ASSEMBLY SUBSTITUTE FOR

SENATE, No. 1705 and ASSEMBLY, No. 2651

 

STATE OF NEW JERSEY

 

 

ADOPTED FEBRUARY 20, 1997

 

 

Sponsored by Senators INVERSO, MATHEUSSEN Assemblyman AZZOLINA, Senators McGreevey, Sinagra, Rice, Bubba, LaRossa, Bark, Sacco, Kosco, Assemblymen Rocco, Augustine, Bucco and Cohen

 

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. 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 Assembly substitute 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 of inpatient care following a simple mastectomy. The substitute 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.

      The substitute also provides that the provisions of the substitute 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 relieve a patient or physician from any insurer notification requirements.

 

 

                             

 

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