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SCLD Update |
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| Other Topics in this Issue: Breast Cancer Detection |
Breast Cancer Detection Kentucky passed a law (H.B. 864) establishing the Women's Health Act of 1998 ("Act"). The Act requires specified individual and group insurers, including health maintenance organizations (HMOs), that cover mastectomies to make available and offer coverage for reconstructive breast surgery following a mastectomy resulting from breast cancer. In addition, the law prohibits insurers from offering coverage for mastectomies that require the procedure to be performed on an outpatient basis. Newly enacted legislation in South Carolina (H.B. 3985) creates the Omnibus Health Benefits and Education Act of 1998 ("Act"). Effective January 1, 1999, the Act requires specified individual and group insurers, including HMOs, that provide coverage for mastectomy surgery to also cover prosthetic devices and reconstruction of the breast on which surgery was performed. The Act also requires the insurers to cover surgery and reconstruction of the non-diseased breast, if such surgery is determined to be medically necessary by the patient's attending physician and approved by the insurer or HMO. In addition, specified individual and group
insurers, including HMOs, must provide coverage for mammograms performed upon referral by
a physician or by a health testing service. The mammograms must be performed according to
the following guidelines: (1) a baseline mammogram for women ages 35 through 39, (2) every
two years for women ages 40 through 49, (3) annually for women ages 50 and older, or (4)
in accordance with the most recent published guidelines of the American Cancer Society.
Deductibles and co-insurance may apply to the coverage if the provisions apply generally
to other similar benefits provided and paid for under the health insurance policy. See the
additional summaries for this bill in the Breast Cancer Detection/Inpatient Care
and Mammography Quality Assurance, Cervical Cancer Detection/Third-Party
Reimbursement, and Prostate Cancer
Detection/Third-Party Reimbursement sections. Virginia enacted a law (H.B. 1084) requiring the state Board of Medical Assistance Services ("Board") to include in its state plan for medical assistance services, pursuant to Title XIX of the United States Social Security Act, a provision for payment of medical assistance for prostheses following the medically necessary complete or partial removal of a breast for any medical condition. Another Virginia law (H.B. 1202) requires the Board to include medical assistance payment provisions for low-dose screening mammograms according to the following guidelines: (1) a baseline mammogram for women ages 35 through 39, (2) a biennial mammogram for women ages 40 through 49, and (3) an annual mammogram for women ages 50 and older. See the additional summary for H.B. 1202 in the Breast Cancer Detection/Mammography Quality Assurance section. The West Virginia Women's Access to Health Care Act (S.B. 25) prohibits specified individual and group insurers, including HMOs, that provide coverage for surgical services in a hospital inpatient or outpatient setting from denying coverage for breast reconstruction following mastectomy. Hawaii adopted a resolution (H.C.R. 14) requesting the state Auditor to study the social and financial impact of requiring individual and group insurance policies provided by an employer to cover post-mastectomy breast reconstructive surgery for all stages of reconstruction, as well as symmetry operations on the non-cancerous breast. South Carolina's new Omnibus Health Benefits and Education Act of 1998 (H.B. 3985) requires specified individual and group insurers, including HMOs, that provide hospitalization coverage for mastectomies to also provide hospitalization benefits for at least 48 hours following a mastectomy, unless the attending physician releases the patient prior to the expiration of the 48-hour period. Early-released patients must receive coverage for at least one home care visit if ordered by the attending physician. The law is effective January 1, 1999. See the additional summaries for this bill in the Breast Cancer Detection/Third-Party Reimbursement and Mammography Quality Assurance, Cervical Cancer Detection/Third Party Reimbursement, and Prostate Cancer Detection/Third-Party Reimbursement sections. With the passage of H.B. 542, Virginia amends several previously enacted laws relating to breast cancer treatment coverage. The new law requires the state's employee health care plan; specified individual and group health insurers, including HMOs; and the state Board of Medical Assistance Services ("Board") to include coverage for at least: (1) 48 hours of inpatient care following a radical or modified radical mastectomy, and (2) 24 hours of inpatient care following a total mastectomy or partial mastectomy with lymph node dissection for breast cancer treatment. Individual, group, and HMO coverage becomes effective July 1, 1998, while payment of medical assistance by the Board must be made pursuant to Title XIX of the United States Social Security Act. Coverage for inpatient care is not required when