[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[S. 3584 Introduced in Senate (IS)]







110th CONGRESS
  2d Session
                                S. 3584

To comprehensively prevent, treat, and decrease overweight and obesity 
                      in our Nation's populations.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

           September 25 (legislative day, September 17), 2008

 Mr. Bingaman introduced the following bill; which was read twice and 
  referred to the Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
To comprehensively prevent, treat, and decrease overweight and obesity 
                      in our Nation's populations.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Obesity Prevention, Treatment, and 
Research Act of 2008''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) In 2001, the United States Surgeon General released the 
        Call to Action to Prevent and Decrease Overweight and Obesity 
        to bring attention to the public health problems related to 
        obesity.
            (2) Since the Surgeon General's call to action, the 
        problems of obesity and overweight have become epidemic, 
        occurring in all ages, ethnicities and races, and individuals 
        in every State.
            (3) The United States now has the highest prevalence of 
        obesity among the developed nations, according to 2006 data by 
        the Organisation for Economic Co-operation and Development. The 
        prevalence of obesity in the United States (34 percent) is more 
        than twice the average for other developed nations (13 
        percent). The closest nation in prevalence of obesity is the 
        United Kingdom (24 percent) which is over 25 percent less than 
        the United States.
            (4) The National Health and Nutrition Examination Survey in 
        2006 estimated that 32 percent of children and adolescents aged 
        2 to 19 and an alarming 66 percent of adults are overweight or 
        obese.
            (5) More than 30 percent of young people in grades 9 
        through 12 do not regularly engage in vigorous intensity 
        physical activity, while almost 40 percent of adults are 
        sedentary and 70 percent report getting less than 20 minutes of 
        regular physical activity per day.
            (6) The Institute of Medicine, in their 2005 publication 
        ``Preventing Childhood Obesity: Health in the Balance'', 
        reported that over the last 3 decades, the rate of childhood 
        obesity has tripled for children aged 6 to 11 years, and 
        doubled for children aged 2 to 5 years old and in adolescents 
        aged 12 to 19 years old. In 2004, approximately 9,000,000 
        children over 6 years of age were obese. Only 2 percent of 
        children eat a healthy diet consistent with Federal nutrition 
        guidelines.
            (7) For children born in 2000, it is estimated the lifetime 
        risk of being diagnosed with type 2 diabetes is 40 percent for 
        females and 30 percent for males.
            (8) Overweight and obesity disproportionately affect 
        minority populations and women. According to the 2006 
        Behavioral Risk Factor Surveillance System of the Centers for 
        the Disease Control and Prevention, 61 percent of adults in the 
        United States are overweight or obese.
            (9) The Centers for the Disease Control and Prevention 
        estimates the annual expenditures related to overweight and 
        obesity in the United States to be $117,000,000,000 in 2001 and 
        rising rapidly.
            (10) The Centers for the Disease Control and Prevention 
        estimates that the increase in the number of overweight and 
        obese Americans between 1987 and 2001 resulted in a 27 percent 
        increase in per capita health costs, and that as many as 
        112,000 deaths per year are associated with obesity.
            (11) Being overweight or obese increases the risk of 
        chronic diseases including diabetes, heart disease, stroke, 
        certain cancers, arthritis, and other health problems.
            (12) According to the National Institute of Diabetes and 
        Digestive and Kidney Diseases, individuals who are obese have a 
        50 to 100 percent increased risk of premature death.
            (13) Healthy People 2010 goals identify overweight and 
        obesity as 1 of the Nation's leading health problems and 
        include objectives for increasing the proportion of adults who 
        are at a healthy weight, reducing the proportion of adults who 
        are obese, and reducing the proportion of children and 
        adolescents who are overweight or obese.
            (14) Another Healthy People 2010 goal is to eliminate 
        health disparities among different segments of the population. 
        Obesity is a health problem that disproportionally impacts 
        medically underserved populations.
            (15) Food and beverage advertisers are estimated to spend 
        $10,000,000 to $12,000,000,000 per year to target children and 
        youth.
            (16) The United States spends less than 2 percent of its 
        annual health expenditures on prevention.
            (17) Employer health promotion investments net a return of 
        $3 for every $1 invested.
            (18) High-energy dense and low-nutrient dense foods 
        represent 30 percent of American's total calorie intake. Fast 
        food company menus are twice the energy density of recommended 
        healthful diets.
            (19) Research suggests that individuals eat too much high-
        energy dense foods without feeling full because the brain's 
        pathways that regulate hunger and influence normal food intake 
        are not triggered by these foods.
            (20) Packaging, product placement, and high-energy dense 
        food content manipulation contribute to the overweight and 
        obesity epidemic in the United States.
            (21) Such marketing and content manipulation techniques 
        have been used by other industries to encourage consumption at 
        the expense of health. To help individuals make healthy 
        choices, education and information must be available with 
        clear, consistent, and accurate labeling.

