```

[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 1548 Introduced in Senate (IS)]

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.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Access to America's Orthopaedic 
Services Act of 2009''.

SEC. 2. TABLE OF CONTENTS.

    The table of contents for this Act is as follows:

Sec. 1. Short title.
Sec. 2. Table of contents.
Sec. 3. Definition.
                    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.

SEC. 3. DEFINITION.

    In this Act, the term ``Secretary'' means the Secretary of Health 
and Human Services, except as otherwise provided.

                    TITLE I--MUSCULOSKELETAL HEALTH

SEC. 101. FINDINGS.

    Congress makes the following findings:
            (1) Musculoskeletal diseases and other conditions are the 
        leading cause of disability in the United States.
            (2) Musculoskeletal conditions account for more than one-
        half of all chronic conditions in people over 50 years of age 
        in developed countries.
            (3) More than 1 in 4 individuals in the United States has a 
        musculoskeletal condition requiring medical attention.
            (4) Direct and indirect costs for bone and joint health are 
        $849,000,000,000 per year in the United States.
            (5) Musculoskeletal conditions are the greatest cause of 
        total lost workdays and medical bed days in the United States.
            (6) The 2004 Surgeon General Report on Bone Health and 
        Osteoporosis concluded that there is a lack of awareness of 
        bone disease among the public and health care professionals.
            (7) Research demonstrates that there is need among ethnic 
        and racial minorities to improve knowledge of and treatment for 
        musculoskeletal diseases and other conditions.

SEC. 102. MUSCULOSKELETAL RESEARCH.

    (a) Regulations Concerning Reporting Criteria for Percent of 
Effort.--
            (1) In general.--The Secretary, in consultation with the 
        Director of the National Institutes of Health, shall establish, 
        by regulation, criteria for accounting for and reporting the 
        percent of effort expended by researchers, with respect to 
        research that is--
                    (A) conducted during each fiscal year beginning 
                after the last day of the second full fiscal year 
                following the date of enactment of this Act; and
                    (B) funded through research grants, on 
                musculoskeletal health, awarded by either the Director 
                of the National Institutes of Health or the Director of 
                the Agency for Healthcare Research and Quality.
            (2) Deadline for regulations.--Not later than the last day 
        of the 2-year period beginning on the date of enactment of this 
        Act, the Secretary shall issue the regulations required by 
        paragraph (1).
    (b) New Investigators in Musculoskeletal Research.--
            (1) Report.--Not later than 90 days after the last day of 
        each fiscal year that begins more than 1 year following the 
        date of enactment of this Act, the Secretary, in consultation 
        with the Director of the National Institutes of Health, shall 
        prepare and submit to Congress a report on each of the 
        following:
                    (A) The number of new investigators who are awarded 
                grants for musculoskeletal health research by the 
                National Institutes of Health during the fiscal year 
                involved.
                    (B) The total amount of funds awarded to those 
                investigators through such grants during the fiscal 
                year.
                    (C) The percentage of the National Institutes of 
                Health's budget for musculoskeletal health research 
                that was awarded to those investigators through such 
                grants during the fiscal year.
                    (D) The backgrounds of those investigators who are 
                awarded such grants during the fiscal year, analyzed by 
                race and ethnicity.
                    (E) A description of the efforts made by the 
                Director of the National Institutes of Health to 
                encourage individuals from underrepresented minority 
                groups (as defined by the Secretary) to apply for 
                grants for musculoskeletal health research awarded by 
                the National Institutes of Health during the fiscal 
                year.
            (2) Recommendations.--The first report submitted under 
        paragraph (1) shall include, and subsequent reports may 
        include, recommendations concerning additional resources that 
        the National Institutes of Health or other entities could use--
                    (A) to increase the number of new investigators 
                awarded grants referred to in paragraph (1)(A); and
                    (B) to increase the number of new investigators 
                awarded such grants who are members of underrepresented 
                minority groups (as defined by the Secretary).
