BOX 2.4 State Laws Mandating Cancer Care Benefit Coverage

Screening

  • At least 15 states have enacted laws requiring coverage for prostate cancer screening, applying primarily to people over age 50 or over 40 for high-risk individuals. Most state laws require coverage of the prostate specific antigen (PSA) test, and slightly more than half of the laws require coverage of digital rectal examination. The laws apply mostly to private insurers and specialized managed care providers (Alaska, Colorado, Delaware, Georgia, Illinois, Louisiana, Maine, Maryland, Minnesota, New Jersey, North Carolina, North Dakota, South Carolina, Texas, Virginia).
  • Twenty-two states have enacted laws requiring coverage for cervical cancer screening. In most cases, the law calls for coverage of an examination annually or as recommended by a physician. The laws apply primarily to private insurers and specialized managed care providers, with only a few states mandating this of public employee health plans and Medicaid or state medical assistance programs (Alaska, California, Delaware, District of Columbia, Georgia, Illinois, Kansas, Louisiana, Maine, Massachusetts, Minnesota, Nevada, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Rhode Island, South Carolina, Virginia, West Virginia).
  • All 50 states have enacted laws requiring third-party payers to offer or provide coverage for mammograms. For most states there is required coverage for annual exams for women over 50.

Treatment

  • At least 16 states have enacted laws requiring physicians to distribute information to patients about breast cancer treatment (California, Florida, Georgia, Illinois, Kansas, Kentucky, Massachusetts, Maryland, Maine, Michigan, Minnesota, Montana, New Jersey, New York, Pennsylvania, Texas). For most states, this includes information about the specific treatment (e.g., surgery, radiation) and information about reconstructive surgery and mammography.
  • Several states have also enacted regulations requiring third-party payers to provide a specified amount of inpatient care following a mastectomy, lumpectomy, or lymph node dissection. For mastectomy the minimum length of stay ranges from 24 hours (Virginia) to 72 hours (New Jersey) following modified radical mastectomy. Most other states that have such laws require coverage for a 48-hour stay or as directed by the physician (Arkansas, Connecticut, Florida, Illinois, Kentucky, Maine, Montana, New Mexico, New York, North Carolina, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Texas).
  • A number of states have laws requiring third-party payers, particularly private insurers and private managed care providers, to cover reconstructive surgery and/or prosthetic devices following mastectomy (Arizona, Arkansas, California, Connecticut, Florida, Illinois, Indiana, Kentucky, Louisiana, Maine, Maryland, Michigan, Missouri, Montana, Nevada, New Hampshire, New Jersey, New York, North Carolina, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Virginia, Washington, West Virginia).


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