SRC-JFA H.B. 349 75(R)   BILL ANALYSIS


Senate Research Center   H.B. 349
By: Hamric (Shapiro)
Economic Development
5-14-97
Engrossed


DIGEST 

Currently, health benefit plans are not required to provide coverage for
inpatient hospital stay following a mastectomy.  Women undergoing the
physically and emotionally traumatic course of mastectomy may not receive
adequate care and medical oversight due to pressures from some health
benefit plans to reduce hospital stays.  This bill would require health
benefit plans that provide benefits for the treatment of breast cancer to
include coverage for a minimum of 48 hours following a mastectomy and 24
hours following a lymph node dissection.  

PURPOSE

As proposed, H.B. 349 requires health benefit plans that provide benefits
for the treatment of breast cancer to include coverage for a minimum of 48
hours following a mastectomy and 24 hours following a lymph node
dissection.   

RULEMAKING AUTHORITY

Rulemaking authority is granted to the commissioner of insurance in
SECTION 1 (Sections 5 and 6, Article 21.52G, Insurance Code) of this bill.

SECTION BY SECTION ANALYSIS

SECTION 1. Amends Chapter 21E, Insurance Code, by adding Article 21.52G,
as follows:  

Art. 21.52G.  COVERAGE FOR HOSPITAL STAYS FOLLOWING
PERFORMANCE OF A MASTECTOMY AND CERTAIN RELATED PROCEDURES

Sec.  1.  DEFINITIONS.  Defines "enrollee" and "health benefit plan."  

Sec. 2.  SCOPE OF ARTICLE.  Provides that this article applies only to
certain health benefit plans.  Provides that this article applies to a
health benefit plan that provides coverage only for a specific disease or
condition or for hospitalization.  Provides that this article does not
apply to certain health benefit plans.   

Sec. 3.  REQUIRED COVERAGE FOR MINIMUM INPATIENT STAY FOLLOWING MASTECTOMY
OR RELATED PROCEDURE; EXCEPTION.  Requires a health benefit plan that
provides benefits for the treatment of breast cancer to include coverage
for inpatient care for an enrollee for a minimum of 48 hours following a
mastectomy; and 24 hours following a lymph node dissection for the
treatment of breast cancer.  Provides that a health benefit plan is not
required to provide the minimum hours of coverage of inpatient care
required under Subsection (a) of this section if the enrollee and the
enrollee's attending physician determine that a shorter period of
inpatient care is appropriate.   

Sec.  4.  PROHIBITIONS.  Prohibits the issuer of a health benefit plan
from performing certain actions.  

Sec.  5.  NOTICE.  Requires each health benefit plan to provide written
notice to each enrollee under the plan regarding the coverage required by
this article.  Requires the notice to be provided in accordance with rules
adopted by the commissioner of insurance  (commissioner).   

Sec. 6.  RULES.  Requires the commissioner to adopt rules as necessary to
administer this article.   

SECTION 2. Effective date: September 1, 1997.
  Makes application of this Act prospective to January 1, 1998. 

SECTION 3. Emergency clause.