I 
111TH CONGRESS 
1ST SESSION H. R. 3911 
To amend the Public Health Service Act and Employee Retirement Income 
Security Act of 1974 to require that group and individual health insur-
ance coverage and group health plans provide coverage for qualified 
individuals for bone mass measurement (bone density testing) to prevent 
fractures associated with osteoporosis. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 22, 2009 
Mrs. MALONEY (for herself and Mrs. CAPITO) introduced the following bill; 
which was referred to the Committee on Energy and Commerce, and in 
addition to the Committee on Education and Labor, 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 con-
cerned 
A BILL 
To amend the Public Health Service Act and Employee Re-
tirement Income Security Act of 1974 to require that 
group and individual health insurance coverage and 
group health plans provide coverage for qualified individ-
uals for bone mass measurement (bone density testing) 
to prevent fractures associated with osteoporosis. 
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; FINDINGS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Osteoporosis Early Detection and Prevention Act of 
2009’’. 
(b) FINDINGS.—Congress makes the following find-
ings: 
(1) NATURE OF OSTEOPOROSIS.— 
(A) Osteoporosis is a disease characterized 
by low bone mass and structural deterioration 
of bone tissue leading to bone fragility and in-
creased susceptibility to fractures of the hip, 
spine, and wrist. 
(B) Osteoporosis has no symptoms and 
typically remains undiagnosed until a fracture 
occurs. 
(C) Once a fracture occurs, the condition 
has usually advanced to the stage where the 
likelihood is high that another fracture will 
occur. 
(D) There is no cure for osteoporosis, but 
drug therapy has been shown to reduce new hip 
and spine fractures by 50 percent and other 
treatments, such as nutrition therapy, have also 
proven effective. 
(2) 
INCIDENCE
OF
OSTEOPOROSIS.— 
Osteoporosis is a common condition: 
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(A) Of the 44 million Americans who have 
(or are at risk for) osteoporosis, 80 percent are 
women. 
(B) Annually there are 1.5 million bone 
fractures attributable to osteoporosis. 
(C) Half of all women, and one-fourth of 
all men, age 50 or older will have a bone frac-
ture due to osteoporosis. 
(3) IMPACT
OF
OSTEOPOROSIS.—The cost of 
treating osteoporosis is significant: 
(A) The annual cost of osteoporosis in the 
United States was $17 billion in 2001. 
(B) The average cost in the United States 
of repairing a hip fracture due to osteoporosis 
is $37,000, while the average cost of an 
osteoporosis screening test ranges from $59 to 
$300. 
(C) Fractures due to osteoporosis fre-
quently result in disability and institutionaliza-
tion of individuals. 
(D) Because osteoporosis is a progressive 
condition causing fractures primarily in aging 
individuals, preventing fractures particularly in 
post menopausal women before they become eli-
gible for Medicare, has a significant potential of 
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reducing osteoporosis-related costs under the 
Medicare program. 
(4) USE OF BONE MASS MEASUREMENT.— 
(A) Bone mass measurement is a non- 
invasive, painless, and reliable way to diagnose 
osteoporosis before costly fractures occur. 
(B) Low bone mass is as predictive of fu-
ture fractures as is high cholesterol or high 
blood pressure of heart disease or stroke. 
(C) Bone mass measurement is the only 
reliable method of detecting osteoporosis at an 
early stage. 
(D) Under section 4106 of the Balanced 
Budget Act of 1997, Medicare provides cov-
erage, effective July 1, 1998, for bone mass 
measurement for qualified individuals who are 
at risk of developing osteoporosis. 
SEC. 2. REQUIRING COVERAGE OF BONE MASS MEASURE-
MENT UNDER HEALTH PLANS. 
(a) GROUP HEALTH PLANS.— 
(1) PUBLIC
HEALTH
SERVICE
ACT
AMEND-
MENTS.—(A) Subpart 2 of part A of title XXVII of 
the Public Health Service Act is amended by adding 
at the end the following new section: 
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‘‘SEC. 2708. STANDARDS RELATING TO BENEFITS FOR BONE 
MASS MEASUREMENT. 
