[Congressional Record Volume 145, Number 75 (Monday, May 24, 1999)]
[Senate]
[Pages S5849-S5851]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. TORRICELLI (for himself and Ms. Snowe):
  S. 1106. A bill to amend the Public Health Service Act and Employee 
Retirement Income Security Act of 1974 to require that group and 
individual health insurance coverage and group health plans provide 
coverage for qualified individuals for bone mass measurement (bone 
density testing) to prevent fractures associated with osteoporosis; to 
the Committee on Health, Education, Labor, and Pensions.


    early detection and prevention of osteoporosis and related bone 
                          diseases act of 1999

  Mr. TORRICELLI. Mr. President, I rise today to introduce the Early 
Detection and Prevention of Osteoporosis and Related Bone Diseases Act 
of 1999 along with my colleague from Maine, Senator Snowe.
  Osteoporosis and other related bone diseases pose a major public 
health threat. More than 28 million Americans, 80 percent of whom are 
women, suffer from, or are at risk for, osteoporosis. Between three and 
four million Americans suffer from related bone diseases like Paget's 
disease or osteogenesis imperfecta. Today, in the United States, 10 
million individuals already have osteoporosis and 18 million more have 
low bone mass, placing them at increased risk.
  Osteoporosis is often called the ``silent disease'' because bone loss 
occurs without symptoms. People often do not know they have 
osteoporosis until their bones become so weak that a sudden bump or 
fall causes a fracture or a vertebra to collapse. Every year, there are 
1.5 million bone fractures caused by osteoporosis. Half of all women, 
and one-eighth of all men, age 50 or older, will suffer a bone fracture 
due to osteoporosis.
  Osteoporosis is a progressive condition that has no known cure; thus, 
prevention and treatment are key. The Early Detection and Prevention of 
Osteoporosis and Related Bone Diseases Act of 1999 seeks to combat 
osteoporosis, and related bone diseases like Paget's disease by 
requiring private health plans to cover bone mass measurement tests for 
qualified individuals who are at risk for developing osteoporosis.
  Bone mass measurement is the only reliable method of detecting 
osteoporosis in its early stages. The test is non-invasive and painless 
and is as predictive of future fractures as high cholesterol or high 
blood pressure is of heart disease or stroke. This provision is similar 
to a provision in the Balanced Budget Act of 1997 that requires 
Medicare coverage of bone mass measurements.
  Medical experts agree that osteoporosis is preventable. Thus, if the 
toll of osteoporosis and other related bone diseases is to be reduced, 
the commitment to prevention and treatment must be significantly 
increased.
  Last year, Congress reauthorized the Women's Health Research and 
Prevention Act. This legislation authorized $3 million for a national 
resource center to increase public knowledge and awareness of 
osteoporosis, and $40 million for osteoporosis research at the National 
Institutes of Health (NIH). This was an important first step in the 
fight against osteoporosis. Congress must now maintain its commitment 
to prevention by ensuring women have access to bone mass measurement 
tests.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1106

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE; FINDINGS.

