1.
(a)This Act may be cited as the Access to America’s Orthopaedic Services Act of 2009
.
2.Table of contents; definition
(a)The table of contents for this Act is as follows:
Sec. 1. Short title.
Sec. 2. Table of contents; definition.
Title I—Musculoskeletal Health
Sec. 101. Findings.
Sec. 102. Musculoskeletal research.
Sec. 103. Musculoskeletal trauma research and care.
Sec. 104. Transplants, tissues, and replacement joints.
Sec. 105. Traffic and workplace safety.
Sec. 106. Public education campaign.
Sec. 107. Orthopaedic physician workforce training study.
Sec. 108. Bone density under the Medicare Program.
Sec. 109. Access to orthopaedic services for beneficiaries of Medicaid and SCHIP.
Sec. 110. Age-related programs.
Sec. 111. Minority health disparities.
Title II—Third longitudinal study on aging
Sec. 201. Third longitudinal study on aging.
(b)For purposes of the Act, the term Secretary means the Secretary of Health and Human Services, except as otherwise provided.
<enum>I</enum><header>Musculoskeletal Health</header>
<section id="H15726F9194984CB8B976F5DAD437B21"><enum>101.</enum><header>Findings</header><text display-inline="no-display-inline">Congress makes the following findings:</text>
<paragraph id="H41BE74B50880419D8E105314990566AF"><enum>(1)</enum><text>Musculoskeletal diseases and conditions are the leading cause of disability in the United States.</text></paragraph>
<paragraph id="H8105D893FD224245891C91F4AC6B06F9"><enum>(2)</enum><text>Musculoskeletal diseases account for more than one-half of all chronic conditions in people over 50 years of age in developed countries.</text></paragraph>
<paragraph id="HA0B9ECE31E124F06A7A6BBC311A4D1FA"><enum>(3)</enum><text>More than one in four individuals in the United States has a musculoskeletal condition requiring medical attention.</text></paragraph>
<paragraph id="HDA14944F211E4397A2EF6829BB81F5E2"><enum>(4)</enum><text>Direct and indirect costs for bone and joint health are $849,000,000,000 per year in the United States.</text></paragraph>
<paragraph id="HCD084D794CA64C728E2B902E1360CFC"><enum>(5)</enum><text>Musculoskeletal conditions are the greatest cause of total lost workdays and medical bed days in the United States.</text></paragraph>
<paragraph id="H76FB1F9163B54E6E80CF34D579886691"><enum>(6)</enum><text>The 2004 Surgeon General Report on Bone Health and Osteoporosis concluded that there is a lack of awareness of bone disease among the public and health care professionals.</text></paragraph>
<paragraph id="H4A8ABC65505B4304B1EB9DB871BC8713"><enum>(7)</enum><text display-inline="yes-display-inline">Research demonstrates that there is need among ethnic and racial minorities to improve knowledge of and treatment for musculoskeletal diseases and conditions.</text></paragraph></section>
<section id="HF610044F53C7449E8FAA96BB00B33B40"><enum>102.</enum><header>Musculoskeletal research</header>
<subsection id="HB39A535DAA2D4DC38FBE4268CDB17BF9"><enum>(a)</enum><header>Regulations concerning reporting criteria for percent of effort</header>
<paragraph id="H3FC0E824D7CE4EBBAD11EFE9DF37C22"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary, in consultation with the Director of the National Institutes of Health, shall establish, by regulation, criteria for accounting and reporting the percent of effort expended by researchers, with respect to research that is—</text>
<subparagraph id="HBE5BF59A2BB44D8A93D5F7E5129C92EB"><enum>(A)</enum><text>conducted during each fiscal year beginning after the last day of the second fiscal year following the date of enactment of this Act; and</text></subparagraph>
<subparagraph id="HB3468099B6E14FB0BBD8ABE89142998"><enum>(B)</enum><text display-inline="yes-display-inline">funded through research grants on musculoskeletal health awarded by either the Director of the National Institutes of Health or the Director of the Agency for Healthcare Research and Quality.</text></subparagraph></paragraph>
<paragraph id="HB42D3E938AD143D284F86C583936804B"><enum>(2)</enum><header>Deadline for regulations</header><text>Not later than the last day of the 2-year period beginning on the date of enactment of this Act, the Secretary shall issue and implement the regulations required by <internal-xref idref="H3FC0E824D7CE4EBBAD11EFE9DF37C22" legis-path="102.(a)(1)">paragraph (1)</internal-xref>.</text></paragraph></subsection>
<subsection id="H2F6A116E930A4E30B95E81EABE431EE0"><enum>(b)</enum><header>New Investigators in Musculoskeletal Research</header>
<paragraph id="H4AB9AD188CFF41A4817C85C61355DEAD"><enum>(1)</enum><header>Report</header><text display-inline="yes-display-inline">Not later than 90 days after the last day of each fiscal year that begins more than one year following the date of enactment of this Act, the Secretary, in consultation with the Director of the National Institutes of Health, shall prepare and submit to Congress a report on the following:</text>