‘‘(a) REQUIREMENTS FOR COVERAGE OF BONE MASS 
MEASUREMENT.—A group health plan, and a health in-
surance issuer offering group health insurance coverage, 
shall include (consistent with this section) coverage for 
bone mass measurement for beneficiaries and participants 
who are qualified individuals. 
‘‘(b) DEFINITIONS RELATING
TO COVERAGE.—In 
this section: 
‘‘(1) BONE
MASS
MEASUREMENT.—The term 
‘bone mass measurement’ means a radiologic or 
radioisotopic procedure or other procedure approved 
by the Food and Drug Administration performed on 
an individual for the purpose of identifying bone 
mass or detecting bone loss or determining bone 
quality, and includes a physician’s interpretation of 
the results of the procedure. Nothing in this para-
graph shall be construed as requiring a bone mass 
measurement to be conducted in a particular type of 
facility or to prevent such a measurement from 
being conducted through the use of mobile facilities 
that are otherwise qualified. 
‘‘(2) QUALIFIED INDIVIDUAL.—The term ‘quali-
fied individual’ means an individual who— 
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‘‘(A) is at clinical risk for osteoporosis, in-
cluding an estrogen-deficient woman; 
‘‘(B) has vertebral abnormalities; 
‘‘(C) is receiving chemotherapy or long- 
term gluococorticoid (steroid) therapy; 
‘‘(D) has primary hyperparathyroidism, 
hyperthyroidism, or excess thyroid replacement; 
or 
‘‘(E) is being monitored to assess the re-
sponse to or efficacy of approved osteoporosis 
drug therapy. 
‘‘(c) LIMITATION ON FREQUENCY REQUIRED.—Tak-
ing into account the standards established under section 
1861(rr)(3) of the Social Security Act, the Secretary shall 
establish standards regarding the frequency with which a 
qualified individual shall be eligible to be provided benefits 
for bone mass measurement under this section. The Sec-
retary may vary such standards based on the clinical and 
risk-related characteristics of qualified individuals. 
‘‘(d) RESTRICTIONS ON COST-SHARING.— 
‘‘(1) IN GENERAL.—Subject to paragraph (2), 
nothing in this section shall be construed as pre-
venting a group health plan or issuer from imposing 
deductibles, coinsurance, or other cost-sharing in re-
lation to bone mass measurement under the plan (or 
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health insurance coverage offered in connection with 
a plan). 
‘‘(2) LIMITATION.—Deductibles, coinsurance, 
and other cost-sharing or other limitations for bone 
mass measurement may not be imposed under para-
graph (1) to the extent they exceed the deductibles, 
coinsurance, and limitations that are applied to simi-
lar services under the group health plan or health 
insurance coverage. 
‘‘(e) PROHIBITIONS.—A group health plan, and a 
health insurance issuer offering group health insurance 
coverage in connection with a group health plan, may 
not— 
‘‘(1) deny to an individual eligibility, or contin-
ued eligibility, to enroll or to renew coverage under 
the terms of the plan, solely for the purpose of 
avoiding the requirements of this section; 
‘‘(2) provide incentives (monetary or otherwise) 
to individuals to encourage such individuals not to 
be provided bone mass measurements to which they 
are entitled under this section or to providers to in-
duce such providers not to provide such measure-
ments to qualified individuals; 
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‘‘(3) prohibit a provider from discussing with a 
patient osteoporosis preventive techniques or medical 
treatment options relating to this section; or 
‘‘(4) penalize or otherwise reduce or limit the 
reimbursement of a provider because such provider 
provided bone mass measurements to a qualified in-
dividual in accordance with this section. 
‘‘(f) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to require an individual who is a 
participant or beneficiary to undergo bone mass measure-
ment. 
‘‘(g) NOTICE.—A group health plan under this part 
shall comply with the notice requirement under section 
714(g) of the Employee Retirement Income Security Act 
of 1974 with respect to the requirements of this section 
as if such section applied to such plan. 
