,i #aacth ,,congress #ast ,session ,h4 ,r4 #aeca ,,in ,,the ,,house ,,of ,,representatives ,april #ab1 #bjac ,ms4 ,de,lauro 7for herself1 ,mr4 ,bishop of ,georgia1 ,ms4 ,bordallo1 ,mr4 ,braley of ,iowa1 ,ms4 ,brown of ,florida1 ,mrs4 ,capps1 ,mr4 ,carson of ,indiana1 ,ms4 ,castor of ,florida1 ,ms4 ,chu1 ,mr4 ,clay1 ,mr4 ,cohen1 ,mr4 ,connolly1 ,mr4 ,conyers1 ,mr4 ,cooper1 ,ms4 ,de,gette1 ,mr4 ,dingell1 ,ms4 ,edwards1 ,mr4 ,ellison1 ,mr4 ,engel1 ,mr4 ,farr1 ,ms4 ,fudge1 ,mr4 ,grijalva1 ,mr4 ,hastings of ,florida1 ,mr4 ,higgins1 ,mr4 ,himes1 ,mr4 ,holt1 ,mr4 ,israel1 ,ms4 ,jackson ,lee1 ,ms4 ,eddie ,bernice ,johnson of ,texas1 ,mr4 ,johnson of ,georgia1 ,ms4 ,kaptur1 ,mr4 ,langevin1 ,mr4 ,larson of ,connecticut1 ,ms4 ,lee of ,california1 ,mr4 ,levin1 ,mr4 ,lewis1 ,mr4 ,lo,biondo1 ,mr4 ,loebsack1 ,ms4 ,lofgren1 ,mrs4 ,lowey1 ,mrs4 ,carolyn ,b4 ,maloney of ,new ,york1 ,mr4 ,markey1 ,mr4 ,mc,govern1 ,mr4 ,mc,intyre1 ,ms4 ,moore1 ,mr4 ,moran1 ,mr4 ,nadler1 ,mrs4 ,napolitano1 ,mr4 ,neal1 ,mr4 ,pastor of ,arizona1 ,mr4 ,payne1 ,ms4 ,pingree of ,maine1 ,mr4 ,price of ,north ,carolina1 ,mr4 ,rahall1 ,mr4 ,rangel1 ,ms4 ,roybal-,allard1 ,mr4 ,ruppersberger1 ,mr4 ,rush1 ,mr4 ,ryan of ,ohio1 ,mr4 ,sablan1 ,ms4 ,linda ,t4 ,snchez of ,california1 ,mr4 ,sarbanes1 ,ms4 ,schakowsky1 ,mr4 ,schiff1 ,ms4 ,schwartz1 ,mr4 ,david ,scott of ,georgia1 ,mr4 ,serrano1 ,mr4 ,sherman1 ,ms4 ,slaughter1 ,ms4 ,speier1 ,ms4 ,tsongas1 ,mr4 ,van ,hollen1 ,ms4 ,wasserman ,schultz1 ,ms4 ,wilson of ,florida1 and ,mr4 ,young of ,alaska7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committees on ,ways and ,means and ,education and the ,workforce1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to require that health plans provide coverage for a minimum hospital stay for mastectomies1 lumpectomies1 and lymph node dissection for the treatment of breast cancer and coverage for secondary consultations4 #a4 ,short title ,this ,act may be cited as the ,breast ,cancer ,patient ,protection ,act of #bjac4 #b4 ,findings ,congress finds the following3 7#a7 ,according to the ,national ,cancer ,institute1 excluding cancers of the skin1 breast cancer is the most frequently diagnosed cancer in women4 7#b7 ,according to the ,national ,cancer ,institute1 an estimated #ci1eaj women and #daj men died from breast cancer in #bjab4 7#c7 ,according to the ,national ,cancer ,institute1 in #bjab an estimated #bbf1hgj new cases of breast cancer were diagnosed in women1 and an estimated #b1aij breast cancer cases were diagnosed in men4 7#d7 ,according to the ,american ,cancer ,society1 most breast cancer patients undergo some type of surgical treatment1 which may involve lumpectomy or mastectomy with removal of some of the axillary lymph nodes4 7#e7 ,the offering and operation of health plans affect commerce among the ,states4 7#f7 ,health care providers located in a ,state serve patients who reside in the ,state and patients who reside in other ,states4 7#g7 ,in order to provide for uniform treatment of health care providers and patients among the ,states1 it is necessary to cover health plans operating in one ,state as well as health plans operating among the several ,states4 7#h7 ,research has indicated that treatment for breast cancer varies according to type of insurance coverage and ,state of residence4 7#i7 ,breast cancer patients have reported adverse outcomes1 including infection and inadequately controlled pain1 resulting from premature hospital discharge following breast cancer surgery4 #c4 ,amendments to the ,employee ,retirement ,income ,security ,act of #aigd 7a7 ,in general ,subpart ,b of part #g of subtitle ,b of title ,i of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aahe et seq47 is amended by adding at the end the following3 #gaf4 ,required coverage for minimum hospital stay for mastectomies1 lumpectomies1 and lymph node dissections for the treatment of breast cancer and coverage for secondary consultations 7a7 ,inpatient care 7#a7 ,in general ,a group health plan1 and a health insurance issuer providing health insurance coverage in connection with a group health plan1 that provides medical and surgical benefits shall ensure that inpatient 7and in the case of a lumpectomy1 outpatient7 coverage and radiation therapy is provided for breast cancer treatment4 ,such plan or coverage may not-- 7,a7 insofar as the attending physician1 in consultation with the patient1 determines it to be medically necessary-- 7i7 restrict benefits for any hospital length of stay in connection with a mastectomy or breast conserving surgery 7such as a lumpectomy7 for the treatment of breast cancer to less than #dh hours2 or 7ii7 restrict benefits for any hospital length of stay in connection with a lymph node dissection for the treatment of breast cancer to less than #bd hours2 or 7,b7 require that a provider obtain authorization from the plan or the issuer for prescribing any length of stay required under this paragraph4 7#b7 ,exception ,nothing in this section shall be construed as requiring the