senate Bill S6993

Amended

Relates to information and access to breast reconstructive surgery

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Sponsor

Co-Sponsors

Bill Status


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor
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actions

  • 04 / Mar / 2010
    • REFERRED TO HEALTH
  • 08 / Mar / 2010
    • AMEND (T) AND RECOMMIT TO HEALTH
  • 08 / Mar / 2010
    • PRINT NUMBER 6993A
  • 03 / May / 2010
    • NOTICE OF COMMITTEE CONSIDERATION - REQUESTED
  • 11 / May / 2010
    • AMEND AND RECOMMIT TO HEALTH
  • 11 / May / 2010
    • PRINT NUMBER 6993B
  • 25 / May / 2010
    • 1ST REPORT CAL.649
  • 26 / May / 2010
    • 2ND REPORT CAL.
  • 27 / May / 2010
    • ADVANCED TO THIRD READING
  • 28 / May / 2010
    • SUBSTITUTED BY A10094B

Summary

Relates to information and access to breast reconstructive surgery.

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Bill Details

See Assembly Version of this Bill:
A10094
Versions:
S6993
S6993A
S6993B
Legislative Cycle:
2009-2010
Law Section:
Public Health Law
Laws Affected:
Amd ยง2803-o, Pub Health L

Sponsor Memo

BILL NUMBER: S6993

TITLE OF BILL :
An act to amend the public health law, in relation to information and
access to reconstructive surgery following breast cancer surgery


PURPOSE :
To ensure that information relating to the availability and access to
reconstructive surgery following breast cancer surgery is provided to
all breast cancer surgery patients.

SUMMARY OF PROVISIONS :
Amends section 2803-o of the Public Health Law to require hospitals to
provide certain specified information concerning reconstructive
surgery to patients before they undergo mastectomy surgery, lymph node
dissection or a lumpectomy following a diagnosis of breast cancer

EXISTING LAW :
While existing federal and state law mandates insurance coverage for
reconstructive surgery, no requirement currently exists that would
ensure that women have the necessary information about reconstructive
surgery options that they might wish to consider nor about their
potential access to such services.

JUSTIFICATION :
240,000 women will be diagnosed with breast cancer this year in the
United States and approximately 40,000 women will die of the disease.
Over the last forty years, considerable progress has been made in the
diagnosis, detection, and treatment of breast cancel. Genetic testing
for susceptibility genes like BRCA, targeted chemotherapeutics like
Herceptin, and microsurgical reconstructive techniques have given
women more hope, more options, and a better chance of not only
surviving but recovering from this disease.

Breast cancer care, at the highest level, is delivered by a
multi-specialty group of physicians and surgeons that include a
medical oncologist, a breast Surgeon, a radiation oncologist, and a
reconstructive surgeon. Despite the advances and the progress, there
remains a significant disparity in the care provided to women with
breast cancer, particularly with respect to access to reconstructive
surgery.

Reconstruction of the breast after cancer surgery has not always been
the standard-of-care. With the development of improved reconstructive
techniques during the last two decades, we entered a new era in breast
cancer care. Reconstruction has repeatedly been shown to improve the
quality of life and overall well-being of women who have been treated
for breast cancer. However, it is not for everyone; there are some
women who undergo surgery for breast cancer who either do not want or
are not candidates for reconstruction.

In the 1990s, studies showed a great disparity among women who
received reconstruction and those who did not. This disparity related
to the patient's socioeconomic and educational status as well as to
the breast surgeon's practice setting. When breast reconstruction was
viewed as a cosmetic procedure, insurance companies were not compelled
to pay for it. Poor women often could not afford to pay out-of-pocket
for the procedure. To address this disparity, Congress passed the
Women's Health and Cancer Rights Act in 1998. This legislation
guaranteed universal coverage for reconstruction after surgery for
breast cancer and comparable provisions were added to New York State
Insurance Law to ensure that coverage was extended here in New York.

Despite these laws, however, disparities in access to reconstructive
surgery remain. Several important national studies conducted under
the leadership of Amy Alderman at the University of Michigan and
Caprice Greenberg at Dana Farber analyzed why many women did not
receive reconstruction. The two dominant causes were their failure to
understand their options and breast surgeons' failures to refer their
patients to a reconstructive surgeon. According to a recent report by
Greenberg, the greatest predictor of reconstruction was a documented
discussion about reconstruction between the breast surgeon and
patient. This critical discussion is not taking place often enough.

Statistics on the type of treatment women receive for breast cancer
care at a particular hospital or in a particular region are not
publicly available. The best surrogate is to compare the patient
population of interest with a similar one from a studied database.
The Surveillance, Epidemiology, and End Results (SEER) cancer
registry, run by the National Cancer Institute (NC1), provides this
opportunity. Analysis of treatment received by women in different
settings provides stark contrasts. The SEER database looks at women
treated in a variety of geographic settings, with attention paid to
factors such as level of education, socioeconomic status, type of
medical center (cancer center vs community hospital), and a variety of
other factors. Multiple analyses show that poor, uneducated women are
far less likely to receive reconstruction. Their breast surgeons are
less likely to discuss it with them. They are less likely to receive
treatment at a dedicated cancer center. They are more likely to
receive a lumpectomy and radiation than to undergo a mastectomy
followed by reconstruction. Greenberg et al. reported the disturbing
fact that women with Medicare had a reconstruction rate of 11%
compared with women with managed care or indemnity insurance who
received reconstruction approximately 54% of the time. Nationally,
across multiple socioeconomic groups and different treatment
environments, only 33% of women undergoing surgery for breast cancer
will receive reconstruction.

