Legislative record

Breast reconstruction coverage.

Repeals provisions requiring a state employee health plan, policy of accident and sickness insurance, and health maintenance organization contract to provide certain post-mastectomy coverage. Requires a state employee health plan, policy of accident and sickness insurance, and health maintenance organization contract to: (1) provide coverage for breast reconstruction surgery and all modalities, types, and techniques of a health care service provided for the breast reconstruction surgery; and (2) provide access to an adequate breast reconstruction surgeon network. Prohibits a utilization review entity from denying a claim for breast reconstruction surgery for which prior authorization was granted unless the utilization review entity provides a formal declaration of compelling evidence of health care provider fraud in the prior authorization or claim submission process.