provision of inpatient coverage if the attending physician1 in consultation with the patient1 determines that either a shorter period of hospital stay1 or outpatient treatment1 is medically appropriate4 7b7 ,prohibition on certain modifications ,in implementing the requirements of this section1 a group health plan1 and a health insurance issuer providing health insurance coverage in connection with a group health plan1 may not modify the terms and conditions of coverage based on the determination by a participant or beneficiary to request less than the minimum coverage required under subsection 7a74 7c7 ,notice ,a group health plan1 and a health insurance issuer providing health insurance coverage in connection with a group health plan1 shall provide notice to each participant and beneficiary under such plan regarding the coverage required by this section in accordance with regulations promulgated by the ,secretary4 ,such notice shall be in writing and prominently positioned in the summary of the plan made available or distributed by the plan or issuer and shall be transmitted-- 7#a7 in the next mailing made by the plan or issuer to the participant or beneficiary2 or 7#b7 as part of any yearly informational packet sent to the participant or beneficiary2 whichever is earlier4 7d7 ,secondary consultations 7#a7 ,in general ,a group health plan1 and a health insurance issuer providing health insurance coverage in connection with a group health plan1 that provides coverage with respect to medical and surgical services provided in relation to the diagnosis and treatment of cancer shall ensure that coverage is provided for secondary consultations1 on terms and conditions that are no more restrictive than those applicable to the initial consultations1 by specialists in the appropriate medical fields 7including pathology1 radiology1 and oncology7 to confirm or refute such diagnosis4 ,such plan or issuer shall ensure that coverage is provided for such secondary consultation whether such consultation is based on a positive or negative initial diagnosis4 ,in any case in which the attending physician certifies in writing that services necessary for such a secondary consultation are not sufficiently available from specialists operating under the plan with respect to whose services coverage is otherwise provided under such plan or by such issuer1 such plan or issuer shall ensure that coverage is provided with respect to the services necessary for the secondary consultation with any other specialist selected by the attending physician for such purpose at no additional cost to the individual beyond that which the individual would have paid if the specialist was participating in the network of the plan4 7#b7 ,exception ,nothing in paragraph 7#a7 shall be construed as requiring the provision of secondary consultations where the patient determines not to seek such a consultation4 7e7 ,prohibition on penalties or incentives ,a group health plan1 and a health insurance issuer providing health insurance coverage in connection with a group health plan1 may not-- 7#a7 penalize or otherwise reduce or limit the reimbursement of a provider or specialist because the provider or specialist provided care to a participant or beneficiary in accordance with this section2 7#b7 provide financial or other incentives to a physician or specialist to induce the physician or specialist to keep the length of inpatient stays of patients following a mastectomy1 lumpectomy1 or a lymph node dissection for the treatment of breast cancer below certain limits or to limit referrals for secondary consultations2 or 7#c7 provide financial or other incentives to a physician or specialist to induce the physician or specialist to refrain from referring a participant or beneficiary for a secondary consultation that would otherwise be covered by the plan or coverage involved under subsection 7d74 4 7b7 ,clerical amendment ,the table of contents in section #a of the ,employee ,retirement ,income ,security ,act of #aigd is amended by inserting after the item relating to section #gae the following3 ,sec4 #gaf4 ,required coverage for minimum hospital stay for mastectomies1 lumpectomies1 and lymph node dissections for the treatment of breast cancer and coverage for secondary consultations4 4 7c7 ,effective dates 7#a7 ,in general ,the amendments made by this section shall apply with respect to plan years beginning on or after the date that is #ij days after the date of enactment of this ,act4 7#b7 ,special rule for collective bargaining agreements ,in the case of a group health plan maintained pursuant to #a or more collective bargaining agreements between employee representatives and #a or more employers ratified before the date of enactment of this ,act1 the amendments made by this section shall not apply to plan years beginning before the date on which the last collective bargaining agreements relating to the plan terminates 7determined without regard to any extension thereof agreed to after the date of