November 18, 2019
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_h0111__
HB 111

1
A bill to be entitled
2An act relating to breast cancer treatment; providing a
3short title; amending ss. 627.64171, 627.66121, and
4641.31, F.S.; including lymph node dissections under
5provisions prescribing the length of hospital stay
6relating to a mastectomy and the outpatient postsurgical
7followup care that specified health insurers and health
8maintenance organizations must cover; limiting
9application; providing an effective date.
10
11Be It Enacted by the Legislature of the State of Florida:
12
13     Section 1.  This act may be cited as the "Mary B. Hooks
14Act."
15     Section 2.  Subsections (1) and (2) and paragraph (a) of
16subsection (4) of section 627.64171, Florida Statutes, are
17amended to read:
18     627.64171  Coverage for length of stay and outpatient
19postsurgical care.--
20     (1)  Any health insurance policy that is issued, amended,
21delivered, or renewed in this state which provides coverage for
22breast cancer treatment may not limit inpatient hospital
23coverage for lymph node dissections or mastectomies to any
24period that is less than that determined by the treating
25physician to be medically necessary in accordance with
26prevailing medical standards and after consultation with the
27insured patient.
28     (2)  Any health insurance policy that provides coverage for
29lymph node dissections or mastectomies under subsection (1) must
30also provide coverage for outpatient postsurgical followup care
31in keeping with prevailing medical standards by a licensed
32health care professional qualified to provide postsurgical lymph
33node dissection or mastectomy care. The treating physician,
34after consultation with the insured patient, may choose that the
35outpatient care be provided at the most medically appropriate
36setting, which may include the hospital, treating physician's
37office, outpatient center, or home of the insured patient.
38     (4)(a)  This section does not require an insured patient to
39have a lymph node dissection or the mastectomy in the hospital
40or stay in the hospital for a fixed period of time following the
41lymph node dissection or mastectomy.
42     Section 3.  Subsections (1) and (2) and paragraph (a) of
43subsection (4) of section 627.66121, Florida Statutes, are
44amended to read:
45     627.66121  Coverage for length of stay and outpatient
46postsurgical care.--
47     (1)  Any group, blanket, or franchise accident or health
48insurance policy that is issued, amended, delivered, or renewed
49in this state which provides coverage for breast cancer
50treatment may not limit inpatient hospital coverage for lymph
51node dissections or mastectomies to any period that is less than
52that determined by the treating physician to be medically
53necessary in accordance with prevailing medical standards and
54after consultation with the insured patient.
55     (2)  Any group, blanket, or franchise accident or health
56insurance policy that provides coverage for lymph node
57dissections or mastectomies under subsection (1) must also
58provide coverage for outpatient postsurgical followup care in
59keeping with prevailing medical standards by a licensed health
60care professional qualified to provide postsurgical lymph node
61dissection or mastectomy care. The treating physician, after
62consultation with the insured patient, may choose that the
63outpatient care be provided at the most medically appropriate
64setting, which may include the hospital, treating physician's
65office, outpatient center, or home of the insured patient.
66     (4)(a)  This section does not require an insured patient to
67have a lymph node dissection or the mastectomy in the hospital
68or stay in the hospital for a fixed period of time following the
69lymph node dissection or mastectomy.
70     Section 4.  Paragraphs (a) and (c) of subsection (31) of
71section 641.31, Florida Statutes, are amended to read:
72     641.31  Health maintenance contracts.--
73     (31)(a)  Health maintenance contracts that provide
74coverage, benefits, or services for breast cancer treatment may
75not limit inpatient hospital coverage for lymph node dissections
76or mastectomies to any period that is less than that determined
77by the treating physician under contract with the health
78maintenance organization to be medically necessary in accordance
79with prevailing medical standards and after consultation with
80the covered patient. Such contract must also provide coverage
81for outpatient postsurgical followup care in keeping with
82prevailing medical standards by a licensed health care
83professional under contract with the health maintenance
84organization qualified to provide postsurgical lymph node
85dissection or mastectomy care. The treating physician under
86contract with the health maintenance organization, after
87consultation with the covered patient, may choose that the
88outpatient care be provided at the most medically appropriate
89setting, which may include the hospital, treating physician's
90office, outpatient center, or home of the covered patient.
91     (c)1.  This subsection does not require a covered patient
92to have a lymph node dissection or the mastectomy in the
93hospital or stay in the hospital for a fixed period of time
94following the lymph node dissection or mastectomy.
95     2.  This subsection does not prevent a contract from
96imposing deductibles, coinsurance, or other cost sharing in
97relation to benefits pursuant to this subsection, except that
98such cost sharing shall not exceed cost sharing with other
99benefits.
100     Section 5.  This act shall take effect July 1, 2010.


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