House File 440 - Introduced



                                       HOUSE FILE       
                                       BY  FORD


    Passed House,  Date               Passed Senate, Date             
    Vote:  Ayes        Nays           Vote:  Ayes        Nays         
                 Approved                            

                                      A BILL FOR

  1 An Act requiring health insurance coverage of certain services
  2    related to the diagnosis, treatment, and management of
  3    osteoporosis for qualified insured individuals.
  4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
  5 TLSB 2388HH 83
  6 av/rj/24

PAG LIN



  1  1    Section 1.  NEW SECTION.  514C.24  COVERAGE FOR
  1  2 OSTEOPOROSIS DIAGNOSIS, TREATMENT, AND MANAGEMENT.
  1  3    1.  Notwithstanding the uniformity of treatment
  1  4 requirements of section 514C.6, a contract, policy, or plan
  1  5 providing for third=party payment or prepayment of health or
  1  6 medical expenses that provides coverage for hospital or
  1  7 medical treatment or services for illness shall provide
  1  8 coverage related to services for the diagnosis, treatment, and
  1  9 appropriate management of osteoporosis for a qualified insured
  1 10 individual that includes bone mass measurement or bone density
  1 11 testing, and other United States food and drug
  1 12 administration=approved technologies as deemed medically
  1 13 appropriate.
  1 14    2.  This section applies to the following classes of
  1 15 third=party payment provider contracts, policies, or plans
  1 16 delivered, issued for delivery, continued, or renewed in this
  1 17 state on or after January 1, 2010:
  1 18    a.  Individual or group accident and sickness insurance
  1 19 providing coverage on an expense=incurred basis.
  1 20    b.  An individual or group hospital or medical service
  1 21 contract issued pursuant to chapter 509, 514, or 514A.
  1 22    c.  An individual or group Medicare supplemental policy,
  1 23 unless coverage pursuant to such a policy is preempted by
  1 24 federal law.
  1 25    d.  An individual or group health maintenance organization
  1 26 contract regulated under chapter 514B.
  1 27    e.  A plan established pursuant to chapter 509A for public
  1 28 employees.
  1 29    3.  This section shall not apply to accident=only,
  1 30 specified disease, short=term hospital or medical, hospital
  1 31 confinement indemnity, credit, dental, vision, long=term care,
  1 32 basic hospital and medical=surgical expense coverage as
  1 33 defined by the commissioner, disability income insurance
  1 34 coverage, coverage issued as a supplement to liability
  1 35 insurance, workers' compensation or similar insurance, or
  2  1 automobile medical payment insurance.
  2  2    4.  As used in this section:
  2  3    a.  "Bone mass measurement" or "bone density testing" means
  2  4 a radiologic or radioisotopic procedure or other
  2  5 scientifically proven technology performed on an individual
  2  6 for the purpose of identifying bone mass or detecting bone
  2  7 loss.
  2  8    b.  "Qualified insured individual" means an individual who
  2  9 is one of the following:
  2 10    (1)  An estrogen=deficient woman at clinical risk for
  2 11 osteoporosis.
  2 12    (2)  An individual with vertebral abnormalities.
  2 13    (3)  An individual receiving long=term glucocorticoid
  2 14 therapy.
  2 15    (4)  An individual with primary hyperparathyroidism.
  2 16    (5)  An individual being monitored to assess the response
  2 17 to or efficacy of osteoporosis drug therapies.
  2 18    5.  The commissioner of insurance shall adopt rules
  2 19 pursuant to chapter 17A as necessary to administer this
  2 20 section.
  2 21                           EXPLANATION
  2 22    This bill requires insurers offering certain individual or
  2 23 group health insurance contracts, policies, or plans in the
  2 24 state to provide coverage for certain services related to the
  2 25 diagnosis, treatment, and management of osteoporosis for
  2 26 qualified insured individuals.
  2 27    The bill requires that such coverage include bone mass
  2 28 measurement or bone density testing and other technologies
  2 29 approved by the federal food and drug administration as
  2 30 medically appropriate.  "Bone mass measurement" or "bone
  2 31 density testing" is defined as a radiologic or radioisotopic
  2 32 procedure or other scientifically proven technology performed
  2 33 on an individual for the purpose of identifying bone mass or
  2 34 detecting bone loss.
  2 35    The required coverage must be provided to qualified insured
  3  1 individuals.  A "qualified insured individual" is defined as
  3  2 an individual who is an estrogen=deficient woman at clinical
  3  3 risk for osteoporosis; an individual with vertebral
  3  4 abnormalities; an individual receiving long=term
  3  5 glucocorticoid therapy; an individual with primary
  3  6 hyperparathyroidism; or an individual being monitored to
  3  7 assess the response to or efficacy of osteoporosis drug
  3  8 therapies.
  3  9    The provisions of the bill are applicable to third=party
  3 10 payment provider contracts, policies, or plans delivered,
  3 11 issued for delivery, continued, or renewed in this state on or
  3 12 after January 1, 2010.  The commissioner of insurance is
  3 13 required to adopt rules under Code chapter 17A as necessary to
  3 14 administer the provisions of the bill.
  3 15 LSB 2388HH 83
  3 16 av/rj/24