Bill Text: NY S00252 | 2015-2016 | General Assembly | Introduced


Bill Title: Requires health insurance policies and contracts shall provide coverage for the diagnosis and treatment of lymphedema; and requires such coverage shall include benefits for equipment, supplies, devices, complex decongestive therapy and out-patient self management training and education for the treatment of lymphedema.

Spectrum: Partisan Bill (Republican 2-0)

Status: (Introduced - Dead) 2016-01-06 - REFERRED TO INSURANCE [S00252 Detail]

Download: New_York-2015-S00252-Introduced.html
                           S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________
                                          252
                              2015-2016 Regular Sessions
                                   I N  S E N A T E
                                      (PREFILED)
                                    January 7, 2015
                                      ___________
       Introduced  by  Sens. LAVALLE, GOLDEN -- read twice and ordered printed,
         and when printed to be committed to the Committee on Insurance
       AN ACT to amend the insurance law,  in  relation  to  requiring  certain
         health insurance coverage for lymphedema
         THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
       BLY, DO ENACT AS FOLLOWS:
    1    Section 1.  Clause  (ii)  of  subparagraph  (A)  of  paragraph  20  of
    2  subsection (i) of section 3216 of the insurance law, as added by chapter
    3  21  of  the  laws of 1997, is amended and a new clause (iii) is added to
    4  read as follows:
    5    (ii) surgery and reconstruction of  the  other  breast  to  produce  a
    6  symmetrical appearance; AND
    7    (III) PROSTHESES AND PHYSICAL COMPLICATIONS OF ALL STAGES OF MASTECTO-
    8  MY, INCLUDING LYMPHEDEMA;
    9    S 2. Subsection (i) of section 3216 of the insurance law is amended by
   10  adding two new paragraphs 32 and 33 to read as follows:
