Increasing Access to Osteoporosis Testing for Medicare Beneficiaries Act of 2021

II 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 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 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Increasing Access to 4 Osteoporosis Testing for Medicare Beneficiaries Act of 5 2021’’. 6 VerDate Sep 11 2014 04:24 Jun 16, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1943.IS S1943 kjohnson on DSK79L0C42PROD with BILLS 2 •S 1943 IS SEC. 2. FINDINGS. 1 The Congress finds the following: 2 (1) Osteoporosis is a major public health prob- 3 lem with 54 million Americans as of 2010 having ei- 4 ther low bone mass or osteoporosis, responsible for 5 over 2,000,000 fractures per year, including over 6 300,000 hip fractures. The estimated total cost of 7 these fractures in 2005 was $17,000,000,000 and 8 expected to rise to over $25,000,000,000 by 2025. 9 (2) Osteoporosis is a silent disease that often is 10 not discovered until a fracture occurs. One out of 11 two women and up to one of four men will suffer an 12 osteoporotic fracture in their lifetimes. 13 (3) While both men and women may develop 14 osteoporosis, 80 percent are women. 15 (4) Most women are not aware of their personal 16 risk factors for osteoporosis, the prevalence of, or 17 the morbidity and mortality associated with the dis- 18 ease, despite the fact that broken bones due to 19 osteoporosis lead to more hospitalizations and great- 20 er health care costs than heart attack, stroke, or 21 breast cancer in women age 55 and above. 22 (5) A woman’s risk of hip fracture is equal to 23 her combined risk of breast, uterine, and ovarian 24 cancer. More women die in the United States in the 25 VerDate Sep 11 2014 04:24 Jun 16, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1943.IS S1943 kjohnson on DSK79L0C42PROD with BILLS 3 •S 1943 IS year following a hip fracture than from breast can- 1 cer. 2 (6) One out of four people who have an 3 osteoporotic hip fracture will need long-term nursing 4 home care. Half of those who experience osteoporotic 5 hip fractures are unable to walk without assistance. 6 (7) Elderly women are so afraid of losing their 7 independence that 8 in 10 would rather die than 8 break their hip and be admitted to a nursing home. 9 (8) Bone density testing is more powerful in 10 predicting fractures than cholesterol is in predicting 11 myocardial infarction or blood pressure in predicting 12 stroke. 13 (9) Osteoporosis remains both under-recognized 14 and under-treated. Over a 7-year period (2007– 15 2013), 45 percent of older female Medicare bene- 16 ficiaries had no DXA bone density test, and 25 per- 17 cent had only one test. 18 (10) DXA testing in older women declined in 19 2014 to the lowest point in 10 years. 20 (11) A decade of steady decline in hip fractures 21 stopped abruptly in 2013. Since then, there have 22 been more than 14,000 additional hip fractures, 23 costing over $560,000,000, leading to 2,800 more 24 deaths than expected if the decline had continued. 25 VerDate Sep 11 2014 04:24 Jun 16, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1943.IS S1943 kjohnson on DSK79L0C42PROD with BILLS 4 •S 1943 IS SEC. 3. INCREASING ACCESS TO OSTEOPOROSIS PREVEN- 1 TION AND TREATMENT. 2 (a) IN GENERAL.—Section 1848(b) of the Social Se- 3 curity Act (42 U.S.C. 1395w–4(b)) is amended— 4 (1) in paragraph (4)(B)— 5 (A) by striking ‘‘and the first 2 months of 6 2012’’ and inserting ‘‘the first 2 months of 7 2012, 2022, and each subsequent year’’; and 8 (B) by striking ‘‘paragraph (6)’’ and in- 9 serting ‘‘paragraphs (6) and (12)’’; and 10 (2) by adding at the end the following: 11 ‘‘(12) ESTABLISHING MINIMUM PAYMENT FOR 12 OSTEOPOROSIS TESTS.— 13 ‘‘(A) FLOOR ON LOCALITY PAYMENT 14 AMOUNTS.—For a dual-energy x-ray 15 absorptiometry service (identified by HCPCS 16 codes 77080, 77085, and 77086 (and any suc- 17 ceeding codes)) furnished during 2022 or a sub- 18 sequent year, after determining the payment 19 amount otherwise applicable under this section 20 (without application of this paragraph), if the 21 otherwise applicable payment amount would be 22 less than the floor on the payment amount for 23 the fee schedule area (as determined in sub- 24 paragraph (B)), the Secretary shall increase the 25 otherwise applicable payment amount for such 26 VerDate Sep 11 2014 04:24 Jun 16, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1943.IS S1943 kjohnson on DSK79L0C42PROD with BILLS 5 •S 1943 IS fee schedule area to the floor on the payment 1 amount for such fee schedule area. 2 ‘‘(B) DETERMINATION OF FLOOR ON PAY- 3 MENT AMOUNT.—For purposes of subparagraph 4 (A), the floor on the payment amount for a fee 5 schedule area shall be equal to the product of— 6 ‘‘(i) the national minimum payment 7 for such service specified in subparagraph 8 (C); and 9 ‘‘(ii) the geographic adjustment factor 10 established under subsection (e)(2) for 11 such fee schedule area for the respective 12 year. 13 ‘‘(C) NATIONAL MINIMUM PAYMENT 14 AMOUNTS.—For purposes of subparagraph (B), 15 the national minimum payment amounts are 16 the following: 17 ‘‘(i) For services identified by HCPCS 18 code 77080, $98 (with national minimum 19 payment amounts of $87.11 for the tech- 20 nical component and $10.89 for the profes- 21 sional component). 22 ‘‘(ii) For services identified by 23 HCPCS code 77086, $35 (with national 24 minimum payment amounts of $27.18 for 25 VerDate Sep 11 2014 04:24 Jun 16, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1943.IS S1943 kjohnson on DSK79L0C42PROD with BILLS 6 •S 1943 IS the technical component and $7.82 for the 1 professional component). 2 ‘‘(iii) For the bundled code for dual 3 energy absorptiometry and vertebral frac- 4 ture assessment studies identified as 5 HCPCS code 77085, $133 (with national 6 minimum payment amounts of $114.29 for 7 the technical component and $18.71 for 8 the professional component).’’. 9 (b) EXEMPTION FROM BUDGET NEUTRALITY.—Sec- 10 tion 1848(c)(2)(B)(iv) of the Social Security Act (42 11 U.S.C. 1395w–4(c)(2)(B)(iv)) is amended— 12 (1) in subclause (IV), by striking ‘‘and’’ at the 13 end; 14 (2) in subclause (V), by striking the period at 15 the end and inserting ‘‘; and’’; and 16 (3) by adding at the end the following new sub- 17 clause: 18 ‘‘(VI) subsection (b)(12) shall 19 not be taken into account in applying 20 clause (ii)(II) for 2022 or a subse- 21 quent year.’’. 22 Æ VerDate Sep 11 2014 04:24 Jun 16, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6301 E:\BILLS\S1943.IS S1943 kjohnson on DSK79L0C42PROD with BILLS