II

105TH CONGRESS

1ST SESSION S. 1536

To amend the Public Health Service Act and Employee Retirement Income

Security Act of 1974 to require that group and individual health insurance coverage and group health plans provide coverage for qualified

individuals for bone mass measurement (bone density testing) to prevent

fractures associated with osteoporosis and to help women make informed

choices about their reproductive and post-menopausal health care, and

to otherwise provide for research and information concerning osteoporosis

and other related bone diseases.

IN THE SENATE OF THE UNITED STATES

NOVEMBER 13, 1997

Mr. TORRICELLI (for himself and Ms. SNOWE) introduced the following bill;

which was read twice and referred to the Committee on Labor and

Human Resources

A BILL

To amend the Public Health Service Act and Employee Retirement Income Security Act of 1974 to require that

group and individual health insurance coverage and

group health plans provide coverage for qualified individuals for bone mass measurement (bone density testing)

to prevent fractures associated with osteoporosis and to

help women make informed choices about their reproductive and post-menopausal health care, and to otherwise

provide for research and information concerning

osteoporosis and other related bone diseases.
2

•S 1536 IS

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; FINDINGS.

4 (a) SHORT TITLE.—This Act may be cited as the

5 ‘‘Early Detection and Prevention of Osteoporosis and Re6 lated Bone Diseases Act of 1997’’.

7 (b) FINDINGS.—Congress makes the following

8 findings:

9 (1) NATURE OF OSTEOPOROSIS.—

10 (A) Osteoporosis is a disease characterized

11 by low bone mass and structural deterioration

12 of bone tissue leading to bone fragility and in13 creased susceptibility to fractures of the hip,

14 spine, and wrist.

15 (B) Osteoporosis has no symptoms and

16 typically remains undiagnosed until a fracture

17 occurs.

18 (C) Once a fracture occurs, the condition

19 has usually advanced to the stage where the

20 likelihood is high that another fracture will

21 occur.

22 (D) There is no cure for osteoporosis, but

23 drug therapy has been shown to reduce new hip

24 and spine fractures by 50 percent and other
3

•S 1536 IS

1 treatments, such as nutrition therapy, have also

2 proven effective.

3 (2) INCIDENCE OF OSTEOPOROSIS AND RELAT4 ED BONE DISEASES.—

5 (A) 28 million Americans have (or are at

6 risk for) osteoporosis, 80 percent of which are

7 women.

8 (B) Osteoporosis is responsible for 1.5 mil9 lion bone fractures annually, including more

10 than 300,000 hip fractures, 700,000 vertebral

11 fractures and 200,000 fractures of the wrists.

12 (C) Half of all women, and one-eighth of

13 all men, age 50 or older will have a bone frac14 ture due to osteoporosis.

15 (D) Between 3 and 4 million Americans

16 have Paget’s disease, osteogenesis imperfecta,

17 hyperparathyroidism, and other related meta18 bolic bone diseases.

19 (3) IMPACT OF OSTEOPOROSIS.—The cost of

20 treating osteoporosis is significant:

21 (A) The annual cost of osteoporosis in the

22 United States is $13.8 billion and is expected to

23 increase precipitously because the proportion of

24 the population comprised of older persons is ex25 panding and each generation of older persons
4

•S 1536 IS

1 tends to have a higher incidence of osteoporosis

2 than preceding generations.

3 (B) The average cost in the United States

4 of repairing a hip fracture due to osteoporosis

5 is $32,000.

6 (C) Fractures due to osteoporosis fre7 quently result in disability and institutionaliza8 tion of individuals.

9 (D) Because osteoporosis is a progressive

10 condition and affects primarily aging individ11 uals, reductions in the incidence or severity of

12 osteoporosis, particularly for post menopausal

13 women before they become eligible for medicare,

14 has a significant potential of reducing

15 osteoporosis-related costs under the medicare

16 program.

17 (4) USE OF BONE MASS MEASUREMENT.—

18 (A) Bone mass measurement is the only

19 reliable method of detecting osteoporosis at an

20 early stage.

