I 
110TH CONGRESS 
2D SESSION 
H. R. 6478 
To improve research, diagnosis, and treatment of musculoskeletal diseases, 
conditions, and injuries, to conduct a longitudinal study on aging, and 
for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 10, 2008 
Ms. SOLIS (for herself, Mr. BURGESS, Mr. GENE GREEN of Texas, Mr. PRICE 
of Georgia, Mr. ANDREWS, Mr. BACA, Mr. FARR, Mr. GRIJALVA, Mr. 
HINOJOSA, Mr. KUHL of New York, Mr. SCOTT of Georgia, Ms. SUTTON, 
Mr. TAYLOR, and Mr. MICHAUD) introduced the following bill; which was 
referred to the Committee on Energy and Commerce, and in addition to 
the Committee on Science and Technology, for a period to be subse-
quently determined by the Speaker, in each case for consideration of such 
provisions as fall within the jurisdiction of the committee concerned 
A BILL 
To improve research, diagnosis, and treatment of musculo-
skeletal diseases, conditions, and injuries, to conduct a 
longitudinal study on aging, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Access to America’s Orthopedic Services Act of 2008’’. 
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SEC. 2. TABLE OF CONTENTS; DEFINITION. 
(a) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
Sec. 1. Short title. 
Sec. 2. Table of contents; definition. 
TITLE I—MUSCULOSKELETAL HEALTH 
Sec. 101. Findings. 
Sec. 102. Musculoskeletal research. 
Sec. 103. Musculoskeletal trauma research and care. 
Sec. 104. Transplants, tissues, and replacement joints. 
Sec. 105. Traffic and workplace safety. 
Sec. 106. Public education campaign. 
Sec. 107. Orthopedic physician workforce training study. 
Sec. 108. Bone density under the Medicare Program. 
Sec. 109. Access to orthopedic services for beneficiaries of Medicaid and 
SCHIP. 
Sec. 110. Age-related programs. 
Sec. 111. Minority health disparities. 
TITLE II—THIRD LONGITUDINAL STUDY ON AGING 
Sec. 201. Third longitudinal study on aging. 
(b) SECRETARY DEFINED.—For purposes of the Act, 
the term ‘‘Secretary’’ means the Secretary of Health and 
Human Services, except as otherwise provided. 
TITLE I—MUSCULOSKELETAL 
HEALTH 
SEC. 101. FINDINGS. 
Congress makes the following findings: 
(1) Musculoskeletal diseases and conditions are 
the leading cause of disability in the United States. 
(2) Musculoskeletal diseases account for more 
than one-half of all chronic conditions in people over 
50 years of age in developed countries. 
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(3) More than one in four individuals in the 
United States has a musculoskeletal condition re-
quiring medical attention. 
(4) Direct and indirect costs for bone and joint 
health are $849,000,000,000 per year in the United 
States. 
(5) Musculoskeletal conditions are the greatest 
cause of total lost workdays and medical bed days in 
the United States. 
(6) The 2004 Surgeon General Report on Bone 
Health and Osteoporosis concluded that there is a 
lack of awareness of bone disease among the public 
and health care professionals. 
(7) Research demonstrates that there is need 
among ethnic and racial minorities to improve 
knowledge of and treatment for musculoskeletal dis-
eases and conditions. 
SEC. 102. MUSCULOSKELETAL RESEARCH. 
(a) REGULATIONS CONCERNING REPORTING CRI-
TERIA FOR PERCENT OF EFFORT.— 
(1) IN GENERAL.—The Secretary, in consulta-
tion with the Director of the National Institutes of 
Health, shall establish, by regulation, criteria for ac-
counting and reporting the percent of effort ex-
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pended by researchers, with respect to research that 
is— 
(A) conducted during each fiscal year be-
ginning after the last day of the second fiscal 
year following the date of enactment of this 
Act; and 
(B) funded through research grants on 
musculoskeletal health awarded by either the 
Director of the National Institutes of Health or 
the Director of the Agency for Healthcare Re-
search and Quality. 
(2) DEADLINE FOR REGULATIONS.—Not later 
than the last day of the 2-year period beginning on 
the date of enactment of this Act, the Secretary 
shall issue and implement the regulations required 
by paragraph (1). 
(b) NEW INVESTIGATORS IN MUSCULOSKELETAL RE-
SEARCH.— 
(1) REPORT.—Not later than 90 days after the 
last day of each fiscal year that begins more than 
one year following the date of enactment of this Act, 
the Secretary, in consultation with the Director of 
the National Institutes of Health, shall prepare and 
submit to Congress a report on the following: 
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(A) The number of new investigators who 
are awarded grants for musculoskeletal health 
research by the National Institutes of Health 
during the fiscal year. 
