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Second Regular Session
Sixty-first General Assembly
LLS NO. 980017.01 DFH
HOUSE BILL 981294
STATE OF COLORADO
BY REPRESENTATIVES S. Williams, Clarke, Dyer, Gordon, June, Kaufman, Keller, Tate, and Tool;
also SENATOR J. Johnson.
A BILL FOR AN ACT
CONCERNING HEALTH CARE COVERAGE PARITY FOR TEMPOROMANDIBULAR
(Note: This summary applies to this bill as introduced
and does not necessarily reflect any amendments that may be subsequently
Directs that any group or individual policy, plan certificate, or contract of a health insurance carrier, health maintenance organization, or nonprofit hospital, medicalsurgical and health service corporation that provides coverage for any diagnostic, nonsurgical treatment, or surgical procedure involving a bone or joint of the skeletal structure shall not exclude or deny the same coverage for the same diagnostic, nonsurgical treatment, or surgical procedure involving any bone or joint of the face, neck, or head if, under the accepted standards of the profession of the provider rendering the service, the procedure is medically necessary to treat a condition caused by congenital deformity, disease, or injury.
States that this provision shall not be construed to encourage surgical procedures over appropriate nonsurgical procedures or to prohibit continued coverage of nonsurgical procedures in the treatment of a bone or joint of the face, neck, or head.
Applies to policies, plans, or contracts issued or
renewed on or after January 1, 1999.
Be it enacted by the General Assembly of the State of Colorado:
SECTION 1. 1016104, Colorado Revised Statutes, is amended BY THE ADDITION OF A NEW SUBSECTION to read:
1016104. Mandatory coverage provisions. (12) Diagnostic, nonsurgical treatment, or surgical procedures involving bones or joints of the face, neck, or head. (a) ALL INDIVIDUAL AND GROUP SICKNESS AND ACCIDENT INSURANCE POLICIES, EXCEPT SUPPLEMENTAL POLICIES COVERING A SPECIFIED DISEASE OR OTHER LIMITED BENEFIT, THAT ARE DELIVERED OR ISSUED FOR DELIVERY WITHIN THE STATE BY AN ENTITY SUBJECT TO THE PROVISIONS OF PART 2 OF THIS ARTICLE AND ALL INDIVIDUAL AND GROUP HEALTH CARE SERVICE OR INDEMNITY CONTRACTS ISSUED BY AN ENTITY SUBJECT TO THE PROVISIONS OF PART 3 OR 4 OF THIS ARTICLE, AS WELL AS ANY OTHER GROUP HEALTH CARE COVERAGE PROVIDED TO RESIDENTS OF THIS STATE, THAT PROVIDE COVERAGE FOR ANY DIAGNOSTIC, NONSURGICAL TREATMENT, OR SURGICAL PROCEDURE INVOLVING A BONE OR JOINT OF THE SKELETAL STRUCTURE SHALL NOT EXCLUDE OR DENY THE SAME COVERAGE FOR THE SAME DIAGNOSTIC, NONSURGICAL TREATMENT, OR SURGICAL PROCEDURE INVOLVING ANY BONE OR JOINT OF THE FACE, NECK, OR HEAD IF, UNDER THE ACCEPTED STANDARDS OF THE PROFESSION OF THE PROVIDER RENDERING THE SERVICE, THE PROCEDURE IS NECESSARY TO TREAT A CONDITION CAUSED BY CONGENITAL DEFORMITY, DISEASE, OR INJURY.
(b) THIS SUBSECTION (12) SHALL NOT BE CONSTRUED TO AFFECT ANY OTHER COVERAGE REQUIRED UNDER THIS ARTICLE OR TO RESTRICT THE SCOPE OF COVERAGE UNDER ANY POLICY, CERTIFICATE, OR CONTRACT ISSUED OR DELIVERED IN THIS STATE BY A CARRIER.
(c) NOTHING IN THIS SUBSECTION (12) SHALL BE CONSTRUED TO ENCOURAGE SURGICAL PROCEDURES OVER APPROPRIATE NONSURGICAL PROCEDURES OR TO PROHIBIT THE CONTINUED COVERAGE OF NONSURGICAL PROCEDURES IN THE TREATMENT OF A BONE OR JOINT OF THE FACE, NECK, OR HEAD.
SECTION 2. Effective date applicability. This act shall take effect January 1, 1999, and shall apply to health policies, plans, or contracts issued or renewed on or after said date.
SECTION 3. Safety clause. The general assembly hereby finds, determines, and declares that this act is necessary for the immediate preservation of the public peace, health, and safety.