‘‘(h) LEVEL
AND TYPE
OF REIMBURSEMENTS.— 
Nothing in this section shall be construed to prevent a 
group health plan or a health insurance issuer offering 
group health insurance coverage from negotiating the level 
and type of reimbursement with a provider for care pro-
vided in accordance with this section. 
‘‘(i) PREEMPTION.— 
‘‘(1) IN GENERAL.—The provisions of this sec-
tion do not preempt State law relating to health in-
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surance coverage to the extent such State law pro-
vides greater benefits with respect to osteoporosis 
detection or prevention. 
‘‘(2) CONSTRUCTION.—Section 2723(a)(1) shall 
not be construed as superseding a State law de-
scribed in paragraph (1).’’. 
(B) Section 2723(c) of such Act (42 U.S.C. 
300gg–23(c)) is amended by striking ‘‘section 2704’’ 
and inserting ‘‘sections 2704 and 2708’’. 
(2) ERISA AMENDMENTS.—(A) Subpart B of 
part 7 of subtitle B of title I of the Employee Re-
tirement Income Security Act of 1974 is amended by 
adding at the end the following new section: 
‘‘SEC. 715. STANDARDS RELATING TO BENEFITS FOR BONE 
MASS MEASUREMENT. 
‘‘(a) REQUIREMENTS FOR COVERAGE OF BONE MASS 
MEASUREMENT.—A group health plan, and a health in-
surance issuer offering group health insurance coverage, 
shall include (consistent with this section) coverage for 
bone mass measurement for beneficiaries and participants 
who are qualified individuals. 
‘‘(b) DEFINITIONS RELATING
TO COVERAGE.—In 
this section: 
‘‘(1) BONE
MASS
MEASUREMENT.—The term 
‘bone mass measurement’ means a radiologic or 
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radioisotopic procedure or other procedure approved 
by the Food and Drug Administration performed on 
an individual for the purpose of identifying bone 
mass or detecting bone loss or determining bone 
quality, and includes a physician’s interpretation of 
the results of the procedure. Nothing in this para-
graph shall be construed as requiring a bone mass 
measurement to be conducted in a particular type of 
facility or to prevent such a measurement from 
being conducted through the use of mobile facilities 
that are otherwise qualified. 
‘‘(2) QUALIFIED INDIVIDUAL.—The term ‘quali-
fied individual’ means an individual who— 
‘‘(A) is at clinical risk for osteoporosis, in-
cluding an estrogen-deficient woman; 
‘‘(B) has vertebral abnormalities; 
‘‘(C) is receiving chemotherapy or long- 
term gluococorticoid (steroid) therapy; 
‘‘(D) has primary hyperparathyroidism, 
hyperthyroidism, or excess thyroid replacement; 
or 
‘‘(E) is being monitored to assess the re-
sponse to or efficacy of approved osteoporosis 
drug therapy. 
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‘‘(c) LIMITATION ON FREQUENCY REQUIRED.—The 
standards established under section 2708(c) of the Public 
Health Service Act shall apply to benefits provided under 
this section in the same manner as they apply to benefits 
provided under section 2708 of such Act. 
‘‘(d) RESTRICTIONS ON COST-SHARING.— 
‘‘(1) IN GENERAL.—Subject to paragraph (2), 
nothing in this section shall be construed as pre-
venting a group health plan or issuer from imposing 
deductibles, coinsurance, or other cost-sharing in re-
lation to bone mass measurement under the plan (or 
health insurance coverage offered in connection with 
a plan). 
‘‘(2) LIMITATION.—Deductibles, coinsurance, 
and other cost-sharing or other limitations for bone 
mass measurement may not be imposed under para-
graph (1) to the extent they exceed the deductibles, 
coinsurance, and limitations that are applied to simi-
lar services under the group health plan or health 
insurance coverage. 