   11    (32)  EVERY POLICY WHICH PROVIDES HOSPITAL, SURGICAL, MEDICAL OR MAJOR
   12  MEDICAL COVERAGE SHALL PROVIDE COVERAGE FOR THE  DIFFERENTIAL  DIAGNOSIS
   13  AND TREATMENT OF LYMPHEDEMA. SUCH COVERAGE SHALL INCLUDE, IN ADDITION TO
   14  BENEFITS FOR A COURSE OF MANUAL LYMPH DRAINAGE WHOSE FREQUENCY AND DURA-
   15  TION  IS  DETERMINED  BY  THE  TREATING  PHYSICIAN OR THERAPIST BASED ON
   16  MEDICAL NECESSITY AND NOT BASED ON PHYSICAL THERAPY  AND  REHABILITATION
   17  STANDARDS,  BENEFITS FOR EQUIPMENT, SUPPLIES, DEVICES, COMPLEX DECONGES-
   18  TIVE THERAPY, AND OUT-PATIENT SELF-MANAGEMENT TRAINING AND EDUCATION FOR
   19  THE TREATMENT OF LYMPHEDEMA, IF PRESCRIBED BY A HEALTH CARE PROFESSIONAL
   20  LEGALLY AUTHORIZED TO PRESCRIBE OR PROVIDE SUCH ITEMS UNDER TITLE  EIGHT
   21  OF  THE  EDUCATION  LAW.    LYMPHEDEMA  THERAPY  ADMINISTERED UNDER THIS
   22  SECTION SHALL BE ADMINISTERED ONLY BY A THERAPIST CERTIFIED  TO  PERFORM
   23  LYMPHEDEMA  TREATMENT  BY  THE  LYMPHOLOGY  ASSOCIATION OF NORTH AMERICA
   24  (LANA) OR CERTIFIED IN  ACCORDANCE  WITH  STANDARDS  EQUIVALENT  TO  THE
        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD03136-01-5
       S. 252                              2
    1  CERTIFICATION  STANDARDS  OF LANA.   SUCH EQUIPMENT, SUPPLIES OR DEVICES
    2  SHALL INCLUDE, BUT NOT BE LIMITED TO,  BANDAGES,  COMPRESSION  GARMENTS,
    3  PADS,  ORTHOTIC  SHOES  AND  DEVICES, WITH REPLACEMENTS WHEN REQUIRED TO
    4  MAINTAIN COMPRESSIVE FUNCTION OR TO ACCOMMODATE CHANGES IN THE PATIENT'S
    5  DIMENSIONS.  COVERAGE  SHALL  BE  PROVIDED FOR FOLLOW-UP TREATMENTS WHEN
    6  MEDICALLY REQUIRED OR TO PERIODICALLY VALIDATE HOME TECHNIQUES, TO MONI-
    7  TOR PROGRESS AGAINST THE WRITTEN TREATMENT PLAN AND TO MODIFY THE TREAT-
    8  MENT PLAN AS REQUIRED. NO INDIVIDUAL, OTHER THAN A LICENSED PHYSICIAN OR
    9  SURGEON COMPETENT TO EVALUATE THE SPECIFIC CLINICAL ISSUES  INVOLVED  IN
   10  THE  CARE  REQUESTED, MAY DENY REQUESTS FOR AUTHORIZATION OF HEALTH CARE
   11  SERVICES PURSUANT TO THIS SECTION.
   12    (A) A POLICY WHICH IS A MANAGED HEALTH CARE PRODUCT MAY  REQUIRE  SUCH
   13  HEALTH  CARE PROFESSIONAL BE A MEMBER OF SUCH MANAGED HEALTH CARE PLAN'S
   14  PROVIDER NETWORK, PROVIDED THAT SUCH NETWORK INCLUDES SUFFICIENT  HEALTH
   15  CARE  PROFESSIONALS  WHO ARE QUALIFIED BY SPECIFIC EDUCATION, EXPERIENCE
   16  AND CREDENTIALS TO PROVIDE THE COVERED BENEFITS DESCRIBED IN THIS  PARA-
   17  GRAPH.
   18    (B)  NO INSURER, CORPORATION, OR HEALTH MAINTENANCE ORGANIZATION SHALL
   19  IMPOSE UPON ANY PERSON RECEIVING BENEFITS PURSUANT TO THIS PARAGRAPH ANY
   20  COPAYMENT, FEE, POLICY YEAR OR  CALENDAR  YEAR,  OR  DURATIONAL  BENEFIT
