To require that health plans provide coverage for a minimum hospital stay for mastectomies, lumpectomies, and lymph node dissection for the treatment of breast cancer and coverage for secondary consultations.
Committees
House Energy and Commerce; House Ways and Means; House Education and Labor
Bill Summary
Breast Cancer Patient Protect Act of 2008 - Amends the Employee Retirement Income Security Act of 1974 (ERISA), the Public Health Service Act, and the Internal Revenue Code to require a group health plan or a health issuer offering group health insurance coverage that provides medical and surgical benefits to ensure that inpatient (and in the case of a lumpectomy, outpatient) coverage and radiation therapy are provided for breast cancer treatment. Prohibits such a plan or issuer from: (1) restricting benefits for any hospital length of stay to less than 48 hours in connection with a mastectomy or breast conserving surgery or 24 hours in connection with a lymph node dissection, insofar as the attending physician, in consultation with the patient, determines such stay to be medically necessary; or (2) requiring that a provider obtain authorization from the plan or issuer for prescribing any such length of stay.Requires such a plan or issuer to: (1) provide notice (prominently in the summary of the plan) to each participant and beneficiary regarding the coverage required under this Act; (2) ensure that coverage is provided for secondary consultations (on terms and conditions that are no more restrictive than those applicable to the initial consultations) by specialists in the appropriate medical fields to confirm or refute a diagnosis of cancer; and (3) ensure that coverage is provided for such secondary consultations whether the consultation is based on a positive or negative initial diagnosis.Prohibits such a plan or issuer from: (1) penalizing or otherwise reducing or limiting the reimbursement of a provider or specialist because of care to a participant or beneficiary in accordance with this Act; (2) providing incentives for a physician or specialist to keep the length of inpatient stays below certain limits following a mastectomy, lumpectomy, or a lymph node dissection for the treatment of breast cancer or to limit referrals for secondary consultations; or (3) providing incentives for a physician or specialist to refrain from referring a participant or beneficiary for a secondary consultation that would otherwise be covered.Applies such requirements to health insurance issuers offering coverage in the individual market.Allows a health insurance issuer that provides individual health insurance coverage to nonrenew or discontinue an individual's coverage based on the intentional concealment of material facts regarding a health condition related to the condition for which coverage is being claimed. Sets forth procedures for notice and independent, external review of any proposed nonrenewal, discontinuation, or rescission of health insurance coverage.
To require that health plans provide coverage for a minimum hospital stay for mastectomies, lumpectomies, and lymph node dissection for the treatment of breast cancer and coverage for secondary consultations.
Breast Cancer Patient Protect Act of 2008 - Amends the Employee Retirement Income Security Act of 1974 (ERISA), the Public Health Service Act, and the Internal Revenue Code to require a group health plan or a health issuer offering group health insurance coverage that provides medical and surgical benefits to ensure that inpatient (and in the case of a lumpectomy, outpatient) coverage and radiation therapy are provided for breast cancer treatment. Prohibits such a plan or issuer from: (1) restricting benefits for any hospital length of stay to less than 48 hours in connection with a mastectomy or breast conserving surgery or 24 hours in connection with a lymph node dissection, insofar as the attending physician, in consultation with the patient, determines such stay to be medically necessary; or (2) requiring that a provider obtain authorization from the plan or issuer for prescribing any such length of stay.Requires such a plan or issuer to: (1) provide notice (prominently in the summary of the plan) to each participant and beneficiary regarding the coverage required under this Act; (2) ensure that coverage is provided for secondary consultations (on terms and conditions that are no more restrictive than those applicable to the initial consultations) by specialists in the appropriate medical fields to confirm or refute a diagnosis of cancer; and (3) ensure that coverage is provided for such secondary consultations whether the consultation is based on a positive or negative initial diagnosis.Prohibits such a plan or issuer from: (1) penalizing or otherwise reducing or limiting the reimbursement of a provider or specialist because of care to a participant or beneficiary in accordance with this Act; (2) providing incentives for a physician or specialist to keep the length of inpatient stays below certain limits following a mastectomy, lumpectomy, or a lymph node dissection for the treatment of breast cancer or to limit referrals for secondary consultations; or (3) providing incentives for a physician or specialist to refrain from referring a participant or beneficiary for a secondary consultation that would otherwise be covered.Applies such requirements to health insurance issuers offering coverage in the individual market.Allows a health insurance issuer that provides individual health insurance coverage to nonrenew or discontinue an individual's coverage based on the intentional concealment of material facts regarding a health condition related to the condition for which coverage is being claimed. Sets forth procedures for notice and independent, external review of any proposed nonrenewal, discontinuation, or rescission of health insurance coverage.