I 
108TH CONGRESS 
2D SESSION 
H. R. 4154 
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 
APRIL 2, 2004 
Mrs. MALONEY (for herself and Ms. HART) 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 consider-
ation of such provisions as fall within the jurisdiction of the committee 
concerned 
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,
SECTION 1. SHORT TITLE; FINDINGS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Osteoporosis Early Detection and Prevention Act of 
2004’’. 
(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:
(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
‘‘SEC. 2707. 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—
‘‘(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
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;
‘‘(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-
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 2707’’. 
(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. 714. 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