   21  LIMITATION  OR  MAXIMUM  FOR  BENEFITS  OR  SERVICES THAT IS NOT EQUALLY
   22  IMPOSED UPON ALL INDIVIDUALS IN THE SAME BENEFIT CATEGORY.
   23    (C) THIS PARAGRAPH SHALL NOT  APPLY  TO  SHORT-TERM  TRAVEL,  ACCIDENT
   24  ONLY, LIMITED OR SPECIFIED DISEASE, OR INDIVIDUAL CONVERSION POLICIES OR
   25  CONTRACTS, NOR TO POLICIES OR CONTRACTS DESIGNED FOR ISSUANCE TO PERSONS
   26  ELIGIBLE  FOR  COVERAGE  UNDER  TITLE  XVIII OF THE SOCIAL SECURITY ACT,
   27  KNOWN AS MEDICARE, OR ANY OTHER SIMILAR COVERAGE UNDER STATE OR  FEDERAL
   28  GOVERNMENTAL PLANS.
   29    (D)  FOR  PURPOSES  OF  THIS PARAGRAPH, A "MANAGED CARE PRODUCT" SHALL
   30  MEAN A POLICY WHICH REQUIRES THAT MEDICAL OR OTHER HEALTH CARE  SERVICES
   31  COVERED  UNDER  THE  POLICY,  OTHER  THAN  EMERGENCY  CARE  SERVICES, BE
   32  PROVIDED BY, OR PURSUANT TO A REFERRAL FROM A PRIMARY CARE PROVIDER, AND
   33  THAT SERVICES PROVIDED PURSUANT TO SUCH A  REFERRAL  BE  RENDERED  BY  A
   34  HEALTH CARE PROVIDER PARTICIPATING IN THE INSURER'S MANAGED CARE PROVID-
   35  ER  NETWORK.  IN  ADDITION,  A  MANAGED CARE PRODUCT SHALL ALSO MEAN THE
   36  IN-NETWORK PORTION OF A CONTRACT WHICH REQUIRES THAT  MEDICAL  OR  OTHER
   37  HEALTH  CARE  SERVICES  COVERED UNDER THE CONTRACT, OTHER THAN EMERGENCY
   38  CARE SERVICES, BE PROVIDED BY, OR PURSUANT TO A REFERRAL FROM A  PRIMARY
   39  CARE PROVIDER, AND THAT SERVICES PROVIDED PURSUANT TO SUCH A REFERRAL BE
   40  RENDERED  BY  A  HEALTH  CARE  PROVIDER  PARTICIPATING  IN THE INSURER'S
   41  MANAGED CARE PROVIDER NETWORK, IN ORDER FOR THE INSURED TO  BE  ENTITLED
   42  TO THE MAXIMUM REIMBURSEMENT UNDER THE CONTRACT.
   43    (33)  PATIENTS  UNDERGOING ANY SURGERY OR RADIOTHERAPY PROCEDURE SHALL
   44  BE PROVIDED INFORMATION ON THE RISK OF LYMPHEDEMA ASSOCIATED  WITH  THAT
   45  PROCEDURE,  AND  THE  POTENTIAL  POST-PROCEDURE  SYMPTOMS OF LYMPHEDEMA.
   46  INFORMED CONSENT AGREEMENTS FOR ALL SURGERIES  AND  RADIATION  THERAPIES
   47  SHALL  INCLUDE INFORMATION ON THE RISK OF LYMPHEDEMA ASSOCIATED WITH THE
   48  ALTERNATIVE PROCEDURES.
   49    S 3. Clause (ii) of subparagraph (A) of paragraph 10 of subsection (k)
   50  of section 3221 of the insurance law, as added by chapter 21 of the laws
   51  of 1997, is amended and a new clause (iii) is added to read as follows:
   52    (ii) surgery and reconstruction of  the  other  breast  to  produce  a
   53  symmetrical appearance; AND
   54    (III) PROSTHESES AND PHYSICAL COMPLICATIONS OF ALL STAGES OF MASTECTO-
   55  MY, INCLUDING LYMPHEDEMA;
       S. 252                              3
    1    S 4. Subsection (k) of section 3221 of the insurance law is amended by
    2  adding two new paragraphs 20 and 21 to read as follows:
