II 

111TH CONGRESS 

1ST SESSION S. 1548 

To improve research, diagnosis, and treatment of musculoskeletal diseases, 

conditions, and injuries, to conduct a longitudinal study on aging, and 

for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JULY 30, 2009 

Mr. CARDIN (for himself and Mr. BURR) introduced the following bill; which 

was read twice and referred to the Committee on Health, Education, 

Labor, and Pensions 

A BILL 

To improve research, diagnosis, and treatment of musculoskeletal diseases, conditions, and injuries, to conduct a 

longitudinal study on aging, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Access to America’s 

5 Orthopaedic Services Act of 2009’’. 

6 SEC. 2. TABLE OF CONTENTS. 

7 The table of contents for this Act is as follows: 

Sec. 1. Short title. 

Sec. 2. Table of contents. 

Sec. 3. Definition. 


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TITLE I—MUSCULOSKELETAL HEALTH 

Sec. 101. Findings. 

Sec. 102. Musculoskeletal research. 

Sec. 103. Musculoskeletal trauma research and care. 

Sec. 104. Transplants, tissues, and replacement joints. 

Sec. 105. Traffic and workplace safety. 

Sec. 106. Public education campaign. 

Sec. 107. Orthopaedic physician workforce training study. 

Sec. 108. Bone density under the Medicare program. 

Sec. 109. Access to orthopaedic services for beneficiaries of Medicaid and 

SCHIP. 

Sec. 110. Age-related programs. 

Sec. 111. Minority health disparities. 

TITLE II—THIRD LONGITUDINAL STUDY ON AGING 

Sec. 201. Third longitudinal study on aging. 

1 SEC. 3. DEFINITION. 

2 In this Act, the term ‘‘Secretary’’ means the Sec3 retary of Health and Human Services, except as otherwise 

4 provided. 

5 TITLE I—MUSCULOSKELETAL 

6 HEALTH 

7 SEC. 101. FINDINGS. 

8 Congress makes the following findings: 

9 (1) Musculoskeletal diseases and other condi10 tions are the leading cause of disability in the 

11 United States. 

12 (2) Musculoskeletal conditions account for more 

13 than one-half of all chronic conditions in people over 

14 50 years of age in developed countries. 

15 (3) More than 1 in 4 individuals in the United 

16 States has a musculoskeletal condition requiring 

17 medical attention. 


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1 (4) Direct and indirect costs for bone and joint 

2 health are $849,000,000,000 per year in the United 

3 States. 

4 (5) Musculoskeletal conditions are the greatest 

5 cause of total lost workdays and medical bed days in 

6 the United States. 

7 (6) The 2004 Surgeon General Report on Bone 

8 Health and Osteoporosis concluded that there is a 

9 lack of awareness of bone disease among the public 

10 and health care professionals. 

11 (7) Research demonstrates that there is need 

12 among ethnic and racial minorities to improve 

13 knowledge of and treatment for musculoskeletal dis14 eases and other conditions. 

15 SEC. 102. MUSCULOSKELETAL RESEARCH. 

16 (a) REGULATIONS CONCERNING REPORTING CRI17 TERIA FOR PERCENT OF EFFORT.— 

18 (1) IN GENERAL.—The Secretary, in consulta19 tion with the Director of the National Institutes of 

20 Health, shall establish, by regulation, criteria for ac21 counting for and reporting the percent of effort ex22 pended by researchers, with respect to research that 

23 is— 

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1 cal year following the date of enactment of this 

2 Act; and 

3 (B) funded through research grants, on 

4 musculoskeletal health, awarded by either the 

5 Director of the National Institutes of Health or 

6 the Director of the Agency for Healthcare Re7 search and Quality. 

8 (2) DEADLINE FOR REGULATIONS.—Not later 

9 than the last day of the 2-year period beginning on 

10 the date of enactment of this Act, the Secretary 

11 shall issue the regulations required by paragraph 

12 (1). 