21 (B) Low bone mass is as predictive of fu22 ture fractures as is high cholesterol or high

23 blood pressure of heart disease or stroke.
5

•S 1536 IS

1 (C) Bone mass measurement is a non2 invasive, painless, and reliable way to diagnose

3 osteoporosis before costly fractures occur.

4 (D) Under section 4106 of the Balanced

5 Budget Act of 1997, Medicare will provide cov6 erage, effective July 1, 1998, for bone mass

7 measurement for qualified individuals who are

8 at risk of developing osteoporosis.

9 (5) RESEARCH ON OSTEOPOROSIS AND RELAT10 ED BONE DISEASES.—

11 (A) Technology now exists, and new tech12 nology is developing, that will permit the early

13 diagnosis and prevention of osteoporosis and re14 lated bone diseases as well as management of

15 these conditions once they develop.

16 (B) Funding for research on osteoporosis

17 and related bone diseases is severely con18 strained at key research institutes, including

19 the National Institute of Arthritis and Musculo20 skeletal and Skin Diseases, the National Insti21 tute on Aging, the National Institute of Dia22 betics and Digestive and Kidney Diseases, the

23 National Institute of Dental Research, and the

24 National Institute of Child Health and Human

25 Development.
6

•S 1536 IS

1 (C) Further research is needed to improve

2 medical knowledge concerning—

3 (i) cellular mechanisms related to the

4 processes of bone resorption and bone for5 mation, and the effect of different agents

6 on bone remodeling;

7 (ii) risk factors for osteoporosis, in8 cluding newly discovered risk factors, risk

9 factors related to groups not ordinarily

10 studied (such as men and minorities), risk

11 factors related to genes that help to control

12 skeletal metabolism, and risk factors relat13 ing to the relationship of aging processes

14 to the development of osteoporosis;

15 (iii) bone mass measurement tech16 nology, including more widespread and

17 cost-effective techniques for making more

18 precise measurements and for interpreting

19 measurements;

20 (iv) calcium (including bioavailability,

21 intake requirements, and the role of cal22 cium in building heavier and denser skele23 tons), and vitamin D and its role as an es24 sential vitamin in adults;
7

•S 1536 IS

1 (v) prevention and treatment, includ2 ing the efficacy of current therapies, alter3 native drug therapies for prevention and

4 treatment, and the role of exercise; and

5 (vi) rehabilitation.

6 (D) Further educational efforts are needed

7 to increase public and professional knowledge of

8 the causes of, methods for avoiding, and treat9 ment of osteoporosis.

10 SEC. 2. REQUIRING COVERAGE OF BONE MASS MEASURE11 MENT UNDER HEALTH PLANS.

12 (a) GROUP HEALTH PLANS.—

13 (1) PUBLIC HEALTH SERVICE ACT AMEND14 MENTS.—

15 (A) IN GENERAL.—Subpart 2 of part A of

16 title XXVII of the Public Health Service Act,

17 as amended by section 703(a) of Public Law

18 104–204, is amended by adding at the end the

19 following new section:

20 ‘‘SEC. 2706. STANDARDS RELATING TO BENEFITS FOR BONE

21 MASS MEASUREMENT.

22 ‘‘(a) REQUIREMENTS FOR COVERAGE OF BONE MASS

23 MEASUREMENT.—A group health plan, and a health in24 surance issuer offering group health insurance coverage,

25 shall include (consistent with this section) coverage for
8

•S 1536 IS

1 bone mass measurement for beneficiaries and participants

2 who are qualified individuals.

3 ‘‘(b) DEFINITIONS RELATING TO COVERAGE.—In

4 this section:

5 ‘‘(1) BONE MASS MEASUREMENT.—The term

6 ‘bone mass measurement’ means a radiologic or

7 radioisotopic procedure or other procedure approved

8 by the Food and Drug Administration performed on

9 an individual for the purpose of identifying bone

10 mass or detecting bone loss or determining bone

11 quality, and includes a physician’s interpretation of

12 the results of the procedure. Nothing in this para13 graph shall be construed as requiring a bone mass

14 measurement to be conducted in a particular type of

15 facility or to prevent such a measurement from

16 being conducted through the use of mobile facilities

17 that are otherwise qualified.