<subparagraph id="H951777DAD4E74FCCBCF2EF05B712954B"><enum>(A)</enum><text display-inline="yes-display-inline">The number of new investigators who are awarded grants for musculoskeletal health research by the National Institutes of Health during the fiscal year.</text></subparagraph>
<subparagraph id="H7D28AAA8A13F47598E05E2CBADF56DD"><enum>(B)</enum><text display-inline="yes-display-inline">The total amount of funds awarded to those investigators under such grants during the fiscal year.</text></subparagraph>
<subparagraph id="HE0304B24AF904C89B2E9A55805D6D823"><enum>(C)</enum><text display-inline="yes-display-inline">The percentage of the National Institutes of Health’s budget for musculoskeletal health research that was awarded to such investigators through such grants during the fiscal year.</text></subparagraph>
<subparagraph id="H8C8D9E35F8294EA687B6CF6FD1F3E500"><enum>(D)</enum><text display-inline="yes-display-inline">The race and ethnicity of the new investigators who are awarded such grants during the fiscal year.</text></subparagraph>
<subparagraph id="HB8701F76EBC84A769FB819B93441ACF8"><enum>(E)</enum><text display-inline="yes-display-inline">A description of the efforts made by the Director of the National Institutes of Health to encourage individuals from underrepresented minority groups (as defined by the Secretary) to apply for grants for musculoskeletal health research awarded by the National Institutes of Health during the fiscal year.</text></subparagraph></paragraph>
<paragraph id="H1C2995F151C64268B4B1060989EAD560"><enum>(2)</enum><header>Recommendations</header><text display-inline="yes-display-inline">The first report submitted under <internal-xref idref="H4AB9AD188CFF41A4817C85C61355DEAD" legis-path="102.(b)(1)">paragraph (1)</internal-xref> shall include, and subsequent reports may include, recommendations concerning additional resources that the National Institutes of Health or other entities could use—</text>
<subparagraph display-inline="no-display-inline" id="HFFED40D15BCB4C7800F2AD8295D79D29"><enum>(A)</enum><text display-inline="yes-display-inline">to increase the number of new investigators awarded grants referred to in <internal-xref idref="H951777DAD4E74FCCBCF2EF05B712954B" legis-path="102.(b)(1)(A)">paragraph (1)(A)</internal-xref>; and</text></subparagraph>
<subparagraph id="HC88E0F138E3C48B98425FFDC63C3579"><enum>(B)</enum><text display-inline="yes-display-inline">to increase the number of new investigators awarded such grants who are members of underrepresented minority groups.</text></subparagraph></paragraph>
<paragraph id="H7EDE46740E504ED4B94051CAEFD53DC1"><enum>(3)</enum><header>Definitions</header><text>For purposes of this section, the following definitions apply:</text>
<subparagraph id="H36BF9A02B43E4EBCB50683EEDB46DB2"><enum>(A)</enum><header>New investigator</header><text display-inline="yes-display-inline">The term <term>new investigator</term> has the meaning given the term <term>new investigator</term> by the Secretary for purposes of administering title III of the Public Health Service Act (42 U.S.C. 241 et seq.), but only with respect to musculoskeletal health research.</text></subparagraph>
<subparagraph commented="no" id="HAA83F0A8598E4DCDA5FB9E16894E24C8"><enum>(B)</enum><header>Race; ethnicity</header><text display-inline="yes-display-inline">The terms <term>race</term> and <term>ethnicity</term> have the meaning given such terms by the Office of Management and Budget for purposes of Federal statistics and administrative reporting.</text></subparagraph></paragraph></subsection></section>
<section id="HA6E8B4E586F94716BB8B74ED958F2900"><enum>103.</enum><header>Musculoskeletal trauma research and care</header>
<subsection commented="no" id="H57DEB23CFD7F4C7DA318359301E59341"><enum>(a)</enum><header> Musculoskeletal trauma research</header>
<paragraph id="H38F6CD503FFE44F7B52B76C5D654FB40"><enum>(1)</enum><header>Report</header><text>Not later than 2 years after the date of enactment of this Act, the Secretary shall prepare and submit to Congress a report on all programs and activities relating to musculoskeletal trauma care that are being conducted by the Federal Government or supported by funding made available by Federal Government.</text></paragraph>
<paragraph id="H81569AFBCE694BE9B8F0903EC31110C7"><enum>(2)</enum><header>Contents of Report</header><text>Such report shall include, at a minimum, the following:</text>
