I
105TH CONGRESS
1ST SESSION
H. R. 2693
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 and to help women make informed
choices about their reproductive and post-menopausal health care.
IN THE HOUSE OF REPRESENTATIVES
OCTOBER 22, 1997
Mrs. MALONEY of New York (for herself, Mrs. MORELLA, Mr. PASCRELL, Mr.
COOK, Mrs. TAUSCHER, Mrs. KELLY, Mr. NEAL of Massachusetts, Ms.
DELAURO, Mr. NADLER, Mr. LANTOS, Ms. SLAUGHTER, Ms. KIL-
PATRICK, 
Mr. 
FROST, 
Mr. 
SANDERS, 
Mrs. 
THURMAN, 
Mr.
FALEOMAVAEGA, Mr. GUTIERREZ, Mr. LIPINSKI, Mr. MCGOVERN, Mr.
EVANS, Ms. EDDIE BERNICE JOHNSON of Texas, Mr. ACKERMAN, Mr.
GREEN, Mr. DELLUMS, Mr. RUSH, Mr. FILNER, Mr. SHERMAN, Ms.
HOOLEY of Oregon, Mr. FAZIO of California, Mr. WYNN, Mr. BROWN of
California, Mr. CONDIT, Mr. CLEMENT, Mr. KENNEDY of Rhode Island,
Mr. KLECZKA, Mr. HINCHEY, Mr. FORD, Ms. ESHOO, and Ms. WOOL-
SEY) introduced the following bill; which was referred to the Committee
on 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 juris-
diction 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 and to
help women make informed choices about their reproduc-
tive and post-menopausal health care.
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
1997’’.
(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 28 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-eighth 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 is $13.8 billion.
(B) The average cost in the United States
of repairing a hip fracture due to osteoporosis
is $32,000.
(C) Fractures due to osteoporosis fre-
quently result in disability and institutionaliza-
tion of individuals.
(D) Because osteoporosis is a progressive
condition and affects primarily aging individ-
uals, reductions in the incidence or severity of
osteoporosis, particularly for post menopausal
women before they become eligible for Medicare,
has 
a 
significant 
potential 
of 
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 will provide 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, as amended by sec-
tion 703(a) of Public Law 104–204, is amended by
adding at the end the following new section:
‘‘SEC. 2706. 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 an estrogen-deficient woman at
clinical risk for osteoporosis;
‘‘(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.—
‘‘(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)), as amended by section 604(b)(2) of
Public Law 104–204, is amended by striking ‘‘sec-
tion 2704’’ and inserting ‘‘sections 2704 and 2706’’.
(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, as amended
by section 702(a) of Public Law 104–204, is amend-
ed by adding at the end the following new section:
‘‘SEC. 713. 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 an estrogen-deficient woman at
clinical risk for osteoporosis;
‘‘(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.—
The standards established under section 2706(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 2706
of such Act.
‘‘(d) RESTRICTIONS ON COST-SHARING.—
‘‘(1) IN GENERAL.—Subject to paragraph (2),
nothing in this section shall be construed as prevent-
ing 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 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)(1), for purposes of assuring
notice of such requirements under the plan; except that
the summary description required to be provided under the
last 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)), as amended by section 603(b)(1) of Public
Law 104–204, is amended by striking ‘‘section 711’’
and inserting ‘‘sections 711 and 713’’.
(C) Section 732(a) of such Act (29 U.S.C.
1191a(a)), as amended by section 603(b)(2) of Pub-
lic Law 104–204, is amended by striking ‘‘section
711’’ and inserting ‘‘sections 711 and 713’’.
(D) The table of contents in section 1 of such
Act is amended by inserting after the item relating
to section 712 the following new item:
‘‘Sec. 713. Standards relating to benefits for bone mass measurement.
(b) INDIVIDUAL HEALTH INSURANCE.—(1) Part B
of title XXVII of the Public Health Service Act, as amend-
ed by section 605(a) of Public Law 104–204, is amended
by inserting after section 2751 the following new section:
‘‘SEC. 2752. STANDARDS RELATING TO BENEFITS FOR BONE
MASS MEASUREMENT.
‘‘(a) IN GENERAL.—The provisions of section 2706
(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 713(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.
‘‘(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)), as added by section 605(b)(3)(B) of
Public Law 104–204, is amended by striking ‘‘section
2751’’ and inserting ‘‘sections 2751 and 2752’’.
(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,
1999.
(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 individ-
ual market on or after such date.
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