MISSISSIPPI LEGISLATURE

2000 Regular Session

To: Insurance

By: Senator(s) Kirby, Blackmon

AN ACT TO REQUIRE THAT CERTAIN HEALTH INSURANCE POLICIES AND THE STATE AND SCHOOL EMPLOYEES HEALTH INSURANCE PLAN SHALL PROVIDE RECONSTRUCTIVE SURGERY AFTER A MASTECTOMY HAS BEEN PERFORMED; TO PROVIDE THAT WRITTEN NOTICE OF THE AVAILABILITY OF SUCH COVERAGE SHALL BE DELIVERED TO THE POLICYHOLDER UPON ENROLLMENT AND ANNUALLY THEREAFTER; TO REQUIRE THAT CERTAIN HEALTH INSURANCE POLICIES SHALL PROVIDE COVERAGE OF CERTAIN CANCER SCREENING PROCEDURES; TO REQUIRE THAT CERTAIN HEALTH INSURANCE POLICIES SHALL PROVIDE COVERAGE OF A MINIMUM OF 48 HOURS OF INPATIENT CARE FOR A WOMAN FOLLOWING A NORMAL MASTECTOMY; AND FOR RELATED PURPOSES.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:

SECTION 1. The following section shall be codified in Chapter 9 of Title 85:

(1) As used in this section, the term "health insurance issuer" means any insurance company, hospital or medical service plan or any entity defined in Section 83-41-303(N), which offers group or individual health insurance coverage in the State of Mississippi.

(2) A health insurance issuer providing health insurance coverage in connection with a group or individual health plan that provides medical and surgical benefits with respect to a mastectomy shall provide an insured or enrollee who is receiving benefits in connection with a mastectomy and who elects breast reconstruction in connection with such mastectomy, coverage for all stages of reconstruction of the breast on which the mastectomy has been performed; surgery and reconstruction of the other breast to produce a symmetrical appearance; and prostheses and physical complications of mastectomy, including lymphedemas in a manner determined in consultation with the attending physician and the patient. Such coverage may be subject to annual deductibles and coinsurance provisions as may be deemed appropriate and as are consistent with those established for other benefits under the plan or coverage. Written notice of the availability of such coverage shall be delivered to the insured in the case of an individual policy, and to the certificate holder in the case of a group policy, upon enrollment.

(3) A health insurance issuer providing health insurance coverage in connection with a group or individual health plan shall provide notice to the named insured in the case of an individual policy, and to each certificate holder in the case of a group policy, regarding the coverage required by this section. Such notice shall be in writing and prominently positioned in any literature or correspondence made available or distributed by the health insurance issuer and shall be transmitted to the named insured or certificate holder not later than July 1, 2000. The notice prescribed by this subsection shall be filed with and approved by the Commissioner of Insurance before distribution by the health insurance issuer.

(4) A health insurance issuer offering group or individual health insurance coverage in connection with a group health plan, may not:

(a) Deny to 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 the section; or

(b) Penalize or otherwise reduce or limit the reimbursement of an attending provider or provide incentives (monetary or otherwise) to an attending provider to induce such provider to provide care to an insured or enrollee in a manner inconsistent with this section.

(5) A health insurance issuer providing health insurance coverage in connection with a group or individual health plan shall provide coverage for mammograms, breast ultrasounds, pap smears (lab and procedure), biopsies, flexible sigmoidoscopies, hemocult stool specimens, chest x-rays, CEA (blood tests for colon cancer), CA 125 (blood tests for ovarian cancer), PSA (blood tests for prostate cancer), thermographies and colonoscopies.

(6) (a) A health insurance issuer providing health insurance coverage in connection with a group or individual health plan shall provide coverage of a minimum of forty-eight (48) hours of inpatient care for a woman following a normal mastectomy.

(b) Any decision to shorten the length of inpatient stay to less than that provided under this paragraph (a) of this subsection shall be made by the attending providers after conferring with the patient.

(c) If a woman is discharged pursuant to paragraph (b) of this subsection prior to the inpatient length of stay provided under paragraph (a) of this subsection, coverage shall be provided for a follow-up visit within forty-eight (48) hours of discharge. Services provided shall be consistent with protocols and guidelines developed by national professional organizations for these services.

(7) Nothing in this section shall be construed to prevent a health insurance issuer offering group or individual health insurance coverage from negotiating the level and type of reimbursement with a provider for care provided in accordance with this section.

SECTION 2. The following section shall be codified in Chapter 15 of Title 25:

(1) The State and School Employees Health Insurance Plan shall provide an enrollee who is receiving benefits in connection with a mastectomy and who elects breast reconstruction in connection with such mastectomy, coverage for all stages of reconstruction of the breast on which the mastectomy has been performed; surgery and reconstruction of the other breast to produce a symmetrical appearance; and prostheses and physical complications of mastectomy, including lymphedemas in a manner determined in consultation with the attending physician and the patient. Such coverage may be subject to annual deductibles and coinsurance provisions as may be deemed appropriate and as are consistent with those established for other benefits under the plan. Written notice of the availability of such coverage shall be delivered to the certificate holder upon enrollment and annually thereafter.

(2) The State and School Employees Health Insurance Plan shall provide notice to each enrollee regarding the coverage required by this section. Such notice shall be in writing and prominently positioned in any literature or correspondence made available or distributed by the plan and shall be transmitted to the enrollee not later than July 1, 2000.

(3) The State and School Employees Health Insurance Plan may not:

(a) Deny to 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 the section; or

(b) Penalize or otherwise reduce or limit the reimbursement of an attending provider or provide incentives (monetary or otherwise) to an attending provider to induce such provider to provide care to an enrollee in a manner inconsistent with this section.

(4) Nothing in this section shall be construed to prevent the plan from negotiating the level and type of reimbursement with a provider for care provided in accordance with this section.

SECTION 3. This act shall take effect and be in force from and after its passage.