ASSEMBLY, No. 2551
STATE OF NEW JERSEY
INTRODUCED DECEMBER 9, 1996
By Assemblywomen HECK and VANDERVALK
An Act providing for minimum hospital stays following certain breast cancer surgeries, and amending and supplementing parts of the statutory law.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Section 1 of P.L.1983, c.50 (C.17:48-6b) is amended to read as follows:
1. a. Every subscription certificate and group and individual contract providing hospital service benefits delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide benefits for the treatment of breast cancer and reconstructive breast surgery, including but not limited to the cost of prostheses and, under any contract providing outpatient x-ray or radiation therapy, benefits for outpatient chemotherapy following surgical procedures in connection with the treatment of breast cancer shall be included as a part of the outpatient x-ray or radiation therapy benefit. The subscription certificate or contract shall also provide coverage 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 dissection for the treatment of breast cancer, however, the subscription certificate or contract shall not be required to provide for a minimum of 48 hours and 24 hours, respectively, of inpatient care if the attending physician and the subscriber determine that a shorter period of inpatient care is appropriate.
b. Every hospital service corporation shall provide notice to subscribers regarding the coverage required by subsection a. of this section in accordance with that subsection and regulations promulgated by the Commissioner of Banking and Insurance pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.). The notice shall be in writing and prominently positioned in any literature or correspondence and shall be transmitted at the earliest of: (1) the next mailing to the subscriber; (2) the yearly informational packet sent to the subscriber; or (3) March 1, 1997.
c. The provisions of this section shall apply to all contracts in which the hospital service corporation has reserved the right to change the premium. Such benefits shall be provided to the same extent as for any other sickness under the contract.
(cf: P.L.1983, c.50, s.1)
2. Section 1 of P.L.1983, c.51 (C.17:48A-7b) is amended to read as follows:
1. a. Every subscription certificate and group and individual contract providing medical service benefits delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide benefits for the treatment of breast cancer and reconstructive breast surgery, including but not limited to the costs of prostheses and, under any contract providing out-of-hospital x-ray or radiation therapy, benefits for out-of-hospital chemotherapy following surgical procedures in connection with the treatment of breast cancer shall be included as a part of the out-of-hospital x-ray or radiation therapy benefit. The subscription certificate or contract shall also provide coverage 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 dissection for the treatment of breast cancer, however, the subscription certificate or contract shall not be required to provide for a minimum of 48 hours and 24 hours, respectively, of inpatient care if the attending physician and the subscriber determine that a shorter period of inpatient care is appropriate.
b. Every medical service corporation shall provide notice to subscribers regarding the coverage required by subsection a. of this section in accordance with that subsection and regulations promulgated by the Commissioner of Banking and Insurance pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.). The notice shall be in writing and prominently positioned in any literature or correspondence and shall be transmitted at the earliest of: (1) the next mailing to the subscriber; (2) the yearly informational packet sent to the subscriber; or (3) March 1, 1997.
c. The provisions of this section shall apply to all contracts in which the medical service corporation has reserved the right to change the premium. Such benefits shall be provided to the same extent as for any other sickness under the contract.
(cf: P.L.1983, c.51, s.1)
3. Section 35 of P.L.1985, c.236 (C.17:48E-35) is amended to read as follows:
35. a. Every subscription certificate and group and individual contract providing health service coverage, delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the commissioner on or after the effective date of this act, shall provide benefits for the treatment of breast cancer and reconstructive breast surgery, including, but not limited to: the cost of prostheses and, under any contract providing outpatient x-ray or radiation therapy, benefits for outpatient chemotherapy following surgical procedures in connection with the treatment of breast cancer, which shall be included as a part of the outpatient x-ray or radiation therapy benefit. The subscription certificate or contract shall also provide coverage 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 dissection for the treatment of breast cancer, however, the subscription certificate or contract shall not be required to provide for a minimum of 48 hours and 24 hours, respectively, of inpatient care if the attending physician and the subscriber determine that a shorter period of inpatient care is appropriate.
b. Every health service corporation shall provide notice to subscribers regarding the coverage required by subsection a. of this section in accordance with that subsection and regulations promulgated by the Commissioner of Banking and Insurance pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.). The notice shall be in writing and prominently positioned in any literature or correspondence and shall be transmitted at the earliest of: (1) the next mailing to the subscriber; (2) the yearly informational packet sent to the subscriber; or (3) March 1, 1997.
c. The provisions of this section shall apply to all contracts in which the health service corporation has reserved the right to change the premium. These benefits shall be provided to the same extent as for any other sickness under the contract.
(cf: P.L. 985, c.236, s.35)
4. Section 1 of P.L. 1983, c.53 (C.17B:26-2.1a) is amended to read as follows:
1. a. Every health insurance policy providing hospital or medical expense benefits delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide benefits for the treatment of breast cancer and reconstructive breast surgery, including but not limited to the costs of prostheses and, under any policy providing outpatient x-ray or radiation therapy, the costs of outpatient chemotherapy following surgical procedures in connection with the treatment of breast cancer shall be included as a part of the outpatient x-ray or radiation therapy coverage. The policy shall also provide coverage 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 dissection for the treatment of breast cancer, however, the policy shall not be required to provide for a minimum of 48 hours and 24 hours, respectively, of inpatient care if the attending physician and the policyholder determine that a shorter period of inpatient care is appropriate.
b. Every insurer shall provide notice to policyholders regarding the coverage required by subsection a. of this section in accordance with that subsection and regulations promulgated by the Commissioner of Banking and Insurance pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.). The notice shall be in writing and prominently positioned in any literature or correspondence and shall be transmitted at the earliest of: (1) the next mailing to the policyholder; (2) the yearly informational packet sent to the policyholder; or (3) March 1, 1997.
c. The provisions of this section shall apply to all policies in which the insurer has reserved the right to change the premium. Such benefits shall be provided to the same extent as for any other sickness under the policy.