<subparagraph commented="no" id="H35BD207EA3F44BF8A74269C3A4DE786"><enum>(A)</enum><text display-inline="yes-display-inline">Information on the status of each Federal program and activity referred to in <internal-xref idref="H38F6CD503FFE44F7B52B76C5D654FB40" legis-path="103.(a)(1)">paragraph (1)</internal-xref>, including specific information on any research program and activity.</text></subparagraph>
<subparagraph commented="no" id="H225DA4FA74C84BDA94B678AC5575B5C8"><enum>(B)</enum><text display-inline="yes-display-inline">Information on the methods being used to coordinate research being conducted under such Federal programs and activities and the effectiveness of such methods.</text></subparagraph></paragraph>
<paragraph id="H00FFA8EF432C43B697EEB1FBCB4F90"><enum>(3)</enum><header>Consultation</header><text display-inline="yes-display-inline">In preparing and submitting the report under <internal-xref idref="H38F6CD503FFE44F7B52B76C5D654FB40" legis-path="103.(a)(1)">paragraph (1)</internal-xref>, the Secretary shall consult with—</text>
<subparagraph id="H3372A4444A494713BD55C3478FD3867B"><enum>(A)</enum><text>the Secretary of Defense; and</text></subparagraph>
<subparagraph id="HEE68ABF24BE44B6BA611A72698AA8E7"><enum>(B)</enum><text>the heads of other Federal departments and agencies that administer programs and activities that are relevant to musculoskeletal trauma care, as determined by the Secretary.</text></subparagraph></paragraph></subsection>
<subsection id="HAD2A06001AF74888B09C660711E81454"><enum>(b)</enum><header>orthopaedic treatment through trauma systems</header>
<paragraph id="H6DC2030AE6834C5785FEBEEFDB27512D"><enum>(1)</enum><header>Study</header><text display-inline="yes-display-inline">The Secretary shall conduct a study on the impact of trauma care systems that connect hospitals with other providers of health care services (including orthopedists) on musculoskeletal health.</text></paragraph>
<paragraph id="H4D07CD8E09CB4D1E9449B9004A800E7"><enum>(2)</enum><header>Purposes of study</header><text>The purposes of the study under <internal-xref idref="H6DC2030AE6834C5785FEBEEFDB27512D" legis-path="103.(b)(1)">paragraph (1)</internal-xref> shall include, at a minimum, the following:</text>
<subparagraph id="HCC51037ECC1E438DBF93CA298CEBE49"><enum>(A)</enum><text>An examination of the provision of acute and rehabilitative care to trauma patients with musculoskeletal conditions or injuries.</text></subparagraph>
<subparagraph id="HC2908469EE8A443E8C2F860224BEB46"><enum>(B)</enum><text>An examination of epidemiological data on trauma patients with musculoskeletal conditions or injuries, including the number of such patients, the number of such conditions and injuries, and the types of such conditions and injuries.</text></subparagraph>
<subparagraph id="H2E431982C6F64A52ABD428534E005D24"><enum>(C)</enum><text>An evaluation of the ability of a patient with an orthopaedic condition or injury originating from musculoskeletal trauma to access specialty care relevant to that condition or injury.</text></subparagraph>
<subparagraph id="H892C5A7B1DDF4B839CB067968BCB5594"><enum>(D)</enum><text>An examination of the impact of trauma rehabilitation care on musculoskeletal health and the ability of trauma patients with musculoskeletal conditions or injuries to access postacute rehabilitative services.</text></subparagraph></paragraph>
<paragraph id="H50059E0778B640F8A7AB9D2278B54000"><enum>(3)</enum><header>Report</header><text>Not later than 2 years after the date of enactment of this Act, the Secretary shall submit to Congress a report on the results of the study under <internal-xref idref="H6DC2030AE6834C5785FEBEEFDB27512D" legis-path="103.(b)(1)">paragraph (1)</internal-xref>, including recommendations for improving the treatment of trauma patients with musculoskeletal injuries.</text></paragraph></subsection></section>
<section id="H0FFACC1F77C045A2B0E4792558D4FD42"><enum>104.</enum><header>Transplants, tissues, and replacement joints</header>
<subsection commented="no" id="H5F89563C1A144B798500FC6C7B1ED77B"><enum>(a)</enum><header>Transplantation Transmission Sentinel Network</header><text display-inline="yes-display-inline">Section 372(b)(2) of the Public Health Service Act (42 U.S.C. 274(b)(2)) is amended—</text>
<paragraph commented="no" id="HCF5CAA65829C4B939BA8BF54DD1D6138"><enum>(1)</enum><text>in subparagraph (N) by striking <quote>and</quote> at the end;</text></paragraph>
<paragraph id="H22C513218CAB4F65A3C91987EC48D965"><enum>(2)</enum><text display-inline="yes-display-inline">in subparagraph (O) by striking the period at the end and inserting <quote>, and</quote>; and</text></paragraph>
<paragraph commented="no" id="H0A8B548C5A74470AA331731FB9A1DBA3"><enum>(3)</enum><text>by adding at the end the following:</text>
