[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 1943 Introduced in Senate (IS)]
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117th CONGRESS
1st Session
S. 1943
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 SENATE OF THE UNITED STATES
May 27, 2021
Ms. Collins (for herself, Mr. Cardin, Mr. Marshall, Ms. Stabenow, Mrs.
Capito, Mr. King, Mr. Cassidy, Ms. Sinema, Mr. Menendez, and Ms. Rosen)
introduced the following bill; which was read twice and referred to the
Committee on Finance
_______________________________________________________________________
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) Osteoporosis is a major public health problem with 54
million Americans as of 2010 having either low bone mass or
osteoporosis, responsible for over 2,000,000 fractures per
year, including over 300,000 hip fractures. The estimated total
cost of these fractures in 2005 was $17,000,000,000 and
expected to rise to over $25,000,000,000 by 2025.
(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) While both men and women may develop osteoporosis, 80
percent are women.
(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) Elderly women are so afraid of losing their
independence that 8 in 10 would rather die than break their hip
and be admitted to a nursing home.
(8) Bone density testing is more powerful in predicting
fractures than cholesterol is in predicting myocardial
infarction or blood pressure in predicting stroke.
(9) Osteoporosis remains both under-recognized and under-
treated. Over a 7-year period (2007-2013), 45 percent of older
female Medicare beneficiaries had no DXA bone density test, and
25 percent had only one test.
(10) DXA testing in older women declined in 2014 to the
lowest point in 10 years.
(11) A decade of steady decline in hip fractures stopped
abruptly in 2013. Since then, there have been more than 14,000
additional hip fractures, costing over $560,000,000, leading to
2,800 more deaths than expected if the decline had continued.
SEC. 3. INCREASING ACCESS TO OSTEOPOROSIS PREVENTION AND TREATMENT.
(a) In General.--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, 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.--
``(A) Floor on locality payment amounts.--For a
dual-energy x-ray absorptiometry service (identified by
HCPCS codes 77080, 77085, and 77086 (and any succeeding
codes)) furnished during 2022 or a subsequent year,
after determining the payment amount otherwise
applicable under this section (without application of
this paragraph), if the otherwise applicable payment
amount would be less than the floor on the payment
amount for the fee schedule area (as determined in
subparagraph (B)), the Secretary shall increase the
otherwise applicable payment amount for such fee
schedule area to the floor on the payment amount for
such fee schedule area.
``(B) Determination of floor on payment amount.--
For purposes of subparagraph (A), the floor on the
payment amount for a fee schedule area shall be equal
to the product of--
``(i) the national minimum payment for such
service specified in subparagraph (C); and
``(ii) the geographic adjustment factor
established under subsection (e)(2) for such
fee schedule area for the respective year.
``(C) National minimum payment amounts.--For
purposes of subparagraph (B), the national minimum
payment amounts are the following:
``(i) For services identified by HCPCS code
77080, $98 (with national minimum payment
amounts of $87.11 for the technical component
and $10.89 for the professional component).
``(ii) For services identified by HCPCS
code 77086, $35 (with national minimum payment
amounts of $27.18 for the technical component
and $7.82 for the professional component).
``(iii) For the bundled code for dual
energy absorptiometry and vertebral fracture
assessment studies identified as HCPCS code
77085, $133 (with national minimum payment
amounts of $114.29 for the technical component
and $18.71 for the professional component).''.
(b) Exemption From Budget Neutrality.--Section 1848(c)(2)(B)(iv) of
the Social Security Act (42 U.S.C. 1395w-4(c)(2)(B)(iv)) is amended--
(1) in subclause (IV), by striking ``and'' at the end;
(2) in subclause (V), by striking the period at the end and
inserting ``; and''; and
(3) by adding at the end the following new subclause:
``(VI) subsection (b)(12) shall not
be taken into account in applying
clause (ii)(II) for 2022 or a
subsequent year.''.
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