S-1055.1 _______________________________________________
SENATE BILL 5471
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State of Washington 55th Legislature 1997 Regular Session
By Senators Wojahn, Deccio, Thibaudeau, Winsley, Bauer, Long, Franklin, Kline, Loveland, Jacobsen, Snyder, Kohl, Spanel, Fraser, Fairley, McAuliffe and Brown
Read first time 01/28/97. Referred to Committee on Health & Long‑Term Care.
AN ACT Relating to osteoporosis health services coverage; adding a new section to chapter 41.05 RCW; adding new sections to chapter 48.20 RCW; adding a new section to chapter 48.21 RCW; adding a new section to chapter 48.44 RCW; adding a new section to chapter 48.46 RCW; and creating new sections.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
NEW SECTION. Sec. 1. This act may be known and cited as the "osteoporosis health services coverage act."
NEW SECTION. Sec. 2. (1) The legislature finds the following:
(a) Osteoporosis affects twenty-five million Americans and each year results in one and one-half million fractures of the hip, spine, wrist, and other bones, costing the nation at least ten billion dollars;
(b) Osteoporosis progresses silently, in most cases undiagnosed until a fracture occurs, and once a fracture occurs the disease is already advanced and the likelihood is high that another fracture will occur;
(c) Half of all women and twenty percent of men will suffer a fracture due to osteoporosis;
(d) Since osteoporosis progresses silently and has no cure, prevention and early diagnosis are key to reducing the prevalence and devastation of this disease;
(e) Medical experts agree that osteoporosis is highly preventable and treatable. However, once the disease progresses to the point of fracture, its associated consequences often lead to disability and institutionalization and exact a heavy toll on quality of life;
(f) Given the current national focus on health care reform and reducing unnecessary health care expenditures through the use of health promotion and disease prevention programs, mandating coverage of services related to prevention, early diagnosis, and timely treatment of osteoporosis is a cost-effective approach for states to embrace;
(g) Bone mass measurement is the only way to detect the presence of low bone mass and to assess the individual's risk for fracture and this aids in selecting appropriate therapies and interventions; ordinary x-rays are not sensitive enough to detect osteoporosis until twenty-five to forty percent of bone mass has been lost and the disease is far advanced;
(h) Currently available technologies for bone mass measurement include: Single and dual-photon absorptiometry; single and dual energy x-ray absorptiometry; quantitative computed tomography; and radiographic absorptiometry. Other technologies for measuring bone mass are under investigation and may become scientifically proven technologies in the future; and
(i) Other services related to the prevention, diagnosis, and treatment of osteoporosis, including visits to health care professionals and reimbursement for scientifically proven technologies for bone mass measurement and United States food and drug administration-approved medications, can be used effectively to reduce the cost and pain that osteoporosis inflicts upon its victims.
(2) To mandate coverage for services related to the prevention, diagnosis, and treatment of osteoporosis, including, but not limited to, visits to health care professionals, reimbursement for scientifically proven bone mass measurement, which is bone density testing, and United States food and drug administration-approved medications, to prevent fractures associated with osteoporosis.
NEW SECTION. Sec. 3. A new section is added to chapter 41.05 RCW to read as follows:
(1) All state-purchased health care that provides hospital, medical, or surgical coverage shall include coverage for qualified individuals for services related to the prevention, diagnosis, and treatment of osteoporosis. The services may include, but are not limited to, visits to health care professionals, reimbursement for scientifically proven bone mass measurement, which is bone density testing, and United States food and drug administration-approved medications.
(2) State-purchased health care shall identify and use the most up-to-date, scientifically accurate educational materials to increase patient awareness and encourage the prevention of osteoporosis.
(3) The definitions in section 4 of this act apply to this section.
NEW SECTION. Sec. 4. A new section is added to chapter 48.20 RCW to read as follows:
Unless the context clearly requires otherwise, the definitions in this section apply to section 5 of this act.
(1) "Bone mass measurement" means a radiologic or radioisotopic procedure or other scientifically proven technologies performed on an individual for the purpose of detecting bone loss.
(2) "Qualified individual" means:
(a) An estrogen-deficient woman at clinical risk for osteoporosis;
(b) An individual with vertebral abnormalities;
(c) An individual receiving long-term glucocorticoid, which is steroid, therapy;
(d) An individual with primary hyperparathyroidism; or
(e) An individual being monitored to assess the response to or efficacy of approved osteoporosis drug therapies.
(3) "Services related to the prevention, diagnosis, and treatment of osteoporosis" means visits to health care professionals, reimbursement for scientifically proven bone mass measurement, which is bone density testing, and United States food and drug administration-approved medications. Optional additional services to be covered are: Psychological counseling, rehabilitation services, occupational therapy, case management, home care, and prosthetic devices.
NEW SECTION. Sec. 5. A new section is added to chapter 48.20 RCW to read as follows:
(1) An insurer that offers to any individual a health benefit plan that provides hospital, medical, or surgical coverage shall include coverage for qualified individuals for services related to the prevention, diagnosis, and treatment of osteoporosis. The services may include, but are not limited to, visits to health care professionals, reimbursement for scientifically proven bone mass measurement, which is bone density testing, and United States food and drug administration-approved medications.
(2) An insurer that offers to any individual a health benefit plan shall identify and use the most up-to-date, scientifically accurate educational materials to increase patient awareness and encourage the prevention of osteoporosis.
NEW SECTION. Sec. 6. A new section is added to chapter 48.21 RCW to read as follows:
(1) A group insurance contract or blanket disability insurance contract providing health care services that provides hospital, medical, or surgical coverage shall include coverage for qualified individuals for services related to the prevention, diagnosis, and treatment of osteoporosis. The services may include, but are not limited to, visits to health care professionals, reimbursement for scientifically proven bone mass measurement, which is bone density testing, and United States food and drug administration-approved medications.
(2) A contract shall identify and use the most up-to-date, scientifically accurate educational materials to increase patient awareness and encourage the prevention of osteoporosis.
(3) The definitions in section 4 of this act apply to this section.
NEW SECTION. Sec. 7. A new section is added to chapter 48.44 RCW to read as follows:
(1) A health service contractor that provides hospital, medical, or surgical coverage shall include coverage for qualified individuals for services related to the prevention, diagnosis, and treatment of osteoporosis. The services may include, but are not limited to, visits to health care professionals, reimbursement for scientifically proven bone mass measurement, which is bone density testing, and United States food and drug administration-approved medications.
(2) The contractor shall identify and use the most up-to-date, scientifically accurate educational materials to increase patient awareness and encourage the prevention of osteoporosis.
(3) The definitions in section 4 of this act apply to this section.
NEW SECTION. Sec. 8. A new section is added to chapter 48.46 RCW to read as follows:
(1) A health maintenance organization that provides hospital, medical, or surgical coverage shall include coverage for qualified individuals for services related to the prevention, diagnosis, and treatment of osteoporosis. The services may include, but are not limited to, visits to health care professionals, reimbursement for scientifically proven bone mass measurement, which is bone density testing, and United States food and drug administration-approved medications.
(2) A health maintenance organization shall identify and use the most up-to-date, scientifically accurate educational materials to increase patient awareness and encourage the prevention of osteoporosis.
(3) The definitions in section 4 of this act apply to this section.
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