Increasing Access to Osteoporosis Testing for Medicare Beneficiaries Act of 2021
Bill: H.R.3517 | Sponsor: Rep. Larson, John B. (D-CT)
Policy area: Health

Summary:
Increasing Access to Osteoporosis Testing for Medicare Beneficiaries Act of 2021
This bill specifies that certain Medicare payment rules applicable to imaging services shall apply to dual-energy x-ray absorptiometry services used in bone mass scans beginning in 2022.
The Centers for Medicare & Medicaid Services must establish national minimum payment amounts for such services.

To amend title XVIII of the Social Security Act to improve access to, 
and utilization of, bone mass measurement benefits under part B of the 
 Medicare program by establishing a minimum payment amount under such 
                    part for bone mass measurement.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Increasing Access to Osteoporosis 
Testing for Medicare Beneficiaries Act of 2021''.

SEC. 2. FINDINGS.

    The Congress finds the following:
            (1) The total annual expense of providing care for 
        osteoporotic fractures among Medicare beneficiaries, including 
        direct medical costs as well as indirect societal costs related 
        to productivity losses and informal caregiving, has been 
        estimated at $57 billion in 2018, with an expected increase to 
        over $95 billion in 2040.
            (2) Osteoporosis is a silent disease that often is not 
        discovered until a fracture occurs. One out of two women and up 
        to one of four men will suffer an osteoporotic fracture in 
        their lifetimes.
            (3) Osteoporosis disproportionately impacts women, who 
        account for 71 percent of osteoporotic fractures, and 75 
        percent of costs.
            (4) Most women are not aware of their personal risk factors 
        for osteoporosis, the prevalence of, or the morbidity and 
        mortality associated with the disease, despite the fact that 
        broken bones due to osteoporosis lead to more hospitalizations 
        and greater health care costs than heart attack, stroke, or 
        breast cancer in women age 55 and above.
            (5) A woman's risk of hip fracture is equal to her combined 
        risk of breast, uterine, and ovarian cancer. More women die in 
        the United States in the year following a hip fracture than 
        from breast cancer.
            (6) One out of four people who have an osteoporotic hip 
        fracture will need long-term nursing home care. Half of those 
        who experience osteoporotic hip fractures are unable to walk 
        without assistance.
            (7) Nearly one in five Medicare patients die within one 
        year of a new osteoporotic fracture. Beneficiaries with a hip 
        fracture had the highest mortality where approximately 30 
        percent died within 12 months of the fracture.
            (8) Bone density testing is more powerful in predicting 
        fractures than cholesterol is in predicting myocardial 
        infarction or blood pressure in predicting stroke.
            (9) Since 2007, Medicare has cut DXA reimbursement by over 
        72 percent. By 2019, the payment cuts caused a loss of 44 
        percent of DXA office providers resulting in declines in 
        expected DXA testing, leaving 1.65 million women undiagnosed 
        and untreated for osteoporosis.
            (10) A decade of steady decline in hip fractures stopped 
        abruptly in 2013. As of 2019, there have been more than 71,775 
        additional hip fractures, costing almost $3 billion, leading to 
        almost 16,000 additional deaths than expected if the decline 
        had continued.
            (11) An estimated 205,000 Medicare Fee For Service 
        beneficiaries, or about 15 percent of those who had a new 
        osteoporotic fracture, suffered one or more subsequent 
        fractures within 12 months of the initial fracture.

SEC. 3. INCREASING ACCESS TO OSTEOPOROSIS PREVENTION AND TREATMENT.

    Section 1848(b) of the Social Security Act (42 U.S.C. 1395w-4(b)) 
is amended--
            (1) in paragraph (4)(B)--
                    (A) by striking ``and the first 2 months of 2012'' 
                and inserting ``the first 2 months of 2012, and 2022 
                and each subsequent year''; and
                    (B) by striking ``paragraph (6)'' and inserting 
                ``paragraphs (6) and (12)''; and
            (2) by adding at the end the following:
            ``(12) Establishing minimum payment for osteoporosis 
        tests.--For dual-energy x-ray absorptiometry services 
        (identified by HCPCS codes 77080 and 77082 and successor codes 
        77085 and 77086 (and any succeeding codes)) furnished during 
        2022 or a subsequent year, the Secretary shall establish a 
        national minimum payment amount under this subsection--
                    ``(A) for such services identified by HCPCS code 
                77080, equal to $98 (with national minimum payment 
                amounts of $87.11 for the technical component and 
                $10.89 for the professional component);
                    ``(B) for such services identified by HCPCS code 
                77086, equal to $35 (with national minimum payment 
                amounts of $27.18 for the technical component and $7.82 
                for the professional component); and
                    ``(C) for the bundled code for dual energy 
                absorptiometry and vertebral fracture assessment 
                studies identified as HCPCS code 77085, equal to $133 
                (with national minimum payment amounts of $114.29 for 
                the technical component and $18.71 for the professional 
                component).
        Such minimum payment amounts shall be adjusted by the 
        geographical adjustment factor established under subsection 
        (e)(2) for the services for the respective year.''.
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