SB 648 - Morbid Obesity Surgical Intervention Act - provide

First Reader Summary

A bill to amend Article 1 of Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to insurance generally, so as to require health insurers to provide coverage for the treatment of morbid obesity when medically indicated; to provide for a short title; to offer for legislative findings; to provide definitions; to provide for the issuance of rules and regulations by the Commissioner of Insurance; to provide for adjustment of current contracts.

Page Numbers - 1/ 2/ 3

Code Sections - 33-24-59.1

SB 648                                             LC 19 3823 
 
 
 
 
 
 
                        A BILL TO BE ENTITLED 
                               AN ACT 
 
 
  1- 1  To amend Article 1 of Chapter 24 of Title 33 of the Official 
  1- 2  Code of Georgia Annotated, relating to insurance generally, 
  1- 3  so as to require health insurers to provide coverage for the 
  1- 4  treatment of morbid obesity when medically indicated; to 
  1- 5  provide for a short title; to offer for legislative 
  1- 6  findings; to provide definitions; to provide for the 
  1- 7  issuance of rules and regulations by the Commissioner of 
  1- 8  Insurance; to provide for adjustment of current contracts; 
  1- 9  to provide for related matters; to repeal conflicting laws; 
  1-10  and for other purposes. 
 
  1-11       BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA: 
 
  1-12                           SECTION 1. 
 
  1-13  Article 1 of Chapter 24 of Title 33 of the Official Code of 
  1-14  Georgia Annotated, relating to insurance generally, is 
  1-15  amended by adding at the end thereof the following: 
 
  1-16    "33-24-59.1. 
 
  1-17    (a) This Code section shall be known and may be cited as 
  1-18    the 'Morbid Obesity Surgical Intervention Act.' 
 
  1-19    (b) The General Assembly finds and declares that: 
 
  1-20      (1) Morbid obesity is defined as a weight which is at 
  1-21      least 100 pounds over or twice the ideal weight for 
  1-22      frame, age, height, and gender as specified in the 1983 
  1-23      Metropolitan Life Insurance tables; 
 
  1-24      (2) Whereas many health care insurers cover the costs of 
  1-25      treatment for patients diagnosed as morbidly obese by 
  1-26      their physicians, many other insurers refuse to cover 
  1-27      such costs; 
 
  1-28      (3) There is sufficient scientific data that implicate 
  1-29      morbid obesity as the cause of many other medical 
  1-30      problems and costly health complications, such as 
  1-31      diabetes, hypertension, heart disease, and stroke. 
  1-32      These data indirectly question the safety and 
 
 
 
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  2- 1      appropriateness of the continued refusal of some 
  2- 2      insurers to cover the medically indicated treatment of 
  2- 3      the morbidly obese patient.  The association of morbid 
  2- 4      obesity with the aforementioned devastating diseases 
  2- 5      refutes any claim of a purely cosmetic indication for 
  2- 6      the treatment of obesity and clearly designates morbid 
  2- 7      obesity as a life-threatening disease; 
 
  2- 8      (4) The cost of managing the complications of morbid 
  2- 9      obesity, largely due to inadequate treatment, far 
  2-10      outweighs the cost of expeditious, effective medical 
  2-11      treatment.  Therefore, insurers who continue to refuse 
  2-12      to pay for the primary treatment of morbid obesity are 
  2-13      contributing to the high cost of management of secondary 
  2-14      complications; 
 
  2-15      (5) Guidelines developed by the National Institute of 
  2-16      Health, the American Society for Bariatric Surgery, the 
  2-17      American Obesity Association, and Shape Up America and 
  2-18      embraced by the American Medical Association and the 
  2-19      American College of Surgeons recommend that patients who 
  2-20      are morbidly obese receive responsible, affordable 
  2-21      medical treatment for their obesity; 
 
  2-22      (6) The diagnosis of morbid obesity should be a clinical 
  2-23      decision made by a physician based on the guidelines set 
  2-24      by the appropriate health and medical associations and 
  2-25      Body Mass Index (BMI) equal to or greater than 35.  The 
  2-26      treatment modality should also be a clinical decision 
  2-27      made by the physician based on set guidelines; and 
 
  2-28      (7) Two surgical procedures are currently being utilized 
  2-29      to treat patients with morbid obesity.  Each one is 
  2-30      based on one of two principles:  reduction in the 
  2-31      capacity of the stomach, thereby limiting the amount of 
  2-32      food ingested; or alteration in the intestinal 
  2-33      absorption of nutrients. 
 
  2-34      (c)(1) As used in this Code section, the term: 
 
  2-35        (A) 'Health benefit policy' means any individual or 
  2-36        group plan, policy, or contract for health care 
  2-37        services issued, delivered, issued for delivery, or 
  2-38        renewed in this state, including those contracts 
  2-39        executed by the State of Georgia on behalf of 
  2-40        indigents and on behalf of state employees under 
  2-41        Article 1 of Chapter 18 of Title 45, by a health care 
  2-42        corporation, health maintenance organization, 
  2-43        preferred provider organization, accident and sickness 
 
 
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  3- 1        insurer, fraternal benefit society, hospital service 
  3- 2        corporation, medical service corporation, or other 
  3- 3        insurer or similar entity. 
 
  3- 4        (B) 'Insurer' means an accident and sickness insurer, 
  3- 5        fraternal benefit society, hospital service 
  3- 6        corporation, medical service corporation, health care 
  3- 7        corporation, health maintenance organization, or any 
  3- 8        similar entity authorized to issue contracts under 
  3- 9        this title, and any other publicly funded state health 
  3-10        care program. 
 
  3-11      (2) Every health benefit policy that is delivered, 
  3-12      issued, executed, or renewed in this state or approved 
  3-13      for issuance or renewal in this state by the 
  3-14      Commissioner on or after July 1, 1998, shall offer 
  3-15      coverage for the surgical intervention of morbid 
  3-16      obesity. 
 
  3-17    (d) The Commissioner of Insurance shall adopt rules and 
  3-18    regulations necessary to implement the provisions of this 
  3-19    Code section in compliance with current guidelines 
  3-20    established by professional medical organizations relating 
  3-21    to the treatment of morbid obesity." 
 
  3-22                           SECTION 2. 
 
  3-23  All contracts relating to the provision of health care 
  3-24  services in effect on July 1, 1998, shall be appropriately 
  3-25  adjusted to reflect any change in services provided as 
  3-26  required by this Act. 
 
  3-27                           SECTION 3. 
 
  3-28  All laws and parts of laws in conflict with this Act are 
  3-29  repealed. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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