This text of Indiana § 5-10-8-7.2 (Breast cancer; definitions; self-insurance programs; health maintenance
organizations; diagnostic services) is published on Counsel Stack Legal Research, covering Indiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.
2.
(a)As used in this section, "breast cancer
diagnostic service" means a procedure intended to aid in the diagnosis
of breast cancer. The term includes procedures performed on an
inpatient basis and procedures performed on an outpatient basis,
including the following:
(1)Breast cancer screening mammography.
(2)Surgical breast biopsy.
(3)Pathologic examination and interpretation.
(b)As used in this section, "breast cancer outpatient treatment
services" means procedures that are intended to treat cancer of the
human breast and that are delivered on an outpatient basis. The term
includes the following:
(5)Other outpatient cancer treatment services prescribed by a
physician.
(6)Medical follow-up services relate
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2. (a) As used in this section, "breast cancer
diagnostic service" means a procedure intended to aid in the diagnosis
of breast cancer. The term includes procedures performed on an
inpatient basis and procedures performed on an outpatient basis,
including the following:
(1) Breast cancer screening mammography.
(2) Surgical breast biopsy.
(3) Pathologic examination and interpretation.
(b) As used in this section, "breast cancer outpatient treatment
services" means procedures that are intended to treat cancer of the
human breast and that are delivered on an outpatient basis. The term
includes the following:
(1) Chemotherapy.
(2) Hormonal therapy.
(3) Radiation therapy.
(4) Surgery.
(5) Other outpatient cancer treatment services prescribed by a
physician.
(6) Medical follow-up services related to the procedures set forth
in subdivisions (1) through (5).
(c) As used in this section, "breast cancer rehabilitative services"
means procedures that are intended to improve the results of or to
ameliorate the debilitating consequences of the treatment of breast
cancer and that are delivered on an inpatient or outpatient basis. The
term includes the following:
(1) Physical therapy.
(2) Psychological and social support services.
(3) Reconstructive plastic surgery, including chest wall
reconstruction and aesthetic flat closure (as defined by the
National Cancer Institute).
(d) As used in this section, "breast cancer screening mammography"
means a standard, two (2) view per breast, low-dose radiographic
examination of the breasts that is:
(1) furnished to an asymptomatic woman; and
(2) performed by a mammography services provider using
equipment designed by the manufacturer for and dedicated
specifically to mammography in order to detect unsuspected
breast cancer.
The term includes the interpretation of the results of a breast cancer
screening mammography by a physician.
(e) As used in this section, "covered individual" means a female
individual who is:
(1) covered under a self-insurance program established under
section 7(b) of this chapter to provide group health coverage; or
(2) entitled to services under a contract with a health maintenance
organization (as defined in IC 27-13-1-19) that is entered into or
renewed under section 7(c) of this chapter.
(f) As used in this section, "mammography services provider" means
an individual or facility that:
(1) has been accredited by the American College of Radiology;
(2) meets equivalent guidelines established by the Indiana
department of health; or
(3) is certified by the federal Department of Health and Human
Services for participation in the Medicare program (42 U.S.C.
1395 et seq.).
(g) As used in this section, "woman at risk" means a woman who
meets at least one (1) of the following descriptions:
(1) A woman who has a personal history of breast cancer.
(2) A woman who has a personal history of breast disease that
was proven benign by biopsy.
(3) A woman whose mother, sister, or daughter has had breast
cancer.
(4) A woman who is at least thirty (30) years of age and has not
given birth.
(h) A self-insurance program established under section 7(b) of this
chapter to provide health care coverage must provide covered
individuals with coverage for breast cancer diagnostic services, breast
cancer outpatient treatment services, and breast cancer rehabilitative
services. The coverage must provide reimbursement for breast cancer
screening mammography at a level at least as high as:
(1) the limitation on payment for screening mammography
services established in 42 CFR 405.534(b)(3) according to the
Medicare Economic Index at the time the breast cancer screening
mammography is performed; or
(2) the rate negotiated by a contract provider according to the
provisions of the insurance policy;
whichever is lower. The costs of the coverage required by this
subsection may be paid by the state or by the employee or by a
combination of the state and the employee.
(i) A contract with a health maintenance organization that is entered
into or renewed under section 7(c) of this chapter must provide covered
individuals with breast cancer diagnostic services, breast cancer
outpatient treatment services, and breast cancer rehabilitative services.
(j) The coverage required by subsection (h) and services required by
subsection (i) may not be subject to dollar limits, deductibles, or
coinsurance provisions that are less favorable to covered individuals
than the dollar limits, deductibles, or coinsurance provisions applying
to physical illness generally under the self-insurance program or
contract with a health maintenance organization.
(k) The coverage for breast cancer diagnostic services required by
subsection (h) and the breast cancer diagnostic services required by
subsection (i) must include the following:
(1) In the case of a covered individual who is at least thirty-five
(35) years of age but less than forty (40) years of age, at least one
(1) baseline breast cancer screening mammography performed
upon the individual before she becomes forty (40) years of age.
(2) In the case of a covered individual who is:
(A) less than forty (40) years of age; and
(B) a woman at risk;
at least one (1) breast cancer screening mammography performed
upon the covered individual every year.
(3) In the case of a covered individual who is at least forty (40)
years of age, at least one (1) breast cancer screening
mammography performed upon the individual every year.
(4) Any additional mammography views that are required for
proper evaluation.
(5) Ultrasound services, if determined medically necessary by the
physician treating the covered individual.
(l) The coverage for breast cancer diagnostic services required by
subsection (h) and the breast cancer diagnostic services required by
subsection (i) shall be provided in addition to any benefits specifically
provided for x-rays, laboratory testing, or wellness examinations.