I

107TH CONGRESS

1ST SESSION H. R. 1683

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.

IN THE HOUSE OF REPRESENTATIVES

MAY 2, 2001

Mrs. MALONEY of New York (for herself, Mrs. MORELLA, Mr. PASCRELL,

Mrs. KELLY, Mr. FROST, Mr. RANGEL, Ms. PELOSI, Mr. LANGEVIN, Mrs.

THURMAN, Mr. MCNULTY, Ms. JACKSON-LEE of Texas, and Mr.

TIERNEY) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on

Education and the Workforce, 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 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.
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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 ‘‘Osteoporosis Early Detection and Prevention Act of

6 2001’’.

7 (b) FINDINGS.—Congress makes the following find8 ings:

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
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1 treatments, such as nutrition therapy, have also

2 proven effective.

3 (2) INCIDENCE OF OSTEOPOROSIS.—

4 Osteoporosis is a common condition:

5 (A) Of the 28 million Americans who have

6 (or are at risk for) osteoporosis, 80 percent are

7 women.

8 (B) Annually there are 1.5 million bone

9 fractures attributable to osteoporosis.

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

11 all men, age 50 or older will have a bone frac12 ture due to osteoporosis.

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

14 treating osteoporosis is significant:

15 (A) The annual cost of osteoporosis in the

16 United States is $13.8 billion.

17 (B) The average cost in the United States

18 of repairing a hip fracture due to osteoporosis

19 is $32,000, while the average cost of an

20 osteoporosis screening test is $250.

21 (C) Fractures due to osteoporosis fre22 quently result in disability and institutionaliza23 tion of individuals.

24 (D) Because osteoporosis is a progressive

25 condition causing fractures primarily in aging
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1 individuals, preventing fractures particularly in

2 post menopausal women before they become eli3 gible for medicare, has a significant potential of

4 reducing osteoporosis-related costs under the

5 medicare program.

6 (4) USE OF BONE MASS MEASUREMENT.—

7 (A) Bone mass measurement is a non8 invasive, painless, and reliable way to diagnose

9 osteoporosis before costly fractures occur.

10 (B) Low bone mass is as predictive of fu11 ture fractures as is high cholesterol or high

12 blood pressure of heart disease or stroke.

13 (C) Bone mass measurement is the only

14 reliable method of detecting osteoporosis at an

15 early stage.

16 (D) Under section 4106 of the Balanced

17 Budget Act of 1997, medicare provides cov18 erage, effective July 1, 1998, for bone mass

19 measurement for qualified individuals who are

20 at risk of developing osteoporosis.

21 SEC. 2. REQUIRING COVERAGE OF BONE MASS MEASURE22 MENT UNDER HEALTH PLANS.

23 (a) GROUP HEALTH PLANS.—

24 (1) PUBLIC HEALTH SERVICE ACT AMEND25 MENTS.—(A) Subpart 2 of part A of title XXVII of
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1 the Public Health Service Act is amended by adding

2 at the end the following new section:

3 ‘‘SEC. 2707. STANDARDS RELATING TO BENEFITS FOR BONE

4 MASS MEASUREMENT.

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

6 MEASUREMENT.—A group health plan, and a health in7 surance issuer offering group health insurance coverage,

8 shall include (consistent with this section) coverage for

9 bone mass measurement for beneficiaries and participants

10 who are qualified individuals.

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

12 this section:

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

14 ‘bone mass measurement’ means a radiologic or

15 radioisotopic procedure or other procedure approved

16 by the Food and Drug Administration performed on

17 an individual for the purpose of identifying bone

18 mass or detecting bone loss or determining bone

19 quality, and includes a physician’s interpretation of

20 the results of the procedure. Nothing in this para21 graph shall be construed as requiring a bone mass

22 measurement to be conducted in a particular type of

23 facility or to prevent such a measurement from

24 being conducted through the use of mobile facilities

25 that are otherwise qualified.
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1 ‘‘(2) QUALIFIED INDIVIDUAL.—The term ‘quali2 fied individual’ means an individual who—

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

4 clinical risk for osteoporosis;

5 ‘‘(B) has vertebral abnormalities;

6 ‘‘(C) is receiving chemotherapy or long7 term gluococorticoid (steroid) therapy;

8 ‘‘(D) has primary hyperparathyroidism,

9 hyperthyroidism, or excess thyroid replacement;

10 or

11 ‘‘(E) is being monitored to assess the re12 sponse to or efficacy of approved osteoporosis

13 drug therapy.

