HLS 16RS-782 ENGROSSED
2016 Regular Session
HOUSE BILL NO. 694
BY REPRESENTATIVES MORENO, ABRAHAM, ANDERS, CHAD BROWN,
CROMER, DAVIS, GLOVER, HOLLIS, HUVAL, PIERRE, SEABAUGH, AND
TALBOT
INSURANCE/HEALTH: Provides relative to required coverage for reconstructive surgeries
following mastectomies
1 AN ACT
2To amend and reenact R.S. 22:1077 and to repeal R.S. 22:272(E) and R.S. 40:2209, relative
3 to required coverage of reconstructive surgeries following mastectomies; to delete
4 the requirement that such coverage be performed under the same policy under which
5 the mastectomy was performed; to specify that such coverage shall be for breast
6 reconstruction procedures selected by the patient in consultation with attending
7 physicians; to provide with respect to covered components of reconstruction; to
8 provide with respect to notices of the availability of such coverage; to provide for
9 definitions; and to provide for related matters.
10Be it enacted by the Legislature of Louisiana:
11 Section 1. R.S. 22:1077 is hereby amended and reenacted to read as follows:
12 ยง1077. Required coverage for reconstructive surgery following mastectomies
13 A. The legislature hereby finds that approximately three thousand women
14 will be diagnosed with breast cancer each year in Louisiana. Studies documenting
15 breast cancer statistics indicate that Louisiana has the highest mastectomy rate in the
16 nation: fifty-one percent of all women diagnosed with breast cancer will undergo a
17 mastectomy as part of their treatment regimen. Despite laws which require insurers
18 and physicians to inform women that breast reconstruction is an insured surgical
19 option, seven of ten women are not provided this information. The purpose of this
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HB NO. 694
1 Section is to assure that state law mirrors the federal Women's Health and Cancer
2 Rights Act, to extend its application to all health insurance issuers in Louisiana, to
3 stress that decisions regarding the reconstructive procedures to be performed shall
4 be made solely by the patient in consultation with attending physicians, and to clarify
5 that all stages of breast reconstruction decided pursuant to this Section are medically
6 necessary and shall not be excluded from coverage.
7 A. B. A group health plan, a health insurance insurer providing health
8 insurance coverage in connection with a group health plan, or health insurance
9 coverage Any health benefit plan offered by a health insurance insurer in the
10 individual market issuer that provides medical and surgical benefits with respect to
11 a partial or full mastectomy shall provide, in the case of a participant or beneficiary
12 who is receiving benefits in connection with a mastectomy and who elects breast
13 reconstruction in connection with such mastectomy, also provide medical and
14 surgical benefits for breast reconstruction. coverage for reconstruction of the breast
15 on which the mastectomy has been performed, coverage for surgery and
16 reconstruction of the other breast to produce a symmetrical appearance, and coverage
17 for prostheses and physical complications, all states of mastectomy, including
18 lymphedemas and such Such coverage shall be in a manner determined in
19 consultation with the attending physician and the patient. for breast reconstruction
20 procedures selected by the patient in consultation with attending physicians. The
21 coverage provided in this Section may be subject to annual deductibles, coinsurance,
22 and copayment provisions as may be deemed appropriate and as are consistent with
23 those established for other benefits mastectomy procedures under the plan or
24 coverage. health benefit plan. Written notice of the availability of coverage shall be
25 delivered to the participant insured or enrollee upon enrollment and annually
26 thereafter as approved by the commissioner of insurance.
27 B. C. A group health plan, a health insurance insurer providing health
28 insurance coverage in connection with a group health plan, or health insurance
29 coverage Any health benefit plan offered by a health insurance insurer in the
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HB NO. 694
1 individual market issuer shall provide notice to each participant and beneficiary
2 insured or enrollee under such plan regarding the coverage required by this Section
3 in accordance with regulations adopted by the department. Department of Insurance.
4 This notice shall be in writing and prominently positioned in any literature or
5 correspondence made available or distributed by the plan or issuer and shall be
6 transmitted in one of the following ways, whichever is earlier:
7 (1) In the next mailing made by the plan or insurer issuer to the participant
8 or beneficiary. insured or enrollee.
9 (2) As part of any yearly annual informational packet sent to the participant
10 or beneficiary. insured or enrollee.
11 (3) Not later than January 1, 2000.
12 C. D. A group health plan, a health insurance insurer offering group health
13 insurance coverage in connection with a group health plan, or health insurance
14 coverage Any health benefit plan offered by a health insurance insurer in the
15 individual market may not issuer shall not: do either of the following:
16 (1) Deny to a patient eligibility, or continued eligibility, to enroll or to renew
17 coverage under the terms of the plan, solely for the purpose of avoiding the
18 requirements of this Section.
19 (2) Penalize or otherwise reduce or limit the reimbursement of an attending
20 provider, or provide monetary or nonmonetary incentives to an attending provider,
21 to induce such provider to provide care to an individual participant or beneficiary
22 insured or enrollee in a manner inconsistent with this Section.
23 (3) Require that the mastectomy procedures and reconstructive procedures
24 be performed under the same policy or plan.
25 (4) Reduce or limit coverage benefits to a patient for the reconstructive
26 procedures performed pursuant to this Section as determined in consultation with the
27 attending physician and patient.
