Amends the Public Health Service Act to apply the above requirements to coverage offered in the individual market.
[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[S. 819 Introduced in Senate (IS)]
107th CONGRESS
1st Session
S. 819
To amend the Public Health Service Act and Employee Retirement Income
Security Act of 1974 to require that group and individual health
insurance coverage and group health plans provide coverage for
qualified individuals for bone mass measurement (bone density testing)
to prevent fractures associated with osteoporosis.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 3, 2001
Mr. Torricelli (for himself and Ms. Snowe) introduced the following
bill; which was read twice and referred to the Committee on Health,
Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To amend the Public Health Service Act and Employee Retirement Income
Security Act of 1974 to require that group and individual health
insurance coverage and group health plans provide coverage for
qualified individuals for bone mass measurement (bone density testing)
to prevent fractures associated with osteoporosis.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; FINDINGS.
(a) Short Title.--This Act may be cited as the ``Early Detection
and Prevention of Osteoporosis and Related Bone Diseases Act of 2001''.
(b) Findings.--Congress makes the following findings:
(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 increased 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 and related bone diseases.--
(A) 28,000,000 Americans have (or are at risk for)
osteoporosis, 80 percent of which are women.
(B) Osteoporosis is responsible for 1.5 million
bone fractures annually, including more than 300,000
hip fractures, 700,000 vertebral fractures and 200,000
fractures of the wrists.
(C) Half of all women, and one-eighth of all men,
age 50 or older will have a bone fracture due to
osteoporosis.
(D) Between 3,000,000 and 4,000,000 Americans have
Paget's disease, osteogenesis imperfecta,
hyperparathyroidism, and other related metabolic bone
diseases.
(3) Impact of osteoporosis.--The cost of treating
osteoporosis is significant:
(A) The annual cost of osteoporosis in the United
States is $13,800,000,000 and is expected to increase
precipitously because the proportion of the population
comprised of older persons is expanding and each
generation of older persons tends to have a higher
incidence of osteoporosis than preceding generations.
(B) The average cost in the United States of
repairing a hip fracture due to osteoporosis is
$32,000.
(C) Fractures due to osteoporosis frequently result
in disability and institutionalization of individuals.
(D) Because osteoporosis is a progressive condition
causing fractures primarily in aging individuals,
preventing fractures, 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 the only reliable
method of detecting osteoporosis at an early stage.
(B) Low bone mass is as predictive of future
fractures as is high cholesterol or high blood pressure
of heart disease or stroke.
(C) Bone mass measurement is a non-invasive,
painless, and reliable way to diagnose osteoporosis
before costly fractures occur.
(D) Under section 4106 of the Balanced Budget Act
of 1997, Medicare provides coverage, effective July 1,
1999, for bone mass measurement for qualified
individuals who are at risk of developing osteoporosis.
(5) Research on osteoporosis and related bone diseases.--
(A) Technology now exists, and new technology is
developing, that will permit the early diagnosis and
prevention of osteoporosis and related bone diseases as
well as management of these conditions once they
develop.
(B) Funding for research on osteoporosis and
related bone diseases is severely constrained at key
research institutes, including the National Institute
of Arthritis and Musculoskeletal and Skin Diseases, the
National Institute on Aging, the National Institute of
Diabetics and Digestive and Kidney Diseases, the
National Institute of Dental Research, and the National
Institute of Child Health and Human Development.
(C) Further research is needed to improve medical
knowledge concerning--
(i) cellular mechanisms related to the
processes of bone resorption and bone
formation, and the effect of different agents
on bone remodeling;
(ii) risk factors for osteoporosis,
including newly discovered risk factors, risk
factors related to groups not ordinarily
studied (such as men and minorities),
risk factors related to genes that help to control skeletal metabolism,
and risk factors relating to the relationship of aging processes to the
development of osteoporosis;
(iii) bone mass measurement technology,
including more widespread and cost-effective
techniques for making more precise measurements
and for interpreting measurements;
(iv) calcium (including bioavailability,
intake requirements, and the role of calcium in
building heavier and denser skeletons), and
vitamin D and its role as an essential vitamin
in adults;
(v) prevention and treatment, including the
efficacy of current therapies, alternative drug
therapies for prevention and treatment, and the
role of exercise; and
(vi) rehabilitation.
(D) Further educational efforts are needed to
increase public and professional knowledge of the
causes of, methods for avoiding, and treatment of
osteoporosis.
SEC. 2. REQUIRING COVERAGE OF BONE MASS MEASUREMENT UNDER HEALTH PLANS.
(a) Group Health Plans.--
(1) Public health service act amendments.--
(A) In general.--Subpart 2 of part A of title XXVII
of the Public Health Service Act (42 U.S.C. 300gg-4) is
amended by adding at the end the following:
``SEC. 2707. STANDARDS RELATING TO BENEFITS FOR BONE MASS MEASUREMENT.
``(a) Requirements for Coverage of Bone Mass Measurement.--A group
health plan, and a health insurance 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 paragraph 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 `qualified
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;
``(E) is being monitored to assess the response to
or efficacy of approved osteoporosis drug therapy;
``(F) is a man with a low trauma fracture; or
``(G) the Secretary determines is eligible.
``(c) Limitation on Frequency Required.--Taking 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 Secretary
may vary such standards based on the clinical and risk-related
characteristics of qualified individuals.
