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10  AN ACT concerning insurance; relating to health insurance; mandating
11    coverage for reconstructive breast surgery following a mastectomy or
12    similar procedure; [relating to diagnosis and treatment of osteo-
13    porosis;] amending K.S.A. 1996 Supp. 40-1909 and 40-19c09 and re-
14    pealing the existing sections; also repealing K.S.A. 40-1909, as
15    amended by section 110 of chapter 229 of the 1996 Session Laws of
16    Kansas, and 40-19c09, as amended by section 113 of chapter 229 of
17    the 1996 Session Laws of Kansas.
18
19  Be it enacted by the Legislature of the State of Kansas:
20    New Section 1.  (a) In this section, ``reconstructive breast surgery''
21  means surgery performed, following a mastectomy, on one breast or both
22  breasts to reestablish symmetry between the two breasts. ``Reconstructive
23  breast surgery'' includes augmentation mammoplasty, reduction mam-
24  moplasty and mastopexy.
25    (b)  An insurance company, health maintenance organization, non-
26  profit medical and hospital corporation or a group subject to K.S.A. 12-
27  2616 and amendments thereto shall provide insurance coverage or health
28  care benefits for reconstructive breast surgery.
29    [(c)  The coverage required by this section shall apply regard-
30  less of whether a mastectomy was performed prior to the effective
31  date of this act.]
32    Sec. 2.  K.S.A. 1996 Supp. 40-1909 is hereby amended to read as
33  follows: 40-1909. (a) Such corporations shall be subject to the provisions
34  of the Kansas general corporation code, articles 60 to 74, inclusive, of
35  chapter 17 of the Kansas Statutes Annotated, applicable to nonprofit cor-
36  porations, to the provisions of K.S.A. 40-214, 40-215, 40-216, 40-218, 40-
37  219, 40-222, 40-223, 40-224, 40-225, 40-226, 40-229, 40-230, 40-231, 40-
38  235, 40-236, 40-237, 40-247, 40-248, 40-249, 40-250, 40-251, 40-252,
39  40-254, 40-2,100, 40-2,101, 40-2,102, 40-2,103, 40-2,104, 40-2,105, 40-
40  2,114, 40-2,116, 40-2,117, 40-2a01 to 40-2a19, inclusive, 40-2216 to 40-
41  2221, inclusive, 40-2229, 40-2230, 40-2250, 40-2251, 40-2253, 40-2254,
42  40-2401 to 40-2421, inclusive, 40-3301 to 40-3313, inclusive, and
43  amendments thereto, and to the provisions of K.S.A. 1996 Supp. 40-2,153
HB 2297--Am. by HCW
                                     

 1  and, 40-2,154, 40-2,160 and 40-2,161, and amendments thereto, and
 2  K.S.A. 1996 Supp. 40-2,160 section 1 [sections 1 and 4], except as the
 3  context otherwise requires, and shall not be subject to any other provi-
 4  sions of the insurance code except as expressly provided in this act.
 5    (b)  No policy, agreement, contract or certificate issued by a corpo-
 6  ration to which this section applies shall contain a provision which ex-
 7  cludes, limits or otherwise restricts coverage because medicaid benefits
 8  as permitted by title XIX of the social security act of 1965 are or may be
 9  available for the same accident or illness.
10    (c)  Violation of subsection (b) shall be subject to the penalties pre-
11  scribed by K.S.A. 40-2407 and 40-2411, and amendments thereto.
12    Sec. 3.  K.S.A. 1996 Supp. 40-19c09 is hereby amended to read as
13  follows: 40-19c09. (a) Corporations organized under the nonprofit med-
14  ical and hospital service corporation act shall be subject to the provisions
15  of the Kansas general corporation code, articles 60 to 74, inclusive, of
16  chapter 17 of the Kansas Statutes Annotated, applicable to nonprofit cor-
17  porations, to the provisions of K.S.A. 40-214, 40-215, 40-216, 40-218, 40-
18  219, 40-222, 40-223, 40-224, 40-225, 40-226, 40-229, 40-230, 40-231, 40-
19  235, 40-236, 40-237, 40-247, 40-248, 40-249, 40-250, 40-251, 40-252,
20  40-254, 40-2,100, 40-2,101, 40-2,102, 40-2,103, 40-2,104, 40-2,105, 40-
21  2,116, 40-2,117, 40-2a01 et seq., 40-2111 to 40-2116, inclusive, 40-2215
22  to 40-2220, inclusive, 40-2221a, 40-2221b, 40-2229, 40-2230, 40-2250,
23  40-2251, 40-2253, 40-2254, 40-2401 to 40-2421, inclusive, and 40-3301
24  to 40-3313, inclusive, and amendments thereto, and to the provisions of
25  K.S.A. 1996 Supp. 40-2,153 and, 40-2,154, 40-2,160 and 40-2,161, and
26  amendments thereto, and K.S.A. 1996 Supp. 40-2,160 section 1 [sections
27  1 and 4], except as the context otherwise requires, and shall not be sub-
28  ject to any other provisions of the insurance code except as expressly
29  provided in this act.
30    (b)  No policy, agreement, contract or certificate issued by a corpo-
31  ration to which this section applies shall contain a provision which ex-
32  cludes, limits or otherwise restricts coverage because medicaid benefits
33  as permitted by title XIX of the social security act of 1965 are or may be
34  available for the same accident or illness.
35    (c)  Violation of subsection (b) shall be subject to the penalties pre-
36  scribed by K.S.A. 40-2407 and 40-2411, and amendments thereto.
37    [New Sec. 4.  (a) This section shall be known and may be cited
38  as the ``bone mass measurement coverage act.''
39    [(b)  The legislature hereby finds the following:
40    [(1)  Osteoporosis affects 25 million Americans and each year
41  results in 1.5 million fractures of the hip, spine, wrist and other
42  bones, costing the nation at least $18 billion;
43    [(2)  osteoporosis progresses silently, in most cases undiagno-
HB 2297--Am. by HCW
                                     

