Medical Nutrition Therapy Act of 2021

I 117TH CONGRESS 1ST SESSION H. R. 3108 To amend title XVIII of the Social Security Act to expand the availability of medical nutrition therapy services under the Medicare program. IN THE HOUSE OF REPRESENTATIVES MAY 11, 2021 Ms. KELLY of Illinois (for herself and Mr. UPTON) 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 sub- sequently 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 expand the availability of medical nutrition therapy services 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 ‘‘Medical Nutrition 4 Therapy Act of 2021’’. 5 SEC. 2. FINDINGS. 6 Congress finds the following: 7 VerDate Sep 11 2014 23:53 Jun 10, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3108.IH H3108 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 3108 IH (1) Over two-thirds of Medicare fee-for-service 1 beneficiaries have two or more chronic conditions, 2 many of which can be prevented, delayed, treated, or 3 managed through nutrition. 4 (2) Individuals from many racial and ethnic mi- 5 nority backgrounds are more likely to be diagnosed 6 with chronic diseases such as diabetes, prediabetes, 7 chronic kidney disease, end-stage renal disease, and 8 obesity. 9 (3) The Centers for Disease Control and Pre- 10 vention finds that individuals are at an increased 11 risk of severe illness from COVID–19 if they have 12 cancer, chronic kidney disease, diabetes, heart condi- 13 tions such as health failure or coronary artery dis- 14 ease, or obesity. 15 (4) Coverage for medical nutrition therapy is 16 only available to Medicare part B beneficiaries with 17 diabetes or a renal disease, despite medical nutrition 18 therapy being part of the standard of care, in clin- 19 ical guidelines, and medically necessary for many 20 more chronic conditions. 21 (5) Medical nutrition therapy has been shown 22 to be a cost-effective component of treatment for 23 obesity, diabetes, hypertension, dyslipidemia, HIV 24 VerDate Sep 11 2014 23:53 Jun 10, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3108.IH H3108 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 3108 IH infection, unintended weight loss in older adults and 1 other chronic conditions. 2 SEC. 3. EXPANDING THE AVAILABILITY OF MEDICAL NU- 3 TRITION THERAPY SERVICES UNDER THE 4 MEDICARE PROGRAM. 5 (a) IN GENERAL.—Section 1861 of the Social Secu- 6 rity Act (42 U.S.C. 1395x) is amended— 7 (1) in subsection (s)(2)(V), by striking ‘‘in the 8 case of’’ and all that follows through ‘‘organiza- 9 tions’’; and 10 (2) in subsection (vv)— 11 (A) in paragraph (1)— 12 (i) by striking ‘‘disease management’’ 13 and inserting ‘‘the prevention, manage- 14 ment, or treatment of a disease or condi- 15 tion specified in paragraph (4)’’; and 16 (ii) by striking ‘‘by a physician’’ and 17 all that follows through the period at the 18 end and inserting the following: ‘‘by a— 19 ‘‘(A) physician (as defined in subsection 20 (r)(1)); 21 ‘‘(B) physician assistant; 22 ‘‘(C) nurse practitioner; 23 ‘‘(D) clinical nurse specialist (as defined in 24 subsection (aa)(5)(B)); or 25 VerDate Sep 11 2014 23:53 Jun 10, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3108.IH H3108 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 3108 IH ‘‘(E) in the case of such services furnished 1 to manage such a disease or condition that is 2 an eating disorder, a clinical psychologist (as 3 defined by the Secretary). 4 Such term shall not include any services furnished 5 to an individual for the prevention, management, or 6 treatment of a renal disease if such individual is re- 7 ceiving maintenance dialysis for which payment is 8 made under section 1881.’’; and 9 (B) by adding at the end the following new 10 paragraph: 11 ‘‘(4) For purposes of paragraph (1), the diseases and 12 conditions specified in this paragraph are the following: 13 ‘‘(A) Diabetes and prediabetes. 14 ‘‘(B) A renal disease. 15 ‘‘(C) Obesity (as defined for purposes of sub- 16 section (yy)(2)(C) or as otherwise defined by the 17 Secretary). 18 ‘‘(D) Hypertension. 19 ‘‘(E) Dyslipidemia. 20 ‘‘(F) Malnutrition. 21 ‘‘(G) Eating disorders. 22 ‘‘(H) Cancer. 23 ‘‘(I) Gastrointestinal diseases, including celiac 24 disease. 25 VerDate Sep 11 2014 23:53 Jun 10, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3108.IH H3108 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 3108 IH ‘‘(J) HIV. 1 ‘‘(K) AIDS. 2 ‘‘(L) Cardiovascular disease. 3 ‘‘(M) Any other disease or condition— 4 ‘‘(i) specified by the Secretary relating to 5 unintentional weight loss; 6 ‘‘(ii) for which the Secretary determines 7 the services described in paragraph (1) to be 8 medically necessary and appropriate for the 9 prevention, management, or treatment of such 10 disease or condition, consistent with any appli- 11 cable recommendations of the United States 12 Preventive Services Task Force; or 13 ‘‘(iii) for which the Secretary determines 14 the services described in paragraph (1) are 15 medically necessary, consistent with either pro- 16 tocols established by registered dietitians or nu- 17 trition professional organizations or with ac- 18 cepted clinical guidelines identified by the Sec- 19 retary.’’. 20 (b) EXCLUSION MODIFICATION.—Section 1862(a)(1) 21 is amended— 22 (1) in subparagraph (O), by striking ‘‘and’’ at 23 the end; 24 VerDate Sep 11 2014 23:53 Jun 10, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3108.IH H3108 kjohnson on DSK79L0C42PROD with BILLS 6 •HR 3108 IH (2) in subparagraph (P), by striking the semi- 1 colon at the end and inserting ‘‘, and’’; and 2 (3) by adding at the end the following new sub- 3 paragraph: 4 ‘‘(Q) in the case of medical nutrition therapy 5 services (as defined in section 1861(vv)), which are 6 not furnished for the prevention, management, or 7 treatment of a disease or condition specified in para- 8 graph (4) of such section;’’. 9 (c) EFFECTIVE DATE.—The amendments made by 10 this section shall apply with respect to items and services 11 furnished on or after January 1, 2023. 12 Æ VerDate Sep 11 2014 23:53 Jun 10, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6301 E:\BILLS\H3108.IH H3108 kjohnson on DSK79L0C42PROD with BILLS