Increasing Access to Osteoporosis Testing for Medicare Beneficiaries Act of 2021
Bill: S.1943 | Sponsor: Sen. Collins, Susan M. (R-ME)
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 bill also establishes 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) Osteoporosis is a major public health problem with 54 
        million Americans as of 2010 having either low bone mass or 
        osteoporosis, responsible for over 2,000,000 fractures per 
        year, including over 300,000 hip fractures. The estimated total 
        cost of these fractures in 2005 was $17,000,000,000 and 
        expected to rise to over $25,000,000,000 by 2025.
            (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) While both men and women may develop osteoporosis, 80 
        percent are women.
            (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) Elderly women are so afraid of losing their 
        independence that 8 in 10 would rather die than break their hip 
        and be admitted to a nursing home.
            (8) Bone density testing is more powerful in predicting 
        fractures than cholesterol is in predicting myocardial 
        infarction or blood pressure in predicting stroke.
            (9) Osteoporosis remains both under-recognized and under-
        treated. Over a 7-year period (2007-2013), 45 percent of older 
        female Medicare beneficiaries had no DXA bone density test, and 
        25 percent had only one test.
            (10) DXA testing in older women declined in 2014 to the 
        lowest point in 10 years.
            (11) A decade of steady decline in hip fractures stopped 
        abruptly in 2013. Since then, there have been more than 14,000 
        additional hip fractures, costing over $560,000,000, leading to 
        2,800 more deaths than expected if the decline had continued.

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

    (a) In General.--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, 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.--
                    ``(A) Floor on locality payment amounts.--For a 
                dual-energy x-ray absorptiometry service (identified by 
                HCPCS codes 77080, 77085, and 77086 (and any succeeding 
                codes)) furnished during 2022 or a subsequent year, 
                after determining the payment amount otherwise 
                applicable under this section (without application of 
                this paragraph), if the otherwise applicable payment 
                amount would be less than the floor on the payment 
                amount for the fee schedule area (as determined in 
                subparagraph (B)), the Secretary shall increase the 
                otherwise applicable payment amount for such fee 
                schedule area to the floor on the payment amount for 
                such fee schedule area.
                    ``(B) Determination of floor on payment amount.--
                For purposes of subparagraph (A), the floor on the 
                payment amount for a fee schedule area shall be equal 
                to the product of--
                            ``(i) the national minimum payment for such 
                        service specified in subparagraph (C); and
                            ``(ii) the geographic adjustment factor 
                        established under subsection (e)(2) for such 
                        fee schedule area for the respective year.
                    ``(C) National minimum payment amounts.--For 
                purposes of subparagraph (B), the national minimum 
                payment amounts are the following:
                            ``(i) For services identified by HCPCS code 
                        77080, $98 (with national minimum payment 
                        amounts of $87.11 for the technical component 
                        and $10.89 for the professional component).
                            ``(ii) For services identified by HCPCS 
                        code 77086, $35 (with national minimum payment 
                        amounts of $27.18 for the technical component 
                        and $7.82 for the professional component).
                            ``(iii) For the bundled code for dual 
                        energy absorptiometry and vertebral fracture 
                        assessment studies identified as HCPCS code 
                        77085, $133 (with national minimum payment 
                        amounts of $114.29 for the technical component 
                        and $18.71 for the professional component).''.
    (b) Exemption From Budget Neutrality.--Section 1848(c)(2)(B)(iv) of 
the Social Security Act (42 U.S.C. 1395w-4(c)(2)(B)(iv)) is amended--
            (1) in subclause (IV), by striking ``and'' at the end;
            (2) in subclause (V), by striking the period at the end and 
        inserting ``; and''; and
            (3) by adding at the end the following new subclause:
                                    ``(VI) subsection (b)(12) shall not 
                                be taken into account in applying 
                                clause (ii)(II) for 2022 or a 
                                subsequent year.''.
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