[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 769 Introduced in Senate (IS)]
111th CONGRESS
1st Session
S. 769
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 SENATE OF THE UNITED STATES
April 1, 2009
Mrs. Lincoln (for herself, Ms. Snowe, Mr. Whitehouse, Ms. Stabenow, and
Mrs. Feinstein) introduced the following bill; which was read twice and
referred to the Committee on Finance
_______________________________________________________________________
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 2009''.
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) DXA is a cost-effective preventive test with proven
results in real world settings. DXA testing increases the
number of individuals who are diagnosed and treated, resulting
in a dramatic reduction in hip fractures and related costs.
(9) Unlike other imaging procedures, DXA remains severely
underutilized with only 1 in 4 women taking advantage of the
benefit every 2 years.
(10) 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
is projected to increase by 50 percent over the next 2
decades, reaching $25,300,000,000 in 2025.
(11) Underutilization of bone mass measurement will also
strain the Medicaid budget, which funds treatment for
osteoporosis in low-income Americans.
(12) Reimbursement under the Medicare program for DXA
provided in physician offices and other non-hospital settings
was reduced by 50 percent and is scheduled to be reduced by a
total of 62 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 30
percent by 2010.
(13) 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)), as amended by section 144 of the Medicare
Improvements for Patients and Providers Act of 2008 (Public Law 110-
275), is amended by adding at the end the following new paragraph:
``(6) 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, 2010.
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, and the quality of,
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 to
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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