            (3) Definitions.--In this section:
                    (A) New investigator.--The term ``new 
                investigator'' has the meaning given the term by the 
                Secretary for purposes of administering title III of 
                the Public Health Service Act (42 U.S.C. 241 et seq.), 
                but only with respect to musculoskeletal health 
                research.
                    (B) Race; ethnicity.--The terms ``race'' and 
                ``ethnicity'' have the meanings given such terms by the 
                Office of Management and Budget for purposes of Federal 
                statistics and administrative reporting.

SEC. 103. MUSCULOSKELETAL TRAUMA RESEARCH AND CARE.

    (a)  Musculoskeletal Trauma Research.--
            (1) Report.--Not later than 2 years after the date of 
        enactment of this Act, the Secretary shall prepare and submit 
        to Congress a report on all programs and activities relating to 
        musculoskeletal trauma care that are being conducted by the 
        Federal Government or supported by funding made available by 
        Federal Government.
            (2) Contents of report.--Such report shall include, at a 
        minimum, each of the following:
                    (A) Information on the status of each Federal 
                program and activity referred to in paragraph (1), 
                including specific information on any research program 
                and activity.
                    (B) Information on the methods being used to 
                coordinate research being conducted under such Federal 
                programs and activities and the effectiveness of such 
                methods.
            (3) Consultation.--In preparing the report under paragraph 
        (1), the Secretary shall consult with--
                    (A) the Secretary of Defense; and
                    (B) the heads of other Federal departments and 
                agencies that administer programs and activities 
                relating to musculoskeletal trauma care, as determined 
                by the Secretary of Health and Human Services.
    (b) Orthopaedic Treatment Through Trauma Care Systems.--
            (1) Study.--The Secretary shall conduct a study on the 
        impact of trauma care systems that connect hospitals with other 
        providers of musculoskeletal health care services (including 
        orthopedists).
            (2) Purposes of study.--The purposes of the study under 
        paragraph (1) shall include, at a minimum, each of the 
        following:
                    (A) An examination of the provision of acute and 
                rehabilitative care to trauma patients with 
                musculoskeletal injuries or other conditions.
                    (B) An examination of epidemiological data on 
                trauma patients with musculoskeletal injuries or other 
                conditions, including the number of such patients, the 
                number of such injuries and conditions, and the types 
                of such injuries and conditions.
                    (C) An evaluation of the ability of a patient with 
                an orthopaedic injury or other condition originating 
                from musculoskeletal trauma to access specialty care 
                relevant to that injury or condition.
                    (D) An examination of the impact of trauma 
                rehabilitation care on musculoskeletal health and the 
                ability of trauma patients with musculoskeletal 
                injuries or other conditions to access postacute 
                rehabilitative services.
            (3) Report.--Not later than 2 years after the date of 
        enactment of this Act, the Secretary shall submit to Congress a 
        report on the results of the study conducted under paragraph 
        (1), including recommendations for improving the treatment of 
        trauma patients with musculoskeletal injuries or other 
        conditions.

SEC. 104. TRANSPLANTS, TISSUES, AND REPLACEMENT JOINTS.

    (a) Transplantation Transmission Sentinel Network.--Section 
372(b)(2) of the Public Health Service Act (42 U.S.C. 274(b)(2)) is 
amended--
            (1) in subparagraph (N), by striking ``and'' at the end;
            (2) in subparagraph (O), by striking the period at the end 
        and inserting ``, and''; and
            (3) by adding at the end the following:
            ``(P) establish and operate a national web-based system, to 
        be known as the `Transplantation Transmission Sentinel 
        Network', for the detection, reporting, and tracking of disease 
        transmission from organ, tissue, or eye donors to organ, tissue 
        or eye transplant recipients.''.
    (b) Accreditation of Establishments and Personnel Engaged in the 
Manufacture of Human Cells, Tissues, or Cellular or Tissue-Based 
Products.--
            (1) In general.--The Secretary shall issue regulations 
        relating to the accreditation of--
                    (A) establishments; and
                    (B) personnel who participate in the recovery, 
                processing, storage, labeling, packaging, or 
                distribution of human cells, tissues, or cellular or 
                tissue-based products for such establishments.
