[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.
______