Text: H.R.4864 — 101st Congress (1989-1990)All Information (Except Text)

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HR 4864 IH
101st CONGRESS
2d Session
 H. R. 4864
To amend the Public Health Service Act to establish and coordinate research
programs for osteoporosis and related bone disorders, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
May 17, 1990
Ms. SNOWE (for herself, Mr. DOWNEY, Mr. DONNELLY, Mrs. JOHNSON of Connecticut,
Mr. PAYNE of New Jersey, Mrs. SAIKI, Mrs. LLOYD, Mrs. SCHROEDER, Ms. LONG,
Mr. RINALDO, Mrs. UNSOELD, Mr. STAGGERS, Mrs. BOXER, Ms. OAKAR, Mrs. MORELLA,
and Mrs. VUCANOVICH) introduced the following bill; which was referred to
the Committee on Energy and Commerce
A BILL
To amend the Public Health Service Act to establish and coordinate research
programs for osteoporosis and related bone disorders, and for other purposes.
  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 `Osteoporosis and Related Bone Disorders
  Research, Education, and Health Services Act of 1990'.
SEC. 2. FINDINGS.
  Congress finds that--
  (1) osteoporosis, or porous bone, is a condition characterized by an
  excessive loss of bone tissue and an increased susceptibility to fractures
  of the hip, spine, and wrist;
  (2) an estimated 24 million Americans have osteoporosis, with many cases
  undiagnosed because the condition develops without symptoms until a strain,
  bump, or fall causes a fracture;
  (3) between 3 and 4 million Americans have Paget's disease, Osteogenesis
  Imperfecta, and other related metabolic bone disorders;
  (4) osteoporosis is responsible for 1,300,000 bone fractures annually,
  including more than 250,000 hip fractures, 500,000 vertebral fractures,
  200,000 fractures of the wrist, and 200,000 fractures at other limb sites;
  (5) osteoporosis affects one-third to one-half of all postmenopausal women
  and nearly half of all people over age 75;
  (6) direct medical costs of osteoporosis reached an estimated $10,000,000,000
  in 1988 for the United States, not including the costs of family care and
  lost work for caregivers;
  (7) direct medical costs of osteoporosis are 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;
  (8) technology now exists, and new technology is developing, that will
  permit early diagnosis and prevention of osteoporosis as well as management
  of the condition once it has developed;
  (9) funding for research on osteoporosis and related bone disorders is
  severely constrained at key research institutes, including the National
  Institute of Arthritis and Musculoskeletal and Skin Diseases and the
  National Institute on Aging;
  (10) further research is needed to improve medical knowledge concerning--
  (A) cellular mechanisms related to the processes of bone resorption and
  bone formation, and the effect of different agents on bone remodeling;
  (B) risk factors for osteoporosis, including newly discovered risk factors,
  risk factors related to groups not ordinarily studied, such as men and
  minorities, and the relationship of aging processes to the development
  of osteoporosis;
  (C) bone mass measurement technology, including techniques for making
  faster and more precise measurements and for interpreting measurements;
  (D) calcium, including bioavailability, intake requirements, and the role
  of calcium in building heavier and denser skeletons;
  (E) prevention and treatment, including the efficacy of current therapies,
  alternative drug therapies for prevention and treatment, and the role of
  exercise; and
  (F) rehabilitation; and
  (11) further educational efforts are needed to increase public and
  professional knowledge of the causes of, methods for avoiding, and treatment
  of osteoporosis.
SEC. 3. OSTEOPOROSIS RESEARCH.
  Subpart 4 of part C of title IV of the Public Health Service Act (42
  U.S.C. 285d et seq.) is amended--
  (1) by inserting after the subpart heading the following new chapter heading:
`CHAPTER 1--ARTHRITIS';
and
  (2) by adding at the end the following new chapter:
`CHAPTER 2--OSTEOPOROSIS
`SEC. 442A. DEFINITIONS.
  `As used in this chapter:
  `(1) ADVISORY PANEL- The term `Advisory Panel' means the Advisory Panel
  on Osteoporosis and Related Disorders, established in section 442D.
  `(2) COUNCIL- The term `Council' means the Interagency Council on
  Osteoporosis and Related Disorders, established in section 442C.
  `(3) DEPARTMENT- The term `Department' means the Department of Health and
  Human Services.