       (a) Short Title.--This Act may be cited as the ``Early 
     Detection and Prevention of Osteoporosis and Related Bone 
     Diseases Act of 1999''.
       (b) Findings.--Congress makes the following findings:
       (1) Nature of osteoporosis.--
       (A) Osteoporosis is a disease characterized by low bone 
     mass and structural deterioration of bone tissue leading to 
     bone fragility and increased susceptibility to fractures of 
     the hip, spine, and wrist.
       (B) Osteoporosis has no symptoms and typically remains 
     undiagnosed until a fracture occurs.
       (C) Once a fracture occurs, the condition has usually 
     advanced to the stage where the likelihood is high that 
     another fracture will occur.
       (D) There is no cure for osteoporosis, but drug therapy has 
     been shown to reduce new hip and spine fractures by 50 
     percent and other treatments, such as nutrition therapy, have 
     also proven effective.
       (2) Incidence of osteoporosis and related bone diseases.--
       (A) 28 million Americans have (or are at risk for) 
     osteoporosis, 80 percent of which are women.
       (B) Osteoporosis is responsible for 1.5 million bone 
     fractures annually, including more than 300,000 hip 
     fractures, 700,000 vertebral fractures and 200,000 fractures 
     of the wrists.
       (C) Half of all women, and one-eighth of all men, age 50 or 
     older will have a bone fracture due to osteoporosis.
       (D) Between 3 and 4 million Americans have Paget's disease, 
     osteogenesis imperfecta, hyperparathyroidism, and other 
     related metabolic bone diseases.
       (3) Impact of osteoporosis.--The cost of treating 
     osteoporosis is significant:
       (A) The annual cost of osteoporosis in the United States is 
     $13.8 billion and is expected to increase precipitously 
     because the proportion of the population comprised of older 
     persons is expanding and each generation of older persons 
     tends to have a higher incidence of osteoporosis than 
     preceding generations.
       (B) The average cost in the United States of repairing a 
     hip fracture due to osteoporosis is $32,000.
       (C) Fractures due to osteoporosis frequently result in 
     disability and institutionalization of individuals.
       (D) Because osteoporosis is a progressive condition causing 
     fractures primarily in aging individuals, preventing 
     fractures, particularly for post menopausal women before they 
     become eligible for medicare, has a significant potential of 
     reducing osteoporosis-related costs under the medicare 
     program.
       (4) Use of bone mass measurement.--
       (A) Bone mass measurement is the only reliable method of 
     detecting osteoporosis at an early stage.
       (B) Low bone mass is as predictive of future fractures as 
     is high cholesterol or high blood pressure of heart disease 
     or stroke.
       (C) Bone mass measurement is a non-invasive, painless, and 
     reliable way to diagnose osteoporosis before costly fractures 
     occur.
       (D) Under section 4106 of the Balanced Budget Act of 1997, 
     Medicare provides coverage, effective July 1, 1999, for bone 
     mass measurement for qualified individuals who are at risk of 
     developing osteoporosis.
       (5) Research on osteoporosis and related bone diseases.--
       (A) Technology now exists, and new technology is 
     developing, that will permit the early diagnosis and 
     prevention of osteoporosis and related bone diseases as well 
     as management of these conditions once they develop.
       (B) Funding for research on osteoporosis and related bone 
     diseases is severely constrained at key research institutes, 
     including the National Institute of Arthritis and 
     Musculoskeletal and Skin Diseases, the National Institute on 
     Aging, the National Institute of Diabetics and Digestive and 
     Kidney Diseases, the National Institute of Dental Research, 
     and the National Institute of Child Health and Human 
     Development.
       (C) Further research is needed to improve medical knowledge 
     concerning--
       (i) cellular mechanisms related to the processes of bone 
     resorption and bone formation, and the effect of different 
     agents on bone remodeling;
       (ii) risk factors for osteoporosis, including newly 
     discovered risk factors, risk factors related to groups not 
     ordinarily studied (such as men and minorities), risk factors 
     related to genes that help to control skeletal metabolism, 
     and risk factors relating to the relationship of aging 
     processes to the development of osteoporosis;
       (iii) bone mass measurement technology, including more 
     widespread and cost-effective techniques for making more 
     precise measurements and for interpreting measurements;

[[Page S5850]]

       (iv) calcium (including bioavailability, intake 
     requirements, and the role of calcium in building heavier and 
     denser skeletons), and vitamin D and its role as an essential 
     vitamin in adults;
       (v) prevention and treatment, including the efficacy of 
     current therapies, alternative drug therapies for prevention 
     and treatment, and the role of exercise; and
       (vi) rehabilitation.
       (D) Further educational efforts are needed to increase 
     public and professional knowledge of the causes of, methods 
     for avoiding, and treatment of osteoporosis.

     SEC. 2. REQUIRING COVERAGE OF BONE MASS MEASUREMENT UNDER 
                   HEALTH PLANS.

       (a) Group Health Plans.--
       (1) Public health service act amendments.--
       (A) In general.--Subpart 2 of part A of title XXVII of the 
     Public Health Service Act (42 U.S.C. 300gg-4) is amended by 
     adding at the end the following new section:

     ``SEC. 2707. STANDARDS RELATING TO BENEFITS FOR BONE MASS 
                   MEASUREMENT.

