SB 1137 requires health benefit plans offered in Oregon that already cover breast reconstruction services to also cover autologous breast reconstruction procedures, including a broad list of flap-based techniques and hybrid procedures. The bill also requires coverage for all related medically necessary inpatient and outpatient services, procedures, imaging, and revisions to those procedures when prescribed according to accepted standards of care by a licensed health care provider.
The measure defines key terms such as autologous breast reconstruction procedure, revision procedures, accepted standard of care, in-network, out-of-network, carrier, and utilization review. It applies to health benefit plans issued, renewed, or extended on or after January 1, 2026, and amends ORS 743B.001 to incorporate the new coverage section into Oregon’s insurance statutes.
Impact
The bill expands Oregon insurance law by mandating parity in coverage for autologous breast reconstruction within health benefit plans that cover breast reconstruction generally. It also limits carriers’ ability to impose less favorable utilization review, cost-sharing, or network restrictions on these procedures, and requires network adequacy or out-of-network reimbursement protections when in-network access is insufficient. The affected parties are health insurers, health care service contractors, enrollees seeking breast reconstruction after mastectomy or similar treatment, and providers performing reconstructive surgery.
Sentiment
The bill appears to have been broadly and strongly supported. It passed the Senate committee, Senate floor, and House floor unanimously or near-unanimously, with recorded votes of 5-0 in committee, 23-0 in committee on the amended bill, 25-0 in the Senate, and 47-0 in the House. The voting history suggests consensus that the coverage expansion is medically appropriate and policy-wise uncontroversial.
Contention
No major opposition is reflected in the available record, and there are no committee transcripts indicating substantive debate. The only likely policy friction point is the bill’s effect on insurers, since it requires broader coverage, network adequacy, and potentially higher reimbursement for out-of-network providers when adequate in-network access is unavailable. However, the unanimous votes indicate that any such concerns did not generate visible contention during the legislative process.
To Mandate Coverage For Breast Reconstruction Surgeries; To Require Prior Authorization For Breast Reconstruction Surgeries; And To Establish A Minimum Reimbursement Rate For Breast Reconstruction Surgeries.
Requires hospitals to provide breast cancer patients with information concerning reconstructive surgery; prohibits certain provisions in managed care plan contracts.
Requires hospitals to provide breast cancer patients with information concerning reconstructive surgery; prohibits certain provisions in managed care plan contracts.