I 

112TH CONGRESS 

1ST SESSION H. R. 2020 

To amend title XVIII of the Social Security Act to improve access to, 

and utilization of, bone mass measurement benefits under the Medicare 

part B program by extending the minimum payment amount for bone 

mass measurement under such program through 2013. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 26, 2011 

Mr. BURGESS (for himself, Ms. BERKLEY, Mrs. MYRICK, Ms. SCHWARTZ, Mr. 

SESSIONS, Mr. RANGEL, Mr. GENE GREEN of Texas, and Mrs. MCMORRIS RODGERS) introduced the following bill; which was referred to the 

Committee on Energy 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 jurisdiction 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 the Medicare part B program by extending the minimum payment amount for bone mass measurement under such program through 2013. 

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


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Preservation of Access 

3 to Osteoporosis Testing for Medicare Beneficiaries Act of 

4 2011’’. 

5 SEC. 2. FINDINGS. 

6 Congress finds the following: 

7 (1) Since 1997, Congress has recognized the 

8 importance of osteoporosis prevention by standard9 izing coverage under the Medicare program for bone 

10 mass measurement. 

11 (2) Osteoporosis remains underdiagnosed and 

12 undertreated despite numerous Federal initiatives, 

13 including recommendations of the United States 

14 Preventive Services Task Force, the 2004 United 

15 States Surgeon General’s Report on Bone Health 

16 and Osteoporosis, and education, counseling, and re17 ferral for bone mass measurement during the Wel18 come to Medicare exam. 

19 (3) Even though osteoporosis is a highly man20 ageable disease, many patients lack access to early 

21 diagnosis that can prevent debilitating fractures, 

22 morbidity, and loss of mobility. 

23 (4) Although Caucasians are most likely to sus24 tain osteoporosis fractures, from 2005 to 2025 the 

25 cost of fractures among other populations is pro26 jected to increase by 175 percent for Latinos and 


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1 Asian-Americans and 80 percent for African-Ameri2 cans. 

3 (5) African-American women are more likely 

4 than Caucasian women to die following a hip frac5 ture. 

6 (6) Osteoporosis is a critical women’s health 

7 issue. Women account for 71 percent of fractures 

8 and 75 percent of osteoporosis-associated costs and 

9 the incidence of osteoporosis-related fractures is 

10 greater than the annual combined incidence, with re11 spect to women, of heart attack, stroke, and breast 

12 cancer. 

13 (7) The World Health Organization, the Cen14 ters for Medicare & Medicaid Services, and other 

15 medical experts concur that the most widely accept16 ed method of measuring bone mass to predict frac17 ture risk is dual-energy x-ray absorptiometry (in this 

18 section referred to as ‘‘DXA’’). Vertebral fracture 

19 assessment (in this section referred to as ‘‘VFA’’) is 

20 another test used to identify patients at high risk for 

21 future fracture. 

22 (8) DXA is a cost-effective preventive test with 

23 proven results in real world settings. DXA testing 

24 increases the number of people diagnosed with 


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1 osteoporosis and treated, dramatically reducing hip 

2 fractures and related costs. 

3 (9) DXA screening is associated with a signifi4 cant (37 percent) reduction in hip fracture rates. 

5 (10) Unlike other imaging procedures, DXA re6 mains severely underutilized, with only one in four 

7 women enrolled in the Medicare program getting a 

8 DXA every two years. 

9 (11) Underutilization of bone mass measure10 ment will strain the Medicare budget because— 

11 (A) over half of all individuals in the 

12 United States who are age 50 or older have 

13 osteoporosis or low bone mass; 

14 (B) more than 52.4 million people in the 

15 United States had osteoporosis or low bone 

16 mass in 2010, as compared to 44 million people 

17 in the United States in 2002; 

18 (C) osteoporosis fractures are projected to 

19 increase by almost 50 percent from 2005 to 

20 2025 with over 3 million fractures expected to 

21 occur annually by 2025; 

22 (D) the population aged 65 and older rep23 resents 89 percent of fracture costs; and 

24 (E) the economic burden of osteoporosis 

25 fractures is projected to increase by nearly 50 


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1 percent from 2005 to 2025, reaching 25.3 mil2 lion in 2025. 

3 (12) Underutilization of bone mass measure4 ment will also strain the Medicaid budget, which 

5 bears the cost of nursing home admissions for hip 

6 fractures for low-income Americans. 

7 (13) Reimbursement under the Medicare pro8 gram for DXA provided in physician offices and 

9 other non-hospital settings was reduced by 50 per10 cent and is scheduled to be reduced by a total of 62 

11 percent by 2013. This drop represents one of the 

12 largest reimbursement reductions in the history of 

13 the Medicare program. Reimbursement for VFA will 

14 also be reduced by 30 percent by 2013. 

15 (14) The reduction in reimbursement discour16 ages physicians from continuing to provide access to 

17 DXA or VFA in their offices. DXA testing for older 

18 women declined in 2009 for the first time since Con19 gress passed the Bone Mass Measurement Act in 

20 1997. Since two-thirds of all DXA scans are per21 formed in non-facility settings, such as physician of22 fices, patient access to bone mass measurement will 

23 continue to be severely compromised when more phy24 sicians discontinue providing such tests in their ofVerDate Mar 15 2010 03:53 Jun 02, 2011 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H2020.IH H2020

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1 fices, thereby exacerbating the current underutiliza2 tion of the benefit. 

3 SEC. 3. EXTENDING MINIMUM PAYMENT FOR BONE MASS 

4 MEASUREMENT. 

5 (a) IN GENERAL.—Section 1848 of the Social Secu6 rity Act (42 U.S.C. 1395w–4) is amended— 

7 (1) in subsection (b)— 

8 (A) in paragraph (4)(B), by striking ‘‘for 

9 2010 and 2011’’ and inserting ‘‘for each of 

10 2010 through 2013’’; and 

11 (B) in paragraph (6)— 

12 (i) in the matter preceding subpara13 graph (A), by striking ‘‘and 2011’’ and in14 serting ‘‘, 2011, 2012, and 2013’’; and 

15 (ii) in subparagraph (C), by striking 

16 ‘‘and 2011’’ and inserting ‘‘, 2011, 2012, 

17 and 2013’’; and 

18 (2) in subsection (c)(2)(B)(iv)(IV), by striking 

19 ‘‘or 2011’’ and inserting ‘‘, 2011, 2012, or 2013’’. 

20 (b) IMPLEMENTATION.—Notwithstanding any other 

21 provision of law, the Secretary may implement the amend22 ments made by subsection (a) by program instruction or 

23 otherwise. 

Æ 


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