``(d) Restrictions on Cost-Sharing.--
``(1) In general.--Subject to paragraph (2), nothing in
this section shall be construed as preventing a group health
plan or issuer from imposing deductibles, coinsurance, or other
cost-sharing in relation 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 paragraph (1) to the extent they exceed
the deductibles, coinsurance, and limitations that are applied
to similar 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 continued
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 induce such providers not to provide
such measurements 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 individual in accordance with
this section.
``(f) Rule of Construction.--Nothing in this section shall be
construed to require an individual who is a participant or beneficiary
to undergo bone mass measurement.
``(g) Notice.--A group health plan under this part shall comply
with the notice requirement under section 714(g) of the Employee
Retirement Income Security Act of 1974 with respect to the requirements
of this section as if such section applied to such plan.
``(h) Level and Type of Reimbursements.--Nothing in this section
shall be construed to prevent a group health plan or a health insurance
issuer offering group health insurance coverage from negotiating the
level and type of reimbursement with a provider for care provided in
accordance with this section.
``(i) Preemption.--
``(1) In general.--The provisions of this section do not
preempt State law relating to health insurance coverage to the
extent such State law provides greater benefits with respect to
osteoporosis detection or prevention.
``(2) Construction.--Section 2723(a)(1) shall not be
construed as superseding a State law described in paragraph
(1).''.
(B) Conforming amendment.--Section 2723(c) of the
Public Health Service Act (42 U.S.C. 300gg-23(c)) is
amended by striking ``section 2704'' and inserting
``sections 2704 and 2707''.
(2) ERISA amendments.--
(A) In general.--Subpart B of part 7 of subtitle B
of title I of the Employee Retirement Income Security
Act of 1974 (29 U.S.C. 1185 et seq.) is amended by
adding at the end the following:
``SEC. 714. STANDARDS RELATING TO BENEFITS FOR BONE MASS MEASUREMENT.
``(a) Requirements for Coverage of Bone Mass Measurement.--A group
health plan, and a health insurance 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 paragraph 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 `qualified
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;
``(E) is being monitored to assess the response to
or efficacy of approved osteoporosis drug therapy;
``(F) is a man with a low trauma fracture; or
``(G) the Secretary determines is eligible.
``(c) Limitation on Frequency Required.--The standards established
under section 2707(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 2707 of such Act.
``(d) Restrictions on Cost-Sharing.--
``(1) In general.--Subject to paragraph (2), nothing in
this section shall be construed as preventing a group health
plan or issuer from imposing deductibles, coinsurance, or other
cost-sharing in relation 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 paragraph (1) to the extent they exceed
the deductibles, coinsurance, and limitations that are applied
to similar 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 continued
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 induce such providers not to provide
such measurements 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 individual in accordance with
this section.
``(f) Rule of Construction.--Nothing in this section shall be
construed to require an individual who is a participant or beneficiary
to undergo bone mass measurement.
``(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 section do not
preempt State law relating to health insurance coverage to the
extent such State law provides greater benefits with respect to
osteoporosis detection or prevention.
``(2) Construction.--Section 731(a)(1) shall not be
construed as superseding a State law described in paragraph
(1).''.
(B) Conforming amendments.--
(i) Section 731(c) of the Employee
Retirement Income Security Act of 1974 (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 714''.
(ii) Section 732(a) of the Employee
Retirement Income Security Act of 1974 (29
U.S.C. 1191a(a)), as amended by section
603(b)(2) of Public Law 104-204, is amended by
striking ``section 711'' and inserting
``sections 711 and 714''.
(iii) The table of contents in section 1 of
the Employee Retirement Income Security Act of
1974 is amended by inserting after the item
relating to section 713 the following new item:
``Sec. 714. Standards relating to benefits for bone mass
measurement.''.
(b) Individual Health Insurance.--
(1) In general.--Part B of title XXVII of the Public Health
Service Act is amended by inserting after section 2752 (42
U.S.C. 300gg-52) the following new section:
``SEC. 2753. STANDARDS RELATING TO BENEFITS FOR BONE MASS MEASUREMENT.
``(a) In General.--The provisions of section 2707 (other than
subsection (g)) shall apply to health insurance coverage offered by a
health insurance issuer in the individual 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 section 714(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 section do not
preempt State law relating to health insurance coverage to the
extent such State law provides greater benefits with respect to
osteoporosis detection or prevention.
``(2) Construction.--Section 2762(a) shall not be construed
as superseding a State law described in paragraph (1).''.
(2) Conforming amendments.--Section 2762(b)(2) of the
Public Health Service Act (42 U.S.C. 300gg-62(b)(2)) is amended
by striking ``section 2751'' and inserting ``sections 2751 and
2753''.
(c) Effective Dates.--
(1) Group health plans.--The amendments made by subsection
(a) shall apply with respect to group health plans for plan
years beginning on or after October 1, 2001.
(2) Individual market.--The amendments made by subsection
(b) shall apply with respect to health insurance coverage
offered, sold, issued, renewed, in effect, or operated in the
individual market on or after October 1, 2001.
<all>
Introduced in Senate
Sponsor introductory remarks on measure. (CR S4247)
Read twice and referred to the Committee on Health, Education, Labor, and Pensions. (text of measure as introduced: CR S4247-4249)
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