Increasing Access to Osteoporosis Testing for Medicare Beneficiaries Act of 2019

II 116TH CONGRESS 1ST SESSION S. 283 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 JANUARY 30, 2019 Ms. COLLINS (for herself, Mr. CARDIN, Mrs. BLACKBURN, Mr. KING, Mrs. CAPITO, Mr. WICKER, and Ms. STABENOW) 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 2019’’. 6 VerDate Sep 11 2014 00:03 Feb 06, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S283.IS S283 pamtmann on DSKBFK8HB2PROD with BILLS 2 •S 283 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 million fractures per year, including over 6 300,000 hip fractures. The estimated total cost of 7 these fractures in 2005 was $17 billion and expected 8 to rise to over $25 billion 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 00:03 Feb 06, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S283.IS S283 pamtmann on DSKBFK8HB2PROD with BILLS 3 •S 283 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 million, leading to 2,800 more 24 deaths than expected if the decline had continued. 25 VerDate Sep 11 2014 00:03 Feb 06, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S283.IS S283 pamtmann on DSKBFK8HB2PROD with BILLS 4 •S 283 IS SEC. 3. INCREASING ACCESS TO OSTEOPOROSIS PREVEN- 1 TION AND TREATMENT. 2 Section 1848(b) of the Social Security Act (42 U.S.C. 3 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, 2019, 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.—For dual-energy x-ray 13 absorptiometry services (identified by HCPCS codes 14 77080 and 77082 and successor codes 77085 and 15 77086 (and any succeeding codes)) furnished during 16 2019 or a subsequent year, the Secretary shall es- 17 tablish a national minimum payment amount under 18 this subsection— 19 ‘‘(A) for such services identified by 20 HCPCS code 77080, equal to $98 (with na- 21 tional minimum payment amounts of $87.11 for 22 the technical component and $10.89 for the 23 professional component); 24 ‘‘(B) for such services identified by 25 HCPCS code 77086, equal to $35 (with na- 26 VerDate Sep 11 2014 00:03 Feb 06, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S283.IS S283 pamtmann on DSKBFK8HB2PROD with BILLS 5 •S 283 IS tional minimum payment amounts of $27.18 for 1 the technical component and $7.82 for the pro- 2 fessional component); and 3 ‘‘(C) for the bundled code for dual energy 4 absorptiometry and vertebral fracture assess- 5 ment studies identified as HCPCS code 77085, 6 equal to $133 (with national minimum payment 7 amounts of $114.29 for the technical compo- 8 nent and $18.71 for the professional compo- 9 nent). 10 Such minimum payment amounts shall be adjusted 11 by the geographical adjustment factor established 12 under subsection (e)(2) for the services for the re- 13 spective year.’’. 14 Æ VerDate Sep 11 2014 00:03 Feb 06, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6301 E:\BILLS\S283.IS S283 pamtmann on DSKBFK8HB2PROD with BILLS