    3    (20)  EVERY  GROUP  POLICY ISSUED OR ISSUED FOR DELIVERY IN THIS STATE
    4  WHICH PROVIDES HOSPITAL, SURGICAL, MEDICAL  OR  MAJOR  MEDICAL  COVERAGE
    5  SHALL  PROVIDE  COVERAGE FOR THE DIFFERENTIAL DIAGNOSIS AND TREATMENT OF
    6  LYMPHEDEMA. SUCH COVERAGE SHALL INCLUDE, IN ADDITION TO BENEFITS  FOR  A
    7  COURSE  OF  MANUAL LYMPH DRAINAGE WHOSE FREQUENCY AND DURATION IS DETER-
    8  MINED BY THE TREATING PHYSICIAN OR THERAPIST BASED ON MEDICAL  NECESSITY
    9  AND NOT BASED ON PHYSICAL THERAPY AND REHABILITATION STANDARDS, BENEFITS
   10  FOR  EQUIPMENT,  SUPPLIES,  DEVICES,  COMPLEX  DECONGESTIVE THERAPY, AND
   11  OUT-PATIENT SELF-MANAGEMENT TRAINING AND EDUCATION FOR THE TREATMENT  OF
   12  LYMPHEDEMA,  IF PRESCRIBED BY A HEALTH CARE PROFESSIONAL LEGALLY AUTHOR-
   13  IZED TO PRESCRIBE OR PROVIDE SUCH ITEMS UNDER TITLE EIGHT OF THE  EDUCA-
   14  TION  LAW.   LYMPHEDEMA THERAPY ADMINISTERED UNDER THIS SECTION SHALL BE
   15  ADMINISTERED ONLY BY A THERAPIST CERTIFIED TO PERFORM LYMPHEDEMA  TREAT-
   16  MENT  BY THE LYMPHOLOGY ASSOCIATION OF NORTH AMERICA (LANA) OR CERTIFIED
   17  IN ACCORDANCE WITH STANDARDS EQUIVALENT TO THE  CERTIFICATION  STANDARDS
   18  OF  LANA.  SUCH EQUIPMENT, SUPPLIES OR DEVICES SHALL INCLUDE, BUT NOT BE
   19  LIMITED TO, BANDAGES, COMPRESSION GARMENTS,  PADS,  ORTHOTIC  SHOES  AND
   20  DEVICES,  WITH  REPLACEMENTS WHEN REQUIRED TO MAINTAIN COMPRESSIVE FUNC-
   21  TION OR TO ACCOMMODATE CHANGES IN  THE  PATIENT'S  DIMENSIONS.  COVERAGE
   22  SHALL BE PROVIDED FOR FOLLOW-UP TREATMENTS WHEN MEDICALLY REQUIRED OR TO
   23  PERIODICALLY  VALIDATE  HOME TECHNIQUES, TO MONITOR PROGRESS AGAINST THE
   24  WRITTEN TREATMENT PLAN AND TO MODIFY THE TREATMENT PLAN AS REQUIRED.  NO
   25  INDIVIDUAL,  OTHER  THAN  A  LICENSED  PHYSICIAN OR SURGEON COMPETENT TO
   26  EVALUATE THE SPECIFIC CLINICAL ISSUES INVOLVED IN  THE  CARE  REQUESTED,
   27  MAY  DENY REQUESTS FOR AUTHORIZATION OF HEALTH CARE SERVICES PURSUANT TO
   28  THIS SECTION.
   29    (A) A POLICY WHICH IS A MANAGED HEALTH CARE PRODUCT MAY  REQUIRE  SUCH
   30  HEALTH  CARE PROFESSIONAL BE A MEMBER OF SUCH MANAGED HEALTH CARE PLAN'S
   31  PROVIDER NETWORK, PROVIDED THAT SUCH NETWORK INCLUDES SUFFICIENT  HEALTH
   32  CARE  PROFESSIONALS  WHO ARE QUALIFIED BY SPECIFIC EDUCATION, EXPERIENCE
   33  AND CREDENTIALS TO PROVIDE THE COVERED BENEFITS DESCRIBED IN THIS  PARA-
   34  GRAPH.
   35    (B)  NO INSURER, CORPORATION, OR HEALTH MAINTENANCE ORGANIZATION SHALL
   36  IMPOSE UPON ANY PERSON RECEIVING BENEFITS PURSUANT TO THIS PARAGRAPH ANY
   37  COPAYMENT, FEE, POLICY YEAR OR  CALENDAR  YEAR,  OR  DURATIONAL  BENEFIT