(B) The total amount of funds awarded to 
those investigators under such grants during 
the fiscal year. 
(C) The percentage of the National Insti-
tutes of Health’s budget for musculoskeletal 
health research that was awarded to such inves-
tigators through such grants during the fiscal 
year. 
(D) The race and ethnicity of the new in-
vestigators who are awarded such grants during 
the fiscal year. 
(E) A description of the efforts made by 
the Director of the National Institutes of 
Health to encourage individuals from underrep-
resented minority groups (as defined by the 
Secretary) to apply for grants for musculo-
skeletal health research awarded by the Na-
tional Institutes of Health during the fiscal 
year. 
(2) RECOMMENDATIONS.—The first report sub-
mitted under paragraph (1) shall include, and subse-
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quent reports may include, recommendations con-
cerning additional resources that the National Insti-
tutes of Health or other entities could use— 
(A) to increase the number of new inves-
tigators awarded grants referred to in para-
graph (1)(A); and 
(B) to increase the number of new inves-
tigators awarded such grants who are members 
of underrepresented minority groups. 
(3) DEFINITIONS.—For purposes of this sec-
tion, the following definitions apply: 
(A) NEW INVESTIGATOR.—The term ‘‘new 
investigator’’ has the meaning given the term 
‘‘new investigator’’ by the Secretary for pur-
poses of administering title III of the Public 
Health Service Act (42 U.S.C. 241 et seq.), but 
only with respect to musculoskeletal health re-
search. 
(B) RACE; ETHNICITY.—The terms ‘‘race’’ 
and ‘‘ethnicity’’ have the meaning given such 
terms by the Office of Management and Budget 
for purposes of Federal statistics and adminis-
trative reporting. 
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SEC. 103. MUSCULOSKELETAL TRAUMA RESEARCH AND 
CARE. 
(a) MUSCULOSKELETAL TRAUMA RESEARCH.— 
(1) REPORT.—Not later than 2 years after the 
date of enactment of this Act, the Secretary shall 
prepare and submit to Congress a report on all pro-
grams and activities relating to musculoskeletal 
trauma care that are being conducted by the Federal 
Government or supported by funding made available 
by Federal Government. 
(2) CONTENTS OF REPORT.—Such report shall 
include, at a minimum, the following: 
(A) Information on the status of each Fed-
eral program and activity referred to in para-
graph (1), including specific information on any 
research program and activity. 
(B) Information on the methods being 
used to coordinate research being conducted 
under such Federal programs and activities and 
the effectiveness of such methods. 
(3) CONSULTATION.—In preparing and submit-
ting the report under paragraph (1), the Secretary 
shall consult with— 
(A) the Secretary of Defense; and 
(B) the heads of other Federal depart-
ments and agencies that administer programs 
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and activities that are relevant to musculo-
skeletal trauma care, as determined by the Sec-
retary. 
(b) ORTHOPEDIC TREATMENT THROUGH TRAUMA 
SYSTEMS.— 
(1) STUDY.—The Secretary shall conduct a 
study on the impact of trauma care systems that 
connect hospitals with other providers of health care 
services (including orthopedists) on musculoskeletal 
health. 
(2) PURPOSES OF STUDY.—The purposes of the 
study under paragraph (1) shall include, at a min-
imum, the following: 
(A) An examination of the provision of 
acute and rehabilitative care to trauma patients 
with musculoskeletal conditions or injuries. 
(B) An examination of epidemiological 
data on trauma patients with musculoskeletal 
conditions or injuries, including the number of 
such patients, the number of such conditions 
and injuries, and the types of such conditions 
and injuries. 
(C) An evaluation of the ability of a pa-
tient with an orthopedic condition or injury 
originating from musculoskeletal trauma to ac-
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cess specialty care relevant to that condition or 
injury. 
(D) An examination of the impact of trau-
ma rehabilitation care on musculoskeletal 
health and the ability of trauma patients with 
musculoskeletal conditions or injuries to access 
postacute rehabilitative services. 
(3) REPORT.—Not later than 2 years after the 
date of enactment of this Act, the Secretary shall 
submit to Congress a report on the results of the 
study under paragraph (1), including recommenda-
tions for improving the treatment of trauma patients 
with musculoskeletal injuries. 
SEC. 104. TRANSPLANTS, TISSUES, AND REPLACEMENT 
JOINTS. 