<quoted-block display-inline="no-display-inline" id="HF00A1AEC824A4F66987152BD5B82652B" style="OLC">
<subparagraph id="H6F3C3624073C4FE48803438DE013A1EE"><enum>(P)</enum><text display-inline="yes-display-inline">establish and operate a national Web-based system, to be known as the <quote>Transplantation Transmission Sentinel Network</quote>, for the detection, reporting, and tracking of disease transmission from organ, tissue, or eye donors to organ, tissue and eye transplant recipients.</text></subparagraph><after-quoted-block>. </after-quoted-block></quoted-block></paragraph></subsection>
<subsection commented="no" display-inline="no-display-inline" id="H03F6E52076334D05A6E221F4C4002890"><enum>(b)</enum><header>Accreditation of establishments and personnel engaged in the manufacture of human cells, tissues, or cellular or tissue-based products</header>
<paragraph commented="no" display-inline="no-display-inline" id="H82DBAD6033A240B40065FB316083C2DD"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary shall issue regulations relating to the accreditation of—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="H3B0BBFFC32634DD6B4CE6DFFEFF52F63"><enum>(A)</enum><text display-inline="yes-display-inline">establishments; and</text></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="HAF3D78BAA28D4F9982839108F0B7111B"><enum>(B)</enum><text display-inline="yes-display-inline">personnel who participate in the recovery, processing, storage, labeling, packaging, or distribution of human cells, tissues, or cellular or tissue-based products for such establishments.</text></subparagraph></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="HA7DF9071FB714B01A2D22B4D2C59B2A9"><enum>(2)</enum><header>Authority of Secretary</header><text display-inline="yes-display-inline">In issuing the regulations under paragraph (1), the Secretary shall—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="H6A1F4EEEBE1841BEB1B8C07FA91E4FF3"><enum>(A)</enum><text display-inline="yes-display-inline">establish an accreditation process modeled after the Joint Commission (previously known as the Joint Commission on Accreditation of Healthcare Organizations); or</text></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="HCE45BC220ABC415F00C9693D2253C8E"><enum>(B)</enum><text display-inline="yes-display-inline">adopt an accreditation process established by a private entity that is in effect on the date of enactment of this Act.</text></subparagraph></paragraph>
<paragraph id="H039CC4405BD94F21975000A3E679B42C"><enum>(3)</enum><header>Definitions</header><text>For purposes of this subsection, the following definitions apply:</text>
<subparagraph commented="no" display-inline="no-display-inline" id="HF071D3D598C9464B9863D2D18D7C248E"><enum>(A)</enum><header>Establishment</header><text display-inline="yes-display-inline">The term <term>establishment</term> has the meaning given such term in section 1271.3 of title 21, Code of Federal Regulations (or any successor regulation).</text></subparagraph>
<subparagraph commented="no" display-inline="no-display-inline" id="HE08CBF9BA5D04E32A6B790639FB3CF8"><enum>(B)</enum><header>Human cells, tissues, or cellular or tissue-based products</header><text display-inline="yes-display-inline">The term <term>human cells, tissues, or cellular or tissue-based products</term> has the meaning given such term in section 1271.3 of title 21, Code of Federal Regulations (or any successor regulation).</text></subparagraph></paragraph></subsection>
<subsection id="H72D977AC9D164394B67FC7C3E4E9648F"><enum>(c)</enum><header>National Joint Replacement Registry Study</header>
<paragraph id="H6B6C7EB85E614368A714D99F662390CC"><enum>(1)</enum><header>Study</header><text>The Secretary shall conduct a study evaluating the advantages and disadvantages of establishing a national registry for the purpose of tracking the safety and effectiveness of artificial joints used to replace joints in beneficiaries of the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).</text></paragraph>
<paragraph id="H1D1FA14DD70A4BD398F65EFD9C91738C"><enum>(2)</enum><header>Contents of proposed Registry</header><text>In evaluating the proposed registry under <internal-xref idref="H6B6C7EB85E614368A714D99F662390CC" legis-path="104.(c)(1)">paragraph (1)</internal-xref>, the Secretary shall assume that the registry includes, at a minimum, information on—</text>
<subparagraph id="HCAA2B6A9B1984CC6AB48B206383C6B1F"><enum>(A)</enum><text>the type of joint replaced;</text></subparagraph>
<subparagraph id="H941B1A9078E4499F8029589008B8A6B4"><enum>(B)</enum><text>the side of the body on which the joint is replaced;</text></subparagraph>
