ASSEMBLY, No. 2651

STATE OF NEW JERSEY

INTRODUCED JANUARY 9, 1997

By Assemblyman AZZOLINA

An Act concerning benefits related to mastectomies in the State Health Benefits Program and supplementing P.L.1961, c.49 (C.52:14-17.25 ).

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

    1. The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital or medical expense benefits, shall provide coverage for a minimum of 72 hours of inpatient care following a modified radical mastectomy and a minimum of 48 hours of inpatient care following a simple mastectomy with a lymph node dissection. The contract shall also provide that a carrier shall not require a health care provider to obtain authorization from the carrier for prescribing 72 or 48 hours, as appropriate, of inpatient care as provided for in this section.

    The provisions of this section shall not be construed: to require a patient to receive inpatient care for 72 or 48 hours, as appropriate, if the patient in consultation with the patient's physician determines that a shorter length of stay is medically appropriate; or to relieve a patient or a patient's physician, if appropriate, of any notification requirements to the carrier under the contract.

    2. This act shall take effect immediately.

STATEMENT

    This bill requires the State Health Benefits Program to provide coverage for a minimum of 72 hours of inpatient care following a modified radical mastectomy and a minimum of 48 hours inpatient care following a simple mastectomy with a lymph node dissection. The bill also provides that a carrier under the program shall not require a health care provider to obtain authorization from the carrier for prescribing 72 or 48 hours, as appropriate, of inpatient care.

Requires State Health Benefits Program to provide minimum inpatient care for certain breast surgeries.