[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1187 Introduced in House (IH)]







106th CONGRESS
  1st Session
                                H. R. 1187

To amend title XVIII of the Social Security Act to provide for coverage 
   under part B of the Medicare Program of medical nutrition therapy 
       services furnished by registered dietitians and nutrition 
                             professionals.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 18, 1999

Mrs. Johnson of Connecticut (for herself, Mr. Brown of Ohio, Mr. Upton, 
  Mrs. Thurman, Mr. Serrano, Mr. McCrery, Mr. Kleczka, Ms. Dunn, Mr. 
 Coyne, Mr. English, Mr. Matsui, Mr. Foley, Mr. Neal of Massachusetts, 
   Mr. Nussle, Mr. Tanner, Mr. Portman, Mr. McNulty, Mr. Tauzin, Mr. 
 Waxman, Mr. Lazio, Mr. Towns, Mr. Pickering, Ms. Eshoo, Mr. Boucher, 
     Ms. DeGette, Mr. Green of Texas, Mr. Pallone, Mr. Sawyer, Mr. 
  Strickland, Ms. Pryce of Ohio, Mr. Frost, Mr. Sessions, Mr. Hall of 
Ohio, Ms. Slaughter, Mr. Ackerman, Mr. Allen, Mr. Baird, Mr. Baker, Mr. 
    Baldacci, Mr. Barcia, Mr. Bentsen, Ms. Berkley, Mr. Bishop, Mr. 
 Boehlert, Mr. Bonior, Mr. Borski, Ms. Brown of Florida, Mr. Brown of 
 California, Mr. Canady of Florida, Mr. Clay, Ms. Danner, Mr. DeFazio, 
  Mr. Delahunt, Ms. DeLauro, Mr. Ehlers, Mr. Farr of California, Mr. 
  Filner, Mr. Frank of Massachusetts, Mr. Gejdenson, Mr. Gibbons, Mr. 
  Gillmor, Mr. Gonzalez, Mr. Graham, Mr. Gutierrez, Mr. Hilleary, Mr. 
Hilliard, Mr. Hinchey, Mr. Hoeffel, Mr. Istook, Mr. Jenkins, Ms. Eddie 
Bernice Johnson of Texas, Ms. Kaptur, Mrs. Kelly, Mr. Kennedy of Rhode 
Island, Mr. Kind, Mr. King, Mr. Kucinich, Mr. LaFalce, Mr. Lampson, Mr. 
 Larson, Mr. Leach, Mr. Lucas of Oklahoma, Mr. Lucas of Kentucky, Mrs. 
  Maloney of New York, Mr. Maloney of Connecticut, Mr. Mascara, Mrs. 
 McCarthy of New York, Mr. McGovern, Mr. George Miller of California, 
Mrs. Morella, Mr. Nadler, Mr. Ney, Mr. Oberstar, Mr. Olver, Mr. Ortiz, 
  Mr. Paul, Mr. Payne, Mr. Peterson of Pennsylvania, Mr. Pomeroy, Mr. 
Price of North Carolina, Ms. Rivers, Mr. Rodriguez, Ms. Roybal-Allard, 
Mr. Sabo, Mr. Sanders, Mr. Sandlin, Mr. Schaffer, Mr. Shays, Mr. Shows, 
Mr. Simpson, Ms. Stabenow, Mrs. Tauscher, Mr. Taylor of North Carolina, 
  Mr. Thune, Mr. Vento, Mr. Walsh, Mr. Wamp, Mr. Watkins, Mr. Watt of 
  North Carolina, Mr. Weygand, Mr. Wise, and Mr. Camp) introduced the 
following bill; which was referred to the Committee on 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 committee 
                               concerned

_______________________________________________________________________

                                 A BILL


 
To amend title XVIII of the Social Security Act to provide for coverage 
   under part B of the Medicare Program of medical nutrition therapy 
       services furnished by registered dietitians and nutrition 
                             professionals.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; FINDINGS.

