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.
(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".