(a) TRANSPLANTATION TRANSMISSION SENTINEL 
NETWORK.—Section 372(b)(2) of the Public Health Serv-
ice Act (42 U.S.C. 274(b)(2)) is amended— 
(1) in subparagraph (N) by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (O) by striking the period 
at the end and inserting ‘‘, and’’; and 
(3) by adding at the end the following: 
‘‘(P) establish and operate a national Web- 
based system, to be known as the ‘Transplan-
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tation Transmission Sentinel Network’, for the 
detection, reporting, and tracking of disease 
transmission from organ, tissue, or eye donors 
to organ, tissue and eye transplant recipients.’’. 
(b) ACCREDITATION OF ESTABLISHMENTS AND PER-
SONNEL ENGAGED IN THE MANUFACTURE OF HUMAN 
CELLS, TISSUES, OR CELLULAR OR TISSUE-BASED PROD-
UCTS.— 
(1) IN
GENERAL.—The Secretary shall issue 
regulations relating to the accreditation of— 
(A) establishments; and 
(B) personnel who participate in the recov-
ery, processing, storage, labeling, packaging, or 
distribution of human cells, tissues, or cellular 
or tissue-based products for such establish-
ments. 
(2) AUTHORITY OF SECRETARY.—In issuing the 
regulations under paragraph (1), the Secretary 
shall— 
(A) establish an accreditation process mod-
eled after the Joint Commission (previously 
known as the Joint Commission on Accredita-
tion of Healthcare Organizations); or 
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(B) adopt an accreditation process estab-
lished by a private entity that is in effect on the 
date of enactment of this Act. 
(3) DEFINITIONS.—For purposes of this sub-
section, the following definitions apply: 
(A) ESTABLISHMENT.—The term ‘‘estab-
lishment’’ has the meaning given such term in 
section 1271.3 of title 21, Code of Federal Reg-
ulations (or any successor regulation). 
(B) HUMAN
CELLS, TISSUES, OR
CEL-
LULAR
OR
TISSUE-BASED
PRODUCTS.—The 
term ‘‘human cells, tissues, or cellular or tissue- 
based products’’ has the meaning given such 
term in section 1271.3 of title 21, Code of Fed-
eral Regulations (or any successor regulation). 
(c) NATIONAL
JOINT
REPLACEMENT
REGISTRY 
STUDY.— 
(1) STUDY.—The Secretary shall conduct a 
study evaluating the advantages and disadvantages 
of establishing a national registry for the purpose of 
tracking the safety and effectiveness of artificial 
joints used to replace joints in beneficiaries of the 
Medicare program under title XVIII of the Social 
Security Act (42 U.S.C. 1395 et seq.). 
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(2) CONTENTS
OF
PROPOSED
REGISTRY.—In 
evaluating the proposed registry under paragraph 
(1), the Secretary shall assume that the registry in-
cludes, at a minimum, information on— 
(A) the type of joint replaced; 
(B) the side of the body on which the joint 
is replaced; 
(C) whether more than one operation was 
required in connection with an artificial joint 
replacement; and 
(D) uniform identifiers for the artificial 
joint (including the device lot number and cata-
log number). 
(3) REPORT.—Not later than 2 years after the 
date of enactment of this Act, the Secretary shall 
submit to Congress a report on the results of the 
study under paragraph (1) and recommendation for 
changes to the Medicare program, including any nec-
essary changes to the Medicare claims form, to allow 
for the collection of information required for the reg-
istry. 
SEC. 105. TRAFFIC AND WORKPLACE SAFETY. 
(a) TRAFFIC SAFETY STUDY.— 
(1) STUDY.—The Secretary, in consultation 
with the Secretary of Transportation, shall conduct 
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a study, using epidemiological methods, on the fre-
quency, severity, and likely causes of severe trauma 
to extremities resulting from motor vehicle crashes. 
(2) REPORT.—Not later than 2 years after the 
date of enactment of this Act, the Secretary shall 
submit to Congress a report the results of the study 
under paragraph (1). 
(3) MOTOR VEHICLE DEFINED.—For purposes 
of this subsection, the term ‘‘motor vehicle’’ has the 
meaning given such term in section 405 of title 23, 
United States Code. 
(b) WORKPLACE SAFETY STUDY.— 
(1) IN GENERAL.—The Secretary, in consulta-
tion with the Secretary of Labor, shall conduct a 
study, within the research framework of the Na-
tional Occupational Research Agenda coordinated by 
the National Institute for Occupational Safety and 
Health, on— 
(A) the number of workplace-related mus-
culoskeletal injuries and conditions; and 
(B) medical treatments provided to individ-
uals to treat such injuries and conditions. 