13 (b) NEW INVESTIGATORS IN MUSCULOSKELETAL RE14 SEARCH.— 

15 (1) REPORT.—Not later than 90 days after the 

16 last day of each fiscal year that begins more than 

17 1 year following the date of enactment of this Act, 

18 the Secretary, in consultation with the Director of 

19 the National Institutes of Health, shall prepare and 

20 submit to Congress a report on each of the fol21 lowing: 

22 (A) The number of new investigators who 

23 are awarded grants for musculoskeletal health 

24 research by the National Institutes of Health 

25 during the fiscal year involved. 


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1 (B) The total amount of funds awarded to 

2 those investigators through such grants during 

3 the fiscal year. 

4 (C) The percentage of the National Insti5 tutes of Health’s budget for musculoskeletal 

6 health research that was awarded to those in7 vestigators through such grants during the fis8 cal year. 

9 (D) The backgrounds of those investiga10 tors who are awarded such grants during the 

11 fiscal year, analyzed by race and ethnicity. 

12 (E) A description of the efforts made by 

13 the Director of the National Institutes of 

14 Health to encourage individuals from underrep15 resented minority groups (as defined by the 

16 Secretary) to apply for grants for musculo17 skeletal health research awarded by the Na18 tional Institutes of Health during the fiscal 

19 year. 

20 (2) RECOMMENDATIONS.—The first report sub21 mitted under paragraph (1) shall include, and subse22 quent reports may include, recommendations con23 cerning additional resources that the National Insti24 tutes of Health or other entities could use— 


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1 (A) to increase the number of new inves2 tigators awarded grants referred to in para3 graph (1)(A); and 

4 (B) to increase the number of new inves5 tigators awarded such grants who are members 

6 of underrepresented minority groups (as defined 

7 by the Secretary). 

8 (3) DEFINITIONS.—In this section: 

9 (A) NEW INVESTIGATOR.—The term ‘‘new 

10 investigator’’ has the meaning given the term 

11 by the Secretary for purposes of administering 

12 title III of the Public Health Service Act (42 

13 U.S.C. 241 et seq.), but only with respect to 

14 musculoskeletal health research. 

15 (B) RACE; ETHNICITY.—The terms ‘‘race’’ 

16 and ‘‘ethnicity’’ have the meanings given such 

17 terms by the Office of Management and Budget 

18 for purposes of Federal statistics and adminis19 trative reporting. 

20 SEC. 103. MUSCULOSKELETAL TRAUMA RESEARCH AND 

21 CARE. 

22 (a) MUSCULOSKELETAL TRAUMA RESEARCH.— 

23 (1) REPORT.—Not later than 2 years after the 

24 date of enactment of this Act, the Secretary shall 

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1 grams and activities relating to musculoskeletal 

2 trauma care that are being conducted by the Federal 

3 Government or supported by funding made available 

4 by Federal Government. 

5 (2) CONTENTS OF REPORT.—Such report shall 

6 include, at a minimum, each of the following: 

7 (A) Information on the status of each Fed8 eral program and activity referred to in para9 graph (1), including specific information on any 

10 research program and activity. 

11 (B) Information on the methods being 

12 used to coordinate research being conducted 

13 under such Federal programs and activities and 

14 the effectiveness of such methods. 

15 (3) CONSULTATION.—In preparing the report 

16 under paragraph (1), the Secretary shall consult 

17 with— 

18 (A) the Secretary of Defense; and 

19 (B) the heads of other Federal depart20 ments and agencies that administer programs 

21 and activities relating to musculoskeletal trau22 ma care, as determined by the Secretary of 

23 Health and Human Services. 

24 (b) ORTHOPAEDIC TREATMENT THROUGH TRAUMA

25 CARE SYSTEMS.— 


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1 (1) STUDY.—The Secretary shall conduct a 

2 study on the impact of trauma care systems that 

3 connect hospitals with other providers of musculo4 skeletal health care services (including orthopedists). 

5 (2) PURPOSES OF STUDY.—The purposes of the 

6 study under paragraph (1) shall include, at a min7 imum, each of the following: 

8 (A) An examination of the provision of 

9 acute and rehabilitative care to trauma patients 

10 with musculoskeletal injuries or other condi11 tions. 