28 D. E. In the case of a group health benefit plan maintained pursuant to one
29 or more collective bargaining agreements between employee representatives and one
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HB NO. 694
1 or more employers, any plan amendment made pursuant to a collective bargaining
2 agreement relating to the plan which amends the plan solely to conform to any
3 requirement imposed pursuant to this Section shall not be treated as a termination of
4 the collective bargaining agreement.
5 F. For purposes of this Section:
6 (1) "Breast reconstruction"means all stages of reconstruction of the breast
7 on which a mastectomy has been performed and on the other breast to produce a
8 symmetrical appearance, including but not limited to liposuction performed for
9 transfer to a reconstructed breast or to repair a donor site deformity, tattooing the
10 areola of the breast, surgical adjustments of the non-mastectomized breast,
11 unforeseen medical complications which may require additional reconstruction in the
12 future, and prostheses and physical complications, including but not limited to
13 lymphedemas.
14 (2) "Health benefit plan" means a policy, contract, certificate, or agreement
15 entered into, offered, or issued by a health insurance issuer to provide, deliver,
16 arrange for, pay for, or reimburse any of the costs of health care services. "Health
17 benefit plan" shall not include a plan providing coverage for excepted benefits as
18 defined in R.S. 22:1061 and short-term policies that have a term of less than twelve
19 months.
20 (3) "Health insurance issuer" means an entity subject to the insurance laws
21 and regulations of this state, or subject to the jurisdiction of the commissioner, that
22 contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse
23 any of the costs of health care services, including through a health benefit plan as
24 defined in this Section, and shall include a sickness and accident insurance company,
25 a health maintenance organization, a preferred provider organization, or any similar
26 entity, or any other entity providing a plan of health insurance or health benefits.
27 Section 2. R.S. 22:272(E) and R.S. 40:2209 are hereby repealed in their entirety.
28 Section 3. This Act shall become effective upon signature by the governor or, if not
29signed by the governor, upon expiration of the time for bills to become law without signature
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HB NO. 694
1by the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If
2vetoed by the governor and subsequently approved by the legislature, this Act shall become
3effective on the day following such approval.
DIGEST
The digest printed below was prepared by House Legislative Services. It constitutes no part
of the legislative instrument. The keyword, one-liner, abstract, and digest do not constitute
part of the law or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)]
HB 694 Engrossed 2016 Regular Session Moreno
Abstract: Clarifies the required coverage of reconstructive surgeries following
mastectomies by removing conflicting provisions and adding definitions.
Proposed law clarifies the required coverage of reconstructive surgeries following
mastectomies as follows:
(1)Present law requires coverage of reconstructive surgeries following mastectomies
by various types of health insurers, health plans, PPOs, and HMOs.
Proposed law requires such coverage by a "health benefit plan" offered by a "health
insurance issuer", both broad terms which encompass all of the types of plans and
entities provided for by present law.
(2)Simplifies present law by stating that a health benefit plan that provides medical and
surgical benefits for a partial or full mastectomy shall also provide such benefits for
breast reconstruction.
(3)Present law provides that such coverage shall be in a manner determined in
consultation with the attending physician and the patient.
Proposed law instead provides that coverage shall be for breast reconstruction
procedures selected by the patient in consultation with attending physicians.
(4)Present law provides that such coverage may be subject to annual deductibles,
coinsurance, and copayment provisions as may be deemed appropriate and as are
consistent with those established for other benefits under the plan or coverage.
Proposed law provides that such coverage may be subject to annual deductibles,
coinsurance, and copayment provisions as are consistent with those established for
mastectomy procedures under the health benefit plan.
(5)Present law prohibits health benefit plans from: (a) denying a patient eligibility, or
continued eligibility, to enroll or to renew coverage under the terms of the plan,
solely for the purpose of avoiding the requirements of present law; or (b) penalizing
or otherwise reducing or limiting the reimbursement of an attending provider, or
providing monetary or nonmonetary incentives to an attending provider, to induce
such provider to provide care to in a manner inconsistent with this Section.
Proposed law additionally prohibits health benefit plans from: (a) requiring that
mastectomy procedures and reconstructive procedures be performed under the same
policy or plan; or (b) reducing or limiting coverage benefits to a patient for the
reconstructive procedures performed pursuant to proposed law as determined in
consultation with the attending physician and patient.
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(6)Defines the term "breast reconstruction" as all stages of reconstruction of the breast
on which a mastectomy has been performed and on the other breast to produce a
symmetrical appearance, including but not limited to liposuction performed for
transfer to a reconstructed breast or to repair a donor site deformity, tattooing the
areola of the breast, surgical adjustments of the non-mastectomized breast, and
prostheses and physical complications, including but not limited to lymphedemas.
(7)Provides for legislative findings.
Effective upon signature of governor or lapse of time for gubernatorial action.
(Amends R.S. 22:1077; Repeals R.S. 22:272(E) and R.S. 40:2209)
Summary of Amendments Adopted by House
The Committee Amendments Proposed by House Committee on Insurance to the
original bill:
1. Add unforeseen medical complications which may require additional
reconstruction in the future to the definition of "breast reconstruction".
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