breast reconstructive services, regardless of whether the plastic surgeon is affiliated with the general hospital or a health care provider network; and (3) the availability of coverage under a health benefits plan for reconstructive surgery pursuant to section 1 of P.L.1983, c.50 (C.17:48-6b), section 1 of P.L.1983, c.51 (C.17:48A-7b), section 35 of P.L.1985, c.236 (C.17:48E-35), section 1 of P.L.1983, c.53 (C.17B:26-2.1a), section 1 of P.L.1983, c.52 (C.17B:27-46.1a), section 6 of P.L.1997, c.75 (C.26:2J-4.14), and federal law.  The written notice shall be provided to the patient upon the general hospital’s notification of the patient’s breast cancer diagnosis and in advance of obtaining consent to the surgical procedure.

 

     2.    a.   A contract between a carrier and a health care provider for network participation shall not contain any provision that:

     (1)   prohibits a health care provider from making recommendations or referrals for a covered person to a board-certified plastic surgeon, regardless of network affiliation, who provides the full scope of breast reconstructive services necessary and appropriate to the patient’s treatment needs, as determined by the patient’s treating physician based on the plastic surgeon’s training, experience, and location in relation to the patient’s primary residence, provided that the primary consideration when making such recommendations and referrals shall be the patient’s treatment needs; or

     (2)   seeks to limit the ability of a health care provider to make recommendations or referrals as described in paragraph (1) of this subsection. 

     b.    In no case shall a carrier withhold authorization for reconstructive surgery or related services based on the network status or hospital affiliation of the plastic surgeon who will perform the reconstructive surgery and related services. 

     c.     The provisions of this section shall apply to reconstructive breast surgery or surgery to restore and achieve symmetry between two breasts following treatment or surgery for breast cancer, the breast cancer gene, or other breast abnormality, including, but not limited to, mastectomy surgery, lumpectomy, or radiation.

     d.    As used in this section, “carrier” means a “carrier” as defined in section 2 of P.L.1997, c.192 (C.26:2S-2), the State Health Benefits Program, and the School Employees’ Health Benefits Program.

     e.     The Commissioner of Banking and Insurance shall, pursuant to the “Administrative Procedure Act,” P.L.1968, c.410 (C.52:14B-1 et seq.), adopt rules and regulations as shall be necessary to effectuate the provisions of this section.

 

     3.    This act shall take effect on the 90th day after the date of enactment.