Nutrition CARE Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 3711 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 HOUSE OF REPRESENTATIVES JULY 11, 2019 Ms. JUDY CHU of California (for herself, Mr. CA´RDENAS, Ms. CLARKE of New York, Mr. FITZPATRICK, Mrs. LEE of Nevada, Mr. RASKIN, Mr. ROUDA, Mr. TONKO, Ms. CASTOR of Florida, and Mr. YOUNG) introduced the fol- lowing bill; which was referred to the Committee on Energy and Com- merce, and in addition to the Committee on Ways and Means, for a pe- riod to be subsequently determined by the Speaker, in each case for con- sideration 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 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 2019’’ or the 5 ‘‘Nutrition CARE Act of 2019’’. 6 VerDate Sep 11 2014 00:18 Jul 20, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3711.IH H3711 kjohnson on DSK79L0C42 with BILLS 2 •HR 3711 IH SEC. 2. FINDINGS. 1 Congress finds the following: 2 (1) Eating disorders, including the specific dis- 3 orders of anorexia nervosa, bulimia nervosa, binge 4 eating disorder, avoidant/restrictive food intake dis- 5 order, and other specified feeding or eating dis- 6 orders, are severe biologically based mental illnesses 7 caused by a complex interaction of genetic, biologi- 8 cal, social, behavioral, and psychological factors. 9 (2) Over 30,000,000 individuals in the United 10 States of all ages, races, sizes, sexual orientations, 11 ethnicities, and socioeconomic statuses, are affected 12 by eating disorders during their lifetimes. 13 (3) Eating disorders have one of the highest 14 mortality rates of all mental illnesses, as eating dis- 15 orders can become fatal due to heart failure, kidney 16 failure, stroke, hypoglycemia, and gastric rupture. 17 Additionally, longitudinal studies have found that 18 the suicide risk for those with an eating disorder is 19 23 times the expected risk. 20 (4) Eating disorders can be successfully treated 21 with interventions at the appropriate durations and 22 levels of care, yet only one-third of persons with eat- 23 ing disorders receive any medical, psychiatric, or 24 therapeutic care. Best practice treatment of eating 25 disorders includes patients, their families, and a 26 VerDate Sep 11 2014 00:18 Jul 20, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3711.IH H3711 kjohnson on DSK79L0C42 with BILLS 3 •HR 3711 IH comprehensive team of professionals such as social 1 workers, mental health counselors, primary care 2 practitioners, psychiatrists, psychologists, dietitians, 3 art therapists, and other specialty providers. 4 (5) Studies examining the prevalence of eating 5 disorders and insulin restriction among people with 6 diabetes show that up to 35 percent of women with 7 diabetes restrict insulin in order to lose weight at 8 some point in their life. 9 (6) Research shows that disordered eating 10 among older adults consistently find that rates of 11 disordered eating among the elderly are similar to 12 those of younger persons. 13 (7) Weight loss in the elderly may signal an 14 undiagnosed medical illness or may be the result of 15 a known medical condition and/or its pharmacologic 16 treatment. 17 (8) Eating disorders in the elderly are associ- 18 ated with significant morbidity and mortality, and a 19 wide range of health issues arise secondary to eating 20 disorders, including cardiac, metabolic, gastric, and 21 bone conditions; diagnosis and proper treatment of 22 this population are essential. 23 (9) Eating disorders in the elderly are particu- 24 larly serious because chronic disorders or diseases 25 VerDate Sep 11 2014 00:18 Jul 20, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3711.IH H3711 kjohnson on DSK79L0C42 with BILLS 4 •HR 3711 IH may already compromise a patient’s health. Inad- 1 equate nutrition can result in memory deficits, cog- 2 nitive decline, decubitus ulcers, impaired healing of 3 sores, wounds, or infections, and dizziness, dis- 4 orientation, and falls. 