  `(4) RELATED DISORDERS- The term `related bone disorders' includes--
  `(A) Paget's disease, a bone disease characterized by enlargement and loss
  of density with bowing and deformity of the bones;
  `(B) Osteogenesis Imperfecta, a familial disease marked by extreme
  brittleness of the long bones;
  `(C) hyperparathyroidism, a condition characterized by the presence
  of excess parathormone in the body resulting in disturbance of calcium
  metabolism with loss of calcium from bone and renal damage;
  `(D) hypoparathyroidism, a condition characterized by the absence of
  parathormone resulting in disturbances of calcium metabolism;
  `(E) renal bone disease, a disease characterized by metabolic disturbances
  from dialysis, renal transplants, or other renal disturbances;
  `(F) primary or postmenopausal osteoporosis and secondary osteoporosis,
  such as that induced by corticosteroids; and
  `(G) other general disorders of bone and mineral metabolism including
  abnormalities of vitamin D.
  `(5) RESOURCE CENTER- The term `Resource Center' means the Resource Center
  on Osteoporosis and Related Disorders, established in section 442F.
`SEC. 442B. EXPANSION OF RESEARCH ON OSTEOPOROSIS AND RELATED BONE DISORDERS.
  `(a) RESEARCH- The Director of the National Institute of Arthritis and
  Musculoskeletal and Skin Diseases and the Director of the National Institute
  on Aging shall expand and intensify research on osteoporosis and related
  bone disorders. The research shall be in addition to research that is
  authorized under any other provision of law.
  `(b) RESEARCH CENTERS- The Director of the National Institute of Arthritis
  and Musculoskeletal and Skin Diseases shall increase the number of
  Specialized Centers of Research devoted to research on osteoporosis and
  related bone disorders. The Director of the National Institute on Aging
  shall increase the number of program project grants devoted to creating
  centers of excellence in osteoporosis and related bone disorders.
  `(c) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be appropriated
  to carry out this section $24,000,000 for the National Institute of
  Arthritis and Musculoskeletal and Skin Diseases and $12,000,000 for the
  National Institute on Aging for each of the fiscal years 1991 through 1993,
  and such sums as may be necessary for subsequent fiscal years. These funds
  are in addition to amounts authorized to be appropriated for biomedical
  research relating to osteoporosis and related bone disorders under any
  other provision of law.
`SEC. 442C. INTERAGENCY COUNCIL ON OSTEOPOROSIS AND RELATED BONE DISORDERS.
  `(a) ESTABLISHMENT- There is established in the Department an Interagency
  Council on Osteoporosis and Related Disorders. The Council shall be
  composed of--
  `(1) the Assistant Secretary for Health;
  `(2) the Surgeon General of the United States;
  `(3) the Assistant Secretary for Planning and Evaluation of the Department;
  `(4) the Director of the National Institute of Arthritis and Musculoskeletal
  and Skin Diseases;
  `(5) the Director of the National Institute of Mental Health;
  `(6) the Director of the National Institute on Aging;
  `(7) the Director of the National Institute of Child Health and Human
  Development;
  `(8) the Administrator of the Health Care Financing Administration;
  `(9) the Director of the Agency for Health Care Policy and Research;
  `(10) the Director of the Bureau of Child and Maternal Health;
  `(11) the Commissioner of the Food and Drug Administration;
  `(12) the Director of the National Institute of Dental Research;
  `(13) the Director of the National Institute of Diabetes, Digestive,
  and Kidney Diseases;
  `(14) the Commissioner on Aging;
  `(15) the Director of the Office of Disease Prevention and Health Promotion;
  and
  `(16) such additional members as the Secretary considers appropriate.
  `(b) FUNCTIONS- The Council shall--
  `(1) coordinate research conducted by or through the Department on
  osteoporosis and related bone disorders;
  `(2) establish a mechanism for sharing information on osteoporosis and
  related bone disorders among all officers and employees of the Department
  involved in carrying out programs serving older persons, midlife women,
  and young persons, in order to provide for full communication and exchange
  of information;
  `(3) review and coordinate the most promising areas of research concerning
  osteoporosis and related bone disorders;
  `(4) assist the National Institute of Arthritis and Musculoskeletal and
  Skin Diseases, the National Institute on Aging, the National Institute of
  Diabetes, Digestive and Kidney Disease, the National Institute on Dental
  Research, and other institutes in developing and coordinating plans for
  research on osteoporosis and related bone disorders;
  `(5) assist the Office of Disease Prevention and Health Promotion and the
  Administration on Aging and other offices in developing and coordinating
  plans for education and health promotion on osteoporosis and related bone
  disorders; and
  `(6) establish mechanisms to use the results of research concerning
  osteoporosis and related bone disorders in the development of policies,
  programs, and other measures to improve the quality of life for older
  Americans.