   38  LIMITATION  OR  MAXIMUM  FOR  BENEFITS  OR  SERVICES THAT IS NOT EQUALLY
   39  IMPOSED UPON ALL INDIVIDUALS IN THE SAME BENEFIT CATEGORY.
   40    (C) THIS PARAGRAPH SHALL NOT  APPLY  TO  SHORT-TERM  TRAVEL,  ACCIDENT
   41  ONLY, LIMITED OR SPECIFIED DISEASE, OR INDIVIDUAL CONVERSION POLICIES OR
   42  CONTRACTS, NOR TO POLICIES OR CONTRACTS DESIGNED FOR ISSUANCE TO PERSONS
   43  ELIGIBLE  FOR  COVERAGE  UNDER  TITLE  XVIII OF THE SOCIAL SECURITY ACT,
   44  KNOWN AS MEDICARE, OR ANY OTHER SIMILAR COVERAGE UNDER STATE OR  FEDERAL
   45  GOVERNMENTAL PLANS.
   46    (D)  FOR  PURPOSES  OF  THIS PARAGRAPH, A "MANAGED CARE PRODUCT" SHALL
   47  MEAN A POLICY WHICH REQUIRES THAT MEDICAL OR OTHER HEALTH CARE  SERVICES
   48  COVERED  UNDER  THE  POLICY,  OTHER  THAN  EMERGENCY  CARE  SERVICES, BE
   49  PROVIDED BY, OR PURSUANT TO A REFERRAL FROM A PRIMARY CARE PROVIDER, AND
   50  THAT SERVICES PROVIDED PURSUANT TO SUCH A  REFERRAL  BE  RENDERED  BY  A
   51  HEALTH CARE PROVIDER PARTICIPATING IN THE INSURER'S MANAGED CARE PROVID-
   52  ER  NETWORK.  IN  ADDITION,  A  MANAGED CARE PRODUCT SHALL ALSO MEAN THE
   53  IN-NETWORK PORTION OF A CONTRACT WHICH REQUIRES THAT  MEDICAL  OR  OTHER
   54  HEALTH  CARE  SERVICES  COVERED UNDER THE CONTRACT, OTHER THAN EMERGENCY
   55  CARE SERVICES, BE PROVIDED BY, OR PURSUANT TO A REFERRAL FROM A  PRIMARY
   56  CARE PROVIDER, AND THAT SERVICES PROVIDED PURSUANT TO SUCH A REFERRAL BE
       S. 252                              4
    1  RENDERED  BY  A  HEALTH  CARE  PROVIDER  PARTICIPATING  IN THE INSURER'S
    2  MANAGED CARE PROVIDER NETWORK, IN ORDER FOR THE INSURED TO  BE  ENTITLED
    3  TO THE MAXIMUM REIMBURSEMENT UNDER THE CONTRACT.
    4     (21)  PATIENTS UNDERGOING ANY SURGERY OR RADIOTHERAPY PROCEDURE SHALL
    5  BE PROVIDED INFORMATION ON THE RISK OF LYMPHEDEMA ASSOCIATED  WITH  THAT
    6  PROCEDURE,  AND  THE  POTENTIAL  POST-PROCEDURE  SYMPTOMS OF LYMPHEDEMA.
    7  INFORMED CONSENT AGREEMENTS FOR ALL SURGERIES  AND  RADIATION  THERAPIES
    8  SHALL  INCLUDE INFORMATION ON THE RISK OF LYMPHEDEMA ASSOCIATED WITH THE
    9  ALTERNATIVE PROCEDURES.
   10    S 5. Subparagraph (B) of paragraph 1 of subsection (x) of section 4303
   11  of the insurance law, as added by chapter 21 of the  laws  of  1997,  is
   12  amended and a new subparagraph (C) is added to read as follows:
   13    (B)  surgery  and  reconstruction  of  the  other  breast to produce a
   14  symmetrical appearance; AND
   15    (C) PROSTHESES AND PHYSICAL COMPLICATIONS OF ALL STAGES OF MASTECTOMY,
   16  INCLUDING LYMPHEDEMA;
   17    S 6. Section 4303 of the insurance law is amended by  adding  two  new
   18  subsections (oo) and (pp) to read as follows:
