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§ 15-832.1. Inpatient hospitalization services following mastectomy

West's Annotated Code of MarylandInsuranceEffective: October 1, 2009

West's Annotated Code of Maryland
Insurance (Refs & Annos)
Title 15. Health Insurance
Subtitle 8. Required Health Insurance Benefits (Refs & Annos)
Effective: October 1, 2009
MD Code, Insurance, § 15-832.1
§ 15-832.1. Inpatient hospitalization services following mastectomy
Mastectomy defined
(a) In this section, “mastectomy” means the surgical removal of all or part of a breast as a result of breast cancer.
Application of section
(b) This section applies to:
(1) insurers and nonprofit health service plans that provide inpatient hospital, medical, or surgical benefits to individuals or groups on an expense-incurred basis under health insurance policies or contracts that are issued or delivered in the State; and
(2) health maintenance organizations that provide inpatient hospital, medical, or surgical benefits to individuals or groups under contracts that are issued or delivered in the State.
Coverage for inpatient hospitalization services following mastectomy
(c) An entity subject to this section shall provide coverage for the cost of inpatient hospitalization services for a patient for a minimum of 48 hours following a mastectomy.
Request for shorter length of stay by patient
(d) A patient may request a shorter length of stay than that provided in subsection (c) of this section if the patient decides, in consultation with the patient's attending physician, that less time is needed for recovery.
Coverage for home visits
(e)(1) For a patient who receives less than 48 hours of inpatient hospitalization following a mastectomy or who undergoes a mastectomy on an outpatient basis, an entity subject to this section shall provide coverage for:
(i) one home visit scheduled to occur within 24 hours after discharge from the hospital or outpatient health care facility; and
(ii) an additional home visit if prescribed by the patient's attending physician.
(2) For a patient who remains in the hospital for at least the length of time provided under subsection (c) of this section, an entity subject to this section shall provide coverage for a home visit if prescribed by the attending physician.
Participation of attending physician advocating interests of mastectomy patients
(f) An entity subject to this section may not deny, limit, or otherwise impair the participation of an attending physician under contract with the entity in providing health care services to enrollees or insureds for:
(1) advocating the interest of a mastectomy patient through the entity's utilization review or appeals system;
(2) advocating more than 48 hours of inpatient hospital care for a patient with complications related to a mastectomy; or
(3) prescribing a home visit under subsection (e)(1)(ii) or (2) of this section.
Entities prohibited from refusing reimbursement
(g) An entity subject to this section may not refuse reimbursement under subsection (e)(1) of this section if the services do not occur within the time specified.
Notice to insureds and enrollees about coverage
(h) An entity subject to this section shall provide notice annually to insureds and enrollees about the coverage provided by this section.

Credits

Added by Acts 2009, c. 516, § 1, eff. Oct. 1, 2009; Acts 2009, c. 517, § 1, eff. Oct. 1, 2009.
MD Code, Insurance, § 15-832.1, MD INSURANCE § 15-832.1
Current through legislation effective through April 9, 2023, from the 2024 Regular Session of the General Assembly. Some statute sections may be more current, see credits for details.
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