New Texas Legislation Calls for Insurance Coverage for Heart Attack Screening Tests

CardioBrief recently reported that “the Texas legislature is about to reconsider a controversial bill that would mandate insurance company reimbursement for heart attack screening tests.”

This is notable for several reasons, CardioBrief reports. This is the second go-round for this piece of legislation, having been proposed two years ago with “strong support” from the Society for Heart Attack Prevention and Eradication. This matters because, according to CardioBrief,” this bill “represents an effort to provide legislative muscle to the equally controversial SHAPE guidelines, published in 2006 in a supplement to the American Journal of Cardiology sponsored by Pfizer.”

This HeartWire story provides detailed background information about the SHAPE guidelines and the reaction their publication elicited from the professional cardiology community.

According to the CardioBrief release, “almost all heart attacks” are predicted by atherosclerosis, and that non-invasive imaging tests can be used to pinpoint the disease and measure its severity. However, CardioBrief adds, “many physicians continue to rely solely upon screening for traditional risk factors of atherosclerosis.”

The new bill would apply to men between 45 and 75 and women 55 to 75 who are at an “intermediate” risk for a heart attack, according to their Framingham Risk Score. The legislation would require reimbursement for the collecting of coronary artery calcium scores by CT scan and the evaluation of carotid intima-media thickness and plaque by ultrasonography. These two tests, according to CardioBrief, have shown to be “strong predictors of those who are vulnerable to a heart attack or stroke.”

One of the objections to the proposed Texas legislation has to do with, to paraphrase commentary from Peter Jacobson, MD, in the January 9, 2008 issue of the Journal of the American Medical Association, the potential drawbacks of publishing guidelines that are not subject to outside peer review or input from professional societies. Jacobson described clinical practice guidelines that have been subject to the traditional review process as “flexible instruments”, and contrasted them with legislative mandates, which he called “inflexible, static, and not as easily changed as science advances.”

According to the history of the bill, HB1290 was filed February 16, read for the first time and referred to the House Committee on Insurance February 26, and is scheduled for a public hearing March 10.

The American Heart Association’s chief science officer, Rose Marie Robertson, spoke with CardioBrief after the March 10 hearing, calling the legislation “a very blunt instrument,” though she did add that she would not rule out a legislative approach in the future.

“Legislation we would support in this arena would take a more comprehensive approach,” Robertson said. “We wouldn’t be likely to support legislation that places a disproportionate amount of emphasis on imaging modalities as opposed to a more comprehensive approach” to patient diagnosis and treatment, noting that there are “other approaches that are often efficacious.”

She also said that the AHA’s approach to obesity in children, which focuses on working with insurance companies and other institutions, is “a good example of an approach that is not a legislative approach.”

Click here to read the text of bill introduced by Rene Oliviera 81(R) HB 1290 “relating to health benefit plan coverage for certain tests for the early detection of cardiovascular disease.”