18 ‘‘(2) QUALIFIED INDIVIDUAL.—The term ‘quali19 fied individual’ means an individual who—

20 ‘‘(A) is an estrogen-deficient woman at

21 clinical risk for osteoporosis;

22 ‘‘(B) has vertebral abnormalities;

23 ‘‘(C) is receiving chemotherapy or long24 term gluococorticoid (steroid) therapy;
9

•S 1536 IS

1 ‘‘(D) has primary hyperparathyroidism,

2 hyperthyroidism, or excess thyroid replacement;

3 or

4 ‘‘(E) is being monitored to assess the re5 sponse to or efficacy of approved osteoporosis

6 drug therapy.

7 ‘‘(c) LIMITATION ON FREQUENCY REQUIRED.—Tak8 ing into account the standards established under section

9 1861(rr)(3) of the Social Security Act, the Secretary shall

10 establish standards regarding the frequency with which a

11 qualified individual shall be eligible to be provided benefits

12 for bone mass measurement under this section. The Sec13 retary may vary such standards based on the clinical and

14 risk-related characteristics of qualified individuals.

15 ‘‘(d) RESTRICTIONS ON COST-SHARING.—

16 ‘‘(1) IN GENERAL.—Subject to paragraph (2),

17 nothing in this section shall be construed as prevent18 ing a group health plan or issuer from imposing

19 deductibles, coinsurance, or other cost-sharing in re20 lation to bone mass measurement under the plan (or

21 health insurance coverage offered in connection with

22 a plan).

23 ‘‘(2) LIMITATION.—Deductibles, coinsurance,

24 and other cost-sharing or other limitations for bone

25 mass measurement may not be imposed under para-
10

•S 1536 IS

1 graph (1) to the extent they exceed the deductibles,

2 coinsurance, and limitations that are applied to simi3 lar services under the group health plan or health

4 insurance coverage.

5 ‘‘(e) PROHIBITIONS.—A group health plan, and a

6 health insurance issuer offering group health insurance

7 coverage in connection with a group health plan, may

8 not—

9 ‘‘(1) deny to an individual eligibility, or contin10 ued eligibility, to enroll or to renew coverage under

11 the terms of the plan, solely for the purpose of

12 avoiding the requirements of this section;

13 ‘‘(2) provide incentives (monetary or otherwise)

14 to individuals to encourage such individuals not to

15 be provided bone mass measurements to which they

16 are entitled under this section or to providers to in17 duce such providers not to provide such measure18 ments to qualified individuals;

19 ‘‘(3) prohibit a provider from discussing with a

20 patient osteoporosis preventive techniques or medical

21 treatment options relating to this section; or

22 ‘‘(4) penalize or otherwise reduce or limit the

23 reimbursement of a provider because such provider

24 provided bone mass measurements to a qualified in25 dividual in accordance with this section.
11

•S 1536 IS

1 ‘‘(f) RULE OF CONSTRUCTION.—Nothing in this sec2 tion shall be construed to require an individual who is a

3 participant or beneficiary to undergo bone mass

4 measurement.

5 ‘‘(g) NOTICE.—A group health plan under this part

6 shall comply with the notice requirement under section

7 713(g) of the Employee Retirement Income Security Act

8 of 1974 with respect to the requirements of this section

9 as if such section applied to such plan.

10 ‘‘(h) LEVEL AND TYPE OF REIMBURSEMENTS.—

11 Nothing in this section shall be construed to prevent a

12 group health plan or a health insurance issuer offering

13 group health insurance coverage from negotiating the level

14 and type of reimbursement with a provider for care pro15 vided in accordance with this section.

16 ‘‘(i) PREEMPTION.—

17 ‘‘(1) IN GENERAL.—The provisions of this sec18 tion do not preempt State law relating to health in19 surance coverage to the extent such State law pro20 vides greater benefits with respect to osteoporosis

21 detection or prevention.

