Title: A bill 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.
Policy area: Health

Summary:
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 2019.
The Centers for Medicare & Medicaid Services must establish national minimum payment amounts for such services.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 3160 Introduced in Senate (IS)]

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115th CONGRESS
  2d Session
                                S. 3160

 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.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             June 28, 2018

  Ms. Collins (for herself, Mr. Cardin, Mr. Wicker, Mr. King, and Ms. 
   Stabenow) introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
 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. 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 million fractures per 
        year, including over 300,000 hip fractures. The estimated total 
        cost of these fractures in 2005 was $17 billion and expected to 
        rise to over $25 billion 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 eight in ten 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 million, leading to 
        2,800 more deaths than expected if the decline had continued.

SEC. 2. 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, 2019, 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 
        2017 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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