H 4379 General Bill, By A.W. Byrd, J. Brown, Harvin, Moody-Lawrence, Stuart and 
J.M. White
 A Bill to amend the Code of Laws of South Carolina, 1976, by adding Section
 38-71-225 to enact the Bone Mass Measurement Coverage Act so as to require
 individual or group accident and health or health insurance policies to
 include coverage for bone mass measurement for the prevention, diagnosis, and
 treatment of osteoporosis.

   12/20/95  House  Prefiled
   12/20/95  House  Referred to Committee on Labor, Commerce and Industry
   01/09/96  House  Introduced and read first time HJ-72
   01/09/96  House  Referred to Committee on Labor, Commerce and
                     Industry HJ-72

A BILL

TO AMEND THE CODE OF LAWS OF SOUTH CAROLINA, 1976, BY ADDING SECTION 38-71-225 TO ENACT THE BONE MASS MEASUREMENT COVERAGE ACT SO AS TO REQUIRE INDIVIDUAL OR GROUP ACCIDENT AND HEALTH OR HEALTH INSURANCE POLICIES TO INCLUDE COVERAGE FOR BONE MASS MEASUREMENT FOR THE PREVENTION, DIAGNOSIS, AND TREATMENT OF OSTEOPOROSIS.

Whereas, the General Assembly finds that:

(1) 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 eighteen billion dollars;

(2) 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;

(3) One in two women and one in five men will suffer a fracture due to osteoporosis in their lifetime;

(4) Since osteoporosis progresses silently and currently has no cure, prevention, early diagnosis, and treatment are key to reducing the prevalence and devastation of this disease;

(5) Medical experts agree that osteoporosis is 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;

(6) Given the current national focus on health care reform and reducing unnecessary health care expenditures through the use of health promotion/disease prevention programs, mandating coverage of services, such as bone mass measurement, related to prevention, early diagnosis, and timely treatment of osteoporosis is a cost-effective approach for this State to embrace;

(7) Bone mass measurement is a reliable way to detect the presence of low bone mass and to ascertain the extent of bone loss to help 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;

(8) Currently available technologies for bone mass measurement include: single-photon and dual-photon absorptiometry, single energy and dual energy x-ray absorptiometry, quantitative computed tomography, radiographic absorptiometry; other technologies for measuring bone mass are under investigation and may become scientifically proven technologies in the future;

(9) Scientifically proven technologies for bone mass measurement and other services related to the prevention, diagnosis, and treatment of osteoporosis can be used effectively to reduce the pain and financial burden that osteoporosis inflicts upon its victims. Now, therefore,

Be it enacted by the General Assembly of the State of South Carolina:

SECTION 1. This act may be cited as the "Bone Mass Measurement Coverage Act".

SECTION 2. The 1976 Code is amended by adding:

"Section 38-71-225. (A) An insurer authorized to issue an individual or group accident and health or health insurance policy in this State shall include coverage in the policy for qualified individuals for bone mass measurement for the prevention, diagnosis, and treatment of osteoporosis.

(B) This section applies to individual and group accident and health and health insurance policies issued by a fraternal benefit society, a nonprofit hospital service corporation, a nonprofit medical service corporation, a health care plan, a health maintenance organization, or any similar entity.

(C) For the purposes of this section:

(1) `Bone mass measurement' means a radiologic or radioisotopic procedure or other medically recognized technologies performed on an individual for the purpose of identifying bone mass or 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 (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."

SECTION 3. This act takes effect upon approval by the Governor and applies to accident and health and health insurance policies issued, delivered, issued for delivery, or renewed in this State after December 31, 1996.