22 ‘‘(2) CONSTRUCTION.—Section 2723(a)(1) shall

23 not be construed as superseding a State law de24 scribed in paragraph (1).’’.
12

•S 1536 IS

1 (B) CONFORMING AMENDMENT.—Section

2 2723(c) of such Act (42 U.S.C. 300gg–23(c)),

3 as amended by section 604(b)(2) of Public Law

4 104–204, is amended by striking ‘‘section

5 2704’’ and inserting ‘‘sections 2704 and 2706’’.

6 (2) ERISA AMENDMENTS.—

7 (A) IN GENERAL.—Subpart B of part 7 of

8 subtitle B of title I of the Employee Retirement

9 Income Security Act of 1974, as amended by

10 section 702(a) of Public Law 104–204, is

11 amended by adding at the end the following

12 new section:

13 ‘‘SEC. 713. STANDARDS RELATING TO BENEFITS FOR BONE

14 MASS MEASUREMENT.

15 ‘‘(a) REQUIREMENTS FOR COVERAGE OF BONE MASS

16 MEASUREMENT.—A group health plan, and a health in17 surance issuer offering group health insurance coverage,

18 shall include (consistent with this section) coverage for

19 bone mass measurement for beneficiaries and participants

20 who are qualified individuals.

21 ‘‘(b) DEFINITIONS RELATING TO COVERAGE.—In

22 this section:

23 ‘‘(1) BONE MASS MEASUREMENT.—The term

24 ‘bone mass measurement’ means a radiologic or

25 radioisotopic procedure or other procedure approved
13

•S 1536 IS

1 by the Food and Drug Administration performed on

2 an individual for the purpose of identifying bone

3 mass or detecting bone loss or determining bone

4 quality, and includes a physician’s interpretation of

5 the results of the procedure. Nothing in this para6 graph shall be construed as requiring a bone mass

7 measurement to be conducted in a particular type

8 of facility or to prevent such a measurement from

9 being conducted through the use of mobile facilities

10 that are otherwise qualified.

11 ‘‘(2) QUALIFIED INDIVIDUAL.—The term ‘quali12 fied individual’ means an individual who—

13 ‘‘(A) is an estrogen-deficient woman at

14 clinical risk for osteoporosis;

15 ‘‘(B) has vertebral abnormalities;

16 ‘‘(C) is receiving chemotherapy or long17 term gluococorticoid (steroid) therapy;

18 ‘‘(D) has primary hyperparathyroidism,

19 hyperthyroidism, or excess thyroid replacement;

20 or

21 ‘‘(E) is being monitored to assess the re22 sponse to or efficacy of approved osteoporosis

23 drug therapy.

24 ‘‘(c) LIMITATION ON FREQUENCY REQUIRED.—The

25 standards established under section 2706(c) of the Public
14

•S 1536 IS

1 Health Service Act shall apply to benefits provided under

2 this section in the same manner as they apply to benefits

3 provided under section 2706 of such Act.

4 ‘‘(d) RESTRICTIONS ON COST-SHARING.—

5 ‘‘(1) IN GENERAL.—Subject to paragraph (2),

6 nothing in this section shall be construed as prevent7 ing a group health plan or issuer from imposing

8 deductibles, coinsurance, or other cost-sharing in re9 lation to bone mass measurement under the plan (or

10 health insurance coverage offered in connection with

11 a plan).

12 ‘‘(2) LIMITATION.—Deductibles, coinsurance,

13 and other cost-sharing or other limitations for bone

14 mass measurement may not be imposed under para15 graph (1) to the extent they exceed the deductibles,

16 coinsurance, and limitations that are applied to simi17 lar services under the group health plan or health

18 insurance coverage.

19 ‘‘(e) PROHIBITIONS.—A group health plan, and a

20 health insurance issuer offering group health insurance

21 coverage in connection with a group health plan, may

22 not—

23 ‘‘(1) deny to an individual eligibility, or contin24 ued eligibility, to enroll or to renew coverage under
15

•S 1536 IS

1 the terms of the plan, solely for the purpose of

2 avoiding the requirements of this section;

3 ‘‘(2) provide incentives (monetary or otherwise)

4 to individuals to encourage such individuals not to

5 be provided bone mass measurements to which they

6 are entitled under this section or to providers to in7 duce such providers not to provide such measure8 ments to qualified individuals;

9 ‘‘(3) prohibit a provider from discussing with a

10 patient osteoporosis preventive techniques or medical

11 treatment options relating to this section; or

12 ‘‘(4) penalize or otherwise reduce or limit the

13 reimbursement of a provider because such provider

14 provided bone mass measurements to a qualified in15 dividual in accordance with this section.