       ``(a) Requirements for Coverage of Bone Mass Measurement.--
     A group health plan, and a health insurance issuer offering 
     group health insurance coverage, shall include (consistent 
     with this section) coverage for bone mass measurement for 
     beneficiaries and participants who are qualified individuals.
       ``(b) Definitions Relating to Coverage.--In this section:
       ``(1) Bone mass measurement.--The term `bone mass 
     measurement' means a radiologic or radioisotopic procedure or 
     other procedure approved by the Food and Drug Administration 
     performed on an individual for the purpose of identifying 
     bone mass or detecting bone loss or determining bone quality, 
     and includes a physician's interpretation of the results of 
     the procedure. Nothing in this paragraph shall be construed 
     as requiring a bone mass measurement to be conducted in a 
     particular type of facility or to prevent such a measurement 
     from being conducted through the use of mobile facilities 
     that are otherwise qualified.
       ``(2) Qualified individual.--The term `qualified 
     individual' means an individual who--
       ``(A) is an estrogen-deficient woman at clinical risk for 
     osteoporosis;
       ``(B) has vertebral abnormalities;
       ``(C) is receiving chemotherapy or long-term 
     gluococorticoid (steroid) therapy;
       ``(D) has primary hyperparathyroidism, hyperthyroidism, or 
     excess thyroid replacement;
       ``(E) is being monitored to assess the response to or 
     efficacy of approved osteoporosis drug therapy;
       ``(F) is a man with a low trauma fracture; or
       ``(G) the Secretary determines is eligible.
       ``(c) Limitation on Frequency Required.--Taking into 
     account the standards established under section 1861(rr)(3) 
     of the Social Security Act, the Secretary shall establish 
     standards regarding the frequency with which a qualified 
     individual shall be eligible to be provided benefits for bone 
     mass measurement under this section. The Secretary may vary 
     such standards based on the clinical and risk-related 
     characteristics of qualified individuals.
       ``(d) Restrictions on Cost-Sharing.--
       ``(1) In general.--Subject to paragraph (2), nothing in 
     this section shall be construed as preventing a group health 
     plan or issuer from imposing deductibles, coinsurance, or 
     other cost-sharing in relation to bone mass measurement under 
     the plan (or health insurance coverage offered in connection 
     with a plan).
       ``(2) Limitation.--Deductibles, coinsurance, and other 
     cost-sharing or other limitations for bone mass measurement 
     may not be imposed under paragraph (1) to the extent they 
     exceed the deductibles, coinsurance, and limitations that are 
     applied to similar services under the group health plan or 
     health insurance coverage.
       ``(e) Prohibitions.--A group health plan, and a health 
     insurance issuer offering group health insurance coverage in 
     connection with a group health plan, may not--
       ``(1) deny to an individual eligibility, or continued 
     eligibility, to enroll or to renew coverage under the terms 
     of the plan, solely for the purpose of avoiding the 
     requirements of this section;
       ``(2) provide incentives (monetary or otherwise) to 
     individuals to encourage such individuals not to be provided 
     bone mass measurements to which they are entitled under this 
     section or to providers to induce such providers not to 
     provide such measurements to qualified individuals;
       ``(3) prohibit a provider from discussing with a patient 
     osteoporosis preventive techniques or medical treatment 
     options relating to this section; or
       ``(4) penalize or otherwise reduce or limit the 
     reimbursement of a provider because such provider provided 
     bone mass measurements to a qualified individual in 
     accordance with this section.
       ``(f) Rule of Construction.--Nothing in this section shall 
     be construed to require an individual who is a participant or 
     beneficiary to undergo bone mass measurement.
       ``(g) Notice.--A group health plan under this part shall 
     comply with the notice requirement under section 714(g) of 
     the Employee Retirement Income Security Act of 1974 with 
     respect to the requirements of this section as if such 
     section applied to such plan.
       ``(h) Level and Type of Reimbursements.--Nothing in this 
     section shall be construed to prevent a group health plan or 
     a health insurance issuer offering group health insurance 
     coverage from negotiating the level and type of reimbursement 
     with a provider for care provided in accordance with this 
     section.
       ``(i) Preemption.--
       ``(1) In general.--The provisions of this section do not 
     preempt State law relating to health insurance coverage to 
     the extent such State law provides greater benefits with 
     respect to osteoporosis detection or prevention.
       ``(2) Construction.--Section 2723(a)(1) shall not be 
     construed as superseding a State law described in paragraph 
     (1).''.
       (B) Conforming amendment.--Section 2723(c) of such Act (42 
     U.S.C. 300gg-23(c)) is amended by striking ``section 2704'' 
     and inserting ``sections 2704 and 2707''.
       (2) ERISA amendments.--
       (A) In general.--Subpart B of part 7 of subtitle B of title 
     I of the Employee Retirement Income Security Act of 1974 (29 
     U.S.C. 1185 et seq.) is amended by adding at the end the 
     following new section:

