bone mass measurement for beneficiaries and participants
who are qualified individuals.
‘‘(b) DEFINITIONS RELATING
TO COVERAGE.—In
this section:
‘‘(1) BONE
MASS
MEASUREMENT.—The term
‘bone mass measurement’ means a radiologic or
radioisotopic procedure or other procedure approved
by the Food and Drug Administration performed on
an individual for the purpose of identifying bone
mass or detecting bone loss or determining bone
quality, and includes a physician’s interpretation of
the results of the procedure. Nothing in this para-
graph shall be construed as requiring a bone mass
measurement to be conducted in a particular type
of facility or to prevent such a measurement from
being conducted through the use of mobile facilities
that are otherwise qualified.
‘‘(2) QUALIFIED INDIVIDUAL.—The term ‘quali-
fied individual’ means an individual who—
‘‘(A) is an estrogen-deficient woman at
clinical risk for osteoporosis;
‘‘(B) has vertebral abnormalities;
‘‘(C) is receiving chemotherapy or long-
term gluococorticoid (steroid) therapy;
‘‘(D) has primary hyperparathyroidism,
hyperthyroidism, or excess thyroid replacement;
or
‘‘(E) is being monitored to assess the re-
sponse to or efficacy of approved osteoporosis
drug therapy.
‘‘(c) LIMITATION ON FREQUENCY REQUIRED.—The
standards established under section 2707(c) of the Public
Health Service Act shall apply to benefits provided under
this section in the same manner as they apply to benefits
provided under section 2707 of such Act.
‘‘(d) RESTRICTIONS ON COST-SHARING.—
‘‘(1) IN GENERAL.—Subject to paragraph (2),
nothing in this section shall be construed as prevent-
ing a group health plan or issuer from imposing
deductibles, coinsurance, or other cost-sharing in re-
lation to bone mass measurement under the plan (or
health insurance coverage offered in connection with
a plan).
‘‘(2) LIMITATION.—Deductibles, coinsurance,
and other cost-sharing or other limitations for bone
mass measurement may not be imposed under para-
graph (1) to the extent they exceed the deductibles,
coinsurance, and limitations that are applied to simi-
lar services under the group health plan or health
insurance coverage.
‘‘(e) PROHIBITIONS.—A group health plan, and a
health insurance issuer offering group health insurance
coverage in connection with a group health plan, may
not—
‘‘(1) deny to an individual eligibility, or contin-
ued eligibility, to enroll or to renew coverage under
the terms of the plan, solely for the purpose of
avoiding the requirements of this section;
‘‘(2) provide incentives (monetary or otherwise)
to individuals to encourage such individuals not to
be provided bone mass measurements to which they
are entitled under this section or to providers to in-
duce such providers not to provide such measure-
ments to qualified individuals;
‘‘(3) prohibit a provider from discussing with a
patient osteoporosis preventive techniques or medical
treatment options relating to this section; or
‘‘(4) penalize or otherwise reduce or limit the
reimbursement of a provider because such provider
provided bone mass measurements to a qualified in-
dividual in accordance with this section.
‘‘(f) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to require an individual who is a
participant or beneficiary to undergo bone mass measure-
ment.
‘‘(g) NOTICE UNDER GROUP HEALTH PLAN.—The
imposition of the requirements of this section shall be
treated as a material modification in the terms of the plan
described in section 102(a)(1), for purposes of assuring
notice of such requirements under the plan; except that
the summary description required to be provided under the
last sentence of section 104(b)(1) with respect to such
modification shall be provided by not later than 60 days
after the first day of the first plan year in which such
requirements apply.
‘‘(h) PREEMPTION.—
‘‘(1) IN GENERAL.—The provisions of this sec-
tion do not preempt State law relating to health in-
surance coverage to the extent such State law pro-
vides greater benefits with respect to osteoporosis
detection or prevention.
‘‘(2) CONSTRUCTION.—Section 731(a)(1) shall
not be construed as superseding a State law de-
scribed in paragraph (1).’’.
(B) Section 731(c) of such Act (29 U.S.C.
1191(c)) is amended by striking ‘‘section 711’’ and
inserting ‘‘sections 711 and 714’’.
(C) Section 732(a) of such Act (29 U.S.C.
1191a(a)) is amended by striking ‘‘section 711’’ and
inserting ‘‘sections 711 and 714’’.
(D) The table of contents in section 1 of such
Act is amended by inserting after the item relating
to section 712 the following new item:
‘‘Sec. 714. Standards relating to benefits for bone mass measurement.
(b) INDIVIDUAL HEALTH INSURANCE.—(1) Part B
of title XXVII of the Public Health Service Act is amend-
ed by inserting after section 2751 the following new sec-
tion:
‘‘SEC. 2752. STANDARDS RELATING TO BENEFITS FOR BONE
MASS MEASUREMENT.
‘‘(a) IN GENERAL.—The provisions of section 2707
(other than subsection (g)) shall apply to health insurance
coverage offered by a health insurance issuer in the indi-
vidual market in the same manner as it applies to health
insurance coverage offered by a health insurance issuer
in connection with a group health plan in the small or
large group market.
‘‘(b) NOTICE.—A health insurance issuer under this
part shall comply with the notice requirement under sec-
tion 714(g) of the Employee Retirement Income Security
Act of 1974 with respect to the requirements referred to
in subsection (a) as if such section applied to such issuer
and such issuer were a group health plan.
‘‘(c) PREEMPTION.—
‘‘(1) IN GENERAL.—The provisions of this sec-
tion do not preempt State law relating to health in-
surance coverage to the extent such State law pro-
vides greater benefits with respect to osteoporosis
detection or prevention.
‘‘(2) CONSTRUCTION.—Section 2762(a) shall
not be construed as superseding a State law de-
scribed in paragraph (1).’’.
(2) Section 2762(b)(2) of such Act (42 U.S.C.
300gg–62(b)(2)) is amended by striking ‘‘section 2751’’
and inserting ‘‘sections 2751 and 2752’’.
(c) EFFECTIVE DATES.—(1) The amendments made
by subsection (a) shall apply with respect to group health
plans for plan years beginning on or after January 1,
2000.
(2) The amendments made by subsection (b) shall
apply with respect to health insurance coverage offered,
sold, issued, renewed, in effect, or operated in the individ-
ual market on or after such date.
Æ