16 ‘‘(f) RULE OF CONSTRUCTION.—Nothing in this sec17 tion shall be construed to require an individual who is a

18 participant or beneficiary to undergo bone mass

19 measurement.

20 ‘‘(g) NOTICE UNDER GROUP HEALTH PLAN.—The

21 imposition of the requirements of this section shall be

22 treated as a material modification in the terms of the plan

23 described in section 102(a)(1), for purposes of assuring

24 notice of such requirements under the plan; except that

25 the summary description required to be provided under the
16

•S 1536 IS

1 last sentence of section 104(b)(1) with respect to such

2 modification shall be provided by not later than 60 days

3 after the first day of the first plan year in which such

4 requirements apply.

5 ‘‘(h) PREEMPTION.—

6 ‘‘(1) IN GENERAL.—The provisions of this sec7 tion do not preempt State law relating to health in8 surance coverage to the extent such State law pro9 vides greater benefits with respect to osteoporosis

10 detection or prevention.

11 ‘‘(2) CONSTRUCTION.—Section 731(a)(1) shall

12 not be construed as superseding a State law de13 scribed in paragraph (1).’’.

14 (B) CONFORMING AMENDMENTS.—

15 (i) Section 731(c) of such Act (29

16 U.S.C. 1191(c)), as amended by section

17 603(b)(1) of Public Law 104–204, is

18 amended by striking ‘‘section 711’’ and in19 serting ‘‘sections 711 and 713’’.

20 (ii) Section 732(a) of such Act (29

21 U.S.C. 1191a(a)), as amended by section

22 603(b)(2) of Public Law 104–204, is

23 amended by striking ‘‘section 711’’ and in24 serting ‘‘sections 711 and 713’’.
17

•S 1536 IS

1 (iii) The table of contents in section 1

2 of such Act is amended by inserting after

3 the item relating to section 712 the follow4 ing new item:

‘‘Sec. 713. Standards relating to benefits for bone mass measurement.

5 (b) INDIVIDUAL HEALTH INSURANCE.—

6 (1) IN GENERAL.—Part B of title XXVII of the

7 Public Health Service Act, as amended by section

8 605(a) of Public Law 104–204, is amended by in9 serting after section 2751 the following new section:

10 ‘‘SEC. 2752. STANDARDS RELATING TO BENEFITS FOR BONE

11 MASS MEASUREMENT.

12 ‘‘(a) IN GENERAL.—The provisions of section 2706

13 (other than subsection (g)) shall apply to health insurance

14 coverage offered by a health insurance issuer in the indi15 vidual market in the same manner as it applies to health

16 insurance coverage offered by a health insurance issuer

17 in connection with a group health plan in the small or

18 large group market.

19 ‘‘(b) NOTICE.—A health insurance issuer under this

20 part shall comply with the notice requirement under sec21 tion 713(g) of the Employee Retirement Income Security

22 Act of 1974 with respect to the requirements referred to

23 in subsection (a) as if such section applied to such issuer

24 and such issuer were a group health plan.

25 ‘‘(c) PREEMPTION.—
18

•S 1536 IS

1 ‘‘(1) IN GENERAL.—The provisions of this sec2 tion do not preempt State law relating to health in3 surance coverage to the extent such State law pro4 vides greater benefits with respect to osteoporosis

5 detection or prevention.

6 ‘‘(2) CONSTRUCTION.—Section 2762(a) shall

7 not be construed as superseding a State law de8 scribed in paragraph (1).’’.

9 (2) CONFORMING AMENDMENTS.—Section

10 2762(b)(2) of such Act (42 U.S.C. 300gg–62(b)(2)),

11 as added by section 605(b)(3)(B) of Public Law

12 104–204, is amended by striking ‘‘section 2751’’

13 and inserting ‘‘sections 2751 and 2752’’.