12 (B) An examination of epidemiological 

13 data on trauma patients with musculoskeletal 

14 injuries or other conditions, including the num15 ber of such patients, the number of such inju16 ries and conditions, and the types of such inju17 ries and conditions. 

18 (C) An evaluation of the ability of a pa19 tient with an orthopaedic injury or other condi20 tion originating from musculoskeletal trauma to 

21 access specialty care relevant to that injury or 

22 condition. 

23 (D) An examination of the impact of trau24 ma rehabilitation care on musculoskeletal 

25 health and the ability of trauma patients with 


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1 musculoskeletal injuries or other conditions to 

2 access postacute rehabilitative services. 

3 (3) REPORT.—Not later than 2 years after the 

4 date of enactment of this Act, the Secretary shall 

5 submit to Congress a report on the results of the 

6 study conducted under paragraph (1), including rec7 ommendations for improving the treatment of trau8 ma patients with musculoskeletal injuries or other 

9 conditions. 

10 SEC. 104. TRANSPLANTS, TISSUES, AND REPLACEMENT 

11 JOINTS. 

12 (a) TRANSPLANTATION TRANSMISSION SENTINEL

13 NETWORK.—Section 372(b)(2) of the Public Health Serv14 ice Act (42 U.S.C. 274(b)(2)) is amended— 

15 (1) in subparagraph (N), by striking ‘‘and’’ at 

16 the end; 

17 (2) in subparagraph (O), by striking the period 

18 at the end and inserting ‘‘, and’’; and 

19 (3) by adding at the end the following: 

20 ‘‘(P) establish and operate a national web-based 

21 system, to be known as the ‘Transplantation Trans22 mission Sentinel Network’, for the detection, report23 ing, and tracking of disease transmission from 

24 organ, tissue, or eye donors to organ, tissue or eye 

25 transplant recipients.’’. 


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1 (b) ACCREDITATION OF ESTABLISHMENTS AND PER2 SONNEL ENGAGED IN THE MANUFACTURE OF HUMAN

3 CELLS, TISSUES, OR CELLULAR OR TISSUE-BASED PROD4 UCTS.— 

5 (1) IN GENERAL.—The Secretary shall issue 

6 regulations relating to the accreditation of— 

7 (A) establishments; and 

8 (B) personnel who participate in the recov9 ery, processing, storage, labeling, packaging, or 

10 distribution of human cells, tissues, or cellular 

11 or tissue-based products for such establish12 ments. 

13 (2) AUTHORITY OF SECRETARY.—In issuing the 

14 regulations under paragraph (1), the Secretary 

15 shall— 

16 (A) establish an accreditation process mod17 eled after the process used by the Joint Com18 mission (previously known as the Joint Com19 mission on Accreditation of Healthcare Organi20 zations); or 

21 (B) adopt an accreditation process, estab22 lished by a private entity, that is in effect on 

23 the date of enactment of this Act. 

24 (3) DEFINITIONS.—In this subsection: 


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1 (A) ESTABLISHMENT.—The term ‘‘estab2 lishment’’ has the meaning given such term in 

3 section 1271.3 of title 21, Code of Federal Reg4 ulations (or any corresponding similar regula5 tion or ruling). 

6 (B) HUMAN CELLS, TISSUES, OR CEL7 LULAR OR TISSUE-BASED PRODUCTS.—The 

8 term ‘‘human cells, tissues, or cellular or tissue9 based products’’ has the meaning given such 

10 term in section 1271.3 of title 21, Code of Fed11 eral Regulations (or any corresponding similar 

12 regulation or ruling). 

13 (c) NATIONAL JOINT REPLACEMENT REGISTRY

14 STUDY.— 

15 (1) STUDY.—The Secretary shall conduct a 

16 study evaluating the advantages and disadvantages 

17 of establishing a national registry for the purpose of 

18 tracking the safety and effectiveness of artificial 

19 joints used to replace joints in beneficiaries of the 

20 Medicare program under title XVIII of the Social 

21 Security Act (42 U.S.C. 1395 et seq.). 

22 (2) CONTENTS OF PROPOSED REGISTRY.—In 

23 evaluating the proposed registry under paragraph 

24 (1), the Secretary shall assume that the registry in25 cludes, at a minimum, information on— 


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1 (A) the type of joint replaced; 

2 (B) the side of the body on which the joint 

3 is replaced; 

4 (C) whether more than 1 operation was re5 quired in replacing a joint with an artificial 

6 joint; and 

7 (D) uniform identifiers (including the de8 vice lot number and catalog number) for the ar9 tificial joint involved. 