<subparagraph id="H7F9E7A3031414C1687FB5F438E9358DD"><enum>(C)</enum><text>whether more than one operation was required in connection with an artificial joint replacement; and</text></subparagraph>
<subparagraph id="H5D3FB5455421451F9B8800E8F009F90"><enum>(D)</enum><text>uniform identifiers for the artificial joint (including the device lot number and catalog number).</text></subparagraph></paragraph>
<paragraph display-inline="no-display-inline" id="H9C90D91FDF6A40C8A8706FEAEB69DA75"><enum>(3)</enum><header>Report</header><text display-inline="yes-display-inline">Not later than 2 years after the date of enactment of this Act, the Secretary shall submit to Congress a report on the results of the study under <internal-xref idref="H6B6C7EB85E614368A714D99F662390CC" legis-path="104.(c)(1)">paragraph (1)</internal-xref> and recommendation for changes to the Medicare program, including any necessary changes to the Medicare claims form, to allow for the collection of information required for the registry.</text></paragraph></subsection></section>
<section display-inline="no-display-inline" id="H545208A3639E468B953ECCAFA9CD02B" section-type="subsequent-section"><enum>105.</enum><header>Traffic and workplace safety</header>
<subsection id="H1821B6DEF0054876BD57B520D7BE9CE4"><enum>(a)</enum><header>Traffic Safety Study</header>
<paragraph id="H380922CEAEDF4FAC8C62280067FFD5E5"><enum>(1)</enum><header>Study</header><text display-inline="yes-display-inline">The Secretary, in consultation with the Secretary of Transportation, shall conduct a study, using epidemiological methods, on the frequency, severity, and likely causes of severe trauma to extremities resulting from motor vehicle crashes.</text></paragraph>
<paragraph id="H6A11035043574B128B6BC1121E418E3F"><enum>(2)</enum><header>Report</header><text display-inline="yes-display-inline">Not later than 2 years after the date of enactment of this Act, the Secretary shall submit to Congress a report on the results of the study under paragraph (1).</text></paragraph>
<paragraph commented="no" id="H6F71B6B65ABD4A028D69F23C0671036E"><enum>(3)</enum><header>Motor vehicle defined</header><text>For purposes of this subsection, the term <term>motor vehicle</term> has the meaning given such term in section 405 of title 23, United States Code.</text></paragraph></subsection>
<subsection id="H89C01AD84A0641FB841DE38E1934009B"><enum>(b)</enum><header>Workplace Safety Study</header>
<paragraph id="HF3F5C3AFED084B75B1BD19AC50AE10F8"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary, in consultation with the Secretary of Labor, shall conduct a study, within the research framework of the National Occupational Research Agenda coordinated by the National Institute for Occupational Safety and Health, on—</text>
<subparagraph id="H4FDB875082D44A09952D712646B90052"><enum>(A)</enum><text>the number of workplace-related musculoskeletal injuries and conditions; and</text></subparagraph>
<subparagraph id="H8655A311DA7146ECB0F77DD689C94F1C"><enum>(B)</enum><text>medical treatments provided to individuals to treat such injuries and conditions.</text></subparagraph></paragraph>
<paragraph id="HD76577E429BF42C19EACD08B4C5EE326"><enum>(2)</enum><header>Collection methodology</header><text>In conducting the study under <internal-xref idref="HF3F5C3AFED084B75B1BD19AC50AE10F8" legis-path="105.(b)(1)">paragraph (1)</internal-xref>, the Secretary shall collect information in a manner that allows such information to be reported based on the type of musculoskeletal injury or condition and the race and ethnicity of the individual with such injury or condition.</text></paragraph>
<paragraph commented="no" id="H5BB64E6EF0D84E7494D083953699151"><enum>(3)</enum><header>Request for information from State Workers Compensation Boards</header><text>The Secretary may request that the head of each State agency that has jurisdiction over workers compensation submit information relevant to the study under <internal-xref idref="HF3F5C3AFED084B75B1BD19AC50AE10F8" legis-path="105.(b)(1)">paragraph (1)</internal-xref> to the Secretary.</text></paragraph>
<paragraph id="HF497D5DFCB8A40C0B4CEE831B863C997"><enum>(4)</enum><header>Report</header><text display-inline="yes-display-inline">Not later than 2 years after the date of enactment of this Act, the Secretary shall submit to Congress a report on the results of the study under <internal-xref idref="HF3F5C3AFED084B75B1BD19AC50AE10F8" legis-path="105.(b)(1)">paragraph (1)</internal-xref>, categorized by type of injury or condition and race and ethnicity.</text></paragraph></subsection></section>
<section display-inline="no-display-inline" id="H0CCD15EFCDD84D969E753DCB6ED2AF39" section-type="subsequent-section"><enum>106.</enum><header>Public education campaign</header>