5 (10) Studies find that individuals with chronic 6 illnesses and/or disabilities are four times more likely 7 to have anorexia nervosa or bulimia nervosa com- 8 pared to the general population. 9 SEC. 3. PROVIDING COVERAGE OF MEDICAL NUTRITION 10 THERAPY SERVICES FOR INDIVIDUALS WITH 11 EATING DISORDERS UNDER THE MEDICARE 12 PROGRAM. 13 Section 1861 of the Social Security Act (42 U.S.C. 14 1395x) is amended— 15 (1) in subsection (s)(2)(V)— 16 (A) by redesignating clauses (i) through 17 (iii) as subclauses (I) through (III), respec- 18 tively, and adjusting the margins accordingly; 19 (B) in subclause (III), as so redesignated, 20 by striking the semicolon at the end and insert- 21 ing ‘‘; and’’; 22 (C) by striking ‘‘beneficiary with diabetes’’ 23 and inserting the following: ‘‘beneficiary— 24 ‘‘(i) with diabetes’’; and 25 VerDate Sep 11 2014 00:18 Jul 20, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3711.IH H3711 kjohnson on DSK79L0C42 with BILLS 5 •HR 3711 IH (D) by adding at the end the following new 1 clause: 2 ‘‘(ii) beginning January 1, 2020, with an 3 eating disorder (as defined by the Secretary in 4 accordance with most recent edition of the Di- 5 agnostic and Statistical Manual of Mental Dis- 6 orders published by the American Psychiatric 7 Association);’’; and 8 (2) in subsection (vv)— 9 (A) in paragraph (1)— 10 (i) by inserting ‘‘(including manage- 11 ment of an eating disorder (as defined for 12 purposes of subsection (s)(2)(V)(ii)))’’ 13 after ‘‘disease management’’; and 14 (ii) by inserting ‘‘or psychologist (or 15 other mental health professional to the ex- 16 tent authorized under State law) and, in 17 the case of such services furnished to an 18 individual for the purpose of management 19 of such an eating disorder, at the times 20 specified in paragraph (4)’’ before the pe- 21 riod at the end; and 22 (B) by adding at the end the following new 23 paragraph: 24 VerDate Sep 11 2014 00:18 Jul 20, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3711.IH H3711 kjohnson on DSK79L0C42 with BILLS 6 •HR 3711 IH ‘‘(4)(A) For purposes of paragraph (1), the times 1 specified in this paragraph are, with respect to medical 2 nutrition therapy services furnished to an individual for 3 purposes of management of an eating disorder, the fol- 4 lowing: 5 ‘‘(i) 13 hours (including a 1 hour initial assess- 6 ment and 12 hours of reassessment and interven- 7 tion) during the 1-year period beginning on the date 8 such individual is first furnished such services. 9 ‘‘(ii) Subject to subparagraph (B), 4 hours dur- 10 ing each subsequent 1-year period. 11 ‘‘(B) In the case that the physician or psychologist 12 (or other mental health professional to the extent author- 13 ized under State law) treating such individual determines 14 that there has been a change with respect to the diagnosis, 15 medical condition, or treatment regimen relating to the 16 eating disorder of such individual that requires the fur- 17 nishing of medical nutrition therapy services beyond the 18 times specified in subparagraph (A)(ii), the Secretary may 19 provide for an additional number of hours to be available 20 to such individual with respect to a period described in 21 such subparagraph. 22 ‘‘(C) The Secretary may apply such other reasonable 23 limitations with respect to the furnishing of medical nutri- 24 tion therapy services for purposes of management of an 25 VerDate Sep 11 2014 00:18 Jul 20, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3711.IH H3711 kjohnson on DSK79L0C42 with BILLS 7 •HR 3711 IH eating disorder during a period described in subparagraph 1 (A)(ii) as the Secretary determines appropriate.’’. 2 Æ VerDate Sep 11 2014 00:18 Jul 20, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6301 E:\BILLS\H3711.IH H3711 kjohnson on DSK79L0C42 with BILLS