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. MCMOR-
RIS 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 extend-
ing the minimum payment amount for bone mass meas-
urement under such program through 2013. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Preservation of Access 
to Osteoporosis Testing for Medicare Beneficiaries Act of 
2011’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
(1) Since 1997, Congress has recognized the 
importance of osteoporosis prevention by standard-
izing coverage under the Medicare program for bone 
mass measurement. 
(2) Osteoporosis remains underdiagnosed and 
undertreated despite numerous Federal initiatives, 
including recommendations of the United States 
Preventive Services Task Force, the 2004 United 
States Surgeon General’s Report on Bone Health 
and Osteoporosis, and education, counseling, and re-
ferral for bone mass measurement during the Wel-
come to Medicare exam. 
(3) Even though osteoporosis is a highly man-
ageable disease, many patients lack access to early 
diagnosis that can prevent debilitating fractures, 
morbidity, and loss of mobility. 
(4) Although Caucasians are most likely to sus-
tain osteoporosis fractures, from 2005 to 2025 the 
cost of fractures among other populations is pro-
jected to increase by 175 percent for Latinos and 
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Asian-Americans and 80 percent for African-Ameri-
cans. 
(5) African-American women are more likely 
than Caucasian women to die following a hip frac-
ture. 
(6) Osteoporosis is a critical women’s health 
issue. Women account for 71 percent of fractures 
and 75 percent of osteoporosis-associated costs and 
the incidence of osteoporosis-related fractures is 
greater than the annual combined incidence, with re-
spect to women, of heart attack, stroke, and breast 
cancer. 
(7) The World Health Organization, the Cen-
ters for Medicare & Medicaid Services, and other 
medical experts concur that the most widely accept-
ed method of measuring bone mass to predict frac-
ture risk is dual-energy x-ray absorptiometry (in this 
section referred to as ‘‘DXA’’). Vertebral fracture 
assessment (in this section referred to as ‘‘VFA’’) is 
another test used to identify patients at high risk for 
future fracture. 
(8) DXA is a cost-effective preventive test with 
proven results in real world settings. DXA testing 
increases the number of people diagnosed with 
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osteoporosis and treated, dramatically reducing hip 
fractures and related costs. 
(9) DXA screening is associated with a signifi-
cant (37 percent) reduction in hip fracture rates. 
(10) Unlike other imaging procedures, DXA re-
mains severely underutilized, with only one in four 
women enrolled in the Medicare program getting a 
DXA every two years. 
(11) Underutilization of bone mass measure-
ment will strain the Medicare budget because— 
(A) over half of all individuals in the 
United States who are age 50 or older have 
osteoporosis or low bone mass; 
(B) more than 52.4 million people in the 
United States had osteoporosis or low bone 
mass in 2010, as compared to 44 million people 
in the United States in 2002; 
(C) osteoporosis fractures are projected to 
increase by almost 50 percent from 2005 to 
2025 with over 3 million fractures expected to 
occur annually by 2025; 
(D) the population aged 65 and older rep-
resents 89 percent of fracture costs; and 
(E) the economic burden of osteoporosis 
fractures is projected to increase by nearly 50 
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percent from 2005 to 2025, reaching 25.3 mil-
lion in 2025. 
(12) Underutilization of bone mass measure-
ment will also strain the Medicaid budget, which 
bears the cost of nursing home admissions for hip 
fractures for low-income Americans. 
(13) Reimbursement under the Medicare pro-
gram for DXA provided in physician offices and 
other non-hospital settings was reduced by 50 per-
cent and is scheduled to be reduced by a total of 62 
percent by 2013. This drop represents one of the 
largest reimbursement reductions in the history of 
the Medicare program. Reimbursement for VFA will 
also be reduced by 30 percent by 2013. 
(14) The reduction in reimbursement discour-
ages physicians from continuing to provide access to 
DXA or VFA in their offices. DXA testing for older 
women declined in 2009 for the first time since Con-
gress passed the Bone Mass Measurement Act in 
1997. Since two-thirds of all DXA scans are per-
formed in non-facility settings, such as physician of-
fices, patient access to bone mass measurement will 
continue to be severely compromised when more phy-
sicians discontinue providing such tests in their of-
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fices, thereby exacerbating the current underutiliza-
tion of the benefit. 
SEC. 3. EXTENDING MINIMUM PAYMENT FOR BONE MASS 
MEASUREMENT. 
(a) IN GENERAL.—Section 1848 of the Social Secu-
rity Act (42 U.S.C. 1395w–4) is amended— 
(1) in subsection (b)— 
(A) in paragraph (4)(B), by striking ‘‘for 
2010 and 2011’’ and inserting ‘‘for each of 
2010 through 2013’’; and 
(B) in paragraph (6)— 
(i) in the matter preceding subpara-
graph (A), by striking ‘‘and 2011’’ and in-
serting ‘‘, 2011, 2012, and 2013’’; and 
(ii) in subparagraph (C), by striking 
‘‘and 2011’’ and inserting ‘‘, 2011, 2012, 
and 2013’’; and 
(2) in subsection (c)(2)(B)(iv)(IV), by striking 
‘‘or 2011’’ and inserting ‘‘, 2011, 2012, or 2013’’. 
(b) IMPLEMENTATION.—Notwithstanding any other 
provision of law, the Secretary may implement the amend-
ments made by subsection (a) by program instruction or 
otherwise. 
Æ 
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