2016 Tennessee Code
Title 56 - Insurance
Chapter 7 - Policies and Policyholders
Part 25 - Mandated Insurer or Plan Options
§ 56-7-2506. Bone mass measurement coverage -- Osteoporosis.

(a) This section shall be known and may be cited as the "Bone Mass Measurement Coverage Act."

(b) The general assembly finds that:

(1) Osteoporosis affects twenty-five million (25,000,000) Americans and each year results in one million five hundred thousand (1,500,000) fractures of the hip, spine, wrist, and other bones, costing the nation at least eighteen billion dollars ($18,000,000,000);

(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 (1) in two (2) women and one (1) in five (5) men will suffer a fracture due to osteoporosis in their lifetime;

(4) Because osteoporosis progresses silently and currently has no cure, 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 the quality of life;

(6) Given the current national focus on health care reform and the reduction of unnecessary health care expenditures through the use of health promotion programs, bone mass measurement, related to the early diagnosis and the 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 (25-40%) of bone mass has been lost, and the disease is far advanced;

(8) While there are currently available technologies for bone mass measurement, other technologies for measuring bone mass are under investigation and may become scientifically proven technologies in the future; and

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

(c) The purpose of this section is to provide coverage to individuals with a condition or medical history for which bone mass measurement (bone density testing) is determined to be medically necessary for the individual's attending physician or primary care provider for the diagnosis and treatment of osteoporosis.

(d) (1) Any individual, franchise, blanket or group health insurance policy, medical service plan, contract, hospital service corporation contract, hospital and medical service corporation contract, fraternal benefit society, or health maintenance organization that provides coverage for accident and health services, and that is delivered, issued for delivery, amended or renewed on or after July 1, 1996, may also provide coverage for a qualified individual for scientifically proven bone mass measurement (bone density testing) for the diagnosis and treatment of osteoporosis.

(2) Any increase in expenditure requirements on a municipality or a county resulting from this subsection (d) shall be appropriated from funds that the municipality or county receives from the state-shared taxes that are not earmarked by statute for a particular purpose.

(3) This subsection (d) shall not apply to short-term travel, long-term care, credit insurance, dental insurance, disability income, medical surgical supplemental insurance, vision insurance, hospital indemnity, accident-only limited or specified disease policies, or to short-term nonrenewable policies of not more than six (6) months' duration.

(e) As used in subsection (d):

(1) "Bone mass measurement" means a radiologic or radioisotopic procedure or other scientifically proven technologies performed on an individual for the purpose of identifying bone mass or detecting bone loss; and

(2) "Qualified individual" means a person with a condition for which bone mass measurement is determined to be medically necessary by the person's attending physician or primary care physician.