Sponsored by:
Senator JOSEPH A. LAGANA
District 38 (Bergen and Passaic)
Senator VIN GOPAL
District 11 (Monmouth)
SYNOPSIS
Requires hospitals to provide breast cancer patients with information concerning reconstructive surgery; prohibits certain provisions in managed care plan contracts.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning breast cancer and supplementing Title 26 of the Revised Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. Each general hospital licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.) that provides surgical services for the treatment of breast cancer, including, but not limited to, mastectomy surgery, lymph node dissection, or lumpectomy, shall provide information to each patient receiving treatment for breast cancer concerning the option of reconstructive surgery following the provision of surgical services, including the availability of coverage for reconstructive surgery pursuant to section 1 of P.L.1983, c.50 (C.17:48-6b), section 1 of P.L.1983, c.51 (C.17:48A-7b), section 35 of P.L.1985, c.236 (C.17:48E-35), section 1 of P.L.1983, c.53 (C.17B:26-2.1a), section 1 of P.L.1983, c.52 (C.17B:27-46.1a), section 6 of P.L.1997, c.75 (C.26:6J-4.14), and federal law. The information shall be provided to the patient in writing and in advance of obtaining consent to the surgical procedure, and shall include, at a minimum:
(1) a description of the various reconstructive options and the advantages and disadvantages of each;
(2) a description of the provisions of State and federal law that require health benefits carriers to provide coverage for reconstructive surgery;
(3) a description of how a patient may access reconstructive care, including the potential of transferring care to a facility that provides reconstructive care or choosing to pursue reconstruction after completing breast cancer surgery, chemotherapy, and radiotherapy; and
(4) such other information as shall be required by the Commissioner of Health.
b. The Commissioner of Health shall, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), adopt rules and regulations as shall be necessary to effectuate the provisions of this section.
2. a. A contract between a carrier and a health care provider for a managed care plan shall not contain any provision that prohibits a health care provider from referring a covered person to an out-of-network plastic surgeon for reconstructive breast surgery or surgery to restore and achieve symmetry between two breasts following a mastectomy, if there is no reasonable access to an in-network plastic surgeon capable of performing those services within 10 miles of the location where the mastectomy was performed. For purposes of this section, "carrier" shall include the State Health Benefits Program and the School Employees' Health Benefits Program.
b. The Commissioner of Banking and Insurance shall, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), adopt rules and regulations as shall be necessary to effectuate the provisions of this section.
3. This act shall take effect on the 90th day after the date of enactment.
STATEMENT
This bill requires general hospitals that provide surgical services for the treatment of breast cancer, including, but not limited to, mastectomy surgery, lymph node dissection, or lumpectomy, to provide information to breast cancer patients concerning the option of reconstructive surgery following the provision of surgical services, including the availability of coverage for reconstructive surgery pursuant to State and federal law. The information is to be provided to the patient in writing and in advance of obtaining consent to the surgical procedure. The information will include: a description of the various reconstructive options and the advantages and disadvantages of each; a description of the provisions of State and federal law that require health benefits carriers to provide coverage for reconstructive surgery; a description of how a patient may access reconstructive care, including the potential of transferring care to a facility that provides reconstructive care or choosing to pursue reconstruction after completing breast cancer surgery, chemotherapy, and radiotherapy; and any other information as may be required by the Commissioner of Health.
The bill also supplements the "Health Care Quality Act" to provide that a contract between a carrier and a health care provider for a managed care plan shall not contain any provision that prohibits a health care provider from referring a covered person to an out-of-network plastic surgeon for reconstructive breast surgery or surgery to restore and achieve symmetry between two breasts following a mastectomy, if there is no reasonable access to an in-network plastic surgeon capable of performing those services within 10 miles of the location where the mastectomy was performed. For purposes of this bill, "carrier" shall include the State Health Benefits Program and the School Employees' Health Benefits Program.