October 23, 2019
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       Florida Senate - 2010                                     SB 190
       
       
       
       By Senator Joyner
       
       
       
       
       18-00001-10                                            2010190__
    1                        A bill to be entitled                      
    2         An act relating to breast cancer treatment; providing
    3         a short title; amending ss. 627.64171, 627.66121, and
    4         641.31, F.S.; including lymph node dissections under
    5         provisions prescribing the length of hospital stay
    6         relating to a mastectomy and the outpatient
    7         postsurgical followup care that specified health
    8         insurers and health maintenance organizations must
    9         cover; limiting application; providing an effective
   10         date.
   11  
   12  Be It Enacted by the Legislature of the State of Florida:
   13  
   14         Section 1. This act may be cited as the “Mary B. Hooks
   15  Act.”
   16         Section 2. Subsections (1) and (2) and paragraph (a) of
   17  subsection (4) of section 627.64171, Florida Statutes, are
   18  amended to read:
   19         627.64171 Coverage for length of stay and outpatient
   20  postsurgical care.—
   21         (1) Any health insurance policy that is issued, amended,
   22  delivered, or renewed in this state which provides coverage for
   23  breast cancer treatment may not limit inpatient hospital
   24  coverage for lymph node dissections or mastectomies to any
   25  period that is less than that determined by the treating
   26  physician to be medically necessary in accordance with
   27  prevailing medical standards and after consultation with the
   28  insured patient.
   29         (2) Any health insurance policy that provides coverage for
   30  lymph node dissections or mastectomies under subsection (1) must
   31  also provide coverage for outpatient postsurgical followup care
   32  in keeping with prevailing medical standards by a licensed
   33  health care professional qualified to provide postsurgical lymph
   34  node dissection or mastectomy care. The treating physician,
   35  after consultation with the insured patient, may choose that the
   36  outpatient care be provided at the most medically appropriate
   37  setting, which may include the hospital, treating physician’s
   38  office, outpatient center, or home of the insured patient.
   39         (4)(a) This section does not require an insured patient to
   40  have a lymph node dissection or the mastectomy in the hospital
   41  or stay in the hospital for a fixed period of time following the
   42  lymph node dissection or mastectomy.
   43         Section 3. Subsections (1) and (2) and paragraph (a) of
   44  subsection (4) of section 627.66121, Florida Statutes, are
   45  amended to read:
   46         627.66121 Coverage for length of stay and outpatient
   47  postsurgical care.—
   48         (1) Any group, blanket, or franchise accident or health
   49  insurance policy that is issued, amended, delivered, or renewed
   50  in this state which provides coverage for breast cancer
   51  treatment may not limit inpatient hospital coverage for lymph
   52  node dissections or mastectomies to any period that is less than
   53  that determined by the treating physician to be medically
   54  necessary in accordance with prevailing medical standards and
   55  after consultation with the insured patient.
   56         (2) Any group, blanket, or franchise accident or health
   57  insurance policy that provides coverage for lymph node
   58  dissections or mastectomies under subsection (1) must also
   59  provide coverage for outpatient postsurgical followup care in
   60  keeping with prevailing medical standards by a licensed health
   61  care professional qualified to provide postsurgical lymph node
   62  dissection or mastectomy care. The treating physician, after
   63  consultation with the insured patient, may choose that the
   64  outpatient care be provided at the most medically appropriate
   65  setting, which may include the hospital, treating physician’s
   66  office, outpatient center, or home of the insured patient.
   67         (4)(a) This section does not require an insured patient to
   68  have a lymph node dissection or the mastectomy in the hospital
   69  or stay in the hospital for a fixed period of time following the
   70  lymph node dissection or mastectomy.
   71         Section 4. Paragraphs (a) and (c) of subsection (31) of
   72  section 641.31, Florida Statutes, are amended to read:
   73         641.31 Health maintenance contracts.—
   74         (31)(a) Health maintenance contracts that provide coverage,
   75  benefits, or services for breast cancer treatment may not limit
   76  inpatient hospital coverage for lymph node dissections or
   77  mastectomies to any period that is less than that determined by
   78  the treating physician under contract with the health
   79  maintenance organization to be medically necessary in accordance
   80  with prevailing medical standards and after consultation with
   81  the covered patient. Such contract must also provide coverage
   82  for outpatient postsurgical followup care in keeping with
   83  prevailing medical standards by a licensed health care
   84  professional under contract with the health maintenance
   85  organization qualified to provide postsurgical lymph node
   86  dissection or mastectomy care. The treating physician under
   87  contract with the health maintenance organization, after
   88  consultation with the covered patient, may choose that the
   89  outpatient care be provided at the most medically appropriate
   90  setting, which may include the hospital, treating physician’s
   91  office, outpatient center, or home of the covered patient.
   92         (c)1. This subsection does not require a covered patient to
   93  have a lymph node dissection or the mastectomy in the hospital
   94  or stay in the hospital for a fixed period of time following the
   95  lymph node dissection or mastectomy.
   96         2. This subsection does not prevent a contract from
   97  imposing deductibles, coinsurance, or other cost sharing in
   98  relation to benefits pursuant to this subsection, except that
   99  such cost sharing shall not exceed cost sharing with other
  100  benefits.
  101         Section 5. This act shall take effect July 1, 2010.

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