PRINTER'S NO. 3460
No. 2545 Session of 1998
INTRODUCED BY BOSCOLA, BARRAR, HENNESSEY, CORRIGAN, DALEY,
ITKIN, READSHAW, MARKOSEK, COY, OLASZ, BELFANTI, TRELLO,
BROWNE, JOSEPHS, LAUGHLIN, MUNDY, M. COHEN, E. Z. TAYLOR,
LUCYK, SERAFINI, MAHER, ORIE, STABACK, C. WILLIAMS, JAMES,
DeLUCA, RAMOS, YOUNGBLOOD, WASHINGTON, HORSEY AND STEELMAN,
APRIL 23, 1998
REFERRED TO COMMITTEE ON INSURANCE, APRIL 23, 1998
AN ACT
1 Mandating health insurance coverage for diagnosis and treatment
2 of osteoporosis.
3 The General Assembly of the Commonwealth of Pennsylvania
4 hereby enacts as follows:
5 Section 1. Short title.
6 This act shall be known and may be cited as the Osteoporosis
7 Early Detection Act.
8 Section 2. Declaration of policy.
9 The General Assembly finds and declares as follows:
10 (1) Osteoporosis progresses silently, in most cases
11 undiagnosed until a fracture occurs, and once a fracture
12 occurs, the disease is already advanced, and the likelihood
13 is high that another fracture will occur.
14 (2) One in two women and one in five men will suffer a
15 fracture due to osteoporosis in their lifetime.
16 (3) Because osteoporosis progresses silently and
1 currently has no cure, early diagnosis, prevention and
2 treatment are key to reducing the prevalence and devastation
3 of this disease.
4 (4) Medical experts agree that osteoporosis is
5 preventable and treatable; however, once the disease
6 progresses to the point of fracture its associated
7 consequences often lead to disability and
8 institutionalization, and exact a heavy toll on the quality
9 of life.
10 Section 3. Definitions.
11 The following words and phrases when used in this act shall
12 have the meanings given to them in this section unless the
13 context clearly indicates otherwise:
14 "Bone mass measurement." A procedure using dual energy X-ray
15 absorptiometry, or other scientifically proven technology, which
16 is accepted as the industry standard in the medical field,
17 performed on an individual for the purpose of identifying bone
18 mass or detecting bone loss.
19 "Health insurance policy." Any individual or group health,
20 sickness or accident policy or subscriber contract or
21 certificate issued by an entity subject to any one of the
22 following:
23 (1) The act of May 17, 1921 (P.L.682, No.284), known as
24 The Insurance Company Law of 1921.
25 (2) The act of December 29, 1972 (P.L.1701, No.364),
26 known as the Health Maintenance Organization Act.
27 (3) The act of May 18, 1976 (P.L.123, No.54), known as
28 the Individual Accident and Sickness Insurance Minimum
29 Standards Act.
30 (4) The act of December 14, 1992 (P.L.835, No.134),
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1 known as the Fraternal Benefit Societies Code.
2 (5) 40 Pa.C.S. Ch. 61 (relating to hospital plan
3 corporations) or Ch. 63 (relating to professional health
4 services plan corporations).
5 (6) Medical assistance.
6 "Osteoporosis." Deossification with absolute decrease in
7 bone tissue, resulting in structural weakness.
8 "Qualified individual." A person with a condition for which
9 bone mass measurement is determined to be medically necessary by
10 the person's attending physician, primary care physician,
11 obstetrician or gynecologist. A person is considered qualified
12 following a determination by the person's attending physician,
13 primary care physician, obstetrician or gynecologist that the
14 person has one or more clinical indications for bone density
15 testing. For the purposes of this act, a "clinical indication"
16 shall mean any of the following:
17 (1) perimenopausal, postmenopausal or estrogen-deficient
18 status in women;
19 (2) long-term (longer than three months) corticosteroid
20 therapy;
21 (3) fracture in absence of appropriate severe trauma;
22 (4) loss of height of one and one-half inches or more;
23 (5) hyperthyroidism;
24 (6) hyperparathyroidism;
25 (7) Cushing's Syndrome;
26 (8) hypogonadism;
27 (9) prolactinoma;
28 (10) vertebral abnormalities on X-ray (such as
29 compression fractures or radiographic evidence of
30 osteopenia); and
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1 (11) diagnosed osteoporosis or osteopenia for evaluation
2 of ongoing treatment.
3 Section 4. Mandated coverage.
4 (a) Bone mass measurement.--A health insurance policy which
5 is delivered, issued for delivery, renewed, extended or modified
6 in this Commonwealth by a health care insurer shall provide that
7 the health insurance benefits applicable under the policy
8 include bone mass measurement for a qualified individual.
9 (b) Treatment.--If bone mass measurement results in a
10 diagnosis of osteoporosis, benefits shall include treatment for
11 osteoporosis.
12 Section 5. Delivery of policy.
13 If a health insurance policy provides coverage or benefits to
14 a resident of this Commonwealth, it shall be deemed to be
15 delivered in this Commonwealth within the meaning of this act,
16 regardless of whether the health care insurer issuing or
17 delivering the policy is located within or outside this
18 Commonwealth.
19 Section 6. Repeals.
20 All acts and parts of acts are repealed insofar as they are
21 inconsistent with this act.
22 Section 7. Applicability.
23 This act shall apply to all insurance policies, subscriber
24 contracts and group insurance certificates issued under any
25 group master policy delivered or issued for delivery on or after
26 the effective date of this act only to residents of this
27 Commonwealth. This act shall also apply to all renewals of
28 contracts on any renewal date which is on or after the effective
29 date of this act.
30 Section 8. Effective date.
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1 This act shall take effect in 180 days.
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