     ``SEC. 714. STANDARDS RELATING TO BENEFITS FOR BONE MASS 
                   MEASUREMENT.

       ``(a) Requirements for Coverage of Bone Mass Measurement.--
     A group health plan, and a health insurance issuer offering 
     group health insurance coverage, shall include (consistent 
     with this section) coverage for bone mass measurement for 
     beneficiaries and participants who are qualified individuals.
       ``(b) Definitions Relating to Coverage.--In this section:
       ``(1) Bone mass measurement.--The term `bone mass 
     measurement' means a radiologic or radioisotopic procedure or 
     other procedure approved by the Food and Drug Administration 
     performed on an individual for the purpose of identifying 
     bone mass or detecting bone loss or determining bone quality, 
     and includes a physician's interpretation of the results of 
     the procedure. Nothing in this paragraph shall be construed 
     as requiring a bone mass measurement to be conducted in a 
     particular type of facility or to prevent such a measurement 
     from being conducted through the use of mobile facilities 
     that are otherwise qualified.
       ``(2) Qualified individual.--The term `qualified 
     individual' means an individual who--
       ``(A) is an estrogen-deficient woman at clinical risk for 
     osteoporosis;
       ``(B) has vertebral abnormalities;
       ``(C) is receiving chemotherapy or long-term 
     gluococorticoid (steroid) therapy;
       ``(D) has primary hyperparathyroidism, hyperthyroidism, or 
     excess thyroid replacement;
       ``(E) is being monitored to assess the response to or 
     efficacy of approved osteoporosis drug therapy;
       ``(F) is a man with a low trauma fracture; or
       ``(G) the Secretary determines is eligible.
       ``(c) Limitation on Frequency Required.--The standards 
     established under section 2707(c) of the Public Health 
     Service Act shall apply to benefits provided under this 
     section in the same manner as they apply to benefits provided 
     under section 2707 of such Act.
       ``(d) Restrictions on Cost-Sharing.--
       ``(1) In general.--Subject to paragraph (2), nothing in 
     this section shall be construed as preventing a group health 
     plan or issuer from imposing deductibles, coinsurance, or 
     other cost-sharing in relation to bone mass measurement under 
     the plan (or health insurance coverage offered in connection 
     with a plan).
       ``(2) Limitation.--Deductibles, coinsurance, and other 
     cost-sharing or other limitations for bone mass measurement 
     may not be imposed under paragraph (1) to the extent they 
     exceed the deductibles, coinsurance, and limitations that are 
     applied to similar services under the group health plan or 
     health insurance coverage.
       ``(e) Prohibitions.--A group health plan, and a health 
     insurance issuer offering group health insurance coverage in 
     connection with a group health plan, may not--
       ``(1) deny to an individual eligibility, or continued 
     eligibility, to enroll or to renew coverage under the terms 
     of the plan, solely for the purpose of avoiding the 
     requirements of this section;
       ``(2) provide incentives (monetary or otherwise) to 
     individuals to encourage such individuals not to be provided 
     bone mass measurements to which they are entitled under this 
     section or to providers to induce such providers not to 
     provide such measurements to qualified individuals;
       ``(3) prohibit a provider from discussing with a patient 
     osteoporosis preventive techniques or medical treatment 
     options relating to this section; or
       ``(4) penalize or otherwise reduce or limit the 
     reimbursement of a provider because such provider provided 
     bone mass measurements to a qualified individual in 
     accordance with this section.
       ``(f) Rule of Construction.--Nothing in this section shall 
     be construed to require an individual who is a participant or 
     beneficiary to undergo bone mass measurement.
       ``(g) Notice Under Group Health Plan.--The imposition of 
     the requirements of this section shall be treated as a 
     material modification in the terms of the plan described in 
     section 102(a)(1), for purposes of assuring notice of such 
     requirements under the plan; except that the summary 
     description required