14 (c) EFFECTIVE DATES.—

15 (1) GROUP HEALTH PLANS.—The amendments

16 made by subsection (a) shall apply with respect to

17 group health plans for plan years beginning on or

18 after January 1, 1999.

19 (2) INDIVIDUAL MARKET.—The amendments

20 made by subsection (b) shall apply with respect to

21 health insurance coverage offered, sold, issued, re22 newed, in effect, or operated in the individual mar23 ket on or after such date.
19

•S 1536 IS

1 SEC. 3. OSTEOPOROSIS RESEARCH.

2 Subpart 4 of part C of title IV of the Public Health

3 Service Act (42 U.S.C. 285d et seq.) is amended by adding

4 at the end the following new section:

5 ‘‘RESEARCH ON OSTEOPOROSIS AND RELATED DISEASES

6 ‘‘SEC. 442A. (a) EXPANSION OF RESEARCH.—The

7 Director of the Institute, the Director of the National In8 stitute on Aging, the Director of the National Institute

9 of Diabetes and Digestive and Kidney Diseases, the Direc10 tor of the National Institute of Dental Research, and the

11 Director of the National Institute of Child Health and

12 Human Development shall expand and intensify research

13 on osteoporosis and related bone diseases. The research

14 shall be in addition to research that is authorized under

15 any other provision of law.

16 ‘‘(b) MECHANISMS FOR EXPANSION OF RESEARCH.—

17 Each of the Directors specified in subsection (a) shall, in

18 carrying out such subsection, provide for one or more of

19 the following:

20 ‘‘(1) Investigator-initiated research.

21 ‘‘(2) Funding for investigators beginning their

22 research careers.

23 ‘‘(3) Mentorship research grants.

24 ‘‘(c) SPECIALIZED CENTERS OF RESEARCH.—

25 ‘‘(1) IN GENERAL.—The Director of the Insti26 tute, after consultation with the advisory council for
20

•S 1536 IS

1 the Institute, shall make grants to, or enter into

2 contracts with, public or nonprofit private entities

3 for the development and operation of centers to con4 duct research on osteoporosis and related bone dis5 eases. Subject to the extent of amounts made avail6 able in appropriations Acts, the Director shall pro7 vide for not less than three such centers.

8 ‘‘(2) ACTIVITIES.—Each center assisted under

9 this subsection—

10 ‘‘(A) shall, with respect to osteoporosis and

11 related bone diseases—

12 ‘‘(i) conduct basic and clinical re13 search;

14 ‘‘(ii) develop protocols for training

15 physicians, scientists, nurses, and other

16 health and allied health professionals;

17 ‘‘(iii) conduct training programs for

18 such individuals;

19 ‘‘(iv) develop model continuing edu20 cation programs for such professionals;

21 and

22 ‘‘(v) disseminate information to such

23 professionals and the public;

24 ‘‘(B) may use the funds to provide stipends

25 for health and allied health professionals en-
21

•S 1536 IS

1 rolled in training programs described in sub2 paragraph (A)(iii); and

3 ‘‘(C) shall use the facilities of a single in4 stitution, or be formed from a consortium of co5 operating institutions, meeting such require6 ments as may be prescribed by the Director of

7 the Institute.

8 ‘‘(3) DURATION OF SUPPORT.—Support of a

9 center under this subsection may be for a period not

10 exceeding 5 years. Such period may be extended for

11 one or more additional periods not exceeding 5 years

12 if the operations of such center have been reviewed

13 by an appropriate technical and scientific peer re14 view group established by the Director and if such

15 group has recommended to the Director that such

16 period should be extended.