the attending physician, in consultation with the patient, determines that a shorter period of hospital stay is appropriate. With the passage of H.B. 2012 in Arizona, the Medical Radiologic Technology Board of Examiners will expire on July 1, 2001, while the state's mammography quality assurance law relating to radiologic technologists will be repealed on January 1, 2002. In South Carolina, H.B. 3985 requires that all mammograms must be performed upon referral by a physician or by a health testing service that uses radiologic equipment approved by the state Department of Health and Environmental Control. See the additional summaries for this bill in the Breast Cancer Detection/Third-Party Reimbursement and Inpatient Care, Cervical Cancer Detection/Third Party Reimbursement, and Prostate Cancer Detection/Third-Party Reimbursement sections. Virginia's law (H.B. 1202) amends a previous law relating to mammography quality guidelines. In order to be considered eligible for coverage under the state employee health plan, a screening mammogram must be: (1) ordered by a health care practitioner acting within the scope of his/her licensure and, for an HMO enrollee, by the HMO physician; (2) performed by a registered technologist under the direction of a person licensed to practice medicine and surgery and certified by the American Board of Radiology or its equivalent; and (3) interpreted by a qualified radiologist. Additionally, H.B. 1202 requires mammography equipment to meet standards established by the state Department of Health's radiation protection regulations, and mammography film to be retained by the radiologic facility performing the examination, in accordance with the American College of Radiology guidelines or state law. The law also applies to equipment used to perform mammograms on medical assistance recipients. The average radiation exposure must be less than one rad mid-breast, and two views of each breast. Moreover, the equipment used must be dedicated specifically for mammography screening, and must consist of an x-ray tube, filter, compression device, screens, film, and cassette. See the additional summary for this bill in the Breast Cancer Detection/Third-Party Reimbursement section. Screening Programs Maryland passed two laws (H.B. 766 and S.B. 634) that require the state Department of Health anc Mental Hygiene ("Department") to establish a Breast Cancer Program ("Program"). The Program is designed to: (1) provide at least biennial screening mammograms and clinical breast examinations to low-income, under-insured, or uninsured women ages 40 through 49; (2) provide annual screening mammograms and clinical breast examinations to low-income, under-insured, or uninsured women ages 50 and older; and (3) provide diagnosis and treatment for individuals identified as being in need. The Department must administer the Program using a grant program, under which local health departments make arrangements with health care facilities to provide screening mammograms and clinical breast examinations. An individual is deemed eligible if she: (1) has a family income that does not exceed 250 percent of the Federal poverty level; and (2) does not have access to health insurance that covers screening mammograms and clinical breast examinations for women ages 40 and older. For summaries of a Nebraska bill (L.B. 1070) related to screening for breast cancer, see the Tobacco-Use Reduction/Tobacco Education and Tobacco Litigation sections. A resolution adopted by the California legislature (A.C.R. 112) proclaims October 1998 as Breast Cancer Awareness Month. The resolution urges government officials, businesses, communities, health care professionals, educators, volunteers, and citizens of the state to reflect on the progress that has been made in advancing knowledge about breast cancer, and reaffirms the commitment to controlling and finding a cure for breast cancer. Florida passed two resolutions aimed at increasing breast cancer awareness. The first resolution (H.R. 9469) recognizes the American Cancer Society's Buddy Check program as an important tool in the fight against breast cancer. It also urges all women to adopt the program's preventive and supportive steps to minimize the risks associated with breast cancer and to practice early detection methods such as mammography and breast self-examination. Similarly, the second resolution (H.R. 9563) declares October 1998 as Breast Cancer Awareness Month, urging women to recognize the risks associated with breast cancer, to take preventive steps to minimize such risks, and to engage in early detection methods such as mammography. The Oklahoma legislature adopted a resolution (H.R. 1054) declaring May 6, 1998, as Women's Health Day in the state. The resolution urges the legislature to collaborate with the state Women's Health Network to: (1) advance the Network's mission to promote, educate, and heighten awareness of women's health issues statewide; and (2) develop a statewide awareness campaign to educate and raise the awareness of the total population concerning diseases, prevention, risks, and treatment for cervical, breast, and lung cancers, as well as for other specified diseases. |
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