<subsection id="H63308ED854984EFA8E824EF1B7562C64"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary, in consultation with the Secretary of Education, the Secretary of Transportation, the Consumer Product Safety Commission, and the Chair of the President’s Council on Physical Fitness and Sports, shall conduct a national public awareness program on musculoskeletal health.</text></subsection>
<subsection id="H13136C9D124C454597B413C0C93127A9"><enum>(b)</enum><header>Contents of program</header><text>The program shall include, at a minimum, the following components:</text>
<paragraph id="H32D763D39DAA476CA20219767E51FD7F"><enum>(1)</enum><header>General information for the public</header><text display-inline="yes-display-inline">A component providing education to the general public on musculoskeletal health, including education on healthy lifestyle practices relating to musculoskeletal health.</text></paragraph>
<paragraph id="HB97AE18664674A4CB6F0A3203662D9DC"><enum>(2)</enum><header>Education for health professionals</header><text>A component providing education to health professionals on musculoskeletal health, including—</text>
<subparagraph id="H978B519B14774640B37832778F3BF081"><enum>(A)</enum><text>specific information on musculoskeletal health in medically underserved populations (as defined in section 330(b)(3) of the Public Health Service Act (42 U.S.C. 254b(b)(3))); and</text></subparagraph>
<subparagraph id="H3D523AC203414970B9C7FC121F7B986F"><enum>(B)</enum><text>the impact of musculoskeletal diseases and conditions on racial and ethnic minority populations.</text></subparagraph></paragraph>
<paragraph display-inline="no-display-inline" id="H9964505DA825432E83C300C00093B4A"><enum>(3)</enum><header>Education for girls</header><text display-inline="yes-display-inline">A component that utilizes the program popularly known as <quote>powerful bones, powerful girls</quote> to educate girls between 9 and 12 years of age on optimal bone health and the methods to achieve such health, with a focus on reducing the risk that such girls will develop osteoporosis as adults.</text></paragraph>
<paragraph id="H074EB68B8F504044B279AEA1D78B2600"><enum>(4)</enum><header>Education for special populations</header><text>A component providing education to the following populations that address the specific needs of those populations:</text>
<subparagraph id="HA0B2726E620940F180A45012718CB381"><enum>(A)</enum><text>Populations of the United States that have disproportionately high levels of musculoskeletal disease and injury.</text></subparagraph>
<subparagraph id="H674370DA37A3466DB1A6D792F00F7B2"><enum>(B)</enum><text>Populations of the United States that have disproportionally low levels of access to orthopaedic services.</text></subparagraph>
<subparagraph id="H79F5847D90724248B5F023CF3E7EE1F7"><enum>(C)</enum><text display-inline="yes-display-inline">Racial and ethnic minority populations of the United States.</text></subparagraph></paragraph></subsection></section>
<section display-inline="no-display-inline" id="H8EC5A92867B5446AB644B000ADF34619" section-type="subsequent-section"><enum>107.</enum><header>Orthopaedic physician workforce training study</header>
<subsection id="HBC2C097F9197438A8C845346CFAE89"><enum>(a)</enum><header>Study</header><text>The Secretary, acting through the Administrator of the Health Resource Services Administration, shall conduct a study on the amount of funding available for graduate medical education in orthopaedics from all sources and the impact of that amount of funding on the availability of physicians trained in orthopaedics.</text></subsection>
<subsection id="H80709836CD9C4081AE79AFF2878ECBE0"><enum>(b)</enum><header>Report</header><text display-inline="yes-display-inline">Not later than 2 years after the date of enactment of this Act, the Secretary shall submit to Congress a report on the results of the study under <internal-xref idref="HBC2C097F9197438A8C845346CFAE89" legis-path="107.(a)">subsection (a)</internal-xref>.</text></subsection></section>
<section id="H79F51FE427C2468ABD9291858871F576"><enum>108.</enum><header>Bone density under the Medicare Program</header>
<subsection id="H6F9C214074484AA6B11D067D22B131A8"><enum>(a)</enum><header>Standard measurement tool for Bone Density study</header>
<paragraph id="H0E49B26BB4AC4867B88BC2180200E8A1"><enum>(1)</enum><header>Study</header><text display-inline="yes-display-inline">The Secretary, in consultation with the Director of the Agency for Healthcare Research and Quality, the Director of the National Institute of Biomedical Imaging and Bioengineering, and the Administrator of the Centers for Medicare & Medicaid Services, shall conduct a study on—</text>