            (2) Authority of secretary.--In issuing the regulations 
        under paragraph (1), the Secretary shall--
                    (A) establish an accreditation process modeled 
                after the process used by the Joint Commission 
                (previously known as the Joint Commission on 
                Accreditation of Healthcare Organizations); or
                    (B) adopt an accreditation process, established by 
                a private entity, that is in effect on the date of 
                enactment of this Act.
            (3) Definitions.--In this subsection:
                    (A) Establishment.--The term ``establishment'' has 
                the meaning given such term in section 1271.3 of title 
                21, Code of Federal Regulations (or any corresponding 
                similar regulation or ruling).
                    (B) Human cells, tissues, or cellular or tissue-
                based products.--The term ``human cells, tissues, or 
                cellular or tissue-based products'' has the meaning 
                given such term in section 1271.3 of title 21, Code of 
                Federal Regulations (or any corresponding similar 
                regulation or ruling).
    (c) National Joint Replacement Registry Study.--
            (1) Study.--The Secretary shall conduct a study evaluating 
        the advantages and disadvantages of establishing a national 
        registry for the purpose of tracking the safety and 
        effectiveness of artificial joints used to replace joints in 
        beneficiaries of the Medicare program under title XVIII of the 
        Social Security Act (42 U.S.C. 1395 et seq.).
            (2) Contents of proposed registry.--In evaluating the 
        proposed registry under paragraph (1), the Secretary shall 
        assume that the registry includes, at a minimum, information 
        on--
                    (A) the type of joint replaced;
                    (B) the side of the body on which the joint is 
                replaced;
                    (C) whether more than 1 operation was required in 
                replacing a joint with an artificial joint; and
                    (D) uniform identifiers (including the device lot 
                number and catalog number) for the artificial joint 
                involved.
            (3) Report.--Not later than 2 years after the date of 
        enactment of this Act, the Secretary shall submit to Congress a 
        report on the results of the study under paragraph (1) and 
        recommendation for changes to the Medicare program, including 
        any necessary changes to the Medicare claims form, to allow for 
        the collection of information required for the registry.

SEC. 105. TRAFFIC AND WORKPLACE SAFETY.

    (a) Traffic Safety Study.--
            (1) Study.--The Secretary, in consultation with the 
        Secretary of Transportation, shall conduct a study, using 
        epidemiological methods, on the frequency, severity, and likely 
        causes of severe trauma to extremities resulting from motor 
        vehicle crashes.
            (2) Report.--Not later than 2 years after the date of 
        enactment of this Act, the Secretary of Health and Human 
        Services shall submit to Congress a report on the results of 
        the study conducted under paragraph (1).
            (3) Motor vehicle defined.--In this subsection, the term 
        ``motor vehicle'' has the meaning given such term in section 
        405 of title 23, United States Code.
    (b) Workplace Safety Study.--
            (1) In general.--The Secretary, in consultation with the 
        Secretary of Labor, shall conduct a study, within the research 
        framework of the National Occupational Research Agenda 
        coordinated by the National Institute for Occupational Safety 
        and Health, on--
                    (A) the number of workplace-related musculoskeletal 
                injuries and other conditions; and
                    (B) medical treatments provided to individuals to 
                treat such injuries and conditions.
            (2) Collection methodology.--In conducting the study under 
        paragraph (1), the Secretary of Health and Human Services shall 
        collect information in a manner that allows such information to 
        be reported and analyzed on the basis of the type of 
        musculoskeletal injury or condition involved and the race and 
        ethnicity of the individual with such injury or condition.
            (3) Request for information from state workers compensation 
        boards.--The Secretary may request that the head of each State 
        agency that has jurisdiction over workers compensation submit 
        information relevant to the study under paragraph (1) to the 
        Secretary.
            (4) Report.--Not later than 2 years after the date of 
        enactment of this Act, the Secretary shall submit to Congress a 
        report on the results of the study under paragraph (1), 
        analyzed by type of injury or condition, and race and 
        ethnicity.

SEC. 106. PUBLIC EDUCATION CAMPAIGN.

