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| Other Topics in this Issue: Breast Cancer Detection |
Breast Cancer Detection Louisiana passed two laws (S.B. 699 and H.B. 2219) related to third-party reimbursement. Effective January 1, 1998, S.B. 699 requires specified individual and group insurers that provide coverage for mastectomy to cover reconstruction of the breast on which surgery has been performed, and surgery and reconstruction of the other breast to produce a symmetrical appearance. Insurers required to provide coverage include health maintenance organizations (HMOs), preferred provider organizations (PPOs), and the State Employees' Group Benefits Program. Coverage is subject to the same deductibles, co-insurance, and copayment as the mastectomy. Reimbursement for reconstructive surgery is required only if it is performed under the same policy or plan as the mastectomy. Additionally, with the enactment of H.B. 2219, Louisiana now requires the State Employees' Group Benefits Program to provide coverage for breast cancer screening, effective July 1, 1998. See the additional summary of H.B. 2219 in the Cervical Cancer Detection/Third-Party Reimbursement section and the Prostate Cancer Detection/Third-Party Reimbursement section. Missouri passed H.B. 129, which requires certain individual and group insurers, including HMOs and other managed health care organizations, that cover mastectomy to also provide coverage for prosthetic devices or reconstructive surgery necessary to restore symmetry resulting from the mastectomy. The law is effective January 1, 1998. Coverage is subject to the same deductible and coinsurance conditions as those applied to mastectomy. With A.B. 26, Nevada amends its mammography screening reimbursement law by prohibiting designated individual and group insurers, including HMOs, from requiring an insured person to obtain prior authorization for: (1) a baseline mammogram for women aged 35 to 40, and (2) annual mammograms for women aged 40 and over. See the additional summary of this bill in the Cervical Cancer Detection/Third-Party Reimbursement section. In North Carolina, S.B. 714 requires that, effective January 1, 1998, specified private insurers that provide coverage for mastectomy also to cover reconstructive surgery on: (1) each breast on which a mastectomy has been performed, and (2) a nondiseased breast to produce symmetry. Insurers required to provide such coverage include HMOs, PPOs, and certain public employee health plans. Coverage is subject to the same deductibles, co-insurance, and copayment as the mastectomy. Inpatient Care With the enactment of S.B. 273, North Carolina requires specified health insurers, including HMOs, that provide coverage for mastectomy and post-mastectomy inpatient care to ensure that: (1) the decision to discharge a patient following the mastectomy is made by the attending physician in consultation with the patient, and (2) the length of the post-mastectomy hospital stay is based on the patient's health and medical history. California passed S.B. 602, which requires that, until January 1, 2003, contributions to the state Breast Cancer Research Fund be allocated to the University of California in support of the state's Breast Cancer Research Program. California also adopted two resolutions (A.J.R. 25 and A.C.R. 76) related to breast cancer research. A.J.R. 25 urges the Congress and President of the United States to enact the Breast Cancer Research Stamp Act of 1997 to create the "Cure Breast Cancer Research" postage stamp. The resolution also asks the Board of Governors of the U.S. Postal Service to implement this program to supplement the funds available for breast cancer research. A.C.R. 76 recognizes that the only effective means of protecting women against breast cancer is to make breast cancer research a priority and to fund critically needed research into the cause, cure, and prevention of breast cancer. See the additional summary of A.C.R. 76 in the Breast Cancer Detection/Awareness section. The California legislature adopted A.C.R. 76 to heighten public awareness about breast cancer. The legislature declares the month of October as Breast Cancer Awareness Month. Furthermore, October 20, 1997, is designated Breast Exam and Mammography Awareness Day to recognize that breast exams and mammography are the primary methods of breast cancer detection. The resolution encourages: (1) monthly breast self-exams for all women, (2) annual mammograms for women over 50, and (3) women 40 to 49 years of age to consult with their health care providers about mammograms. A.C.R. 76 also resolves that the public education efforts conducted during the month of October should be part of an ongoing, year-round effort to raise public awareness across the state. See the additional summary of this resolution in the Breast Cancer Detection/Research section. |
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