10 (3) REPORT.—Not later than 2 years after the 

11 date of enactment of this Act, the Secretary shall 

12 submit to Congress a report on the results of the 

13 study under paragraph (1) and recommendation for 

14 changes to the Medicare program, including any nec15 essary changes to the Medicare claims form, to allow 

16 for the collection of information required for the reg17 istry. 

18 SEC. 105. TRAFFIC AND WORKPLACE SAFETY. 

19 (a) TRAFFIC SAFETY STUDY.— 

20 (1) STUDY.—The Secretary, in consultation 

21 with the Secretary of Transportation, shall conduct 

22 a study, using epidemiological methods, on the fre23 quency, severity, and likely causes of severe trauma 

24 to extremities resulting from motor vehicle crashes. 


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1 (2) REPORT.—Not later than 2 years after the 

2 date of enactment of this Act, the Secretary of 

3 Health and Human Services shall submit to Con4 gress a report on the results of the study conducted 

5 under paragraph (1). 

6 (3) MOTOR VEHICLE DEFINED.—In this sub7 section, the term ‘‘motor vehicle’’ has the meaning 

8 given such term in section 405 of title 23, United 

9 States Code. 

10 (b) WORKPLACE SAFETY STUDY.— 

11 (1) IN GENERAL.—The Secretary, in consulta12 tion with the Secretary of Labor, shall conduct a 

13 study, within the research framework of the Na14 tional Occupational Research Agenda coordinated by 

15 the National Institute for Occupational Safety and 

16 Health, on— 

17 (A) the number of workplace-related mus18 culoskeletal injuries and other conditions; and 

19 (B) medical treatments provided to individ20 uals to treat such injuries and conditions. 

21 (2) COLLECTION METHODOLOGY.—In con22 ducting the study under paragraph (1), the Sec23 retary of Health and Human Services shall collect 

24 information in a manner that allows such informa25 tion to be reported and analyzed on the basis of the 


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1 type of musculoskeletal injury or condition involved 

2 and the race and ethnicity of the individual with 

3 such injury or condition. 

4 (3) REQUEST FOR INFORMATION FROM STATE

5 WORKERS COMPENSATION BOARDS.—The Secretary 

6 may request that the head of each State agency that 

7 has jurisdiction over workers compensation submit 

8 information relevant to the study under paragraph 

9 (1) to the Secretary. 

10 (4) REPORT.—Not later than 2 years after the 

11 date of enactment of this Act, the Secretary shall 

12 submit to Congress a report on the results of the 

13 study under paragraph (1), analyzed by type of in14 jury or condition, and race and ethnicity. 

15 SEC. 106. PUBLIC EDUCATION CAMPAIGN. 

16 (a) IN GENERAL.—The Secretary, in consultation 

17 with the Secretary of Education, the Secretary of Trans18 portation, the Chairman of the Consumer Product Safety 

19 Commission, and the Chair of the President’s Council on 

20 Physical Fitness and Sports, shall conduct a national pub21 lic awareness program on musculoskeletal health. 

22 (b) CONTENTS OF PROGRAM.—The program shall in23 clude, at a minimum, each of the following components: 

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1 eral public on musculoskeletal health, including edu2 cation on healthy lifestyle practices relating to mus3 culoskeletal health. 

4 (2) EDUCATION FOR HEALTH PROFES5 SIONALS.—A component providing education to 

6 health professionals on musculoskeletal health, in7 cluding— 

8 (A) specific information on musculoskeletal 

9 health in medically underserved populations (as 

10 defined in section 330(b)(3) of the Public 

11 Health Service Act (42 U.S.C. 254b(b)(3))); 

12 and 

13 (B) information of the impact of musculo14 skeletal diseases and other conditions on racial 

15 and ethnic minority populations. 