  `(c) CHAIRPERSON- The Secretary shall select a Chairperson or co-Chairpersons
  for the Council from among its members.
  `(d) QUORUM- A majority of the members of the Council shall constitute a
  quorum, but a lesser number may hold hearings.
  `(e) MEETINGS- The Council shall meet periodically at the call of the
  Chairperson, but not less often than twice each year.
  `(f) EXECUTIVE SECRETARY- The Secretary shall appoint an Executive Secretary
  for the Council.
  `(g) ADMINISTRATIVE STAFF AND SUPPORT- The Secretary shall provide the
  Council with such additional administrative staff and support as may be
  necessary to enable the Council to carry out its functions.
  `(h) REPORTS-
  `(1) INITIAL REPORT-
  `(A) PREPARATION- Not later than 9 months after the date of enactment
  of this chapter, the Executive Secretary of the Council shall prepare a
  report detailing the research plans referred to in paragraphs (4) and (5)
  of subsection (b). The report shall describe the activities to be carried out
  under the research plans during each of the fiscal years 1991 through 1993.
  `(B) OTHER FEDERAL PROGRAMS- To the maximum extent feasible, the report
  shall ensure that activities carried out under the research plans
  are coordinated with, and use the resources of, other Federal programs
  concerning osteoporosis and related bone disorders, including--
  `(i) centers supported by the National Institute of Arthritis and
  Musculoskeletal and Skin Diseases, the National Institute on Aging, and
  the National Institute of Diabetes, Digestive and Kidney Disease;
  `(ii) other centers supported by Federal funds involved in research on
  osteoporosis and related bone disorders; and
  `(iii) other programs concerning osteoporosis and related bone disorders that
  are planned or conducted by Federal agencies such as the Administration on
  Aging and the Office of Disease Prevention and Health Promotion, Federal
  agencies outside the Department, State or local agencies, community
  organizations, or private foundations.
  `(C) DISTRIBUTION- The Executive Secretary of the Council shall--
  `(i) transmit the report to Congress; and
  `(ii) make the report available to the public and to the Advisory Panel.
  `(2) SUBSEQUENT REPORTS- Not later than 12 months after the date on
  which the report required by paragraph (1) is transmitted to Congress,
  and annually thereafter, the Executive Secretary of the Council shall--
  `(A) prepare a report that--
  `(i) describes research and educational initiatives sponsored by the
  Federal Government on osteoporosis and related bone disorders; and
  `(ii) makes recommendations for new research and educational initiatives
  on osteoporosis and related bone disorders; and
  `(B) transmit the report to Congress and make the report available to
  the public.
 `SEC. 442D. ADVISORY PANEL ON OSTEOPOROSIS AND RELATED DISORDERS.
  `(a) ESTABLISHMENT- There is established in the Department an Advisory
  Panel on Osteoporosis and Related Disorders. The Advisory Panel shall
  be composed of the following 15 voting members and additional nonvoting,
  ex officio members:
  `(1) VOTING MEMBERS- The Director of the Office of Technology Assessment
  shall appoint to the Advisory Panel--
  `(A) 5 members who are biomedical research scientists with demonstrated
  achievement in biomedical research on osteoporosis and related bone
  disorders, including at least 1 researcher at a specialized center for
  research in osteoporosis;
  `(B) 2 members with demonstrated achievements in research on community-based
  and family services covering osteoporosis and related bone disorders;
  `(C) 1 member who is knowledgeable in health promotion and disease prevention
  programs concerning osteoporosis and related bone disorders;
  `(D) 2 members who are associated with specialized bone programs affiliated
  with academic health centers;
  `(E) 2 members who are experts in private health care insurance and
  long-term care financing; and
  `(F) 3 members who are representatives of national voluntary organizations
  that are concerned with the problems of individuals with osteoporosis and
  related bone disorders and their families.
