SENATE HEALTH COMMITTEE

 

STATEMENT TO

 

SENATE, No. 1704

 

with committee amendments

 

STATE OF NEW JERSEY

 

DATED: DECEMBER 16, 1996

 

      The Senate Health Committee reports favorably and with committee amendments Senate Bill No. 1704.

      As amended by committee, this bill requires hospital, medical and health service corporations, individual and small and large group commercial insurers, and health maintenance organizations to provide a minimum of 72 hours 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 the insurer or health maintenance organization shall not require a health care provider to obtain authorization from the insurer or health maintenance organization for prescribing the 72 or 48 hours, as appropriate, of inpatient care as provided for in this bill.

      The bill also clarifies that the mandate in the bill is for a carrier to provide coverage for a minimum amount of inpatient care, but if a patient in consultation with the patient's physician determines that a shorter length of stay is medically appropriate, the patient may be discharged sooner. Also, the bill clarifies that the provisions of the bill do not relieve a patient or the patient's physician from any notification requirements to the insurer or health maintenance organization that may be contained in the insurance contract or policy or health maintenance organization enrollee agreement.

      The bill requires an employer in this State who provides coverage to his employees or their dependents for treatment of breast cancer to annually and upon request of an employee at other times during the year, notify his employees whether the employees' coverage for treatment of breast cancer is subject to the requirements of this bill.

      The bill also requires the attending physician of a patient who will undergo a mastectomy, prior to the surgery, to determine if the coverage is subject to the requirements of this bill. If the physician determines that the patient's coverage is not subject to the requirements of this bill, the physician shall promptly notify the patient of that fact and, if known, the duration of inpatient care to which the patient is entitled under the patient's insurance coverage.

      The committee amended the bill to add minimum coverage requirements for a simple mastectomy with a lymph node dissection; to clarify that a patient may be discharged sooner that the mandated minimum coverage when medically appropriate; to clarify that the provisions of the bill do not relieve a patient or physician from any insurer notification requirements; and to add the employer and physician notification requirements. Amendments also specify the types of mastectomies covered under the provisions of the bill.