<subparagraph id="HBF8704D301BF432784FC26C35C00E127"><enum>(A)</enum><text>the cost-effectiveness of all available methods for measuring bone mass in beneficiaries of the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) for the purpose of identifying the most cost-effective method;</text></subparagraph>
<subparagraph id="HE8D5636A27F34ED5A876D1C2FE7199F9"><enum>(B)</enum><text>the cost-effectiveness of different time intervals between each bone mass screening for each such beneficiary for the purpose of identifying the most cost-effective interval;</text></subparagraph>
<subparagraph id="HF49A2C0777EE47E581CAF4F70750054"><enum>(C)</enum><text display-inline="yes-display-inline">the frequency with which the cost-effectiveness of such methods and intervals should be reviewed based on anticipated changes in technology.</text></subparagraph></paragraph>
<paragraph id="HADAAC1406CEB4E85A66C75EDCECE6410"><enum>(2)</enum><header>Report</header>
<subparagraph id="H336E3E94D9234196A45980256C360668"><enum>(A)</enum><header>In general</header><text>Not later than 2 years after the date of enactment of this Act, the Secretary shall submit to Congress and the Secretary of Commerce a report on the results of the study under <internal-xref idref="H0E49B26BB4AC4867B88BC2180200E8A1" legis-path="108.(a)(1)">paragraph (1)</internal-xref>.</text></subparagraph>
<subparagraph id="H66DDC6E4DBEB413A9F968F592EA76397"><enum>(B)</enum><header>Contents of Report</header><text>The report under <internal-xref idref="H336E3E94D9234196A45980256C360668" legis-path="108.(a)(2)(A)">subparagraph (A)</internal-xref> shall include, at a minimum, the following:</text>
<clause id="H185F09FE292D4EFAA73C25D43C395852"><enum>(i)</enum><text>The most cost-effective method for measuring bone mass in beneficiaries of the Medicare program and a recommendation for the adoption of such method by the Medicare program.</text></clause>
<clause id="H01C7DDC1E55C428EBDF51D11C2F555D8"><enum>(ii)</enum><text>The most cost-effective interval between bone mass screenings for such beneficiaries and recommendation for the adoption of such interval by the Medicare program.</text></clause></subparagraph></paragraph>
<paragraph id="HCE5B857E81A84F2E866942E229F660A9"><enum>(3)</enum><header>United States Preventive Services Task Force</header><text>In making the recommendations under <internal-xref idref="H66DDC6E4DBEB413A9F968F592EA76397" legis-path="108.(a)(2)(B)">paragraph (2)(B)</internal-xref>, the Secretary shall take into consideration any relevant guidelines in the most recent Guide to Clinical Preventive Services by the United States Preventive Services Task Force.</text></paragraph>
<paragraph id="HE531E997028E45D6B04E31B4F9C04048"><enum>(4)</enum><header>Revisions to recommendations</header><text display-inline="yes-display-inline">The Secretary shall monitor developments in technology used to measure bone density and prepare and submit to Congress and the Secretary of Commerce reports updating the recommendations made under <internal-xref idref="H66DDC6E4DBEB413A9F968F592EA76397" legis-path="108.(a)(2)(B)">paragraph (2)(B)</internal-xref>, as needed.</text></paragraph></subsection>
<subsection id="HA5F37F9ECC7E49BDA1D821F2378BE1B2"><enum>(b)</enum><header>Standard unit for measuring bone density</header>
<paragraph id="HB8D05E86B3114D17B207CB0006F7ECD4"><enum>(1)</enum><header>Report</header><text>Not later than three years after the date of enactment of this Act, the Secretary of Commerce, acting through the Director of the National Institutes of Standards and Technology, shall prepare and submit to Congress a report on recommendations concerning a standard unit for the measurement of bone mass for use by the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).</text></paragraph>
<paragraph id="HA2C9B829EEAF492DB365C93689A07EFE"><enum>(2)</enum><header>Considerations for recommendations</header><text>In proposing the recommendations under <internal-xref idref="HB8D05E86B3114D17B207CB0006F7ECD4" legis-path="108.(b)(1)">paragraph (1)</internal-xref>, the Secretary of Commerce shall take into consideration the recommendations made under <internal-xref idref="H66DDC6E4DBEB413A9F968F592EA76397" legis-path="108.(a)(2)(B)">subsection (a)(2)(B)</internal-xref>, including any applicable updates to such recommendations made under <internal-xref idref="HE531E997028E45D6B04E31B4F9C04048" legis-path="108.(a)(4)">subsection (a)(4)</internal-xref>, and the accuracy and utility of the recommended standard measurement unit as a diagnostic tool.</text></paragraph></subsection></section>