         TITLE I--OBESITY TREATMENT, PREVENTION, AND REDUCTION

SEC. 101. UNITED STATES COUNCIL ON OVERWEIGHT-OBESITY PREVENTION.

    Part P of title III of the Public Health Service Act (42 U.S.C. 
280g et seq.) is amended by adding at the end the following:

``SEC. 399R. UNITED STATES COUNCIL ON OVERWEIGHT-OBESITY PREVENTION.

    ``(a) Establishment.--The Secretary shall convene a United States 
Council on Overweight-Obesity Prevention (referred to in this section 
as `USCO-OP').
    ``(b) Membership.--
            ``(1) In general.--USCO-OP shall be composed of 20 members, 
        which shall consist of--
                    ``(A) the Secretary;
                    ``(B) the Secretary (or his or her designee) of--
                            ``(i) the Department of Agriculture;
                            ``(ii) the Department of Education;
                            ``(iii) the Department of Housing and Urban 
                        Development;
                            ``(iv) the Department of the Interior
                            ``(v) the Federal Trade Commission;
                            ``(vi) the Department of Transportation; 
                        and
                            ``(vii) any other Federal agency that the 
                        Secretary of Health and Human Services 
                        determines appropriate;
                    ``(C) the Chairman (or his or her designee) of the 
                Federal Communications Commission;
                    ``(D) the Director (or his or her designee) of the 
                Centers for Disease Control and Prevention, the 
                National Institutes of Health, and the Agency for 
                Healthcare Research and Quality;
                    ``(E) the Administrator of the Centers for Medicare 
                and Medicaid Services (or his or her designee);
                    ``(F) the Commissioner of Food and Drugs (or his or 
                her designee); and
                    ``(G) a minimum of 5 representatives, appointed by 
                the Secretary, of expert organizations such as public 
                health associations, key healthcare provider groups, 
                planning and development organizations, education 
                associations, advocacy groups, relevant industries, 
                State and local leadership, and other entities as 
                determined appropriate by the Secretary.
            ``(2) Appointments.--The Secretary shall accept nominations 
        for representation on USCO-OP through public comment before the 
        initial appointment of members of USCO-OP under paragraph 
        (1)(G), and on a regular basis for open positions thereafter, 
        but not less than every 2 years.
            ``(3) Chairperson.--The chairperson of USCO-OP shall be--
                    ``(A) an individual appointed by the President; and
                    ``(B) until the date that an individual is 
                appointed under subparagraph (A), the Secretary.
    ``(c) Meetings.--
            ``(1) In general.--USCO-OP shall meet--
                    ``(A) not later than 180 days after the date of 
                enactment of the Obesity Prevention, Treatment, and 
                Research Act of 2008; and
                    ``(B) at the call of the chairperson thereafter, 
                but in no case less often than 2 times per year.
            ``(2) Meetings of federal agencies.--The representatives of 
        the Federal agencies on USCO-OP shall meet on a regular basis, 
        as determined by the Secretary, to develop strategies to 
        coordinate budgets and discuss other issues that are not 
        otherwise permitted to be discussed in a public forum. The 
        purpose of such meetings shall be to allow more rapid 
        interagency strategic planning and intervention implementation 
        to address the overweight and obesity epidemic.
    ``(d) Duties of USCO-OP.--USCO-OP shall--
            ``(1) develop strategies to comprehensively prevent, treat, 
        and reduce overweight and obesity;
            ``(2) coordinate interagency cooperation and action related 
        to the prevention, treatment, and reduction of overweight and 
        obesity in the United States;
            ``(3) identify best practices in communities to address 
        overweight and obesity;
            ``(4) work with appropriate entities to evaluate the 
        effectiveness of obesity and overweight interventions;
            ``(5) update the National Institutes of Health 1998 
        `Clinical Guidelines on the Identification, Evaluation, and 
        Treatment of Overweight and Obesity in Adults: The Evidence 
        Report' and include sections on childhood obesity in such 
        updated report;
            ``(6) conduct ongoing surveillance and monitoring using 
        tools such as the National Health and Nutrition Examination 
        Survey and the Behavioral Risk Factor Surveillance System and 
        assure adequate and consistent funding to support data 
        collection and analysis to inform policy;
            ``(7) make recommendations to coordinate budgets, grant and 
        pilot programs, policies, and programs across Federal agencies 
        to cohesively address overweight and obesity, including with 
        respect to the grant programs carried out under sections 
        306(n), 399S, and 1904(a)(1)(H);
            ``(8) make recommendations to update and improve the daily 
        physical activity requirements for students under the 
        Elementary and Secondary Education Act of 1965 (20 U.S.C. 6301 
        et seq.) and include recommendations about physical activities 
        that families can do together, and involving parents in these 
        activities;
            ``(9) make recommendations about coverage for obesity-
        related services and for an early and periodic screening, 
        diagnostic, and treatment services program under the State 
        Children's Health Insurance Program established under title XXI 
        of the Social Security Act; and
            ``(10) provide guidelines for childhood obesity health care 
        related treatment under the early and periodic screening, 
        diagnostic, and treatment services program under the Medicaid 
        program established under title XIX of the Social Security Act 
        and otherwise described in section 2103(c)(5) of such Act.
    ``(e) Report.--Not later than 18 months after the date of enactment 
of the Obesity Prevention, Treatment, and Research Act of 2008, and on 
an annual basis thereafter, USCO-OP shall submit to the President and 
to the relevant committees of Congress, a report that--
            ``(1) summarizes the activities and efforts of USCO-OP 
        under this section to coordinate interagency prevention, 
        treatment, and reduction of obesity and overweight, including a 
        detailed strategic plan with recommendations for each Federal 
        agency;
            ``(2) evaluates the effectiveness of these coordinated 
        interventions and conducts interim assessments and reporting of 
        health outcomes, achievement of milestones, and implementation 
        of strategic plan goals starting with the second report, and 
        yearly thereafter; and
            ``(3) makes recommendations for the following year's 
        strategic plan based on data and findings from the previous 
        year.
    ``(f) Technical Assistance.--The Department of Health and Human 
Services may provide technical assistance to USCO-OP to carry out the 
activities under this section.
    ``(g) Permanence of Committee.--Section 14 of the Federal Advisory 
Committee Act (5 U.S.C. App.) shall not apply to USCO-OP.''.

