Texas requires payors to cover heart attack screening tests as of Sept. 1

The Texas Heart Attack Prevention Bill, signed into law by Texas Governor Rick Perry in late June, is set to take effect on Sept. 1, and will require insurance companies to pay for heart attack preventive imaging screening tests.

The legislation will apply to diabetics, men between ages 45 and 75 and women between ages 55 and 75, in additiona to those who are at intermediate risk of a heart attack based on their Framingham Risk Score.

The bill will require reimbursement for two types of cardiovascular imaging procedures:

• The measurement of coronary artery calcium (CAC) score by CT; and
• The measurement of carotid intima-media thickness (CIMT) and plaque by ultrasound.

All state payors will be required to provide a minimum of $200 per patient for these tests every five years.

Two years ago, Texas Rep. Rene Oliveira, supported by the Houston-based Society for Heart Attack Prevention and Eradication (SHAPE), introduced a bill in the Texas Legislature. The bill, which was turned down by the insurance committee then, was recalled before Texas legislators and the House Insurance Committee in March of this year. The bill passed through the Texas House and Senate on June 1 and 3, respectively.

However, the bill has been criticized by others, including professional societies representing the cardiovascular and imaging communities, for its widespread screening approach and potential harm from radiation exposure in this patient population. Yet, when it passed in June, the American College of Cardiology (ACC), which initially withheld an opinion, said it "officially supported" the legislation, whereas the American Heart Association (AHA) and the American College of Radiology (ACR) have refused to take a formal position on the act.  

When the bill was reintroduced in March, the SHAPE Task Force estimated that proper screening of these asymptomatic individuals could have the following outcomes:

• Prevent more than 4,300 deaths from cardiovascular disease each year in Texas (over 90,000 deaths in the U.S.).
• Reduce the Texas population with a history of heart attack – currently estimated to be 550,000 – by as much as 25 percent.
• Save approximately $1.6 billion annually (over 21 billion in the U.S.).

The society also predicted that this effort could prevent 4,300 sudden cardiac deaths and save $1.6 billion per year in Texas.

“[D]etection of atherosclerosis by non-invasive imaging, as suggested by the SHAPE group, accurately identifies plaque and improves the ability to identify at-risk individuals who could benefit from aggressive preventive intervention while sparing low-risk subjects from unnecessary aggressive medical therapy,” said P.K. Shah, MD, director of cardiology at Cedars Sinai Heart Institute in Los Angeles and a leading member of the SHAPE Task Force. “Sadly, these vulnerable patients go undetected until struck by a heart attack because insurance companies don’t cover the newer heart attack screening imaging tests.”

“At one time, imaging technologies to look inside the body and screen for cancer seemed like an impractical idea, but after reimbursement approval they have become part of everyday medicine and have saved countless lives,” said Daniel Berman, MD, chief of cardiovascular imaging at Cedars Sinai and professor of medicine at University of California, Los Angeles, who is also a member of the SHAPE Task Force. With the passage of this bill, he added that the task force anticipates that “tens of thousands of people who are completely unaware of their severe but silent heart disease can be detected and saved from a catastrophic heart attack by getting into intensive treatment.”