[[Page S5851]]

     to be provided under the last sentence of section 104(b)(1) 
     with respect to such modification shall be provided by not 
     later than 60 days after the first day of the first plan year 
     in which such requirements apply.
       ``(h) Preemption.--
       ``(1) In general.--The provisions of this section do not 
     preempt State law relating to health insurance coverage to 
     the extent such State law provides greater benefits with 
     respect to osteoporosis detection or prevention.
       ``(2) Construction.--Section 731(a)(1) shall not be 
     construed as superseding a State law described in paragraph 
     (1).''.
       (B) Conforming amendments.--
       (i) Section 731(c) of such Act (29 U.S.C. 1191(c)), as 
     amended by section 603(b)(1) of Public Law 104-204, is 
     amended by striking ``section 711'' and inserting ``sections 
     711 and 714''.
       (ii) Section 732(a) of such Act (29 U.S.C. 1191a(a)), as 
     amended by section 603(b)(2) of Public Law 104-204, is 
     amended by striking ``section 711'' and inserting ``sections 
     711 and 714''.
       (iii) The table of contents in section 1 of such Act is 
     amended by inserting after the item relating to section 713 
     the following new item:

``Sec. 714. Standards relating to benefits for bone mass measurement.

       (b) Individual Health Insurance.--
       (1) In general.--Part B of title XXVII of the Public Health 
     Service Act is amended by inserting after section 2752 (42 
     U.S.C. 300gg-52) the following new section:

     ``SEC. 27530. STANDARDS RELATING TO BENEFITS FOR BONE MASS 
                   MEASUREMENT.

       ``(a) In General.--The provisions of section 2707 (other 
     than subsection (g)) shall apply to health insurance coverage 
     offered by a health insurance issuer in the individual market 
     in the same manner as it applies to health insurance coverage 
     offered by a health insurance issuer in connection with a 
     group health plan in the small or large group market.
       ``(b) Notice.--A health insurance issuer under this part 
     shall comply with the notice requirement under section 714(g) 
     of the Employee Retirement Income Security Act of 1974 with 
     respect to the requirements referred to in subsection (a) as 
     if such section applied to such issuer and such issuer were a 
     group health plan.
       ``(c) Preemption.--
       ``(1) In general.--The provisions of this section do not 
     preempt State law relating to health insurance coverage to 
     the extent such State law provides greater benefits with 
     respect to osteoporosis detection or prevention.
       ``(2) Construction.--Section 2762(a) shall not be construed 
     as superseding a State law described in paragraph (1).''.
       (2) Conforming amendments.--Section 2762(b)(2) of such Act 
     (42 U.S.C. 300gg-62(b)(2)), as added by section 605(b)(3)(B) 
     of Public Law 104-204, is amended by striking ``section 
     2751'' and inserting ``sections 2751 and 2753''.
       (c) Effective Dates.--
       (1) Group health plans.--The amendments made by subsection 
     (a) shall apply with respect to group health plans for plan 
     years beginning on or after January 1, 2000.
       (2) Individual market.--The amendments made by subsection 
     (b) shall apply with respect to health insurance coverage 
     offered, sold, issued, renewed, in effect, or operated in the 
     individual market on or after such date.
                                 ______