(cf: P.L.1983, c.53, s.1)
5. Section 1 of P.L.1983, c.52 (C.17B:27-46.1a) is amended to read as follows:
1. a. Every group health insurance policy providing hospital or medical expense benefits delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide benefits for the treatment of breast cancer and reconstructive breast surgery, including but not limited to the costs of prostheses and, under any policy providing outpatient x-ray or radiation therapy, the costs of outpatient chemotherapy following surgical procedures in connection with the treatment of breast cancer shall be included as a part of the outpatient x-ray or radiation therapy coverage. The policy shall also provide coverage 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 dissection for the treatment of breast cancer, however, the policy shall not be required to provide for a minimum of 48 hours and 24 hours, respectively, of inpatient care if the attending physician and the policyholder determine that a shorter period of inpatient care is appropriate.
b. Every insurer shall provide notice to policyholders regarding the coverage required by subsection a. of this section in accordance with that subsection and regulations promulgated by the Commissioner of Banking and Insurance pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.). The notice shall be in writing and prominently positioned in any literature or correspondence and shall be transmitted at the earliest of: (1) the next mailing to the policyholder; (2) the yearly informational packet sent to the policyholder; or (3) March 1, 1997.
c. The provisions of this section shall apply to all policies in which the insurer has reserved the right to change the premium. Such benefits shall be provided to the same extent as for any other sickness under the policy.
(cf: P.L.1983, c.52, s.1)
6. (New section) a. Every individual health benefits plan that provides hospital or medical expense benefits and is delivered, issued, executed or renewed or approved for issuance or renewal, in this State pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.) on or after the effective date of P.L. , c. (now before the Legislature as this bill) shall provide benefits 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 dissection for the treatment of breast cancer, however, the health benefits plan shall not be required to provide for a minimum of 48 hours and 24 hours, respectively, of inpatient care if the attending physician and the policyholder determine that a shorter period of inpatient care is appropriate.
b. Every carrier shall provide notice to policyholders regarding the coverage required by subsection a. of this section in accordance with that subsection and regulations promulgated by the New Jersey Individual Health Coverage Program Board pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.). The notice shall be in writing and prominently positioned in any literature or correspondence and shall be transmitted at the earliest of: (1) the next mailing to the plan holder; (2) the yearly informational packet sent to the plan holder; or (3) March 1, 1997.
c. The provisions of this section shall apply to all health benefits plans in which the insurer has reserved the right to change the premium. Benefits required by this section shall be provided to the same extent as for any other medical condition under a health benefits plan.
7. (New section) a. Every small employer health benefits plan that provides hospital or medical expense benefits and is delivered, issued, executed or renewed, or approved for issuance or renewal, in this State pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.) on or after the effective date of P.L. , c. (now before the Legislature as this bill) shall provide benefits 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 dissection for the treatment of breast cancer, however, the health benefits plan shall not be required to provide for a minimum of 48 hours and 24 hours, respectively, of inpatient care if the attending physician and the policyholder determine that a shorter period of inpatient care is appropriate.
b. Every carrier shall provide notice to plan holders regarding the coverage required by subsection a. of this section in accordance with that subsection and regulations promulgated by the New Jersey Small Employer Health Benefits Program Board pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.). The notice shall be in writing and prominently positioned in any literature or correspondence and shall be transmitted at the earliest of: (1) the next mailing to the plan holder; (2) the yearly informational packet sent to the plan holder; or (3) March 1, 1997.
c. The provisions of this section shall apply to all health benefits plans in which the carrier has reserved the right to change the premium. Benefits required by this section shall be provided to the same extent as for any other medical condition under a health benefits plan.
8. (New section) a. A certificate of authority to establish and operate a health maintenance organization in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.) shall not be issued or continued by the Commissioner of Health and Senior Services on or after the effective date of P.L. , c. (now before the Legislature as this bill) unless the enrollee agreement provides health care services 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 dissection for the treatment of breast cancer, however, the enrollee agreement shall not be required to provide for a minimum of 48 hours and 24 hours, respectively, of inpatient care if the attending physician and the enrollee determine that a shorter period of inpatient care is appropriate.
b. Every health maintenance organization shall provide notice to enrollees regarding the coverage required by subsection a. of this section in accordance with that subsection and regulations promulgated by the Commissioner of Health and Senior Services pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.). The notice shall be in writing and prominently positioned in any literature or correspondence and shall be transmitted at the earliest of: (1) the next mailing to the enrollee; (2) the yearly informational packet sent to the enrollee; or (3) March 1, 1997.
c. The provisions of this section shall apply to all enrollee agreements for health care services by health maintenance organizations under which the right to change the schedule of charges for enrollee coverage is reserved. The health care services required by this section shall be provided to the same extent as for any other medical condition under the enrollee agreement.
9. This act shall take effect immediately.
STATEMENT
This bill requires health insurers, including hospital service corporations, medical service corporations, health service corporations, commercial insurers, health benefits plans issued through the New Jersey Individual Health Coverage Program and Small Employer Health Benefits Program Boards, and health maintenance organizations to provide for a minimum of 48 hours of inpatient care following a mastectomy and not less than 24 hours of inpatient care following a lymph node dissection for the treatment of breast cancer. The bill also provides that the decision to remain an inpatient is at the discretion of an insured and a licensed physician.
Under the bill, all insurers are required to notify their insureds in writing of these minimum coverage provisions at the earliest of: (1) the next mailing to the insured; (2) the yearly informational packet sent to the insured; or (3) March 1, 1997.
Requires minimum hospital stays for certain breast cancer surgeries