BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 255|
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THIRD READING
Bill No: SB 255
Author: Pavley (D)
Amended: 4/25/11
Vote: 21
SENATE HEALTH COMMITTEE : 7-0, 01/11/12
AYES: Hernandez, Alquist, Blakeslee, De León, DeSaulnier,
Rubio, Wolk
NO VOTE RECORDED: Strickland, Anderson
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
SUBJECT : Health care coverage: breast cancer
SOURCE : Susan G. Komen for the Cure California
Affiliates
DIGEST : This bill, for purposes of insurance coverage of
mastectomy procedures, revises the definition of mastectomy
to specify that the partial removal of a breast includes
lumpectomy, which includes surgical removal of a tumor with
clear margins, and allows the length of a hospital stay
associated with mastectomy procedures to be determined
postsurgery, consistent with sound clinical principles and
processes.
ANALYSIS : Existing federal law:
1.Defines, under the Patient Protection and Affordable Care
Act, as amended by the Health Care Education and
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Reconciliation Act of 2010, a list of essential health
benefits which health insurance coverage and group health
plans must provide beginning in 2014.
2.Provides protections to patients who choose to have
breast reconstruction in connection with a mastectomy
under the Women's Health and Cancer Rights Act of 1998.
Requires health plans and insurers that provide
mastectomy coverage benefits to cover reconstruction of
the breast removed, surgery and reconstruction of the
other breast to achieve symmetry, any external breast
prostheses needed before or during the reconstruction;
and any physical complications at all stages of
mastectomy, including lymphedema.
Existing state law:
1.Provides for the regulation of health care service plans
by the Department of Managed Health Care and individual
or group health insurers by the California Department of
Insurance.
2.Requires every health plan contract and health insurance
policy to provide coverage for screening for, diagnosis
of, and treatment for breast cancer, including coverage
for prosthetic devices or reconstructive surgery to
restore and achieve symmetry for the patient incidental
to a mastectomy.
3.Requires every health plan and health insurance policy
that provides coverage for mastectomies and lymph node
dissections to allow the length of stay to be determined
by the attending physician and surgeon in consultation
with the patient, cover prosthetic devices or
reconstructive surgery; and cover all complications from
a mastectomy, as specified.
4.Prohibits a health plan or insurer from requiring a
treating physician and surgeon to receive prior approval
in determining length of hospital stay following those
procedures.
5.Defines mastectomy as the removal of all or part of the
breast for medically necessary reasons, as determined by
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a licensed physician and surgeon.
This bill:
1.Revises the definition of mastectomy to specify that the
partial removal of a breast includes, but is not limited
to, lumpectomy, which includes surgical removal of the
tumor with clear margins.
2.Clarifies that the length of a hospital stay associated
with those procedures shall be determined by the
attending physician and surgeon in consultation with the
patient, postsurgery, consistent with sound clinical
principles and processes.
3.Contains findings and declarations related to breast
cancer and breast cancer surgical treatment.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
SUPPORT : (Verified 1/17/12)
Susan G. Komen for the Cure - California Affiliates
(source)
American Congress of Obstetricians and Gynecologists
Breast Cancer Fund
California Communities United Institute
California Medical Association
CommuniCare Health Centers
Michelle's Place, Breast Cancer Resource Center
Junior League of California
Medical Oncology Association of Southern California, Inc.
Planned Parenthood Affiliates of California
Surgical Oncologists, University of California, Davis
Cancer Center
OPPOSITION : (Verified 1/17/12)
America's Health Insurance Plans
Association of California Life and Health Insurance
Companies
California Association of Health Plans
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ARGUMENTS IN SUPPORT : Susan G. Komen for the Cure - the
California Affiliates, states that this bill will improve
health care coverage options for many patients undergoing
mastectomies and lumpectomies.
The Breast Cancer Fund states that placing the definition
of mastectomy and lumpectomy directly in statute will help
ensure that all breast cancer patients have the same
safeguards to help improve their lives and save them from
preventable serious and costly complications.
The California Medical Association (CMA) states that
premature discharge of breast cancer patients from the
hospital can lead to adverse outcomes, including infection
and inadequately controlled pain. CMA contends that this
bill ensures that the length of hospital stay is a decision
made by the physician and patient taking individual needs
into account.
ARGUMENTS IN OPPOSITION : America's Health Insurance
Plans states that health insurance mandates threaten
efforts to provide consumers with meaningful health care
choices and affordable coverage options. The California
Association of Health Plans (CAHP) argues that the mandate
component of this bill is unnecessary because health plans
are already required to cover mastectomies under existing
law and that this is defined as the removal of all or part
of the breast for medically necessary reasons. CAHP also
states that due to health care reform at the federal level,
more time is needed before the Legislature considers
enacting new benefit mandates or changing the laws
governing existing mandates.
CTW:nl 1/18/12 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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