[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[S. 1096 Introduced in Senate (IS)]

112th CONGRESS
  1st Session
                                S. 1096

 To amend title XVIII of the Social Security Act to improve access to, 
 and utilization of, bone mass measurement benefits under the Medicare 
 part B program by extending the minimum payment amount for bone mass 
              measurement under such program through 2013.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 26, 2011

Ms. Snowe (for herself, Ms. Stabenow, Ms. Mikulski, Mr. Cardin, and Mr. 
    Wicker) 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 utilization of, bone mass measurement benefits under the Medicare 
 part B program by extending the minimum payment amount for bone mass 
              measurement under such program through 2013.

    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 ``Preservation of Access to 
Osteoporosis Testing for Medicare Beneficiaries Act of 2011''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Since 1997, Congress has recognized the importance of 
        osteoporosis prevention by standardizing coverage under the 
        Medicare program for bone mass measurement.
            (2) Osteoporosis remains underdiagnosed and undertreated 
        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 education, counseling, and referral for bone 
        mass measurement during 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, from 2005 to 2025 the cost of fractures 
        among other populations is projected to increase by 175 percent 
        for Latinos and Asian-Americans and 80 percent for African-
        Americans.
            (5) African-American women are more likely than Caucasian 
        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 and the incidence of 
        osteoporosis-related fractures is greater than the annual 
        combined incidence, with respect to women, of heart attack, 
        stroke, and breast cancer.
            (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 
        section referred to as ``DXA''). Vertebral fracture assessment 
        (in this section 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 people diagnosed with osteoporosis and treated, 
        dramatically reducing hip fractures and related costs.
            (9) DXA screening is associated with a significant (37 
        percent) reduction in hip fracture rates.
            (10) Unlike other imaging procedures, DXA remains severely 
        underutilized, with only one in four women enrolled in the 
        Medicare program getting a DXA every two years.
            (11) Underutilization of bone mass measurement will strain 
        the Medicare budget because--
                    (A) over half of all individuals in the United 
                States who are age 50 or older have osteoporosis or low 
                bone mass;
                    (B) more than 52.4 million people in the United 
                States had osteoporosis or low bone mass in 2010, as 
                compared to 44 million people in the United States in 
                2002;
                    (C) osteoporosis fractures are projected to 
                increase by almost 50 percent from 2005 to 2025 with 
                over 3 million 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 nearly 50 percent from 2005 
                to 2025, reaching 25.3 million in 2025.
            (12) Underutilization of bone mass measurement will also 
        strain the Medicaid budget, which bears the cost of nursing 
        home admissions for hip fractures for low-income Americans.
            (13) 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 2013. 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 2013.
            (14) The reduction in reimbursement discourages physicians 
        from continuing to provide access to DXA or VFA in their 
        offices. DXA testing for older women declined in 2009 for the 
        first time since Congress passed the Bone Mass Measurement Act 
        in 1997. Since two-thirds of all DXA scans are performed in 
        non-facility settings, such as physician offices, patient 
        access to bone mass measurement will continue to be severely 
        compromised when more physicians discontinue providing such 
        tests in their offices, thereby exacerbating the current 
        underutilization of the benefit.

SEC. 3. EXTENDING MINIMUM PAYMENT FOR BONE MASS MEASUREMENT.

    (a) In General.--Section 1848 of the Social Security Act (42 U.S.C. 
1395w-4) is amended--
            (1) in subsection (b)--
                    (A) in paragraph (4)(B), by striking ``for 2010 and 
                2011'' and inserting ``for each of 2010 through 2013''; 
                and
                    (B) in paragraph (6)--
                            (i) in the matter preceding subparagraph 
                        (A), by striking ``and 2011'' and inserting ``, 
                        2011, 2012, and 2013''; and
                            (ii) in subparagraph (C), by striking ``and 
                        2011'' and inserting ``, 2011, 2012, and 
                        2013''; and
            (2) in subsection (c)(2)(B)(iv)(IV), by striking ``or 
        2011'' and inserting ``, 2011, 2012, or 2013''.
    (b) Implementation.--Notwithstanding any other provision of law, 
the Secretary may implement the amendments made by subsection (a) by 
program instruction or otherwise.
                                 <all>