16 (3) EDUCATION FOR GIRLS.—A component that 

17 utilizes the program popularly known as ‘‘powerful 

18 bones, powerful girls’’ to educate girls ages 9 

19 through 12 on optimal bone health and the methods 

20 to achieve such health, with a focus on reducing the 

21 risk that such girls will develop osteoporosis as 

22 adults. 

23 (4) EDUCATION FOR SPECIAL POPULATIONS.— 

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1 lowing populations, that addresses the specific needs 

2 of those populations: 

3 (A) Populations of the United States that 

4 have disproportionately high levels of musculo5 skeletal disease and injury and other conditions. 

6 (B) Populations of the United States that 

7 have disproportionally low levels of access to 

8 orthopaedic services. 

9 (C) Racial and ethnic minority populations 

10 of the United States. 

11 SEC. 107. ORTHOPAEDIC PHYSICIAN WORKFORCE TRAIN12 ING STUDY. 

13 (a) STUDY.—The Secretary, acting through the Ad14 ministrator of the Health Resources and Services Admin15 istration, shall conduct a study on the amount of funding 

16 available, from all sources, for graduate medical education 

17 in orthopaedics and the impact of that amount of funding 

18 on the availability of physicians trained in orthopaedics. 

19 (b) REPORT.—Not later than 2 years after the date 

20 of enactment of this Act, the Secretary shall submit to 

21 Congress a report on the results of the study conducted 

22 under subsection (a). 

23 SEC. 108. BONE DENSITY UNDER THE MEDICARE PROGRAM. 

24 (a) STANDARD MEASUREMENT TOOL FOR BONE

25 DENSITY STUDY.— 


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1 (1) STUDY.—The Secretary, in consultation 

2 with the Director of the Agency for Healthcare Re3 search and Quality, the Director of the National In4 stitute of Biomedical Imaging and Bioengineering, 

5 and the Administrator of the Centers for Medicare 

6 & Medicaid Services, shall conduct a study on— 

7 (A) the cost-effectiveness of all available 

8 methods for measuring bone mass in bene9 ficiaries of the Medicare program under title 

10 XVIII of the Social Security Act (42 U.S.C. 

11 1395 et seq.) for the purpose of identifying the 

12 most cost-effective method; 

13 (B) the cost-effectiveness of different time 

14 intervals between bone mass screenings for such 

15 beneficiaries for the purpose of identifying the 

16 most cost-effective interval; and 

17 (C) the frequency with which the cost-ef18 fectiveness of such methods and intervals 

19 should be reviewed based on anticipated 

20 changes in technology. 

21 (2) REPORT.— 

22 (A) IN GENERAL.—Not later than 2 years 

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1 retary of Commerce a report on the results of 

2 the study under paragraph (1). 

3 (B) CONTENTS OF REPORT.—The report 

4 submitted under subparagraph (A) shall in5 clude, at a minimum, information on each of 

6 the following: 

7 (i) The most cost-effective method for 

8 measuring bone mass in beneficiaries of 

9 the Medicare program and a recommenda10 tion for the adoption of such method by 

11 the Medicare program. 

12 (ii) The most cost-effective interval 

13 between bone mass screenings for such 

14 beneficiaries and recommendation for the 

15 adoption of such interval by the Medicare 

16 program. 

17 (3) UNITED STATES PREVENTIVE SERVICES

18 TASK FORCE.—In making the recommendations 

19 under paragraph (2)(B), the Secretary shall take 

20 into consideration any relevant guidelines in the 

21 most recent Guide to Clinical Preventive Services 

22 issued by the United States Preventive Services 

23 Task Force. 

24 (4) REVISIONS TO RECOMMENDATIONS.—The 

25 Secretary shall monitor developments in technology 


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1 used to measure bone density and prepare and sub2 mit to Congress and the Secretary of Commerce re3 ports updating the recommendations made under 

4 paragraph (2)(B), as needed. 