(2) 
COLLECTION
METHODOLOGY.—In 
con-
ducting the study under paragraph (1), the Sec-
retary shall collect information in a manner that al-
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lows such information to be reported based on the 
type of musculoskeletal injury or condition and the 
race and ethnicity of the individual with such injury 
or condition. 
(3) REQUEST FOR INFORMATION FROM STATE 
WORKERS COMPENSATION BOARDS.—The Secretary 
may request that the head of each State agency that 
has jurisdiction over workers compensation submit 
information relevant to the study under paragraph 
(1) to the Secretary. 
(4) REPORT.—Not later than 2 years after the 
date of enactment of this Act, the Secretary shall 
submit to Congress a report on the results of the 
study under paragraph (1), categorized by type of 
injury or condition and race and ethnicity. 
SEC. 106. PUBLIC EDUCATION CAMPAIGN. 
(a) IN GENERAL.—The Secretary, in consultation 
with the Secretary of Education, the Secretary of Trans-
portation, the Consumer Product Safety Commission, and 
the Chair of the President’s Council on Physical Fitness 
and Sports, shall conduct a national public awareness pro-
gram on musculoskeletal health. 
(b) CONTENTS OF PROGRAM.—The program shall in-
clude, at a minimum, the following components: 
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(1) GENERAL
INFORMATION
FOR
THE
PUB-
LIC.—A component providing education to the gen-
eral public on musculoskeletal health, including edu-
cation on healthy lifestyle practices relating to mus-
culoskeletal health. 
(2) 
EDUCATION
FOR
HEALTH
PROFES-
SIONALS.—A component providing education to 
health professionals on musculoskeletal health, in-
cluding— 
(A) specific information on musculoskeletal 
health in medically underserved populations (as 
defined in section 330(b)(3) of the Public 
Health Service Act (42 U.S.C. 254b(b)(3))); 
and 
(B) the impact of musculoskeletal diseases 
and conditions on racial and ethnic minority 
populations. 
(3) EDUCATION FOR GIRLS.—A component that 
utilizes the program popularly known as ‘‘powerful 
bones, powerful girls’’ to educate girls between 9 and 
12 years of age on optimal bone health and the 
methods to achieve such health, with a focus on re-
ducing the risk that such girls will develop 
osteoporosis as adults. 
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(4) EDUCATION FOR SPECIAL POPULATIONS.— 
A component providing education to the following 
populations that address the specific needs of those 
populations: 
(A) Populations of the United States that 
have disproportionately high levels of musculo-
skeletal disease and injury. 
(B) Populations of the United States that 
have disproportionally low levels of access to or-
thopedic services. 
(C) Racial and ethnic minority populations 
of the United States. 
SEC. 107. ORTHOPEDIC PHYSICIAN WORKFORCE TRAINING 
STUDY. 
(a) STUDY.—The Secretary, acting through the Ad-
ministrator of the Health Resource Services Administra-
tion, shall conduct a study on the amount of funding avail-
able for graduate medical education in orthopedics from 
all sources and the impact of that amount of funding on 
the availability of physicians trained in orthopedics. 
(b) REPORT.—Not later than 2 years after the date 
of enactment of this Act, the Secretary shall submit to 
Congress a report on the results of the study under sub-
section (a). 
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SEC. 108. BONE DENSITY UNDER THE MEDICARE PROGRAM. 
(a) STANDARD MEASUREMENT TOOL
FOR BONE 
DENSITY STUDY.— 
(1) STUDY.—The Secretary, in consultation 
with the Director of the Agency for Healthcare Re-
search and Quality, the Director of the National In-
stitute of Biomedical Imaging and Bioengineering, 
and the Administrator of the Centers for Medicare 
& Medicaid Services, shall conduct a study on— 
(A) the cost-effectiveness of all available 
methods for measuring bone mass in bene-
ficiaries of the Medicare program under title 
XVIII of the Social Security Act (42 U.S.C. 
1395 et seq.) for the purpose of identifying the 
most cost-effective method; 
(B) the cost-effectiveness of different time 
intervals between each bone mass screening for 
each such beneficiary for the purpose of identi-
fying the most cost-effective interval; 
(C) the frequency with which the cost-ef-
fectiveness of such methods and intervals 
should be reviewed based on anticipated 
changes in technology. 
(2) REPORT.— 
(A) IN GENERAL.—Not later than 2 years 
after the date of enactment of this Act, the Sec-
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