[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4206 Introduced in House (IH)]







110th CONGRESS
  1st Session
                                H. R. 4206

 To amend title XVIII of the Social Security Act to improve access to, 
 and increase utilization of, bone mass measurement benefits under the 
                        Medicare part B Program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           November 15, 2007

 Ms. Berkley (for herself, Mr. Burgess, Mrs. Maloney of New York, Mr. 
 McNulty, Mr. Paul, Mr. Rothman, Mr. Goode, Mr. Sessions, Mrs. Myrick, 
Mr. Gene Green of Texas, Mrs. Capps, Mr. Klein of Florida, Ms. Loretta 
 Sanchez of California, Ms. Moore of Wisconsin, Ms. Roybal-Allard, Ms. 
   Linda T. Sanchez of California, Mrs. Tauscher, Ms. Zoe Lofgren of 
California, Mrs. Davis of California, Ms. Solis, Ms. Matsui, Mr. Berry, 
Mr. Hinchey, Ms. Schakowsky, Ms. Giffords, Ms. Castor, Mrs. Gillibrand, 
Mr. Ellsworth, Ms. Woolsey, Ms. Watson, Ms. Bordallo, Ms. Schwartz, Mr. 
  Israel, Ms. Velazquez, Mr. Pascrell, Ms. McCollum of Minnesota, Mr. 
 Crowley, Mr. Hare, Mr. Johnson of Georgia, Mrs. McCarthy of New York, 
 Ms. Hooley, and Mrs. Napolitano) introduced the following bill; which 
 was referred to the Committee on Energy and Commerce, and in addition 
  to the Committee on Ways and Means, for a period to be subsequently 
   determined by the Speaker, in each case for consideration of such 
 provisions as fall within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
 To amend title XVIII of the Social Security Act to improve access to, 
 and increase utilization of, bone mass measurement benefits under the 
                        Medicare part B Program.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Fracture Prevention and 
Osteoporosis Testing Act of 2007''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Since 1997, Congress has recognized the importance of 
        osteoporosis prevention by standardizing reimbursement under 
        the Medicare program for bone mass measurement.
            (2) One decade later, osteoporosis remains underdiagnosed 
        and untreated despite numerous Federal initiatives, including 
        recommendations of the United States Preventive Services Task 
        Force, the 2004 United States Surgeon General's Report on Bone 
        Health and Osteoporosis, and inclusion of bone mass measurement 
        in the Welcome to Medicare exam.
            (3) Even though osteoporosis is a highly manageable 
        disease, many patients lack access to early diagnosis that can 
        prevent debilitating fractures, morbidity, and loss of 
        mobility.
            (4) Although Caucasians are most likely to sustain 
        osteoporosis fractures, the cost of fractures among the 
        nonwhite population is projected to increase by as much as 180 
        percent over the next 20 years.
            (5) Black women are more likely than White women to die 
        following a hip fracture.
            (6) Osteoporosis is a critical women's health issue. Women 
        account for 71 percent of fractures and 75 percent of 
        osteoporosis-associated costs.
            (7) The World Health Organization, the Centers for Medicare 
        & Medicaid Services, and other medical experts concur that the 
        most widely accepted method of measuring bone mass to predict 
        fracture risk is dual-energy x-ray absorptiometry (in this Act 
        referred to as ``DXA''). Vertebral fracture assessment (in this 
        Act referred to as ``VFA'') is another test used to identify 
        patients at high risk for future fracture.
            (8) Unlike other imaging procedures, bone mass measurement 
        testing remains severely underutilized with less than 20 
        percent of eligible Medicare beneficiaries taking advantage of 
        the benefit.
            (9) Underutilization of bone mass measurement will strain 
        the Medicare budget because--
                    (A) 55 percent of the people age 50 and older in 
                2002 had osteoporosis or low bone mass;
                    (B) more than 61,000,000 people in the United 
                States are projected to have osteoporosis or low bone 
                mass in 2020, as compared to 43,000,000 in 2002;
                    (C) osteoporosis fractures are projected to 
                increase by almost 50 percent over the next 2 decades 
                with at least 3,000,000 fractures expected to occur 
                annually by 2025;
                    (D) the population aged 65 and older represents 89 
                percent of fracture costs; and
                    (E) the economic burden of osteoporosis fractures 
                are projected to increase by 50 percent over the next 2 
                decades, reaching $25,300,000,000 in 2025.
            (10) Underutilization of bone mass measurement will also 
        strain the Medicaid budget, which funds treatment for 
        osteoporosis in low-income Americans.
            (11) Reimbursement under the Medicare program for DXA 
        provided in physician offices and other non-hospital settings 
        was reduced by 40 percent and will be reduced by a total of 75 
        percent by 2010. This drop represents one of the largest 
        reimbursement reductions in the history of the Medicare 
        program. Reimbursement for VFA will also be reduced by 50 
        percent by 2010.
            (12) The reduction in reimbursement discourages physicians 
        from continuing to provide access to DXA or VFA in their 
        offices. Since two-thirds of all DXA scans are performed in 
        nonfacility settings, such as physician offices, patient access 
        to bone mass measurement will be severely compromised when 
        physicians discontinue providing those tests in their offices, 
        thereby exacerbating the current underutilization of the 
        benefit.

SEC. 3. MINIMUM PAYMENT FOR BONE MASS MEASUREMENT.

    (a) In General.--Section 1848(b) of the Social Security Act (42 
U.S.C. 1395w-4(b)) is amended by adding at the end the following:
            ``(5) Treatment of bone mass scans.--Notwithstanding the 
        provisions of paragraph (1), the Secretary shall establish a 
        national minimum payment amount for CPT code 77080 (relating to 
        dual-energy x-ray absorptiometry) and CPT code 77082 (relating 
        to vertebral fracture assessment), and any successor to such 
        codes as identified by the Secretary. Such minimum payment 
        amount shall not be less than 100 percent of the reimbursement 
        rates in effect for such codes (or predecessor codes) on 
        December 31, 2006.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to bone mass measurement furnished on or after January 1, 2008.

SEC. 4. STUDY AND REPORT BY THE INSTITUTE OF MEDICINE.

    (a) In General.--The Secretary of Health and Human Services shall 
enter into an arrangement with the Institute of Medicine of the 
National Academies to conduct a study on the following:
            (1) The ramifications of Medicare reimbursement reductions 
        for DXA and VFA on beneficiary access to bone mass measurement 
        benefits in general and in rural and minority communities 
        specifically.
            (2) Methods to increase use of bone mass measurement by 
        Medicare beneficiaries.
    (b) Report.--The agreement entered into under subsection (a) shall 
provide for the Institute of Medicine to submit to the Secretary and 
the Congress, not later than 1 year after the date of the enactment of 
this Act, a report containing a description of the results of the study 
conducted under such subsection and the conclusions and recommendations 
of the Institute of Medicine regarding each of the issues described in 
paragraphs (1) and (2) of such subsection.
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