  `(2) NONVOTING, EX OFFICIO MEMBERS- The Advisory Panel shall include as
  nonvoting, ex officio members--
  `(A) the Chairperson of the Council;
  `(B) the Director of National Institute of Arthritis and Musculoskeletal
  and Skin Diseases;
  `(C) the Director of the National Institute on Aging; and
  `(D) such other members as the Secretary may appoint.
  `(3) APPOINTMENT- The Director of the Office of Technology Assessment
  shall appoint members to the Advisory Panel within 90 days after the date
  of enactment of this Act. The Director shall not appoint to the Advisory
  Panel individuals who are officers or employees of the Federal Government.
  `(b) FUNCTIONS- The Advisory Panel shall advise the Secretary and Council
  with respect to the identification of--
  `(1) research priorities for projects on osteoporosis, related bone
  disorders, and the care of individuals with osteoporosis or related bone
  disorders;
  `(2) emerging issues in and promising areas of biomedical, clinical,
  and behavioral research on osteoporosis and related bone disorders;
  `(3) emerging issues in research on health services for individuals,
  and the families of individuals, with osteoporosis or related bone disorders;
  `(4) emerging issues in home-based and community-based services and
  systems of services for individuals, and the families of individuals,
  with osteoporosis or related bone disorders;
  `(5) emerging issues in financing health care services and social services
  for individuals, and the families of individuals, with osteoporosis and
  related bone disorders;
  `(6) emerging issues in health promotion programs concerning osteoporosis;
  and
  `(7) emerging issues in professional and public education concerning
  osteoporosis.
  `(c) CHAIRPERSON- The Secretary shall appoint a Chairperson of the Advisory
  Panel from among the members appointed.
  `(d) TERM OF OFFICE- The term of a member of the Advisory Panel shall
  be for the life of the Advisory Panel. A vacancy on the Advisory Panel
  shall be filled in the same manner as the original appointment was made. A
  vacancy on the Advisory Panel shall not affect its powers.
  `(e) QUORUM- A majority of the members of the Advisory Panel appointed
  shall constitute a quorum, but a lesser number may hold hearings. The
  Advisory Panel may establish such subcommittees as the Advisory Panel
  considers appropriate.
  `(f) MEETINGS- The Advisory Panel shall meet at the call of the Chairperson,
  but not less often than twice per year.
  `(g) EXECUTIVE SECRETARY- The Executive Secretary of the Council shall
  serve as Executive Secretary of the Advisory Panel.
  `(h) STAFF AND SUPPORT- The Secretary shall provide the Advisory Panel
  with such additional administrative staff and support as may be necessary
  to enable the Advisory Panel to carry out its functions.
  `(i) COMPENSATION AND TRAVEL EXPENSES-
  `(1) COMPENSATION- Subject to paragraph (2), no member of the Advisory
  Panel shall receive compensation for service on the Advisory Panel.
  `(2) TRAVEL EXPENSES- Each member of the Advisory Panel shall receive
  reimbursement for travel, subsistence, and other necessary expenses incurred
  in the performance of duties of the Advisory Panel.
  `(j) REPORT- The Advisory Panel shall--
  `(1) prepare an annual report, which shall contain recommendations for
  administrative and legislative actions to--
  `(A) improve services, education, and information for individuals, and
  families of individuals, with osteoporosis and related bone disorders;
  `(B) improve professional education; and
  `(C) provide for promising biomedical research related to osteoporosis
  and related bone disorders; and
  `(2) transmit the annual report to the Congress, the Secretary, and the
  Council and make it available to the public.
  `(k) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be appropriated
  to carry out this section $200,000 for each of fiscal years 1991 through
  1993.
`SEC. 442E. AWARDS FOR HEALTH PROMOTION AND DISEASE PREVENTION PROGRAMS.
  `(a) ESTABLISHMENT- The Secretary shall make up to three grants to public
  and private nonprofit entities to establish model health promotion projects
  for community-based education on osteoporosis.
  `(b) PROJECTS-
  `(1) TARGET POPULATIONS- Each project funded under this section shall
  target one of the following populations:
  `(A) Young and teenage girls.
  `(B) Midlife women.
  `(C) Older men and women.
