Title: 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 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2693 Introduced in House (IH)]

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116th CONGRESS
  1st Session
                                H. R. 2693

 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 HOUSE OF REPRESENTATIVES

                              May 14, 2019

  Mr. Larson of Connecticut (for himself, Ms. Sanchez, Mrs. Walorski, 
   Mrs. Brooks of Indiana, Mrs. Trahan, Mr. Marshall, Mr. Byrne, Ms. 
 Clarke of New York, Mr. Courtney, Mr. Rodney Davis of Illinois, Mrs. 
Dingell, Mr. Fitzpatrick, Mr. Hastings, Ms. Johnson of Texas, Mr. Kelly 
 of Pennsylvania, Mr. King of New York, Mrs. Carolyn B. Maloney of New 
York, and Mr. David P. Roe of Tennessee) introduced the following bill; 
  which was referred to the Committee on Energy and Commerce, and in 
    addition to the Committee on Ways and Means, for a period to be 
subsequently determined by the Speaker, in each case for consideration 
  of such provisions as fall within the jurisdiction of the committee 
                               concerned

_______________________________________________________________________

                                 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 is 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) 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) Approximately 25 percent of women over the age of 50 
        who sustain a hip fracture die in the year following the 
        fracture, while a further 20 percent will never leave a nursing 
        facility.
            (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) Since 2007, Medicare has cut DXA reimbursement by over 
        70 percent. By 2016, the payment cuts caused a loss of 36 
        percent of DXA providers, resulting in a 21 percent decline in 
        osteoporosis diagnosis and treatment.
            (11) A decade of steady decline in hip fractures stopped 
        abruptly in 2013. Since then, there have been more than 24,000 
        additional hip fractures, costing over $1 billion, leading to 
        4,800 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 
        2019 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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