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SCLD Update |
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| Other Topics in this Issue: Breast Cancer Detection |
Breast Cancer Detection Virginia passed S.B. 679, which addresses third-party reimbursement for reconstructive breast surgery. Effective July 1, 1998, the legislation will require specified individual and group insurers, including health maintenance organizations, to provide coverage for reconstructive surgery after a mastectomy, in order to restore symmetry between both breasts. This coverage will be determined according to the same procedures used for other medical and surgical coverage, and is subject to durational and dollar limits, deductibles, and co-insurance factors which are at least as favorable as those generally applied to other physical illnesses. The law also requires the state employees' health plan and the state medical assistance program to address coverage for breast reconstructive surgery. The state employees' health plan must provide coverage for the surgery either coincident with or following a mastectomy to restore symmetry. The plan is prohibited from denying coverage, due to a preexisting condition, for persons previously covered by the plan. The state Board of Medical Assistance Services is required to include in its assistance plan, a provision to cover breast reconstructive surgery following the removal of a breast for medical reasons, if prior authorization has been obtained. This coverage provision applies to the removal of a breast for any medical reason, including non-cosmetic breast reduction. Awareness The Ohio legislature enacted H.B. 243-A, to establish that each October will be known as Breast Cancer Awareness Month in the state, and that the third Thursday of each October will be known as Mammography Day, to promote early breast cancer detection. |
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