enactment of this ,act74 ,for purposes of this paragraph1 any plan amendment made pursuant to a collective bargaining agreement relating to the plan which amends the plan solely to conform to any requirement added by this section shall not be treated as a termination of such collective bargaining agreement4 #d4 ,amendments to the ,public ,health ,service ,act 7a7 ,in general ,title ,,xxvii of the ,public ,health ,service ,act is amended by inserting after section #bgbh of such ,act 7#db ,u4,s4,c4 #cjj;gg-#bh71 as redesignated by section #ajja7b7 of the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh71 the following3 #bgbi4 ,required coverage for minimum hospital stay for mastectomies1 lumpectomies1 and lymph node dissections for the treatment of breast cancer and coverage for secondary consultations 7a7 ,inpatient care 7#a7 ,in general ,a group health plan1 and a health insurance issuer providing group or individual health insurance coverage1 that provides medical and surgical benefits shall ensure that inpatient 7and in the case of a lumpectomy1 outpatient7 coverage and radiation therapy is provided for breast cancer treatment4 ,such plan or coverage may not-- 7,a7 insofar as the attending physician1 in consultation with the patient1 determines it to be medically necessary-- 7i7 restrict benefits for any hospital length of stay in connection with a mastectomy or breast conserving surgery 7such as a lumpectomy7 for the treatment of breast cancer to less than #dh hours2 or 7ii7 restrict benefits for any hospital length of stay in connection with a lymph node dissection for the treatment of breast cancer to less than #bd hours2 or 7,b7 require that a provider obtain authorization from the plan or the issuer for prescribing any length of stay required under this paragraph4 7#b7 ,exception ,nothing in this section shall be construed as requiring the provision of inpatient coverage if the attending physician1 in consultation with the patient1 determines that either a shorter period of hospital stay1 or outpatient treatment1 is medically appropriate4 7b7 ,prohibition on certain modifications ,in implementing the requirements of this section1 a group health plan1 and a health insurance issuer providing group or individual health insurance coverage1 may not modify the terms and conditions of coverage based on the determination by a participant or beneficiary to request less than the minimum coverage required under subsection 7a74 7c7 ,notice ,a group health plan1 and a health insurance issuer providing group or individual health insurance coverage1 shall provide notice to each participant and beneficiary under such plan or coverage regarding the coverage required by this section in accordance with regulations promulgated by the ,secretary4 ,such notice shall be in writing and prominently positioned in the summary of the plan or coverage made available or distributed by the plan or issuer and shall be transmitted-- 7#a7 in the next mailing made by the plan or issuer to the participant or beneficiary2 or 7#b7 as part of any yearly informational packet sent to the participant or beneficiary2 whichever is earlier4 7d7 ,secondary consultations 7#a7 ,in general ,a group health plan1 and a health insurance issuer providing group or individual health insurance coverage1 that provides coverage with respect to medical and surgical services provided in relation to the diagnosis and treatment of cancer shall ensure that coverage is provided for secondary consultations1 on terms and conditions that are no more restrictive than those applicable to the initial consultations1 by specialists in the appropriate medical fields 7including pathology1 radiology1 and oncology7 to confirm or refute such diagnosis4 ,such plan or issuer shall ensure that coverage is provided for such secondary consultation whether such consultation is based on a positive or negative initial diagnosis4 ,in any case in which the attending physician certifies in writing that services necessary for such a secondary consultation are not sufficiently available from specialists operating under the plan or coverage with respect to whose services coverage is otherwise provided under such plan or by such issuer1 such plan or issuer shall ensure that coverage is provided with respect to the services necessary for the secondary consultation with any other specialist selected by the attending physician for such purpose at no additional cost to the individual beyond that which the individual would have paid if the specialist was participating in the network of the plan4 7#b7 ,exception ,nothing in paragraph 7#a7 shall be construed as requiring the provision of secondary consultations where the patient determines not to seek such a consultation4 7e7 ,prohibition on penalties or incentives ,a group health plan1 and a health insurance issuer providing group or individual health insurance coverage1 may not-- 7#a7 penalize or otherwise reduce or limit the reimbursement of a provider or specialist because