The bill is designed to educate women regarding the availability of
reconstructive surgery and enhance access to these services. When a
woman is diagnosed with breast cancer, she will be given information
that clearly explains her rights to coverage and her options as they
relate to reconstruction. This is akin to the informed consent a
patient must sign before undergoing any operation.

The bill will also require that the patient receive information
relating to the option of referral to a reconstructive surgeon at the
time of diagnosis or shortly thereafter if she chooses. Because
important decisions on cancer care, such as the choice between having
a mastectomy or a lumpectomy, are influenced, in large part, by the
patient's understanding of reconstructive options, the reconstructive
surgeon must be part of this discussion from the very beginning.

LEGISLATIVE HISTORY :
None.

FISCAL IMPLICATIONS :
None.

EFFECTIVE DATE :
January 1, 2011
view bill text
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

    S. 6993                                                 A. 10094

                      S E N A T E - A S S E M B L Y

                              March 4, 2010
                               ___________

IN  SENATE  --  Introduced  by  Sen.  HASSELL-THOMPSON -- read twice and
  ordered printed, and when printed to be committed to the Committee  on
  Health

IN  ASSEMBLY  --  Introduced  by  M.  of  A.  N. RIVERA -- read once and
  referred to the Committee on Health

AN ACT to amend the public health law, in relation  to  information  and
  access to reconstructive surgery following breast cancer surgery

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Section 2803-o of the public health law, as added by  chap-
ter 20 of the laws of 1997, is amended to read as follows:
  S  2803-o.  Hospital  care  for mastectomy, lumpectomy, and lymph node
dissection patients. 1. When  a  general  hospital  provides  mastectomy
surgery,  lymph node dissection or a lumpectomy, inpatient care shall be
offered for a period as determined by the attending physician in consul-
tation with the patient to be medically appropriate.
  2. (A) EVERY GENERAL HOSPITAL THAT PROVIDES MASTECTOMY SURGERY,  LYMPH
NODE DISSECTION OR A LUMPECTOMY SHALL PROVIDE INFORMATION TO THE PATIENT
CONCERNING  THE  OPTION  OF RECONSTRUCTIVE SURGERY FOLLOWING SUCH PROCE-
DURES,  INCLUDING  THE  AVAILABILITY  OF  COVERAGE  FOR   RECONSTRUCTIVE
SURGERY,  IN  ACCORDANCE  WITH THE PROVISIONS OF SECTIONS THREE THOUSAND
TWO HUNDRED SIXTEEN, THREE THOUSAND  TWO  HUNDRED  TWENTY-ONE  AND  FOUR
THOUSAND  THREE  HUNDRED  THREE  OF  THE  INSURANCE  LAW  AND APPLICABLE
PROVISIONS OF FEDERAL LAW. THE INFORMATION  SHALL  BE  PROVIDED  TO  THE
PATIENT IN WRITING AND IN ADVANCE OF OBTAINING HER CONSENT TO THE SURGI-
CAL  PROCEDURE.  THE  INFORMATION  PROVIDED  SHALL  INCLUDE AT LEAST THE
FOLLOWING:
  (I) A DESCRIPTION OF THE VARIOUS  RECONSTRUCTIVE  OPTIONS  THAT  EXIST
POST-SURGERY AND THE ADVANTAGES AND DISADVANTAGES OF EACH;
  (II)  A  DESCRIPTION OF THE PROVISIONS ASSURING COVERAGE BY PUBLIC AND
PRIVATE INSURANCE PLANS OF THE COSTS RELATED TO POST-SURGERY RECONSTRUC-
TIVE SURGERY UNDER FEDERAL AND STATE LAW;

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD16167-01-0

S. 6993                             2                           A. 10094

  (III) 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
COMPLETION  OF  BREAST  CANCER  SURGERY   AND   CHEMO/RADIOTHERAPY,   IF
WARRANTED;
  (IV) SUCH OTHER INFORMATION AS MAY BE REQUIRED BY THE COMMISSIONER.
  (B) THE FAILURE BY A GENERAL HOSPITAL TO PROVIDE THE REQUIRED INFORMA-
TION  MAY  SUBJECT  THE  GENERAL  HOSPITAL TO ENFORCEMENT AND CORRECTIVE
ACTION IN ACCORDANCE WITH THE PROVISIONS OF THIS ARTICLE BUT  SHALL  NOT
SERVE AS THE BASIS FOR ANY OTHER CIVIL LIABILITY.
  S 2. This act shall take effect January 1, 2011.

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