17 ‘‘(d) DEFINITION OF RELATED BONE DISEASES.—

18 For purposes of this section, the term ‘related bone dis19 eases’ includes—

20 ‘‘(1) Paget’s disease, a bone disease character21 ized by enlargement and loss of density with bowing

22 and deformity of the bones;

23 ‘‘(2) osteogenesis imperfecta, a familial disease

24 marked by extreme brittleness of the long bones;
22

•S 1536 IS

1 ‘‘(3) hyperparathyroidism, a condition charac2 terized by the presence of excess parathormone in

3 the body resulting in disturbance of calcium metabo4 lism with loss of calcium from bone and renal dam5 age;

6 ‘‘(4) hypoparathyroidism, a condition character7 ized by the absence of parathormone resulting in

8 disturbances of calcium metabolism;

9 ‘‘(5) renal bone disease, a disease characterized

10 by metabolic disturbances from dialysis, renal trans11 plants, or other renal disturbances;

12 ‘‘(6) primary or postmenopausal osteoporosis

13 and secondary osteoporosis, such as that induced by

14 corticosteroids; and

15 ‘‘(7) other general diseases of bone and mineral

16 metabolism including abnormalities of vitamin D.

17 ‘‘(e) AUTHORIZATIONS OF APPROPRIATIONS.—

18 ‘‘(1) NATIONAL INSTITUTE OF ARTHRITIS AND

19 MUSCULOSKELETAL AND SKIN DISEASES.—For the

20 purpose of carrying out this section through the Na21 tional Institute of Arthritis and Musculoskeletal and

22 Skin Diseases, there are authorized to be appro23 priated $17,000,000 for each of the fiscal years

24 1999 through 2001, and such sums as may be nec25 essary for each subsequent fiscal year.
23

•S 1536 IS

1 ‘‘(2) NATIONAL INSTITUTE ON AGING.—For the

2 purpose of carrying out this section through the Na3 tional Institute on Aging, there are authorized to be

4 appropriated $10,000,000 for each of the fiscal

5 years 1999 through 2001, and such sums as may be

6 necessary for each subsequent fiscal year.

7 ‘‘(3) NATIONAL INSTITUTE OF DIABETES AND

8 DIGESTIVE AND KIDNEY DISEASES.—For the pur9 pose of carrying out this section through the Na10 tional Institute of Diabetes and Digestive and Kid11 ney Diseases, there are authorized to be appro12 priated $10,000,000 for each of the fiscal years

13 1999 through 2001, and such sums as may be nec14 essary for each subsequent fiscal year.

15 ‘‘(4) NATIONAL INSTITUTE OF DENTAL RE16 SEARCH.—For the purpose of carrying out this sec17 tion through the National Institute of Dental Re18 search, there are authorized to be appropriated

19 $5,000,000 for each of the fiscal years 1999 through

20 2001, and such sums as may be necessary for each

21 subsequent fiscal year.

22 ‘‘(5) NATIONAL INSTITUTE OF CHILD HEALTH

23 AND HUMAN DEVELOPMENT.—For the purpose of

24 carrying out this section through the National Insti25 tute of Child Health and Human Development, there
24

•S 1536 IS

1 are authorized to be appropriated $5,000,000 for

2 each of the fiscal years 1999 through 2001, and

3 such sums as may be necessary for each subsequent

4 fiscal year.

5 ‘‘(6) SPECIALIZED CENTERS OF RESEARCH.—

6 For the purpose of carrying out subsection (c), there

7 are authorized to be appropriated $3,000,000 for

8 each of the fiscal years 1999 through 2001, and

9 such sums as may be necessary for each subsequent

10 fiscal year.

11 ‘‘(7) RELATION TO OTHER PROVISIONS.—Au12 thorizations of appropriations under this subsection

13 are in addition to amounts authorized to be appro14 priated for biomedical research relating to

15 osteoporosis and related bone diseases under any

16 other provision of law.’’.

17 SEC. 4. FUNDING FOR INFORMATION CLEARINGHOUSE ON

18 OSTEOPOROSIS, PAGET’S DISEASE, AND

19 RELATED BONE DISORDERS.

20 Section 409A(d) of the Public Health Service Act (42

21 U.S.C. 284e(d)) is amended by adding at the end the fol22 lowing sentence: ‘‘In addition to other authorizations of

23 appropriations available for the purpose of the establish24 ment and operation of the information clearinghouse

25 under subsection (c), there are authorized to be appro-
25

•S 1536 IS

1 priated for such purpose $1,000,000 for fiscal year 1999,

2 and such sums as may be necessary for each of the fiscal

3 years 2000 and 2001.’’.

Æ