 1  sed until a fracture occurs, and once a fracture occurs, the disease
 2  is already advanced, and the likelihood is high that another frac-
 3  ture will occur;
 4    [(3)  one in two women and one in five men will suffer a fracture
 5  due to osteoporosis during their lifetime;
 6    [(4)  because osteoporosis progresses silently, and, currently
 7  has no cure, early diagnosis and treatment are key to reducing the
 8  prevalence and devastation of this disease;
 9    [(5)  medical experts agree that osteoporosis is preventable and
10  treatable; however, once the disease progresses to the point of
11  fracture its associated consequences often lead to disability, insti-
12  tutionalization and exact a heavy toll on the quality of life;
13    [(6)  given the current national focus on health care reform and
14  the reduction of unnecessary health care expenditures through the
15  use of health promotion programs, bone mass measurement, re-
16  lated to the early diagnosis and the timely treatment of osteopo-
17  rosis is a cost effective approach to embrace;
18    [(7)  bone mass measurement is a reliable way to detect the
19  presence of low bone mass and to ascertain the extent of bone loss
20  to help assess the individual's risk for fracture, and this aids in
21  selecting appropriate therapies and interventions; ordinary x-rays
22  are not sensitive enough to detect osteoporosis until 25-40% of
23  bone mass has been lost, and the disease far advanced;
24    [(8)  while there are currently available technologies for bone
25  mass measurement, other technologies for measuring bone mass
26  are under investigation and may become scientifically proven tech-
27  nologies in the future; and
28    [(9)  scientifically proven technologies for bone mass measure-
29  ment and other services related to the diagnosis and treatment of
30  osteoporosis can be used effectively to reduce the pain and finan-
31  cial burden that osteoporosis inflicts upon its victims.
32    [(c)  The purpose of this section is to provide insurance cover-
33  age to individuals with a condition or medical history for which
34  bone mass measurement (bone density testing) is determined to
35  be medically necessary for the individual's diagnosis and treatment
36  of osteoporosis.
37    [(d)  Any individual or group health insurance policy, medical
38  service plan, contract, hospital service corporation contract, hos-
39  pital and medical service corporation contract, fraternal benefit
40  society or health maintenance organization which provides cov-
41  erage for accident and health services and which is delivered, is-
42  sued for delivery, amended or renewed on or after July 1, 1997,
43  also, shall provide coverage for a qualified individual for scientif-
HB 2297--Am. by HCW
                                     

 1  ically proven bone mass measurement (bone density testing) for
 2  the diagnosis and treatment of osteoporosis.
 3    [(e)  For the purposes of this section:
 4    [(1)  ``Bone mass measurement'' means a radiologic or radiois-
 5  otopic procedure or other scientifically proven technologies per-
 6  formed on an individual for the purpose of identifying bone mass
 7  or detecting bone loss.
 8    [(2)  ``Qualified individual'' means a person with a condition for
 9  which bone mass measurement is determined to be medically nec-
10  essary by the person's attending physician or primary care physi-
11  cian.]
12    Sec. 4. [5.]  K.S.A. 40-1909 and 40-19c09, as amended by section 113
13  of chapter 229 of the 1996 Session Laws of Kansas, and K.S.A. 1996 Supp.
14  40-1909 and 40-19c09, as amended by section 110 of chapter 229 of the
15  1996 Session Laws of Kansas, are hereby repealed.
16    Sec. 5. [6.]  This act shall take effect and be in force from and after
17  its publication in the statute book.