2020 Regular Session ENROLLED
SENATE BILL NO. 494
BY SENATOR CARTER
1 AN ACT
2 To amend and reenact R.S. 22:1077(A) and R.S. 22:1077(B) and (F)(1) as amended by Act
3 119 of the 2019 Regular Session, relative to reconstructive surgery following
4 mastectomies; to provide with respect to contralateral prophylactic mastectomies; to
5 provide for applicability; and to provide for related matters.
6 Be it enacted by the Legislature of Louisiana:
7 Section 1. R.S. 22:1077(A) is hereby amended and reenacted to read as follows:
8 §1077. Required coverage for mastectomies and reconstructive surgery following
9 mastectomies
10 A. The legislature hereby finds that approximately three thousand women
11 will be diagnosed with breast cancer each year in Louisiana. Studies documenting
12 breast cancer statistics indicate that Louisiana has the highest mastectomy rate in the
13 nation: fifty-one percent of all women diagnosed with breast cancer will undergo a
14 mastectomy or bilateral mastectomy as part of their treatment regimen. Despite
15 laws which require insurers and physicians to inform women that breast
16 reconstruction is an insured surgical option, seven of ten women are not provided
17 this information. The purpose of this Section is to assure that state law mirrors the
18 federal Women's Health and Cancer Rights Act, to extend its application to all health
19 insurance issuers in Louisiana, to stress that decisions regarding mastectomies and
20 the reconstructive procedures to be performed shall be made solely by the patient in
21 consultation with attending physicians, and to clarify that mastectomies and all
22 stages of breast reconstruction as defined pursuant to this Section are medically
23 necessary and shall not be excluded from coverage.
24 * * *
25 Section 2. R.S. 22:1077(B) and (F)(1) as amended by Act 119 of the 2019 Regular
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1 Session are hereby amended and reenacted to read as follows:
2 §1077. Required coverage for reconstructive surgery following mastectomies
3 * * *
4 B. Any health benefit plan offered by a health insurance issuer that provides
5 medical and surgical benefits with respect to a partial mastectomy or a full unilateral
6 or bilateral mastectomy shall also provide medical and surgical benefits for breast
7 reconstruction. The coverage shall be for mastectomies, including contralateral
8 prophylactic mastectomies, and breast reconstruction procedures selected by the
9 patient in consultation with attending physicians. The coverage provided in this
10 Section may be subject to annual deductibles, coinsurance, and copayment
11 provisions as are consistent with those established for mastectomy procedures under
12 the health benefit plan. Written notice of the availability of coverage shall be
13 delivered to the insured or enrollee upon enrollment and annually thereafter as
14 approved by the commissioner of insurance.
15 * * *
16 F. For purposes of this Section:
17 (1) "Breast reconstruction" means all stages of reconstruction of the breast
18 on which a mastectomy has been performed and on the other breast to produce a
19 symmetrical appearance, including but not limited to liposuction performed for
20 transfer to a reconstructed breast or to repair a donor site deformity, tattooing the
21 areola of the breast, surgical adjustments of the non-mastectomized breast,
22 unforeseen medical complications which may require additional reconstruction in the
23 future, and prostheses and physical complications, including but not limited to
24 lymphedemas.
25 (1) "Breast reconstruction" means both of the following:
26 (a) All stages of reconstruction of the breast on which a unilateral
27 mastectomy has been performed and on the other breast to produce a symmetrical
28 appearance, including but not limited to contralateral prophylactic mastectomies,
29 liposuction performed for transfer to a reconstructed breast or to repair a donor site
30 deformity, tattooing the areola of the breast, surgical adjustments of the
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1 non-mastectomized breast, unforeseen medical complications which may require
2 additional reconstruction in the future, and prostheses and physical complications,
3 including but not limited to lymphedemas.
4 (b) All stages of reconstruction of both breasts if a bilateral mastectomy has
5 been performed, including but not limited to liposuction performed for transfer to a
6 reconstructed breast or to repair a donor site deformity, tattooing the areola of the
7 breast, unforeseen medical complications which may require additional
8 reconstruction in the future, and prostheses and physical complications, including but
9 not limited to lymphedemas.
10 * * *
11 Section 2. This Act shall apply to any new policy, contract, program, or health
12 coverage plan issued on or after January 1, 2021. Any policy, contract, or health coverage
13 plan in effect prior to January 1, 2021, shall convert to conform to the provisions of this Act
14 on or before the renewal date, but no later than January 1, 2021.
PRESIDENT OF THE SENATE
SPEAKER OF THE HOUSE OF REPRESENTATIVES
GOVERNOR OF THE STATE OF LOUISIANA
APPROVED:
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.