14 ‘‘(c) LIMITATION ON FREQUENCY REQUIRED.—

15 Taking into account the standards established under

16 section 1861(rr)(3) of the Social Security Act, the

17 Secretary shall establish standards regarding the

18 frequency with which a qualified individual shall be

19 eligible to be provided benefits for bone mass meas20 urement under this section. The Secretary may vary

21 such standards based on the clinical and risk-related

22 characteristics of qualified individuals.

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

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

25 nothing in this section shall be construed as pre-
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1 venting a group health plan or issuer from imposing

2 deductibles, coinsurance, or other cost-sharing in re3 lation to bone mass measurement under the plan (or

4 health insurance coverage offered in connection with

5 a plan).

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

7 and other cost-sharing or other limitations for bone

8 mass measurement may not be imposed under para9 graph (1) to the extent they exceed the deductibles,

10 coinsurance, and limitations that are applied to simi11 lar services under the group health plan or health

12 insurance coverage.

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

14 health insurance issuer offering group health insurance

15 coverage in connection with a group health plan, may

16 not—

17 ‘‘(1) deny to an individual eligibility, or contin18 ued eligibility, to enroll or to renew coverage under

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

20 avoiding the requirements of this section;

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

22 to individuals to encourage such individuals not to

23 be provided bone mass measurements to which they

24 are entitled under this section or to providers to in-
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1 duce such providers not to provide such measure2 ments to qualified individuals;

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

4 patient osteoporosis preventive techniques or medical

5 treatment options relating to this section; or

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

7 reimbursement of a provider because such provider

8 provided bone mass measurements to a qualified in9 dividual in accordance with this section.

10 ‘‘(f) RULE OF CONSTRUCTION.—Nothing in this sec11 tion shall be construed to require an individual who is a

12 participant or beneficiary to undergo bone mass measure13 ment.

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

15 shall comply with the notice requirement under section

16 714(g) of the Employee Retirement Income Security Act

17 of 1974 with respect to the requirements of this section

18 as if such section applied to such plan.

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

20 Nothing in this section shall be construed to prevent a

21 group health plan or a health insurance issuer offering

22 group health insurance coverage from negotiating the level

23 and type of reimbursement with a provider for care pro24 vided in accordance with this section.

25 ‘‘(i) PREEMPTION.—
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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 2723(a)(1) shall

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

9 (B) Section 2723(c) of such Act (42 U.S.C.

10 300gg–23(c)) is amended by striking ‘‘section 2704’’

11 and inserting ‘‘sections 2704 and 2707’’.

12 (2) ERISA AMENDMENTS.—(A) Subpart B of

13 part 7 of subtitle B of title I of the Employee Re14 tirement Income Security Act of 1974 is amended by

15 adding at the end the following new section:

16 ‘‘SEC. 714. STANDARDS RELATING TO BENEFITS FOR BONE

17 MASS MEASUREMENT.

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

19 MEASUREMENT.—A group health plan, and a health in20 surance issuer offering group health insurance coverage,

21 shall include (consistent with this section) coverage for

22 bone mass measurement for beneficiaries and participants

23 who are qualified individuals.

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

25 this section:
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1 ‘‘(1) BONE MASS MEASUREMENT.—The term

2 ‘bone mass measurement’ means a radiologic or

3 radioisotopic procedure or other procedure approved

4 by the Food and Drug Administration performed on

5 an individual for the purpose of identifying bone

6 mass or detecting bone loss or determining bone

7 quality, and includes a physician’s interpretation of

8 the results of the procedure. Nothing in this para9 graph shall be construed as requiring a bone mass

10 measurement to be conducted in a particular type of

11 facility or to prevent such a measurement from

12 being conducted through the use of mobile facilities

13 that are otherwise qualified.

14 ‘‘(2) QUALIFIED INDIVIDUAL.—The term ‘quali15 fied individual’ means an individual who—

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

17 clinical risk for osteoporosis;

18 ‘‘(B) has vertebral abnormalities;

19 ‘‘(C) is receiving chemotherapy or long20 term gluococorticoid (steroid) therapy;

21 ‘‘(D) has primary hyperparathyroidism,

22 hyperthyroidism, or excess thyroid replacement;

23 or
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1 ‘‘(E) is being monitored to assess the re2 sponse to or efficacy of approved osteoporosis

3 drug therapy.

4 ‘‘(c) LIMITATION ON FREQUENCY REQUIRED.—

5 The standards established under section 2707(c) of

6 the Public Health Service Act shall apply to benefits

7 provided under this section in the same manner as

8 they apply to benefits provided under section 2707

9 of such Act.