<section id="H69ED5686BC7144049E1BCB00EACDF63"><enum>109.</enum><header>Access to orthopaedic services for beneficiaries of Medicaid and SCHIP</header>
<subsection id="HFE162B87DE0547FD8DE3D8E650C1F6A1"><enum>(a)</enum><header>Report</header><text display-inline="yes-display-inline">Not later than 2 years after the date of enactment of this Act, the Comptroller General of the United States shall prepare and submit a report to Congress on access to orthopaedic services—</text>
<paragraph id="HE3BC7D9988EA437A8CF54147C622D767"><enum>(1)</enum><text>by beneficiaries of the Medicaid program under title XIX of the Social Security Act (42 U.S.C. 1396a et seq.); and</text></paragraph>
<paragraph id="H6AD59A9D72B743A4BDBE21740088C118"><enum>(2)</enum><text>by beneficiaries of the State Children’s Health Insurance program under title XXI of the Social Security Act (42 U.S.C. 1397aa et seq.).</text></paragraph></subsection>
<subsection id="H88D5D4591DBB42B68CD015000357143B"><enum>(b)</enum><header>Focus on barriers To access affecting children</header><text>The report under this section shall include, at a minimum, information on barriers to access to orthopaedic services that disproportionately affect children who are beneficiaries of the Medicaid program or the State Children’s Health Insurance program.</text></subsection></section>
<section id="H70DD129F6A544429A8BA00369E01C28E"><enum>110.</enum><header>Age-related programs</header>
<subsection commented="no" id="H6FB75CC8E5F340E08D989FACC76C65FF"><enum>(a)</enum><header>State-based Examples of Network Innovation, Opportunity, and Replication Grant Program</header><text display-inline="yes-display-inline">The Secretary shall award grants to State agencies in a manner similar to the manner in which grants were awarded under the program of the Department of Health and Human Services popularly known as the <quote>State-based Examples of Network Innovation, Opportunity, and Replication Grant Program</quote> for the purpose of allowing such State agencies to establish or expand health and aging activities for seniors in the areas of clinical preventive services, physical activity, chronic disease self-management, and oral health.</text></subsection>
<subsection id="H7EBEF43ECF464053AA3FD2943B354652"><enum>(b)</enum><header>Childhood musculoskeletal diseases, conditions, and injuries report</header><text>Not later than 2 years after the date of enactment of this Act, the Surgeon General of the Public Health Service shall prepare and submit to Congress a report on the burdens and costs associated with childhood musculoskeletal diseases, conditions, and injuries in the United States.</text></subsection></section>
<section display-inline="no-display-inline" id="H3C91A72016A84165A52FB6E2004B60A6" section-type="subsequent-section"><enum>111.</enum><header>Minority health disparities</header><text display-inline="no-display-inline">The Secretary, acting through the Deputy Assistant Secretary for Minority Health, shall treat musculoskeletal diseases and conditions as a priority for programs and grants affiliated with the Office of Minority Health and may incorporate musculoskeletal diseases and conditions into the initiatives of such Office.</text></section>
<enum>II</enum><header>Third longitudinal study on aging</header>
<section id="H33A7A5B2C6BC4C3C839E005EADC2FB31"><enum>201.</enum><header>Third longitudinal study on aging</header>
<subsection display-inline="no-display-inline" id="H49563382C48B4A2E9BDA5766CBD8A315"><enum>(a)</enum><header>In general</header><text>The Secretary, acting through the Director of the National Center for Health Statistics and in consultation with the Director of the National Institute on Aging, shall conduct a third longitudinal study on aging in the United States in a manner similar to the manner in which the second longitudinal study on aging was conducted.</text></subsection>
<subsection id="HD5016814FACD44609EEA0FDCB2CDFBD"><enum>(b)</enum><header>Duration</header><text display-inline="yes-display-inline">The duration of the third longitudinal study under <internal-xref idref="H49563382C48B4A2E9BDA5766CBD8A315" legis-path="201.(a)">subsection (a)</internal-xref> shall be at least 6 years.</text></subsection>
<subsection id="H10E102DEAE9D4056B0FA8341B8308246"><enum>(c)</enum><header>Availability of data</header><text>Data collected through the third longitudinal study under <internal-xref idref="H49563382C48B4A2E9BDA5766CBD8A315" legis-path="201.(a)">subsection (a)</internal-xref> shall be made available to the public in a time and manner similar to the time and manner in which data from the second longitudinal study on aging was made available to the public.</text></subsection></section>