   19    (OO) EVERY CONTRACT ISSUED BY A HOSPITAL SERVICE CORPORATION OR HEALTH
   20  SERVICE  CORPORATION WHICH PROVIDES HOSPITAL, SURGICAL, MEDICAL OR MAJOR
   21  MEDICAL COVERAGE SHALL PROVIDE COVERAGE FOR THE  DIFFERENTIAL  DIAGNOSIS
   22  AND TREATMENT OF LYMPHEDEMA. SUCH COVERAGE SHALL INCLUDE, IN ADDITION TO
   23  BENEFITS FOR A COURSE OF MANUAL LYMPH DRAINAGE WHOSE FREQUENCY AND DURA-
   24  TION  IS  DETERMINED  BY  THE  TREATING  PHYSICIAN OR THERAPIST BASED ON
   25  MEDICAL NECESSITY AND NOT BASED ON PHYSICAL THERAPY  AND  REHABILITATION
   26  STANDARDS,  BENEFITS FOR EQUIPMENT, SUPPLIES, DEVICES, COMPLEX DECONGES-
   27  TIVE THERAPY, AND OUT-PATIENT SELF-MANAGEMENT TRAINING AND EDUCATION FOR
   28  THE TREATMENT OF LYMPHEDEMA, IF PRESCRIBED BY A HEALTH CARE PROFESSIONAL
   29  LEGALLY AUTHORIZED TO PRESCRIBE OR PROVIDE SUCH ITEMS UNDER TITLE  EIGHT
   30  OF  THE  EDUCATION  LAW.    LYMPHEDEMA  THERAPY  ADMINISTERED UNDER THIS
   31  SECTION SHALL BE ADMINISTERED ONLY BY A THERAPIST CERTIFIED  TO  PERFORM
   32  LYMPHEDEMA  TREATMENT  BY  THE  LYMPHOLOGY  ASSOCIATION OF NORTH AMERICA
   33  (LANA) OR CERTIFIED IN  ACCORDANCE  WITH  STANDARDS  EQUIVALENT  TO  THE
   34  CERTIFICATION  STANDARDS  OF LANA.   SUCH EQUIPMENT, SUPPLIES OR DEVICES
   35  SHALL INCLUDE, BUT NOT BE LIMITED TO,  BANDAGES,  COMPRESSION  GARMENTS,
   36  PADS,  ORTHOTIC  SHOES  AND  DEVICES, WITH REPLACEMENTS WHEN REQUIRED TO
   37  MAINTAIN COMPRESSIVE FUNCTION OR TO ACCOMMODATE CHANGES IN THE PATIENT'S
   38  DIMENSIONS. COVERAGE SHALL BE PROVIDED  FOR  FOLLOW-UP  TREATMENTS  WHEN
   39  MEDICALLY REQUIRED OR TO PERIODICALLY VALIDATE HOME TECHNIQUES, TO MONI-
   40  TOR PROGRESS AGAINST THE WRITTEN TREATMENT PLAN AND TO MODIFY THE TREAT-
   41  MENT PLAN AS REQUIRED. NO INDIVIDUAL, OTHER THAN A LICENSED PHYSICIAN OR
   42  SURGEON  COMPETENT  TO EVALUATE THE SPECIFIC CLINICAL ISSUES INVOLVED IN
   43  THE CARE REQUESTED, MAY DENY REQUESTS FOR AUTHORIZATION OF  HEALTH  CARE
   44  SERVICES PURSUANT TO THIS SECTION.
   45    (1)  A  POLICY WHICH IS A MANAGED HEALTH CARE PRODUCT MAY REQUIRE SUCH
   46  HEALTH CARE PROFESSIONAL BE A MEMBER OF SUCH MANAGED HEALTH CARE  PLAN'S
   47  PROVIDER  NETWORK, PROVIDED THAT SUCH NETWORK INCLUDES SUFFICIENT HEALTH
   48  CARE PROFESSIONALS WHO ARE QUALIFIED BY SPECIFIC  EDUCATION,  EXPERIENCE
   49  AND  CREDENTIALS  TO  PROVIDE  THE  COVERED  BENEFITS  DESCRIBED IN THIS
   50  SUBSECTION.
   51    (2) NO INSURER, CORPORATION, OR HEALTH MAINTENANCE ORGANIZATION  SHALL
   52  IMPOSE  UPON  ANY  PERSON RECEIVING BENEFITS PURSUANT TO THIS SUBSECTION
