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Date: Wednesday, Feb. 12, 1997
FOR IMMEDIATE RELEASE
Contact:  HCFA Press Office (202) 690-6145

In letters to 350 managed care plans contracting with Medicare, HHS said outpatient surgery or limitation on hospital stays may not be required by plans for beneficiaries undergoing surgery for the treatment of breast cancer.

Secretary Shalala said the action was an "immediate first step to ensure that women are not sent home prematurely following a mastectomy." Medicare paid for more than 84,000 mastectomies last year, or about a third of all mastectomies i n the U.S.

In his State of the Union address, President Clinton called requirements for outpatient mastectomies "dangerous and demeaning." He asked Congress to support "bipartisan legislation to guarantee that a woman can stay in the hospital for 48 hours after a mastectomy."

"The decision about appropriate length of stay following surgical treatment for breast cancer should be made by a woman and her doctor," Secretary Shalala said. "We are telling managed care plans that they may not impose sweeping, generalized policies that might endanger a woman's health."

In today's letter, HHS' Health Care Financing Administration says current law requires plans to provide all medically necessary care relating to mastectomies and related surgical interventions. Any plan requiring outpatient mastectomies or limiti ng the hospital stay for Medicare beneficiaries would be interpreted to mean the plan is not supplying necessary services. Such limits "are not supported by the available medical evidence, and do not take into account individual patient circumstance s," the HCFA guidance says.

HCFA Administrator Bruce C. Vladeck said that Medicare patients, who are generally older and may lack social support, may be put at increased risk by having this surgery performed on an outpatient basis, or with insufficient hospital length of sta y.