[Congressional Record Volume 143, Number 50 (Thursday, April 24, 1997)]
[Senate]
[Pages S3676-S3683]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. SNOWE (for herself, Mr. Grassley, Mr. Glenn, Mr. D'Amato, 
        Mr. Inouye, Mr. Rockefeller and Mr. Mack):
  S. 649. A bill to amend title XVIII of the Social Security Act to 
provide for coverage of bone mass measurements for certain individuals 
under part B of the Medicare program; to the Committee on Finance.


         the bone mass measurement standardization act of 1997

 Ms. SNOWE. Mr. President, today I am introducing the Bone Mass 
Measurement Standardization Act of 1997.
  Millions of women in their post-menopausal years face a silent 
killer, a stalker disease we know as osteoporosis. This unforgiving 
bone disease afflicts 28 million Americans; causes 50,000 deaths each 
year; 1.5 million bone fractures annually; and the direct medical costs 
of osteoporosis fracture patients are $13.8 billion each year, or $38 
million every single day. This cost is projected to reach $60 billion 
by the year 2020 and $240 billion by the year 2040 if medical research 
has not discovered an effective treatment.
  The facts also show that one out of every two women have a lifetime 
risk of bone fractures due to osteoporosis, and that it affects half of 
all women over the age of 50 and an astounding 90% of all women over 
75. Perhaps the most tragic consequences of osteoporosis occur with the 
300,000 individuals annually who suffer a hip fracture. Twelve to 
thirteen percent of these persons will die within six months following 
a hip fracture, and of those who survive, 20% will never walk again, 
and 20% will require nursing home care--often for the rest of their 
lives.
  We all know that osteoporosis cannot be cured, although with a 
continued commitment to research in this area I remain hopeful that we 
will find one. We also know that once bone mass is lost, it cannot be 
replaced. Therefore, early detection is our best weapon because it is 
only through early detection that we can thwart the progress of the 
disease and initiate preventive efforts to stop further loss of bone 
mass.
  Bone mass measurement can be used to determine the status of a 
person's bone health and to predict the risk of future fractures. These 
tests are safe, painless, accurate and quick. Our expanding technology 
is adding new methods to determine bone mass and we need to keep up 
with this technology. The most commonly used test currently is DXA 
(Dual energy X-ray Absorptiometry).
  In order to ensure that we detect bone loss early, we need to ensure 
that older women have coverage for bone mass tests. Unfortunately, 
Medicare coverage is inconsistent in its coverage depending on where an 
individual resides. Instead of national coverage of the DXA test, 
Medicare leaves coverage 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-rays do not reveal osteoporosis until 25 to 
40 percent of bone mass has been lost.

  One carrier allows pre-menopausal women to have a DXA test to 
determine whether hormone replacement therapy is indicated. However, it 
does not allow the test to determine treatment for the post-menopausal 
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. Re-testing 
is important to monitor treatment, yet only eight states specifically 
allow coverage for people who are under treatment for osteoporosis.
  This patchwork coverage is confusing to beneficiaries, and means that 
an older woman who lives in one State will be covered, but if she moves 
to another state, she may not be. A woman may also lose coverage if she 
moves to another city within a given State.
  Mr. President, a woman shouldn't have to change zip codes to obtain 
coverage for a preventive test, especially when early intervention is 
the only action we can take right now to slow the loss of bone mass. 
Once it is lost, it cannot be replaced.
  The Medicare Bone Mass Measurement Standardization Act will clarify 
the Medicare coverage policy for DXA testing to make it uniform in all 
states. We all know that an ounce of prevention is worth a pound of 
cure. This bill will ensure that older women, regardless of where they 
live, will have access to bone mass measurement technology that will 
help detect bone loss and allow preventive steps to be taken.

[[Page S3683]]

I urge my colleagues to support this important bill.
 Mr. GRASSLEY. Mr. President, I am pleased to join my colleague 
from Maine, Senator Snowe, to introduce legislation to standardize 
Medicare eligibility for the diagnosis of osteoporosis. It is estimated 
that osteoporosis results in 1.5 million fractures and $20 billion in 
medical costs each year. The Centers for Disease Control and 
Prevention, through the use of 1992 incidence data of bone fractures 
related to osteoporosis, determined that such fractures represent three 
percent of all Medicare costs. A recent report issued by the Alliance 
for Aging Research examined the dramatic savings realized when the 
onset of age-related disability is delayed. The report indicates that 
delaying the onset of osteoporosis by 5 years could save the economy up 
to as much as $10 billion annually.
  In the state of Iowa, 15 percent of men and women over the age of 50, 
which is approximately 340,000 Iowans, have osteoporosis. Women are 
particularly prone to getting osteoporosis, which can lead to bone 
fractures that result in loss of independence and eventually to nursing 
home care. Early detection is critical, and there are effective 
treatments available to prevent bone mass deterioration. An ounce of 
prevention is worth a pound of cure.
  Medicare currently covers bone mass measurement, which is the 
diagnostic tool used to detect osteoporosis. However, Medicare carriers 
have discretion regarding eligibility requirements. States cover bone 
mass measurement on a case-by-case basis; some States cover it when an 
individual is in the early stages of or already has the disease; and 
some States allow early detection of the disease based on whether or 
not the patient is at high risk of developing osteoporosis.
  Medicare carriers in states such as Iowa and Maine promote early 
detection of osteoporosis by covering bone mass measurement for 
individuals at-risk of the disease. However, carriers in more than half 
the States do not allow testing until the person already has the 
disease or is at very high-risk of getting it.
  The legislation I am co-sponsoring with Senator Snowe would help 
reduce the economic and social costs of osteoporosis through early 
detection of this crippling disease. The bill would establish uniform 
eligibility requirements for coverage of bone mass measurement, 
eliminating the variation in Medicare coverage that currently exists. 
It would not require that every individual be screened for the disease, 
only those that are considered at-risk. Medicare is a federal program 
where everyone pays 2.9 percent of their pay. Therefore, everyone 
deserves to have access to the same benefits.
  I congratulate my colleague, Senator Snowe, for taking the lead on 
this very important health issue. I urge my colleagues on both sides of 
the aisle to support this legislation.
                                 ______