the provider or specialist provided care to a participant or beneficiary in accordance with this section2 7#b7 provide financial or other incentives to a physician or specialist to induce the physician or specialist to keep the length of inpatient stays of patients following a mastectomy1 lumpectomy1 or a lymph node dissection for the treatment of breast cancer below certain limits or to limit referrals for secondary consultations2 or 7#c7 provide financial or other incentives to a physician or specialist to induce the physician or specialist to refrain from referring a participant or beneficiary for a secondary consultation that would otherwise be covered by the plan or coverage involved under subsection 7d74 4 7b7 ,effective dates 7#a7 ,in general ,the amendments made by this section shall apply with respect to plan years beginning on or after #ij days after the date of enactment of this ,act4 7#b7 ,special rule for collective bargaining agreements ,in the case of a group health plan maintained pursuant to #a or more collective bargaining agreements between employee representatives and #a or more employers ratified before the date of enactment of this ,act1 the amendments made by this section shall not apply to plan years beginning before the date on which the last collective bargaining agreements relating to the plan terminates 7determined without regard to any extension thereof agreed to after the date of enactment of this ,act74 ,for purposes of this paragraph1 any plan amendment made pursuant to a collective bargaining agreement relating to the plan which amends the plan solely to conform to any requirement added by this section shall not be treated as a termination of such collective bargaining agreement4 #e4 ,amendments to the ,internal ,revenue ,code of #aihf 7a7 ,in general ,subchapter ,b of chapter #ajj of the ,internal ,revenue ,code of #aihf is amended-- 7#a7 in the table of sections1 by inserting after the item relating to section #ihac the following3 ,sec4 #ihad4 ,required coverage for minimum hospital stay for mastectomies1 lumpectomies1 and lymph node dissections for the treatment of breast cancer and coverage for secondary consultations4 2 and 7#b7 by inserting after section #ihac the following3 #ihad4 ,required coverage for minimum hospital stay for mastectomies1 lumpectomies1 and lymph node dissections for the treatment of breast cancer and coverage for secondary consultations 7a7 ,inpatient care 7#a7 ,in general ,a group health plan that provides medical and surgical benefits shall ensure that inpatient 7and in the case of a lumpectomy1 outpatient7 coverage and radiation therapy is provided for breast cancer treatment4 ,such plan may not-- 7,a7 insofar as the attending physician1 in consultation with the patient1 determines it to be medically necessary-- 7i7 restrict benefits for any hospital length of stay in connection with a mastectomy or breast conserving surgery 7such as a lumpectomy7 for the treatment of breast cancer to less than #dh hours2 or 7ii7 restrict benefits for any hospital length of stay in connection with a lymph node dissection for the treatment of breast cancer to less than #bd hours2 or 7,b7 require that a provider obtain authorization from the plan for prescribing any length of stay required under this paragraph4 7#b7 ,exception ,nothing in this section shall be construed as requiring the provision of inpatient coverage if the attending physician1 in consultation with the patient1 determines that either a shorter period of hospital stay1 or outpatient treatment1 is medically appropriate4 7b7 ,prohibition on certain modifications ,in implementing the requirements of this section1 a group health plan may not modify the terms and conditions of coverage based on the determination by a participant or beneficiary to request less than the minimum coverage required under subsection 7a74 7c7 ,notice ,a group health plan shall provide notice to each participant and beneficiary under such plan regarding the coverage required by this section in accordance with regulations promulgated by the ,secretary4 ,such notice shall be in writing and prominently positioned in the summary of the plan made available or distributed by the plan and shall be transmitted-- 7#a7 in the next mailing made by the plan to the participant or beneficiary2 or 7#b7 as part of any yearly informational packet sent to the participant or beneficiary2 whichever is earlier4 7d7 ,secondary consultations 7#a7 ,in general ,a group health plan that provides coverage with respect to medical and surgical services provided in relation to the diagnosis and treatment of cancer shall ensure that coverage is provided for secondary consultations1 on terms and conditions that are no more restrictive than those applicable to the initial consultations1 by specialists in the appropriate medical fields 7including pathology1 radiology1 and oncology7 to confirm or refute such diagnosis4 ,such plan or issuer shall ensure that coverage is provided for such secondary