    (a) In General.--The Secretary, in consultation with the Secretary 
of Education, the Secretary of Transportation, the Chairman of the 
Consumer Product Safety Commission, and the Chair of the President's 
Council on Physical Fitness and Sports, shall conduct a national public 
awareness program on musculoskeletal health.
    (b) Contents of Program.--The program shall include, at a minimum, 
each of the following components:
            (1) General information for the public.--A component 
        providing education to the general public on musculoskeletal 
        health, including education on healthy lifestyle practices 
        relating to musculoskeletal health.
            (2) Education for health professionals.--A component 
        providing education to health professionals on musculoskeletal 
        health, including--
                    (A) specific information on musculoskeletal health 
                in medically underserved populations (as defined in 
                section 330(b)(3) of the Public Health Service Act (42 
                U.S.C. 254b(b)(3))); and
                    (B) information of the impact of musculoskeletal 
                diseases and other conditions on racial and ethnic 
                minority populations.
            (3) Education for girls.--A component that utilizes the 
        program popularly known as ``powerful bones, powerful girls'' 
        to educate girls ages 9 through 12 on optimal bone health and 
        the methods to achieve such health, with a focus on reducing 
        the risk that such girls will develop osteoporosis as adults.
            (4) Education for special populations.--A component 
        providing education to each of the following populations, that 
        addresses the specific needs of those populations:
                    (A) Populations of the United States that have 
                disproportionately high levels of musculoskeletal 
                disease and injury and other conditions.
                    (B) Populations of the United States that have 
                disproportionally low levels of access to orthopaedic 
                services.
                    (C) Racial and ethnic minority populations of the 
                United States.

SEC. 107. ORTHOPAEDIC PHYSICIAN WORKFORCE TRAINING STUDY.

    (a) Study.--The Secretary, acting through the Administrator of the 
Health Resources and Services Administration, shall conduct a study on 
the amount of funding available, from all sources, for graduate medical 
education in orthopaedics and the impact of that amount of funding on 
the availability of physicians trained in orthopaedics.
    (b) Report.--Not later than 2 years after the date of enactment of 
this Act, the Secretary shall submit to Congress a report on the 
results of the study conducted under subsection (a).

SEC. 108. BONE DENSITY UNDER THE MEDICARE PROGRAM.

    (a) Standard Measurement Tool for Bone Density Study.--
            (1) Study.--The Secretary, in consultation with the 
        Director of the Agency for Healthcare Research and Quality, the 
        Director of the National Institute of Biomedical Imaging and 
        Bioengineering, and the Administrator of the Centers for 
        Medicare & Medicaid Services, shall conduct a study on--
                    (A) the cost-effectiveness of all available methods 
                for measuring bone mass in beneficiaries of the 
                Medicare program under title XVIII of the Social 
                Security Act (42 U.S.C. 1395 et seq.) for the purpose 
                of identifying the most cost-effective method;
                    (B) the cost-effectiveness of different time 
                intervals between bone mass screenings for such 
                beneficiaries for the purpose of identifying the most 
                cost-effective interval; and
                    (C) the frequency with which the cost-effectiveness 
                of such methods and intervals should be reviewed based 
                on anticipated changes in technology.
            (2) Report.--
                    (A) In general.--Not later than 2 years after the 
                date of enactment of this Act, the Secretary shall 
                submit to Congress and the Secretary of Commerce a 
                report on the results of the study under paragraph (1).
                    (B) Contents of report.--The report submitted under 
                subparagraph (A) shall include, at a minimum, 
                information on each of the following:
                            (i) The most cost-effective method for 
                        measuring bone mass in beneficiaries of the 
                        Medicare program and a recommendation for the 
                        adoption of such method by the Medicare 
                        program.
                            (ii) The most cost-effective interval 
                        between bone mass screenings for such 
                        beneficiaries and recommendation for the 
                        adoption of such interval by the Medicare 
                        program.
            (3) United states preventive services task force.--In 
        making the recommendations under paragraph (2)(B), the 
        Secretary shall take into consideration any relevant guidelines 
        in the most recent Guide to Clinical Preventive Services issued 
        by the United States Preventive Services Task Force.
