BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 255|
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UNFINISHED BUSINESS
Bill No: SB 255
Author: Pavley (D), et al.
Amended: 8/6/12
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
SENATE FLOOR : 27-6, 1/23/12
AYES: Alquist, Berryhill, Blakeslee, Calderon, Corbett,
Correa, De León, DeSaulnier, Emmerson, Harman, Hernandez,
Kehoe, Leno, Lieu, Liu, Lowenthal, Negrete McLeod,
Padilla, Pavley, Price, Rubio, Simitian, Steinberg,
Strickland, Vargas, Wolk, Wright
NOES: Anderson, Dutton, Fuller, Gaines, Huff, Walters
NO VOTE RECORDED: Cannella, Evans, Hancock, La Malfa,
Runner, Wyland, Yee
ASSEMBLY FLOOR : 71-7, 8/23/12 - See last page for vote
SUBJECT : Health care coverage: breast cancer
SOURCE : Susan G. Komen for the Cure California
Affiliates
DIGEST : This bill clarifies and further specifies a
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current-law mandate related to health care coverage of
breast cancer treatment.
Assembly Amendments specify that the purpose of this bill
is to clarify that existing definition of mastectomy
includes lumpectomy, and prohibits language in this bill
from being construed as establishing a new mandated
benefit.
ANALYSIS : Existing federal law:
1.Defines, under the Patient Protection and Affordable Care
Act, as amended by the Health Care Education and
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
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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
a licensed physician and surgeon.
This bill:
1.Clarifies, for purposes of defining mastectomy, that
partial removal of a breast includes but is not limited
to lumpectomy, which includes surgical removal of the
tumor with clear margins.
2.Requires the determination of length of a hospital stay
following a mastectomy or lymph node dissection to be
made post-surgery, which current law requires a physician
to make in consultation with a patient.
3.Specifies that the purpose of this bill is to clarify
that existing definition of mastectomy includes
lumpectomy, and prohibits language in this bill from
being construed as establishing a new mandated benefit.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
SUPPORT : (Verified 8/23/12)
Susan G. Komen for the Cure, California Affiliates (source)
AFSCME
American Cancer Society
American Congress of Obstetricians and Gynecologists
Breast Cancer Fund
California Communities United Institute
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California Medical Association
California Teachers Association
CommuniCare Health Centers
Democratic Chapter of the Legislative Women's Caucus
Disability Rights Legal Center
Junior League of California
Michelle's Place, Breast Cancer Resource Center
Planned Parenthood Affiliates of California
Surgical Oncologists, University of California, Davis
Cancer Center
ARGUMENTS IN SUPPORT : Susan G. Komen for the Cure,
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.
ASSEMBLY FLOOR : 71-7, 8/23/12
AYES: Achadjian, Alejo, Allen, Ammiano, Atkins, Beall,
Bill Berryhill, Block, Blumenfield, Bonilla, Bradford,
Brownley, Buchanan, Butler, Charles Calderon, Campos,
Carter, Cedillo, Chesbro, Conway, Davis, Dickinson, Eng,
Feuer, Fletcher, Fong, Fuentes, Furutani, Galgiani,
Garrick, Gatto, Gordon, Gorell, Grove, Hall, Harkey,
Hayashi, Hill, Huber, Hueso, Huffman, Jeffries, Jones,
Knight, Lara, Bonnie Lowenthal, Ma, Mendoza, Miller,
Mitchell, Monning, Nestande, Nielsen, Norby, Olsen, Pan,
Perea, V. Manuel Pérez, Portantino, Silva, Skinner,
Smyth, Solorio, Swanson, Torres, Valadao, Wagner,
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Wieckowski, Williams, Yamada, John A. Pérez
NOES: Donnelly, Beth Gaines, Hagman, Halderman, Logue,
Mansoor, Morrell
NO VOTE RECORDED: Cook, Roger Hernández
CTW:n 8/25/12 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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