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Bill > A4738
NJ A4738
NJ A4738Requires hospitals to provide breast cancer patients with information concerning reconstructive surgery; prohibits certain provisions in managed care plan contracts.
summary
Introduced
11/26/2018
11/26/2018
In Committee
05/13/2019
05/13/2019
Crossed Over
Passed
Dead
01/08/2020
01/08/2020
Introduced Session
2018-2019 Regular Session
Bill Summary
This bill requires general hospitals that provide surgical services for the treatment of breast cancer, including, but not limited to, mastectomy surgery, lymph node dissection, or lumpectomy, to provide information to breast cancer patients concerning the option of reconstructive surgery following the provision of surgical services, including the availability of coverage for reconstructive surgery pursuant to State and federal law. The information is to be provided to the patient in writing and in advance of obtaining consent to the surgical procedure. The information will include: a description of the various reconstructive options and the advantages and disadvantages of each; a description of the provisions of State and federal law that require health benefits carriers to provide coverage for reconstructive surgery; a description of how a patient may access reconstructive care, including the potential of transferring care to a facility that provides reconstructive care or choosing to pursue reconstruction after completing breast cancer surgery, chemotherapy, and radiotherapy; and any other information as may be required by the Commissioner of Health. The bill also supplements the "Health Care Quality Act" to provide that a contract between a carrier and a health care provider for a managed care plan shall not contain any provision that prohibits a health care provider from referring a covered person to an out-of-network plastic surgeon for reconstructive breast surgery or surgery to restore and achieve symmetry between two breasts following a mastectomy, if there is no reasonable access to an in-network plastic surgeon capable of performing those services within 10 miles of the location where the mastectomy was performed. For purposes of this bill, "carrier" shall include the State Health Benefits Program and the School Employees' Health Benefits Program.
AI Summary
This bill requires hospitals that provide breast cancer treatment, including mastectomy, to inform patients of their right to consult with and receive reconstructive surgery from a plastic surgeon of their choice, regardless of the surgeon's network affiliation. The bill also prohibits health insurance contract provisions that limit a healthcare provider's ability to refer patients to out-of-network plastic surgeons for reconstructive breast surgery following treatment for breast cancer or other breast abnormalities. Additionally, the bill specifies that insurance carriers cannot deny requests for medically necessary reconstructive surgery based solely on the network status or hospital affiliation of the plastic surgeon. The bill aims to ensure breast cancer patients have access to information and coverage for reconstructive surgery options.
Committee Categories
Health and Social Services
Sponsors (2)
Last Action
Reported out of Assembly Comm. with Amendments, 2nd Reading (on 05/13/2019)
bill text
bill summary
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bill summary
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bill summary
| Document Type | Source Location |
|---|---|
| BillText | https://www.njleg.state.nj.us/2018/Bills/A5000/4738_R1a.HTM |
| Bill | https://www.njleg.state.nj.us/2018/Bills/A5000/4738_R1a.PDF |
| BillText | https://www.njleg.state.nj.us/2018/Bills/A5000/4738_I1.HTM |
| Bill | https://www.njleg.state.nj.us/2018/Bills/A5000/4738_I1.PDF |
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