[Congressional Record Volume 143, Number 29 (Monday, March 10, 1997)]
[Extensions of Remarks]
[Page E417]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




         STANDARDIZE MEDICARE COVERAGE FOR BONE DENSITY TESTING

                                 ______
                                 

                       HON. CONSTANCE A. MORELLA

                              of maryland

                    in the house of representatives

                         Monday, March 10, 1997

  Mrs. MORELLA. Mr. Speaker, osteoporosis is a major public health 
problem affecting 28 million Americans, who either have the disease or 
are at risk due to low bone mass; 80 percent are women. The disease 
causes 1.5 million fractures annually at a cost of $13.8 billion--$38 
million per day--in direct medical expenses, and osteoporotic fractures 
cost the Medicare Program 3 percent of its overall costs. In their 
lifetimes, one in two women and one in eight men over the age of 50 
will fracture a bone due to osteoporosis. A woman's risk of a hip 
fracture is equal to her combined risk of contracting breast, uterine, 
and ovarian cancer.
  Osteoporosis is largely preventable and thousands of fractures could 
be avoided if low bone mass was detected early and treated. We now have 
drugs that promise to reduce fractures by 50 percent. However, 
identification of risk factors alone cannot predict how much bone a 
person has and how strong bone is. Experts estimate that without bone 
density tests, up to 40 percent of women with low bone mass could be 
missed.
  Unfortunately, Medicare's coverage of bone density tests is 
inconsistent. Instead of national coverage of scientifically approved 
types of bone density tests, Medicare leaves decisions to local 
Medicare insurance carriers. The definition of who is qualified to 
receive a bone mass measurement varies from carrier to carrier. Some 
carriers require beneficiaries to have suffered substantial bone loss 
before allowing coverage for a bone density test. For example, in about 
20 States, the carriers require x-ray proof of low bone mass or other 
abnormalities. Unfortunately, standard x-ray tests do not reveal 
osteoporosis until 25 to 40 percent of bone mass has been lost.
  One carrier allows a premenopausal woman to have a DXA test to 
determine whether hormone replacement therapy [HRT] is indicated. 
However, it does not allow the test to determine treatment for the 
postmenopausal women--the majority of Medicare beneficiaries. Other 
carriers have no specific rules to guide reimbursement and cover the 
tests on a haphazard case-by-case basis.
  Frequency of testing also varies from carrier to carrier. Retesting 
is important to monitor treatment, yet only eight States specifically 
allow coverage for people who are under treatment for osteoporosis.
  Inconsistency of bone mass measurement coverage policy is confusing 
and unfair to beneficiaries. Today, Congresswoman Nancy Johnson and I, 
along with 23 of our colleagues, are introducing the Medicare Bone Mass 
Measurement Coverage Standardization Act. The bill would eliminate the 
confusion and standardize Medicare's coverage of bone mass measurement 
tests in order to avoid some of the 1.5 million fractures caused 
annually by osteoporosis. Considering that bone density tests are 
already covered by every Medicare carrier, this bill will not add 
significantly to the cost of the Medicare Program.
  I urge my colleagues to join us as cosponsors of this important 
legislation.

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