‘‘(e) PROHIBITIONS.—A group health plan, and a 
health insurance issuer offering group health insurance 
coverage in connection with a group health plan, may 
not— 
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‘‘(1) deny to an individual eligibility, or contin-
ued eligibility, to enroll or to renew coverage under 
the terms of the plan, solely for the purpose of 
avoiding the requirements of this section; 
‘‘(2) provide incentives (monetary or otherwise) 
to individuals to encourage such individuals not to 
be provided bone mass measurements to which they 
are entitled under this section or to providers to in-
duce such providers not to provide such measure-
ments to qualified individuals; 
‘‘(3) prohibit a provider from discussing with a 
patient osteoporosis preventive techniques or medical 
treatment options relating to this section; or 
‘‘(4) penalize or otherwise reduce or limit the 
reimbursement of a provider because such provider 
provided bone mass measurements to a qualified in-
dividual in accordance with this section. 
‘‘(f) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to require an individual who is a 
participant or beneficiary to undergo bone mass measure-
ment. 
‘‘(g) NOTICE UNDER GROUP HEALTH PLAN.—The 
imposition of the requirements of this section shall be 
treated as a material modification in the terms of the plan 
described in section 102(a), for purposes of assuring no-
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tice of such requirements under the plan; except that the 
summary description required to be provided under the 
fourth sentence of section 104(b)(1) with respect to such 
modification shall be provided by not later than 60 days 
after the first day of the first plan year in which such 
requirements apply. 
‘‘(h) PREEMPTION.— 
‘‘(1) IN GENERAL.—The provisions of this sec-
tion do not preempt State law relating to health in-
surance coverage to the extent such State law pro-
vides greater benefits with respect to osteoporosis 
detection or prevention. 
‘‘(2) CONSTRUCTION.—Section 731(a)(1) shall 
not be construed as superseding a State law de-
scribed in paragraph (1).’’. 
(B) Section 731(c) of such Act (29 U.S.C. 
1191(c)) is amended by striking ‘‘section 711’’ 
and inserting ‘‘sections 711 and 715’’. 
(C) Section 732(a) of such Act (29 U.S.C. 
1191a(a)) is amended by striking ‘‘section 711’’ 
and inserting ‘‘sections 711 and 715’’. 
(D) The table of contents in section 1 of 
such Act is amended by inserting after the item 
relating to section 714 the following new item: 
‘‘715. Standards relating to benefits for bone mass measurement.’’. 
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(b) INDIVIDUAL HEALTH INSURANCE.—(1) Part B 
of title XXVII of the Public Health Service Act is amend-
ed by inserting after section 2753 the following new sec-
tion: 
‘‘SEC. 2754. STANDARDS RELATING TO BENEFITS FOR BONE 
MASS MEASUREMENT. 
‘‘(a) IN GENERAL.—The provisions of section 2708 
(other than subsection (g)) shall apply to health insurance 
coverage offered by a health insurance issuer in the indi-
vidual market in the same manner as it applies to health 
insurance coverage offered by a health insurance issuer 
in connection with a group health plan in the small or 
large group market. 
‘‘(b) NOTICE.—A health insurance issuer under this 
part shall comply with the notice requirement under sec-
tion 715(g) of the Employee Retirement Income Security 
Act of 1974 with respect to the requirements referred to 
in subsection (a) as if such section applied to such issuer 
and such issuer were a group health plan. 
‘‘(c) PREEMPTION.— 
‘‘(1) IN GENERAL.—The provisions of this sec-
tion do not preempt State law relating to health in-
surance coverage to the extent such State law pro-
vides greater benefits with respect to osteoporosis 
detection or prevention. 
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‘‘(2) CONSTRUCTION.—Section 2762(a) shall 
not be construed as superseding a State law de-
scribed in paragraph (1).’’. 
(2) Section 2762(b)(2) of such Act (42 U.S.C. 
300gg–62(b)(2)) is amended by striking ‘‘section 2751’’ 
and inserting ‘‘sections 2751 and 2754’’. 
(c) EFFECTIVE DATES.—(1) The amendments made 
by subsection (a) shall apply with respect to group health 
plans for plan years beginning on or after January 1, 
2010. 
(2) The amendments made by subsection (b) shall 
apply with respect to health insurance coverage offered, 
sold, issued, renewed, in effect, or operated in the indi-
vidual market on or after such date. 
Æ 
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