Nutrition CARE Act of 2021

II 117TH CONGRESS 1ST SESSION S. 584 To amend title XVIII of the Social Security Act to provide coverage of medical nutrition therapy services for individuals with eating disorders under the Medicare program. IN THE SENATE OF THE UNITED STATES MARCH 3, 2021 Ms. HASSAN (for herself, Ms. MURKOWSKI, and Mrs. CAPITO) 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 provide coverage of medical nutrition therapy services for individ- uals with eating disorders under the Medicare program. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Nutrition Counseling 4 Aiding Recovery for Eating Disorders Act of 2021’’ or the 5 ‘‘Nutrition CARE Act of 2021’’. 6 SEC. 2. FINDINGS. 7 Congress finds the following: 8 VerDate Sep 11 2014 23:43 Apr 01, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S584.IS S584 pbinns on DSKJLVW7X2PROD with BILLS 2 •S 584 IS (1) 28,800,000 individuals in the United Sates, 1 or 9 percent of the national population, will have an 2 eating disorder in their lifetime. It is estimated that 3 1,619,300 to 2,080,600 individuals on Medicare part 4 B are affected by an eating disorder, including 5 420,500 to 560,700 beneficiaries who identify as 6 Black, Indigenous, or People of Color. 7 (2) 10,200 deaths per year in the United States 8 occur as a direct result of an eating disorder, equat- 9 ing to 1 death every 52 minutes. Eating disorders 10 have one of the highest mortality rates of all mental 11 illness due to serious medical comorbidities such as 12 stroke, diabetes, and gastric rupture, in addition to 13 the fact that longitudinal studies have found that 14 the suicide risk for those with an eating disorder is 15 23 times the expected risk. 16 (3) Eating disorders can be successfully treated 17 with care encompassing the 4 pillars of successful 18 treatment: medical, psychiatric, therapy, and medical 19 nutrition therapy. In general, Medicare provides 20 some, but not all, care necessary for eating disorders 21 treatment. It doesn’t cover medical nutrition therapy 22 at the outpatient level and provides no coverage at 23 the intensive outpatient or residential treatment lev- 24 els. 25 VerDate Sep 11 2014 23:43 Apr 01, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S584.IS S584 pbinns on DSKJLVW7X2PROD with BILLS 3 •S 584 IS (4) Eating disorders are expensive. The yearly 1 economic cost of eating disorders is 2 $64,700,000,000, with families and individuals expe- 3 riencing an economic loss of $23,500,000,000 per 4 year. Each year, eating disorders are directly re- 5 sponsible for 23,560 inpatient hospitalizations cost- 6 ing $209,700,000 and 53,918 emergency room visits 7 costing $29,300,000. 8 (5) Eating disorders in the elderly are particu- 9 larly serious because chronic disorders or diseases 10 may already compromise a patient’s health and 11 make a patient more prone to serious comorbidities 12 associated with eating disorders, including cardiac, 13 metabolic, gastric, and bone conditions. Early diag- 14 nosis and proper treatment of this population is es- 15 sential. 16 SEC. 3. PROVIDING COVERAGE OF MEDICAL NUTRITION 17 THERAPY SERVICES FOR INDIVIDUALS WITH 18 EATING DISORDERS UNDER THE MEDICARE 19 PROGRAM. 20 Section 1861 of the Social Security Act (42 U.S.C. 21 1395x) is amended— 22 (1) in subsection (s)(2)(V)— 23 VerDate Sep 11 2014 23:43 Apr 01, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S584.IS S584 pbinns on DSKJLVW7X2PROD with BILLS 4 •S 584 IS (A) by redesignating clauses (i) through 1 (iii) as subclauses (I) through (III), respec- 2 tively, and adjusting the margins accordingly; 3 (B) in subclause (III), as so redesignated, 4 by striking the semicolon at the end and insert- 5 ing ‘‘; or’’; 6 (C) by striking ‘‘beneficiary with diabetes’’ 7 and inserting the following: ‘‘beneficiary— 8 ‘‘(i) with diabetes’’; and 9 (D) by adding at the end the following new 10 clause: 11 ‘‘(ii) beginning January 1, 2022, with an 12 eating disorder (as defined by the Secretary in 13 accordance with most recent edition of the Di- 14 agnostic and Statistical Manual of Mental Dis- 15 orders published by the American Psychiatric 16 Association);’’; and 17 (2) in subsection (vv)— 18 (A) in paragraph (1)— 19 (i) by inserting ‘‘(including manage- 20 ment of an eating disorder (as defined for 21 purposes of subsection (s)(2)(V)(ii)))’’ 22 after ‘‘disease management’’; and 23 VerDate Sep 11 2014 23:43 Apr 01, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S584.IS S584 pbinns on DSKJLVW7X2PROD with BILLS 5 •S 584 IS (ii) by striking ‘‘which are furnished 1 by’’ and all that follows through the period 2 and inserting ‘‘which are furnished— 3 ‘‘(A) by a registered dietitian or nutrition 4 professional (as defined in paragraph (2)); 5 ‘‘(B) pursuant to a referral by— 6 ‘‘(i) a physician (as defined in sub- 7 section (r)(1)); or 8 ‘‘(ii) a psychologist (or other mental 9 health professional to the extent authorized 10 under State law); and 11 ‘‘(C) in the case of such services furnished 12 to an individual for the purpose of management 13 of such an eating disorder, at the times speci- 14 fied in paragraph (4).’’; and 15 (B) by adding at the end the following new 16 paragraph: 17 ‘‘(4)(A) For purposes of paragraph (1)(C), the times 18 specified in this paragraph are, with respect to medical 19 nutrition therapy services furnished to an individual for 20 purposes of management of an eating disorder, at least 21 the following: 22 ‘‘(i) 13 hours (including a 1-hour initial assess- 23 ment and 12 hours of reassessment and interven- 24 VerDate Sep 11 2014 23:43 Apr 01, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S584.IS S584 pbinns on DSKJLVW7X2PROD with BILLS 6 •S 584 IS tion) during the 1-year period beginning on the date 1 such individual is first furnished such services. 2 ‘‘(ii) Subject to subparagraph (B), 4 hours dur- 3 ing each subsequent 1-year period. 4 ‘‘(B) The Secretary may apply such other reasonable 5 limitations with respect to the furnishing of medical nutri- 6 tion therapy services for purposes of management of an 7 eating disorder during a period described in subparagraph 8 (A)(ii) as the Secretary determines appropriate.’’. 9 Æ VerDate Sep 11 2014 23:43 Apr 01, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6301 E:\BILLS\S584.IS S584 pbinns on DSKJLVW7X2PROD with BILLS