[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3517 Introduced in House (IH)]
<DOC>
117th CONGRESS
1st Session
H. R. 3517
To amend title XVIII of the Social Security Act to improve access to,
and utilization of, bone mass measurement benefits under part B of the
Medicare program by establishing a minimum payment amount under such
part for bone mass measurement.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 25, 2021
Mr. Larson of Connecticut (for himself, Mrs. Walorski, Ms. Sanchez, Mr.
Burgess, and Mrs. Trahan) introduced the following bill; which was
referred to the Committee on Energy and Commerce, and in addition to
the Committee on Ways and Means, for a period to be subsequently
determined by the Speaker, in each case for consideration of such
provisions as fall within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to improve access to,
and utilization of, bone mass measurement benefits under part B of the
Medicare program by establishing a minimum payment amount under such
part for bone mass measurement.
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 ``Increasing Access to Osteoporosis
Testing for Medicare Beneficiaries Act of 2021''.
SEC. 2. FINDINGS.
The Congress finds the following:
(1) The total annual expense of providing care for
osteoporotic fractures among Medicare beneficiaries, including
direct medical costs as well as indirect societal costs related
to productivity losses and informal caregiving, has been
estimated at $57 billion in 2018, with an expected increase to
over $95 billion in 2040.
(2) Osteoporosis is a silent disease that often is not
discovered until a fracture occurs. One out of two women and up
to one of four men will suffer an osteoporotic fracture in
their lifetimes.
(3) Osteoporosis disproportionately impacts women, who
account for 71 percent of osteoporotic fractures, and 75
percent of costs.
(4) Most women are not aware of their personal risk factors
for osteoporosis, the prevalence of, or the morbidity and
mortality associated with the disease, despite the fact that
broken bones due to osteoporosis lead to more hospitalizations
and greater health care costs than heart attack, stroke, or
breast cancer in women age 55 and above.
(5) A woman's risk of hip fracture is equal to her combined
risk of breast, uterine, and ovarian cancer. More women die in
the United States in the year following a hip fracture than
from breast cancer.
(6) One out of four people who have an osteoporotic hip
fracture will need long-term nursing home care. Half of those
who experience osteoporotic hip fractures are unable to walk
without assistance.
(7) Nearly one in five Medicare patients die within one
year of a new osteoporotic fracture. Beneficiaries with a hip
fracture had the highest mortality where approximately 30
percent died within 12 months of the fracture.
(8) Bone density testing is more powerful in predicting
fractures than cholesterol is in predicting myocardial
infarction or blood pressure in predicting stroke.
(9) Since 2007, Medicare has cut DXA reimbursement by over
72 percent. By 2019, the payment cuts caused a loss of 44
percent of DXA office providers resulting in declines in
expected DXA testing, leaving 1.65 million women undiagnosed
and untreated for osteoporosis.
(10) A decade of steady decline in hip fractures stopped
abruptly in 2013. As of 2019, there have been more than 71,775
additional hip fractures, costing almost $3 billion, leading to
almost 16,000 additional deaths than expected if the decline
had continued.
(11) An estimated 205,000 Medicare Fee For Service
beneficiaries, or about 15 percent of those who had a new
osteoporotic fracture, suffered one or more subsequent
fractures within 12 months of the initial fracture.
SEC. 3. INCREASING ACCESS TO OSTEOPOROSIS PREVENTION AND TREATMENT.
Section 1848(b) of the Social Security Act (42 U.S.C. 1395w-4(b))
is amended--
(1) in paragraph (4)(B)--
(A) by striking ``and the first 2 months of 2012''
and inserting ``the first 2 months of 2012, and 2022
and each subsequent year''; and
(B) by striking ``paragraph (6)'' and inserting
``paragraphs (6) and (12)''; and
(2) by adding at the end the following:
``(12) Establishing minimum payment for osteoporosis
tests.--For dual-energy x-ray absorptiometry services
(identified by HCPCS codes 77080 and 77082 and successor codes
77085 and 77086 (and any succeeding codes)) furnished during
2022 or a subsequent year, the Secretary shall establish a
national minimum payment amount under this subsection--
``(A) for such services identified by HCPCS code
77080, equal to $98 (with national minimum payment
amounts of $87.11 for the technical component and
$10.89 for the professional component);
``(B) for such services identified by HCPCS code
77086, equal to $35 (with national minimum payment
amounts of $27.18 for the technical component and $7.82
for the professional component); and
``(C) for the bundled code for dual energy
absorptiometry and vertebral fracture assessment
studies identified as HCPCS code 77085, equal to $133
(with national minimum payment amounts of $114.29 for
the technical component and $18.71 for the professional
component).
Such minimum payment amounts shall be adjusted by the
geographical adjustment factor established under subsection
(e)(2) for the services for the respective year.''.
<all>