Nutrition CARE Act of 2019

II 116TH CONGRESS 1ST SESSION S. 2907 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 NOVEMBER 20, 2019 Ms. HASSAN (for herself and Ms. MURKOWSKI) 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 2019’’ or the 5 ‘‘Nutrition CARE Act of 2019’’. 6 SEC. 2. FINDINGS. 7 Congress finds the following: 8 VerDate Sep 11 2014 00:17 Nov 28, 2019 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S2907.IS S2907 dlhill on DSKBBY8HB2PROD with BILLS 2 •S 2907 IS (1) Eating disorders, including the specific dis- 1 orders of anorexia nervosa, bulimia nervosa, binge 2 eating disorder, avoidant/restrictive food intake dis- 3 order, and other specified feeding or eating dis- 4 orders, are severe biologically based mental illnesses 5 caused by a complex interaction of genetic, biologi- 6 cal, social, behavioral, and psychological factors. 7 (2) Over 30,000,000 individuals in the United 8 States of all ages, races, sizes, sexual orientations, 9 ethnicities, and socioeconomic statues, are affected 10 by eating disorders during their lifetimes, with dis- 11 ordered eating in elderly persons showing similar 12 prevalence rates as younger persons. 13 (3) Eating disorders have one of the highest 14 mortality rates of all mental illnesses and significant 15 mortality and morbidity rates associated with elderly 16 populations, as eating disorders can become fatal 17 due to heart failure, kidney failure, stroke, hypo- 18 glycemia, and gastric rupture. Additionally, longitu- 19 dinal studies have found that the suicide risk for 20 those with an eating disorder is 23 times the ex- 21 pected risk. 22 (4) Eating disorders can be successfully treated 23 with appropriate interventions, yet only one-third of 24 persons with eating disorders receive any care. Best 25 VerDate Sep 11 2014 00:17 Nov 28, 2019 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S2907.IS S2907 dlhill on DSKBBY8HB2PROD with BILLS 3 •S 2907 IS practice treatment of eating disorders includes pa- 1 tients, their families, and a comprehensive team of 2 professionals such as social workers, mental health 3 counselors, primary care practitioners, psychiatrists, 4 psychologists, dietitians, and other specialty pro- 5 viders 6 (5) Studies find that individuals with chronic 7 illnesses and/or disabilities are four times more likely 8 to have anorexia nervosa or bulimia nervosa com- 9 pared to the general population. 10 SEC. 3. PROVIDING COVERAGE OF MEDICAL NUTRITION 11 THERAPY SERVICES FOR INDIVIDUALS WITH 12 EATING DISORDERS UNDER THE MEDICARE 13 PROGRAM. 14 Section 1861 of the Social Security Act (42 U.S.C. 15 1395x) is amended— 16 (1) in subsection (s)(2)(V)— 17 (A) by redesignating clauses (i) through 18 (iii) as subclauses (I) through (III), respec- 19 tively, and adjusting the margins accordingly; 20 (B) in subclause (III), as so redesignated, 21 by striking the semicolon at the end and insert- 22 ing ‘‘; or’’; 23 (C) by striking ‘‘beneficiary with diabetes’’ 24 and inserting the following: ‘‘beneficiary— 25 VerDate Sep 11 2014 00:17 Nov 28, 2019 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S2907.IS S2907 dlhill on DSKBBY8HB2PROD with BILLS 4 •S 2907 IS ‘‘(i) with diabetes’’; and 1 (D) by adding at the end the following new 2 clause: 3 ‘‘(ii) beginning January 1, 2020, with an 4 eating disorder (as defined by the Secretary in 5 accordance with most recent edition of the Di- 6 agnostic and Statistical Manual of Mental Dis- 7 orders published by the American Psychiatric 8 Association);’’; and 9 (2) in subsection (vv)— 10 (A) in paragraph (1)— 11 (i) by inserting ‘‘(including manage- 12 ment of an eating disorder (as defined for 13 purposes of subsection (s)(2)(V)(ii))))’’ 14 after ‘‘disease management’’; 15 (ii) by striking ‘‘which are furnished 16 by’’ and all that follows through the period 17 and inserting ‘‘which are furnished— 18 ‘‘(A) by a registered dietitian or nutrition 19 professional (as defined in paragraph (2)); 20 ‘‘(B) pursuant to a referral by— 21 ‘‘(i) a physician (as defined in sub- 22 section (r)(1)) a physician (as defined in 23 subsection (r)(1)); or 24 VerDate Sep 11 2014 00:17 Nov 28, 2019 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S2907.IS S2907 dlhill on DSKBBY8HB2PROD with BILLS 5 •S 2907 IS ‘‘(ii) a psychologist (or other mental 1 health professional to the extent authorized 2 under State law); and 3 ‘‘(C) in the case of such services furnished 4 to an individual for the purpose of management 5 of such an eating disorder, at the times speci- 6 fied in paragraph (4).’’; and 7 (B) by adding at the end the following new 8 paragraph: 9 ‘‘(4)(A) For purposes of paragraph (1)(C), the times 10 specified in this paragraph are, with respect to medical 11 nutrition therapy services furnished to an individual for 12 purposes of management of an eating disorder, at least 13 the following: 14 ‘‘(i) 13 hours (including a 1-hour initial assess- 15 ment and 12 hours of reassessment and interven- 16 tion) during the 1-year period beginning on the date 17 such individual is first furnished such services. 18 ‘‘(ii) Subject to subparagraph (B), 4 hours dur- 19 ing each subsequent 1-year period. 20 ‘‘(B) The Secretary may apply such other reasonable 21 limitations with respect to the furnishing of medical nutri- 22 tion therapy services for purposes of management of an 23 VerDate Sep 11 2014 00:17 Nov 28, 2019 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S2907.IS S2907 dlhill on DSKBBY8HB2PROD with BILLS 6 •S 2907 IS eating disorder during a period described in subparagraph 1 (A)(ii) as the Secretary determines appropriate.’’. 2 Æ VerDate Sep 11 2014 00:17 Nov 28, 2019 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6301 E:\BILLS\S2907.IS S2907 dlhill on DSKBBY8HB2PROD with BILLS