   53  ANY COPAYMENT, FEE, POLICY YEAR OR CALENDAR YEAR, OR DURATIONAL  BENEFIT
   54  LIMITATION  OR  MAXIMUM  FOR  BENEFITS  OR  SERVICES THAT IS NOT EQUALLY
   55  IMPOSED UPON ALL INDIVIDUALS IN THE SAME BENEFIT CATEGORY.
       S. 252                              5
    1    (3) THIS SUBSECTION SHALL NOT APPLY  TO  SHORT-TERM  TRAVEL,  ACCIDENT
    2  ONLY, LIMITED OR SPECIFIED DISEASE, OR INDIVIDUAL CONVERSION POLICIES OR
    3  CONTRACTS, NOR TO POLICIES OR CONTRACTS DESIGNED FOR ISSUANCE TO PERSONS
    4  ELIGIBLE  FOR  COVERAGE  UNDER  TITLE  XVIII OF THE SOCIAL SECURITY ACT,
    5  KNOWN  AS MEDICARE, OR ANY OTHER SIMILAR COVERAGE UNDER STATE OR FEDERAL
    6  GOVERNMENTAL PLANS.
    7    (4) FOR PURPOSES OF THIS SUBSECTION, A "MANAGED  CARE  PRODUCT"  SHALL
    8  MEAN  A POLICY WHICH REQUIRES THAT MEDICAL OR OTHER HEALTH CARE SERVICES
    9  COVERED UNDER  THE  POLICY,  OTHER  THAN  EMERGENCY  CARE  SERVICES,  BE
   10  PROVIDED BY, OR PURSUANT TO A REFERRAL FROM A PRIMARY CARE PROVIDER, AND
   11  THAT  SERVICES  PROVIDED  PURSUANT  TO  SUCH A REFERRAL BE RENDERED BY A
   12  HEALTH CARE PROVIDER PARTICIPATING IN THE INSURER'S MANAGED CARE PROVID-
   13  ER NETWORK. IN ADDITION, A MANAGED CARE  PRODUCT  SHALL  ALSO  MEAN  THE
   14  IN-NETWORK  PORTION  OF  A CONTRACT WHICH REQUIRES THAT MEDICAL OR OTHER
   15  HEALTH CARE SERVICES COVERED UNDER THE CONTRACT,  OTHER  THAN  EMERGENCY
   16  CARE  SERVICES, BE PROVIDED BY, OR PURSUANT TO A REFERRAL FROM A PRIMARY
   17  CARE PROVIDER, AND THAT SERVICES PROVIDED PURSUANT TO SUCH A REFERRAL BE
   18  RENDERED BY A  HEALTH  CARE  PROVIDER  PARTICIPATING  IN  THE  INSURER'S
   19  MANAGED  CARE  PROVIDER NETWORK, IN ORDER FOR THE INSURED TO BE ENTITLED
   20  TO THE MAXIMUM REIMBURSEMENT UNDER THE CONTRACT.
   21    (PP) PATIENTS UNDERGOING ANY SURGERY OR RADIOTHERAPY  PROCEDURE  SHALL
   22  BE  PROVIDED  INFORMATION ON THE RISK OF LYMPHEDEMA ASSOCIATED WITH THAT
   23  PROCEDURE, AND THE  POTENTIAL  POST-PROCEDURE  SYMPTOMS  OF  LYMPHEDEMA.
   24  INFORMED  CONSENT  AGREEMENTS  FOR ALL SURGERIES AND RADIATION THERAPIES
   25  SHALL INCLUDE INFORMATION ON THE RISK OF LYMPHEDEMA ASSOCIATED WITH  THE
   26  ALTERNATIVE PROCEDURES.
   27    S  7. This act shall take effect on the first of January next succeed-
   28  ing the date on which it shall have become a law and shall apply to  all
   29  insurance  policies,  contracts  and  plans  issued,  renewed, modified,
   30  altered or amended on or after such effective date.
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