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.

I 116TH CONGRESS 1ST SESSION H. R. 2693 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 14, 2019 Mr. LARSON of Connecticut (for himself, Ms. SA´NCHEZ, Mrs. WALORSKI, Mrs. BROOKS of Indiana, Mrs. TRAHAN, Mr. MARSHALL, Mr. BYRNE, Ms. CLARKE of New York, Mr. COURTNEY, Mr. RODNEY DAVIS of Illinois, Mrs. DINGELL, Mr. FITZPATRICK, Mr. HASTINGS, Ms. JOHNSON of Texas, Mr. KELLY of Pennsylvania, Mr. KING of New York, Mrs. CARO- LYN B. MALONEY of New York, and Mr. DAVID P. ROE of Tennessee) introduced the following bill; which was referred to the Committee on En- ergy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdic- tion 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 05:31 May 23, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H2693.IH H2693 kjohnson on DSK79L0C42 with BILLS 2 •HR 2693 IH SECTION 1. 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 is expected to rise to over $25 billion 8 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) Osteoporosis disproportionately impacts 14 women, who account for 71 percent of osteoporotic 15 fractures, and 75 percent of costs. 16 (4) Most women are not aware of their personal 17 risk factors for osteoporosis, the prevalence of, or 18 the morbidity and mortality associated with the dis- 19 ease, despite the fact that broken bones due to 20 osteoporosis lead to more hospitalizations and great- 21 er health care costs than heart attack, stroke, or 22 breast cancer in women age 55 and above. 23 (5) A woman’s risk of hip fracture is equal to 24 her combined risk of breast, uterine, and ovarian 25 cancer. More women die in the United States in the 26 VerDate Sep 11 2014 05:31 May 23, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2693.IH H2693 kjohnson on DSK79L0C42 with BILLS 3 •HR 2693 IH 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) Approximately 25 percent of women over 7 the age of 50 who sustain a hip fracture die in the 8 year following the fracture, while a further 20 per- 9 cent will never leave a nursing facility. 10 (8) Bone density testing is more powerful in 11 predicting fractures than cholesterol is in predicting 12 myocardial infarction or blood pressure in predicting 13 stroke. 14 (9) Osteoporosis remains both under-recognized 15 and under-treated. Over a 7-year period (2007– 16 2013), 45 percent of older female Medicare bene- 17 ficiaries had no DXA bone density test, and 25 per- 18 cent had only one test. 19 (10) Since 2007, Medicare has cut DXA reim- 20 bursement by over 70 percent. By 2016, the pay- 21 ment cuts caused a loss of 36 percent of DXA pro- 22 viders, resulting in a 21 percent decline in 23 osteoporosis diagnosis and treatment. 24 VerDate Sep 11 2014 05:31 May 23, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2693.IH H2693 kjohnson on DSK79L0C42 with BILLS 4 •HR 2693 IH (11) A decade of steady decline in hip fractures 1 stopped abruptly in 2013. Since then, there have 2 been more than 24,000 additional hip fractures, 3 costing over $1 billion, leading to 4,800 more deaths 4 than expected if the decline had continued. 5 SEC. 2. INCREASING ACCESS TO OSTEOPOROSIS PREVEN- 6 TION AND TREATMENT. 7 Section 1848(b) of the Social Security Act (42 U.S.C. 8 1395w–4(b)) is amended— 9 (1) in paragraph (4)(B)— 10 (A) by striking ‘‘and the first 2 months of 11 2012’’ and inserting ‘‘the first 2 months of 12 2012, 2019, and each subsequent year’’; and 13 (B) by striking ‘‘paragraph (6)’’ and in- 14 serting ‘‘paragraphs (6) and (12)’’; and 15 (2) by adding at the end the following: 16 ‘‘(12) ESTABLISHING MINIMUM PAYMENT FOR 17 OSTEOPOROSIS TESTS.—For dual-energy x-ray 18 absorptiometry services (identified by HCPCS codes 19 77080 and 77082 and successor codes 77085 and 20 77086 (and any succeeding codes)) furnished during 21 2019 or a subsequent year, the Secretary shall es- 22 tablish a national minimum payment amount under 23 this subsection— 24 VerDate Sep 11 2014 05:31 May 23, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2693.IH H2693 kjohnson on DSK79L0C42 with BILLS 5 •HR 2693 IH ‘‘(A) for such services identified by 1 HCPCS code 77080, equal to $98 (with na- 2 tional minimum payment amounts of $87.11 for 3 the technical component and $10.89 for the 4 professional component); 5 ‘‘(B) for such services identified by 6 HCPCS code 77086, equal to $35 (with na- 7 tional minimum payment amounts of $27.18 for 8 the technical component and $7.82 for the pro- 9 fessional component); and 10 ‘‘(C) for the bundled code for dual energy 11 absorptiometry and vertebral fracture assess- 12 ment studies identified as HCPCS code 77085, 13 equal to $133 (with national minimum payment 14 amounts of $114.29 for the technical compo- 15 nent and $18.71 for the professional compo- 16 nent). 17 Such minimum payment amounts shall be adjusted 18 by the geographical adjustment factor established 19 under subsection (e)(2) for the services for the re- 20 spective year.’’. 21 Æ VerDate Sep 11 2014 05:31 May 23, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6301 E:\BILLS\H2693.IH H2693 kjohnson on DSK79L0C42 with BILLS