consultation whether such consultation is based on a positive or negative initial diagnosis4 ,in any case in which the attending physician certifies in writing that services necessary for such a secondary consultation are not sufficiently available from specialists operating under the plan with respect to whose services coverage is otherwise provided under such plan or by such issuer1 such plan or issuer shall ensure that coverage is provided with respect to the services necessary for the secondary consultation with any other specialist selected by the attending physician for such purpose at no additional cost to the individual beyond that which the individual would have paid if the specialist was participating in the network of the plan4 7#b7 ,exception ,nothing in paragraph 7#a7 shall be construed as requiring the provision of secondary consultations where the patient determines not to seek such a consultation4 7e7 ,prohibition on penalties ,a group health plan may not-- 7#a7 penalize or otherwise reduce or limit the reimbursement of a provider or specialist because the provider or specialist provided care to a participant or beneficiary in accordance with this section2 7#b7 provide financial or other incentives to a physician or specialist to induce the physician or specialist to keep the length of inpatient stays of patients following a mastectomy1 lumpectomy1 or a lymph node dissection for the treatment of breast cancer below certain limits or to limit referrals for secondary consultations2 or 7#c7 provide financial or other incentives to a physician or specialist to induce the physician or specialist to refrain from referring a participant or beneficiary for a secondary consultation that would otherwise be covered by the plan involved under subsection 7d74 4 7b7 ,effective dates 7#a7 ,in general ,the amendments made by this section shall apply with respect to plan years beginning on or after the date of enactment of this ,act4 7#b7 ,special rule for collective bargaining agreements ,in the case of a group health plan maintained pursuant to #a or more collective bargaining agreements between employee representatives and #a or more employers ratified before the date of enactment of this ,act1 the amendments made by this section shall not apply to plan years beginning before the date on which the last collective bargaining agreements relating to the plan terminates 7determined without regard to any extension thereof agreed to after the date of enactment of this ,act74 ,for purposes of this paragraph1 any plan amendment made pursuant to a collective bargaining agreement relating to the plan which amends the plan solely to conform to any requirement added by this section shall not be treated as a termination of such collective bargaining agreement4 #f4 ,opportunity for independent1 external third party reviews of certain nonrenewals and discontinuations1 including rescissions1 of individual health insurance coverage 7a7 ,clarification regarding application of guaranteed renewability of individual health insurance coverage ,section #bgdb of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#db7 is amended-- 7#a7 in its heading1 by inserting and continuation in force1 including prohibition of rescission1 after ,guaranteed renewability2 7#b7 in subsection 7a71 by inserting 1 including without rescission1 after continue in force2 and 7#c7 in subsection 7b77#b71 by inserting before the period at the end the following3 1 including intentional concealment of material facts regarding a health condition related to the condition for which coverage is being claimed4 7b7 ,opportunity for independent1 external third party review in certain cases ,subpart #a of part ,b of title ,,xxvii of the ,public ,health ,service ,act is amended by adding at the end the following new section3 #bgdf4 ,opportunity for independent1 external third party review in certain cases 7a7 ,notice and review right ,if a health insurance issuer determines to nonrenew or not continue in force1 including rescind1 health insurance coverage for an individual in the individual market on the basis described in section #bgdb7;b77#b7 before such nonrenewal1 discontinuation1 or rescission1 may take effect the issuer shall provide the individual with notice of such proposed nonrenewal1 discontinuation1 or rescission and an opportunity for a review of such determination by an independent1 external third party under procedures specified by the ,secretary4 7b7 ,independent determination ,if the individual requests such review by an independent1 external third party of a nonrenewal1 discontinuation1 or rescission of health insurance coverage1 the coverage shall remain in effect until such third party determines that the coverage may be nonrenewed1 discontinued1 or rescinded under section #bgdb7;b77#b74 4 7c7 ,effective date ,the amendments made by this section shall apply after the date of the enactment of this ,act with respect to health insurance coverage issued before1 on1 or after such date4