  `(2) SUBJECTS- Projects funded under this section shall--
  `(A) develop educational tools based on scientific information about the
  prevention and management of osteoporosis;
  `(B) provide a model for dissemination of information to the target group,
  with an emphasis on currently existing systems of information; and
  `(C) contain a means of evaluating the effectiveness of the model for the
  target group.
  `(c) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be appropriated
  to carry out this section $375,000 for each of fiscal years 1991 through
  1993.
`SEC. 442F. RESOURCE CENTER ON OSTEOPOROSIS AND RELATED DISORDERS.
  `(a) ESTABLISHMENT- The Director of the National Institute of Arthritis
  and Musculoskeletal and Skin Diseases shall make grants or enter into
  contracts with eligible organizations to establish a Resource Center on
  Osteoporosis and Related Disorders.
  `(b) PURPOSE- The purpose of the Resource Center shall be to facilitate
  and enhance knowledge and understanding of osteoporosis and related bone
  disorders by disseminating information about research results, services
  and educational materials, to health professionals, patients, and the public.
  `(c) FUNCTIONS- An organization receiving a grant or contract under this
  section shall--
  `(1) compile, archive, and disseminate information concerning research,
  demonstration, evaluation, and training programs and projects concerning
  osteoporosis and related bone disorders;
  `(2) annually publish a summary of the information compiled under paragraph
  (1) during the preceding 12-month period, and make the information available
  on request to appropriate individuals and entities, including educational
  institutions, research entities, and Federal and public agencies;
  `(3) provide information and assistance in accessing community services
  to patients and the public;
  `(4) coordinate regional training programs for the development of health
  professional resource networks on osteoporosis and related bone disorders;
  and
  `(5) maintain a resource library on osteoporosis and related bone disorders.
  `(d) INFORMATION SYSTEM AND TELEPHONE LINE-
  `(1) INFORMATION SYSTEM- An organization receiving a grant or contract under
  this section shall establish a central computerized information system to--
  `(A) compile and disseminate information concerning initiatives by State
  and local governments and private entities to provide programs and services
  for individuals with osteoporosis; and
  `(B) translate scientific and technical information concerning the
  initiatives into information readily understandable by the general public,
  and make the information available on request.
  `(2) TELEPHONE LINE- An organization receiving a grant or contract under
  this section shall establish a national toll-free telephone line to make
  available the information described in paragraph (1) and information
  concerning Federal programs, services, and benefits for individuals with
  osteoporosis and their families.
  `(e) FEES- In accordance with regulations issued by the Secretary, the
  organization receiving a grant or contract under this section shall charge
  appropriate fees for providing information through the Research Center as
  specified in subsections (c) or (d). The organization may make exceptions
  to the fees for individuals and organizations who are not financially able
  to pay the fees. The organization shall transfer the sums obtained from
  payment of the fees to the Secretary, who shall use the sums to carry out
  this section.
  `(f) APPLICATION OR PROPOSAL- In order to receive a grant or enter into a
  contract under this section, an organization shall submit an application
  or proposal to the Director of the National Institute of Arthritis and
  Musculoskeletal and Skin Diseases. The application or proposal shall
  contain--
  `(1) information demonstrating that the organization has a network
  of contacts that will enable the organization to receive information
  necessary to operate the central computerized information system described
  in subsection (d)(l); and
  `(2) such other information as the Director may prescribe.
  `(g) ELIGIBLE ORGANIZATIONS- Organizations eligible to receive grants
  under this section shall include public and private nonprofit organizations
  that are knowledgeable about osteoporosis and related bone disorders. The
  Secretary shall establish additional eligibility criteria for organizations
  to receive grants or enter into contracts under this section.
  `(h) RESEARCH SUMMARIES- The Director of the National Institute of Arthritis
  and Musculoskeletal and Skin Diseases, the National Institute on Aging,
  the National Institute of Diabetes, Digestive, and Kidney Diseases,
  the National Institute on Dental Research, and other agencies specified
  by the Secretary shall provide to the Resource Center summaries of the
  findings of research conducted on osteoporosis, related bone disorders,
  or relevant treatments for osteoporosis or related bone disorders.
  `(i) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be appropriated
  to carry out this section $500,000 for fiscal year 1991, and such sums as
  may be necessary for fiscal years 1992 and 1993.'.