5 (b) STANDARD UNIT FOR MEASURING BONE DEN6 SITY.— 

7 (1) REPORT.—Not later than 3 years after the 

8 date of enactment of this Act, the Secretary of Com9 merce, acting through the Director of the National 

10 Institute of Standards and Technology, shall prepare 

11 and submit to Congress a report containing rec12 ommendations concerning a standard unit for the 

13 measurement of bone mass for use by the Medicare 

14 program under title XVIII of the Social Security Act 

15 (42 U.S.C. 1395 et seq.). 

16 (2) CONSIDERATIONS FOR RECOMMENDA17 TIONS.—In proposing the recommendations under 

18 paragraph (1), the Secretary of Commerce shall take 

19 into consideration the recommendations made under 

20 subsection (a)(2)(B), including any applicable up21 dates to such recommendations made under sub22 section (a)(4), and the accuracy and utility of the 

23 recommended standard measurement unit as a diag24 nostic tool. 


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1 SEC. 109. ACCESS TO ORTHOPAEDIC SERVICES FOR BENE2 FICIARIES OF MEDICAID AND SCHIP. 

3 (a) REPORT.—Not later than 2 years after the date 

4 of enactment of this Act, the Comptroller General of the 

5 United States shall prepare and submit a report to Con6 gress on access to orthopaedic services— 

7 (1) by beneficiaries of the Medicaid program 

8 under title XIX of the Social Security Act (42 

9 U.S.C. 1396 et seq.); and 

10 (2) by beneficiaries of the State children’s 

11 health insurance program under title XXI of the So12 cial Security Act (42 U.S.C. 1397aa et seq.). 

13 (b) FOCUS ON BARRIERS TO ACCESS AFFECTING

14 CHILDREN.—The report prepared under this section shall 

15 include, at a minimum, information on barriers to access 

16 to orthopaedic services that disproportionately affect chil17 dren who are beneficiaries of the Medicaid program or the 

18 State children’s health insurance program. 

19 SEC. 110. AGE-RELATED PROGRAMS. 

20 (a) STATE-BASED EXAMPLES OF NETWORK INNOVA21 TION, OPPORTUNITY, AND REPLICATION GRANT PRO22 GRAM.—The Secretary shall award grants to State agen23 cies in a manner similar to the manner in which grants 

24 were awarded under the program of the Department of 

25 Health and Human Services popularly known as the 

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1 tunity, and Replication Grant Program’’ for the purpose 

2 of allowing such State agencies to establish or expand 

3 health and aging activities for seniors in the areas of clin4 ical preventive services, physical activity, chronic disease 

5 self-management, and oral health. 

6 (b) CHILDHOOD MUSCULOSKELETAL DISEASES, 

7 CONDITIONS, AND INJURIES REPORT.—Not later than 2 

8 years after the date of enactment of this Act, the Surgeon 

9 General shall prepare and submit to Congress a report on 

10 the burdens and costs associated with childhood musculo11 skeletal diseases, conditions, and injuries in the United 

12 States. 

13 SEC. 111. MINORITY HEALTH DISPARITIES. 

14 The Secretary, acting through the Deputy Assistant 

15 Secretary for Minority Health, shall treat musculoskeletal 

16 diseases and conditions as a priority for programs and 

17 grants affiliated with the Office of Minority Health and 

18 may incorporate initiatives related to musculoskeletal dis19 eases and conditions into the initiatives of such Office. 

20 TITLE II—THIRD LONGITUDINAL 

21 STUDY ON AGING 

22 SEC. 201. THIRD LONGITUDINAL STUDY ON AGING. 

23 (a) IN GENERAL.—The Secretary, acting through the 

24 Director of the National Center for Health Statistics and 

25 in consultation with the Director of the National Institute 


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1 on Aging, shall conduct a third longitudinal study on 

2 aging in the United States in a manner similar to the 

3 manner in which the second longitudinal study on aging 

4 was conducted. 

5 (b) DURATION.—The duration of the third longitu6 dinal study under subsection (a) shall be at least 6 years. 

7 (c) AVAILABILITY OF DATA.—Data collected through 

8 the third longitudinal study under subsection (a) shall be 

9 made available to the public in a time and manner similar 

10 to the time and manner in which data from the second 

11 longitudinal study on aging was made available to the pub12 lic. 

Æ 


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