    (a) Short Title.--This Act may be cited as the ``Medicare Medical 
Nutrition Therapy Act of 1999''.
    (b) Findings.--Congress finds as follows:
            (1) Medical nutrition therapy is a medically necessary and 
        cost-effective way of treating and controlling many diseases 
        and medical conditions affecting the elderly, including HIV/
        AIDS, cancer, kidney disease, diabetes, heart disease, pressure 
        ulcers, severe burns, and surgical wounds.
            (2) Medical nutrition therapy saves health care costs by 
        speeding recovery and reducing the incidence of complications, 
        resulting in fewer hospitalizations, shorter hospital stays, 
        and reduced drug, surgery, and treatment needs.
            (3) A study conducted by The Lewin Group shows that, after 
        the third year of coverage, savings would be greater than costs 
        for coverage of medical nutrition therapy for all medicare 
        beneficiaries, with savings projected to grow steadily in 
        following years.
            (4) The Agency for Health Care Policy and Research has 
        indicated in its practice guidelines that nutrition is key to 
        both the prevention and the treatment of pressure ulcers (also 
        called bed sores) which annually cost the health care system an 
        estimated $1.3 billion for treatment.
            (5) Almost 17 million patients each year are treated for 
        illnesses or injuries that stem from or place them at risk of 
        malnutrition.
            (6) Because medical nutrition therapy is not covered under 
        part B of the medicare program and because more and more health 
        care is delivered on an outpatient basis, many patients are 
        denied access to the effective, low-tech treatment they need, 
        resulting in an increased incidence of complications and a need 
        for higher cost treatments.

SEC. 2. MEDICARE COVERAGE OF MEDICAL NUTRITION THERAPY SERVICES.

    (a) Coverage.--Section 1861(s)(2) of the Social Security Act (42 
U.S.C. 1395x(s)(2)) is amended--
            (1) by striking ``and'' at the end of subparagraph (S);
            (2) by striking the period at the end of subparagraph (T) 
        and inserting ``; and''; and
            (3) by adding at the end the following new subparagraph:
            ``(U) medical nutrition therapy services (as defined in 
        subsection (uu)(1));''.
    (b) Services Described.--Section 1861 of such Act (42 U.S.C. 1395x) 
is amended by adding at the end the following new subsection:

``Medical Nutrition Therapy Services; Registered Dietitian or Nutrition 
                              Professional

    ``(uu)(1) The term `medical nutrition therapy services' means 
nutritional diagnostic, therapy, and counseling services for the 
purpose of disease management which are furnished by a registered 
dietitian or nutrition professional (as defined in paragraph (2)) 
pursuant to a referral by a physician (as defined in subsection 
(r)(1)).
    ``(2) Subject to paragraph (3), the term `registered dietitian or 
nutrition professional' means an individual who--
            ``(A) holds a baccalaureate or higher degree granted by a 
        regionally accredited college or university in the United 
        States (or an equivalent foreign degree) with completion of the 
        academic requirements of a program in nutrition or dietetics, 
        as accredited by an appropriate national accreditation 
        organization recognized by the Secretary for this purpose;
            ``(B) has completed at least 900 hours of supervised 
        dietetics practice under the supervision of a registered 
        dietitian or nutrition professional; and
            ``(C)(i) is licensed or certified as a dietitian or 
        nutrition professional by the State in which the services are 
        performed, or
            ``(ii) in the case of an individual in a State which does 
        not provide for such licensure or certification, meets such 
        other criteria as the Secretary establishes.
    ``(3) Subparagraphs (A) and (B) of paragraph (2) shall not apply in 
the case of an individual who as of the date of the enactment of this 
subsection is licensed or certified as a dietitian or nutrition 
professional by the State in which medical nutrition therapy services 
are performed.''.
    (c) Payment.--Section 1833(a)(1) of such Act (42 U.S.C. 
1395l(a)(1)) is amended--
            (1) by striking ``and'' before ``(S)'', and
            (2) by inserting before the semicolon at the end the 
        following: ``, and (T) with respect to medical nutrition 
        therapy services (as defined in section 1861(uu)), the amount 
        paid shall be 80 percent of the lesser of the actual charge for 
        the services or the amount determined under the fee schedule 
        established under section 1848(b) for the same services if 
        furnished by a physician''.
    (d) Effective Date.--The amendments made by this section apply to 
services furnished on or after January 1, 2000.
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