Treat and Reduce Obesity Act of 2019

II 116TH CONGRESS 1ST SESSION S. 595 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 SENATE OF THE UNITED STATES FEBRUARY 28, 2019 Mr. CASSIDY (for himself, Mr. CARPER, Mrs. CAPITO, Mr. COONS, Mrs. BLACKBURN, Mr. HEINRICH, Ms. MURKOWSKI, and Ms. KLOBUCHAR) in- troduced the following bill; which was read twice and referred to the Com- mittee on Finance 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 2019’’. 5 SEC. 2. FINDINGS. 6 Congress makes the following findings: 7 (1) According to the Centers for Disease Con- 8 trol and Prevention, about 41 percent of adults aged 9 VerDate Sep 11 2014 00:23 Mar 07, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S595.IS S595 kjohnson on DSK79L0C42 with BILLS 2 •S 595 IS 60 and over had obesity in the period of 2015 1 through 2016, representing more than 27 million 2 people. 3 (2) The National Institutes of Health has re- 4 ported that obesity and overweight are now the sec- 5 ond leading cause of death nationally, with an esti- 6 mated 300,000 deaths a year attributed to the epi- 7 demic. 8 (3) Obesity increases the risk for chronic dis- 9 eases and conditions, including high blood pressure, 10 heart disease, certain cancers, arthritis, mental ill- 11 ness, lipid disorders, sleep apnea, and type 2 diabe- 12 tes. 13 (4) More than half of Medicare beneficiaries are 14 treated for 5 or more chronic conditions per year. 15 The rate of obesity among Medicare beneficiaries 16 doubled from 1987 to 2002 and nearly doubled 17 again by 2016, with Medicare spending on individ- 18 uals with obesity during that time rising proportion- 19 ately to reach $50 billion in 2014. 20 (5) Men and women with obesity at age 65 have 21 decreased life expectancy of 1.6 years for men and 22 1.4 years for women. 23 (6) The direct and indirect cost of obesity was 24 more than $427.8 billion in 2014 and is growing. 25 VerDate Sep 11 2014 00:23 Mar 07, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S595.IS S595 kjohnson on DSK79L0C42 with BILLS 3 •S 595 IS (7) On average, a Medicare beneficiary with 1 obesity costs $2,018 (in 2019 dollars) more than a 2 healthy-weight beneficiary. 3 (8) The prevalence of obesity among older indi- 4 viduals in the United States is growing at a linear 5 rate and, if nothing changes, nearly one in two (47 6 percent) Medicare beneficiaries aged 65 and over 7 will have obesity in 2030, up from slightly more 8 than one in four (28 percent) in 2010. 9 SEC. 3. AUTHORITY TO EXPAND HEALTH CARE PROVIDERS 10 QUALIFIED TO FURNISH INTENSIVE BEHAV- 11 IORAL THERAPY. 12 Section 1861(ddd) of the Social Security Act (42 13 U.S.C. 1395x(ddd)) is amended by adding at the end the 14 following new paragraph: 15 ‘‘(4)(A) Subject to subparagraph (B), the Sec- 16 retary may, in addition to qualified primary care 17 physicians and other primary care practitioners, 18 cover intensive behavioral therapy for obesity fur- 19 nished by any of the following: 20 ‘‘(i) A physician (as defined in subsection 21 (r)(1)) who is not a qualified primary care phy- 22 sician. 23 ‘‘(ii) Any other appropriate health care 24 provider (including a physician assistant, nurse 25 VerDate Sep 11 2014 00:23 Mar 07, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S595.IS S595 kjohnson on DSK79L0C42 with BILLS 4 •S 595 IS practitioner, or clinical nurse specialist (as 1 those terms are defined in subsection (aa)(5)), 2 a clinical psychologist, a registered dietitian or 3 nutrition professional (as defined in subsection 4 (vv))). 5 ‘‘(iii) An evidence-based, community-based 6 lifestyle counseling program approved by the 7 Secretary. 8 ‘‘(B) In the case of intensive behavioral therapy 9 for obesity furnished by a provider described in 10 clause (ii) or (iii) of subparagraph (A), the Secretary 11 may only cover such therapy if such therapy is fur- 12 nished— 13 ‘‘(i) upon referral from, and in coordina- 14 tion with, a physician or primary care practi- 15 tioner operating in a primary care setting or 16 any other setting specified by the Secretary; 17 and 18 ‘‘(ii) in an office setting, a hospital out- 19 patient department, a community-based site 20 that complies with the Federal regulations con- 21 cerning the privacy of individually identifiable 22 health information promulgated under section 23 264(c) of the Health Insurance Portability and 24 VerDate Sep 11 2014 00:23 Mar 07, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S595.IS S595 kjohnson on DSK79L0C42 with BILLS 5 •S 595 IS Accountability Act of 1996, or another setting 1 specified by the Secretary. 2 ‘‘(C) In order to ensure a collaborative effort, 3 the coordination described in subparagraph (B)(i) 4 shall include the health care provider or lifestyle 5 counseling program communicating to the referring 6 physician or primary care practitioner any rec- 7 ommendations or treatment plans made regarding 8 the therapy.’’. 9 SEC. 4. MEDICARE PART D COVERAGE OF OBESITY MEDI- 10 CATION. 11 (a) IN GENERAL.—Section 1860D–2(e)(2)(A) of the 12 Social Security Act (42 U.S.C. 1395w–102(e)(2)(A)) is 13 amended, in the first sentence— 14 (1) by striking ‘‘and other than’’ and inserting 15 ‘‘other than’’; and 16 (2) by inserting after ‘‘benzodiazepines),’’ the 17 following: ‘‘and other than subparagraph (A) of such 18 section if the drug is used for the treatment of obe- 19 sity (as defined in section 1861(yy)(2)(C)) or for 20 weight loss management for an individual who is 21 overweight (as defined in section 1861(yy)(2)(F)(i)) 22 and has one or more related comorbidities,’’. 23 (b) EFFECTIVE DATE.—The amendments made by 24 subsection (a) shall apply to plan years beginning on or 25 VerDate Sep 11 2014 00:23 Mar 07, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S595.IS S595 kjohnson on DSK79L0C42 with BILLS 6 •S 595 IS after the date that is 2 years after the date of the enact- 1 ment of this Act. 2 SEC. 5. REPORT TO CONGRESS. 3 Not later than the date that is 1 year after the date 4 of the enactment of this Act, and every 2 years thereafter, 5 the Secretary of Health and Human Services shall submit 6 a report to Congress describing the steps the Secretary 7 has taken to implement the provisions of, and amend- 8 ments made by, this Act. Such report shall also include 9 recommendations for better coordination and leveraging of 10 programs within the Department of Health and Human 11 Services and other Federal agencies that relate in any way 12 to supporting appropriate research and clinical care (such 13 as any interactions between physicians and other health 14 care providers and their patients) to treat, reduce, and 15 prevent obesity in the adult population. 16 Æ VerDate Sep 11 2014 00:23 Mar 07, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6301 E:\BILLS\S595.IS S595 kjohnson on DSK79L0C42 with BILLS