Treat and Reduce Obesity Act of 2021

I 117TH CONGRESS 1ST SESSION H. R. 1577 To amend title XVIII of the Social Security Act to provide for the coordination of programs to prevent and treat obesity, and for other purposes. IN THE HOUSE OF REPRESENTATIVES MARCH 3, 2021 Mr. KIND (for himself, Mr. REED, Mr. RUIZ, and Mr. WENSTRUP) 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 com- mittee concerned A BILL To amend title XVIII of the Social Security Act to provide for the coordination of programs to prevent and treat obesity, and for other purposes. 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 ‘‘Treat and Reduce Obe- 4 sity Act of 2021’’. 5 SEC. 2. FINDINGS. 6 Congress makes the following findings: 7 VerDate Sep 11 2014 21:43 Apr 23, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H1577.IH H1577 pamtmann on DSKBC07HB2PROD with BILLS 2 •HR 1577 IH (1) According to the Centers for Disease Con- 1 trol and Prevention, about 41 percent of adults aged 2 60 and over had obesity in the period of 2015 3 through 2016, representing more than 27 million 4 people. 5 (2) The National Institutes of Health has re- 6 ported that obesity and overweight are now the sec- 7 ond leading cause of death nationally, with an esti- 8 mated 300,000 deaths a year attributed to the epi- 9 demic. 10 (3) Obesity increases the risk for chronic dis- 11 eases and conditions, including high blood pressure, 12 heart disease, certain cancers, arthritis, mental ill- 13 ness, lipid disorders, sleep apnea, and type 2 diabe- 14 tes. 15 (4) More than half of Medicare beneficiaries are 16 treated for 5 or more chronic conditions per year. 17 The rate of obesity among Medicare beneficiaries 18 doubled from 1987 to 2002 and nearly doubled 19 again by 2016, with Medicare spending on individ- 20 uals with obesity during that time rising proportion- 21 ately to reach $50 billion in 2014. 22 (5) Men and women with obesity at age 65 have 23 decreased life expectancy of 1.6 years for men and 24 1.4 years for women. 25 VerDate Sep 11 2014 21:43 Apr 23, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1577.IH H1577 pamtmann on DSKBC07HB2PROD with BILLS 3 •HR 1577 IH (6) The direct and indirect cost of obesity was 1 more than $427.8 billion in 2014 and is growing. 2 (7) On average, a Medicare beneficiary with 3 obesity costs $2,018 (in 2019 dollars) more than a 4 healthy-weight beneficiary. 5 (8) The prevalence of obesity among older indi- 6 viduals in the United States is growing at a linear 7 rate and, if nothing changes, nearly one in two 8 (47%) Medicare beneficiaries aged 65 and over will 9 have obesity in 2030, up from slightly more than 10 one in four (28%) in 2010. 11 SEC. 3. AUTHORITY TO EXPAND HEALTH CARE PROVIDERS 12 QUALIFIED TO FURNISH INTENSIVE BEHAV- 13 IORAL THERAPY. 14 Section 1861(ddd) of the Social Security Act (42 15 U.S.C. 1395x(ddd)) is amended by adding at the end the 16 following new paragraph: 17 ‘‘(4)(A) Subject to subparagraph (B), the Sec- 18 retary may, in addition to qualified primary care 19 physicians and other primary care practitioners, 20 cover intensive behavioral therapy for obesity fur- 21 nished by any of the following: 22 ‘‘(i) A physician (as defined in subsection 23 (r)(1)) who is not a qualified primary care phy- 24 sician. 25 VerDate Sep 11 2014 21:43 Apr 23, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1577.IH H1577 pamtmann on DSKBC07HB2PROD with BILLS 4 •HR 1577 IH ‘‘(ii) Any other appropriate health care 1 provider (including a physician assistant, nurse 2 practitioner, or clinical nurse specialist (as 3 those terms are defined in subsection (aa)(5)), 4 a clinical psychologist, a registered dietitian or 5 nutrition professional (as defined in subsection 6 (vv))). 7 ‘‘(iii) An evidence-based, community-based 8 lifestyle counseling program approved by the 9 Secretary. 10 ‘‘(B) In the case of intensive behavioral therapy 11 for obesity furnished by a provider described in 12 clause (ii) or (iii) of subparagraph (A), the Secretary 13 may only cover such therapy if such therapy is fur- 14 nished— 15 ‘‘(i) upon referral from, and in coordina- 16 tion with, a physician or primary care practi- 17 tioner operating in a primary care setting or 18 any other setting specified by the Secretary; 19 and 20 ‘‘(ii) in an office setting, a hospital out- 21 patient department, a community-based site 22 that complies with the Federal regulations con- 23 cerning the privacy of individually identifiable 24 health information promulgated under section 25 VerDate Sep 11 2014 21:43 Apr 23, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1577.IH H1577 pamtmann on DSKBC07HB2PROD with BILLS 5 •HR 1577 IH 264(c) of the Health Insurance Portability and 1 Accountability Act of 1996, or another setting 2 specified by the Secretary. 3 ‘‘(C) In order to ensure a collaborative effort, 4 the coordination described in subparagraph (B)(i) 5 shall include the health care provider or lifestyle 6 counseling program communicating to the referring 7 physician or primary care practitioner any rec- 8 ommendations or treatment plans made regarding 9 the therapy.’’. 10 SEC. 4. MEDICARE PART D COVERAGE OF OBESITY MEDI- 11 CATION. 12 (a) IN GENERAL.—Section 1860D–2(e)(2)(A) of the 13 Social Security Act (42 U.S.C. 1395w–102(e)(2)(A)) is 14 amended, in the first sentence— 15 (1) by striking ‘‘and other than’’ and inserting 16 ‘‘other than’’; and 17 (2) by inserting after ‘‘benzodiazepines),’’ the 18 following: ‘‘and other than subparagraph (A) of such 19 section if the drug is used for the treatment of obe- 20 sity (as defined in section 1861(yy)(2)(C)) or for 21 weight loss management for an individual who is 22 overweight (as defined in section 1861(yy)(2)(F)(i)) 23 and has one or more related comorbidities,’’. 24 VerDate Sep 11 2014 21:43 Apr 23, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H1577.IH H1577 pamtmann on DSKBC07HB2PROD with BILLS 6 •HR 1577 IH (b) EFFECTIVE DATE.—The amendments made by 1 subsection (a) shall apply to plan years beginning on or 2 after the date that is 2 years after the date of the enact- 3 ment of this Act. 4 SEC. 5. REPORT TO CONGRESS. 5 Not later than the date that is 1 year after the date 6 of the enactment of this Act, and every 2 years thereafter, 7 the Secretary of Health and Human Services shall submit 8 a report to Congress describing the steps the Secretary 9 has taken to implement the provisions of, and amend- 10 ments made by, this Act. Such report shall also include 11 recommendations for better coordination and leveraging of 12 programs within the Department of Health and Human 13 Services and other Federal agencies that relate in any way 14 to supporting appropriate research and clinical care (such 15 as any interactions between physicians and other health 16 care providers and their patients) to treat, reduce, and 17 prevent obesity in the adult population. 18 Æ VerDate Sep 11 2014 21:43 Apr 23, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6301 E:\BILLS\H1577.IH H1577 pamtmann on DSKBC07HB2PROD with BILLS