            (4) Revisions to recommendations.--The Secretary shall 
        monitor developments in technology used to measure bone density 
        and prepare and submit to Congress and the Secretary of 
        Commerce reports updating the recommendations made under 
        paragraph (2)(B), as needed.
    (b) Standard Unit for Measuring Bone Density.--
            (1) Report.--Not later than 3 years after the date of 
        enactment of this Act, the Secretary of Commerce, acting 
        through the Director of the National Institute of Standards and 
        Technology, shall prepare and submit to Congress a report 
        containing recommendations concerning a standard unit for the 
        measurement of bone mass for use by the Medicare program under 
        title XVIII of the Social Security Act (42 U.S.C. 1395 et 
        seq.).
            (2) Considerations for recommendations.--In proposing the 
        recommendations under paragraph (1), the Secretary of Commerce 
        shall take into consideration the recommendations made under 
        subsection (a)(2)(B), including any applicable updates to such 
        recommendations made under subsection (a)(4), and the accuracy 
        and utility of the recommended standard measurement unit as a 
        diagnostic tool.

SEC. 109. ACCESS TO ORTHOPAEDIC SERVICES FOR BENEFICIARIES OF MEDICAID 
              AND SCHIP.

    (a) Report.--Not later than 2 years after the date of enactment of 
this Act, the Comptroller General of the United States shall prepare 
and submit a report to Congress on access to orthopaedic services--
            (1) by beneficiaries of the Medicaid program under title 
        XIX of the Social Security Act (42 U.S.C. 1396 et seq.); and
            (2) by beneficiaries of the State children's health 
        insurance program under title XXI of the Social Security Act 
        (42 U.S.C. 1397aa et seq.).
    (b) Focus on Barriers To Access Affecting Children.--The report 
prepared under this section shall include, at a minimum, information on 
barriers to access to orthopaedic services that disproportionately 
affect children who are beneficiaries of the Medicaid program or the 
State children's health insurance program.

SEC. 110. AGE-RELATED PROGRAMS.

    (a) State-Based Examples of Network Innovation, Opportunity, and 
Replication Grant Program.--The Secretary shall award grants to State 
agencies in a manner similar to the manner in which grants were awarded 
under the program of the Department of Health and Human Services 
popularly known as the ``State-based Examples of Network Innovation, 
Opportunity, and Replication Grant Program'' for the purpose of 
allowing such State agencies to establish or expand health and aging 
activities for seniors in the areas of clinical preventive services, 
physical activity, chronic disease self-management, and oral health.
    (b) Childhood Musculoskeletal Diseases, Conditions, and Injuries 
Report.--Not later than 2 years after the date of enactment of this 
Act, the Surgeon General shall prepare and submit to Congress a report 
on the burdens and costs associated with childhood musculoskeletal 
diseases, conditions, and injuries in the United States.

SEC. 111. MINORITY HEALTH DISPARITIES.

    The Secretary, acting through the Deputy Assistant Secretary for 
Minority Health, shall treat musculoskeletal diseases and conditions as 
a priority for programs and grants affiliated with the Office of 
Minority Health and may incorporate initiatives related to 
musculoskeletal diseases and conditions into the initiatives of such 
Office.

              TITLE II--THIRD LONGITUDINAL STUDY ON AGING

SEC. 201. THIRD LONGITUDINAL STUDY ON AGING.

    (a) In General.--The Secretary, acting through the Director of the 
National Center for Health Statistics and in consultation with the 
Director of the National Institute on Aging, shall conduct a third 
longitudinal study on aging in the United States in a manner similar to 
the manner in which the second longitudinal study on aging was 
conducted.
    (b) Duration.--The duration of the third longitudinal study under 
subsection (a) shall be at least 6 years.
    (c) Availability of Data.--Data collected through the third 
longitudinal study under subsection (a) shall be made available to the 
public in a time and manner similar to the time and manner in which 
data from the second longitudinal study on aging was made available to 
the public.
                                 <all>
```