Increasing Access to Osteoporosis Testing for Medicare Beneficiaries Act of 2021

I 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. SA´NCHEZ, Mr. BURGESS, and Mrs. TRAHAN) introduced the following bill; which was re- ferred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently de- termined 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 estab- lishing a minimum payment amount under such part for bone mass measurement. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 VerDate Sep 11 2014 22:36 Jun 23, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3517.IH H3517 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 3517 IH SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘Increasing Access to 2 Osteoporosis Testing for Medicare Beneficiaries Act of 3 2021’’. 4 SEC. 2. FINDINGS. 5 The Congress finds the following: 6 (1) The total annual expense of providing care 7 for osteoporotic fractures among Medicare bene- 8 ficiaries, including direct medical costs as well as in- 9 direct societal costs related to productivity losses 10 and informal caregiving, has been estimated at $57 11 billion in 2018, with an expected increase to over 12 $95 billion in 2040. 13 (2) Osteoporosis is a silent disease that often is 14 not discovered until a fracture occurs. One out of 15 two women and up to one of four men will suffer an 16 osteoporotic fracture in their lifetimes. 17 (3) Osteoporosis disproportionately impacts 18 women, who account for 71 percent of osteoporotic 19 fractures, and 75 percent of costs. 20 (4) Most women are not aware of their personal 21 risk factors for osteoporosis, the prevalence of, or 22 the morbidity and mortality associated with the dis- 23 ease, despite the fact that broken bones due to 24 osteoporosis lead to more hospitalizations and great- 25 VerDate Sep 11 2014 22:36 Jun 23, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3517.IH H3517 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 3517 IH er health care costs than heart attack, stroke, or 1 breast cancer in women age 55 and above. 2 (5) A woman’s risk of hip fracture is equal to 3 her combined risk of breast, uterine, and ovarian 4 cancer. More women die in the United States in the 5 year following a hip fracture than from breast can- 6 cer. 7 (6) One out of four people who have an 8 osteoporotic hip fracture will need long-term nursing 9 home care. Half of those who experience osteoporotic 10 hip fractures are unable to walk without assistance. 11 (7) Nearly one in five Medicare patients die 12 within one year of a new osteoporotic fracture. 13 Beneficiaries with a hip fracture had the highest 14 mortality where approximately 30 percent died with- 15 in 12 months of the fracture. 16 (8) Bone density testing is more powerful in 17 predicting fractures than cholesterol is in predicting 18 myocardial infarction or blood pressure in predicting 19 stroke. 20 (9) Since 2007, Medicare has cut DXA reim- 21 bursement by over 72 percent. By 2019, the pay- 22 ment cuts caused a loss of 44 percent of DXA office 23 providers resulting in declines in expected DXA test- 24 VerDate Sep 11 2014 22:36 Jun 23, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3517.IH H3517 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 3517 IH ing, leaving 1.65 million women undiagnosed and 1 untreated for osteoporosis. 2 (10) A decade of steady decline in hip fractures 3 stopped abruptly in 2013. As of 2019, there have 4 been more than 71,775 additional hip fractures, 5 costing almost $3 billion, leading to almost 16,000 6 additional deaths than expected if the decline had 7 continued. 8 (11) An estimated 205,000 Medicare Fee For 9 Service beneficiaries, or about 15 percent of those 10 who had a new osteoporotic fracture, suffered one or 11 more subsequent fractures within 12 months of the 12 initial fracture. 13 SEC. 3. INCREASING ACCESS TO OSTEOPOROSIS PREVEN- 14 TION AND TREATMENT. 15 Section 1848(b) of the Social Security Act (42 U.S.C. 16 1395w–4(b)) is amended— 17 (1) in paragraph (4)(B)— 18 (A) by striking ‘‘and the first 2 months of 19 2012’’ and inserting ‘‘the first 2 months of 20 2012, and 2022 and each subsequent year’’; 21 and 22 (B) by striking ‘‘paragraph (6)’’ and in- 23 serting ‘‘paragraphs (6) and (12)’’; and 24 (2) by adding at the end the following: 25 VerDate Sep 11 2014 22:36 Jun 23, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3517.IH H3517 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 3517 IH ‘‘(12) ESTABLISHING MINIMUM PAYMENT FOR 1 OSTEOPOROSIS TESTS.—For dual-energy x-ray 2 absorptiometry services (identified by HCPCS codes 3 77080 and 77082 and successor codes 77085 and 4 77086 (and any succeeding codes)) furnished during 5 2022 or a subsequent year, the Secretary shall es- 6 tablish a national minimum payment amount under 7 this subsection— 8 ‘‘(A) for such services identified by 9 HCPCS code 77080, equal to $98 (with na- 10 tional minimum payment amounts of $87.11 for 11 the technical component and $10.89 for the 12 professional component); 13 ‘‘(B) for such services identified by 14 HCPCS code 77086, equal to $35 (with na- 15 tional minimum payment amounts of $27.18 for 16 the technical component and $7.82 for the pro- 17 fessional component); and 18 ‘‘(C) for the bundled code for dual energy 19 absorptiometry and vertebral fracture assess- 20 ment studies identified as HCPCS code 77085, 21 equal to $133 (with national minimum payment 22 amounts of $114.29 for the technical compo- 23 nent and $18.71 for the professional compo- 24 nent). 25 VerDate Sep 11 2014 22:36 Jun 23, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3517.IH H3517 kjohnson on DSK79L0C42PROD with BILLS 6 •HR 3517 IH Such minimum payment amounts shall be adjusted 1 by the geographical adjustment factor established 2 under subsection (e)(2) for the services for the re- 3 spective year.’’. 4 Æ VerDate Sep 11 2014 22:36 Jun 23, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6301 E:\BILLS\H3517.IH H3517 kjohnson on DSK79L0C42PROD with BILLS