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

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

12 nothing in this section shall be construed as pre13 venting a group health plan or issuer from imposing

14 deductibles, coinsurance, or other cost-sharing in re15 lation to bone mass measurement under the plan (or

16 health insurance coverage offered in connection with

17 a plan).

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

19 and other cost-sharing or other limitations for bone

20 mass measurement may not be imposed under para21 graph (1) to the extent they exceed the deductibles,

22 coinsurance, and limitations that are applied to simi23 lar services under the group health plan or health

24 insurance coverage.
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1 ‘‘(e) PROHIBITIONS.—A group health plan, and a

2 health insurance issuer offering group health insurance

3 coverage in connection with a group health plan, may

4 not—

5 ‘‘(1) deny to an individual eligibility, or contin6 ued eligibility, to enroll or to renew coverage under

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

8 avoiding the requirements of this section;

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

10 to individuals to encourage such individuals not to

11 be provided bone mass measurements to which they

12 are entitled under this section or to providers to in13 duce such providers not to provide such measure14 ments to qualified individuals;

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

16 patient osteoporosis preventive techniques or medical

17 treatment options relating to this section; or

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

19 reimbursement of a provider because such provider

20 provided bone mass measurements to a qualified in21 dividual in accordance with this section.

22 ‘‘(f) RULE OF CONSTRUCTION.—Nothing in this sec23 tion shall be construed to require an individual who is a

24 participant or beneficiary to undergo bone mass measure25 ment.
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1 ‘‘(g) NOTICE UNDER GROUP HEALTH PLAN.—The

2 imposition of the requirements of this section shall be

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

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

5 notice of such requirements under the plan; except that

6 the summary description required to be provided under the

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

8 modification shall be provided by not later than 60 days

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

10 requirements apply.

11 ‘‘(h) PREEMPTION.—

12 ‘‘(1) IN GENERAL.—The provisions of this sec13 tion do not preempt State law relating to health in14 surance coverage to the extent such State law pro15 vides greater benefits with respect to osteoporosis

16 detection or prevention.

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

18 not be construed as superseding a State law de19 scribed in paragraph (1).’’.

20 (B) Section 731(c) of such Act (29 U.S.C.

21 1191(c)) is amended by striking ‘‘section 711’’ and

22 inserting ‘‘sections 711 and 714’’.

23 (C) Section 732(a) of such Act (29 U.S.C.

24 1191a(a)) is amended by striking ‘‘section 711’’ and

25 inserting ‘‘sections 711 and 714’’.
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1 (D) The table of contents in section 1 of such

2 Act is amended by inserting after the item relating

3 to section 712 the following new item:

‘‘Sec. 714. Standards relating to benefits for bone mass measurement.’’.

4 (b) INDIVIDUAL HEALTH INSURANCE.—(1) Part B

5 of title XXVII of the Public Health Service Act is amend6 ed by inserting after section 2752 the following new sec7 tion:

8 ‘‘SEC. 2753. STANDARDS RELATING TO BENEFITS FOR BONE

9 MASS MEASUREMENT.

10 ‘‘(a) IN GENERAL.—The provisions of section 2707

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

12 coverage offered by a health insurance issuer in the indi13 vidual market in the same manner as it applies to health

14 insurance coverage offered by a health insurance issuer

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

16 large group market.

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

18 part shall comply with the notice requirement under sec19 tion 714(g) of the Employee Retirement Income Security

20 Act of 1974 with respect to the requirements referred to

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

22 and such issuer were a group health plan.

23 ‘‘(c) PREEMPTION.—

24 ‘‘(1) IN GENERAL.—The provisions of this sec25 tion do not preempt State law relating to health in-
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1 surance coverage to the extent such State law pro2 vides greater benefits with respect to osteoporosis

3 detection or prevention.

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

5 not be construed as superseding a State law de6 scribed in paragraph (1).’’.

7 (2) Section 2762(b)(2) of such Act (42 U.S.C.

8 300gg–62(b)(2)) is amended by striking ‘‘section 2751’’

9 and inserting ‘‘sections 2751 and 2753’’.

10 (c) EFFECTIVE DATES.—(1) The amendments made

11 by subsection (a) shall apply with respect to group health

12 plans for plan years beginning on or after January 1,

13 2002.

14 (2) The amendments made by subsection (b) shall

15 apply with respect to health insurance coverage offered,

16 sold, issued, renewed, in effect, or operated in the indi17 vidual market on or after such date.

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