SEC. 102. GRANTS AND DEMONSTRATION PROGRAMS TO PROMOTE POSITIVE HEALTH 
              BEHAVIORS IN POPULATIONS DISPROPORTIONATELY AFFECTED BY 
              OBESITY AND OVERWEIGHT.

    Part P of title III of the Public Health Service Act (42 U.S.C. 
280g et seq.), as amended by section 101, is amended by adding at the 
end the following:

``SEC. 399S. GRANTS AND DEMONSTRATION PROGRAMS TO PROMOTE POSITIVE 
              HEALTH BEHAVIORS IN POPULATIONS DISPROPORTIONATELY 
              AFFECTED BY OBESITY AND OVERWEIGHT.

    ``(a) Eligible Entity.--For purposes of this section, the term 
`eligible entity' means--
            ``(1) a city, county, Indian tribe, tribal organization, 
        territory, or State;
            ``(2) a local, tribal, or State educational agency;
            ``(3) a Federal medical facility, including a federally 
        qualified health center (as defined in section 1861(aa)(4) of 
        the Social Security Act), an Indian Health Service hospital or 
        clinic, any health facility or program operated by or pursuant 
        to a contractor grant from the Indian Health Service, an Indian 
        Health Service entity, an urban Indian center, an Indian tribal 
        clinic, a health care for the homeless center, a rural health 
        center, migrant health center, and any other Federal medical 
        facility;
            ``(4) any entity meeting the criteria for medical home 
        under section 204 of the Tax Relief and Health Care Act of 2006 
        (Public Law 109-432);
            ``(5) a nonprofit organization (such as an academic health 
        center or community health center);
            ``(6) a health department;
            ``(7) any licensed or certified health provider;
            ``(8) an accredited university or college;
            ``(9) a community-based organization;
            ``(10) a local city planning agency; and
            ``(11) any other entity determined appropriate by the 
        Secretary.
    ``(b) Application.--An eligible entity that desires a grant under 
this section shall submit an application at such time, in such manner, 
and containing such information as the Secretary may require, including 
a plan for the use of funds that may be awarded and an evaluation of 
any training that will be provided under such grant.
    ``(c) Grant Demonstration and Pilot Program.--
            ``(1) In general.--The Secretary, acting through the 
        Director of the Centers for Disease Control and Prevention, and 
        in consultation with the United States Council on Overweight-
        Obesity Prevention under section 399R, shall establish and 
        evaluate a grant demonstration and pilot program for entities 
        to--
                    ``(A) prevent, treat, or otherwise reduce 
                overweight and obesity;
                    ``(B) increase the number of children and adults 
                who safely walk or bike to school or work;
                    ``(C) increase the availability and affordability 
                of fresh fruits and vegetables in the community;
                    ``(D) expand safe and accessible walking paths and 
                recreational facilities to encourage physical activity, 
                and other interventions to create healthy communities;
                    ``(E) create advertising, social marketing, and 
                public health campaigns promoting healthier food 
                choices, increased physical activity, and healthier 
                lifestyles targeted to individuals and to families;
                    ``(F) promote increased rates and duration of 
                breastfeeding; and
                    ``(G) increase worksite and employer promotion of 
                and involvement in community initiatives that prevent, 
                treat, or otherwise reduce overweight and obesity.
            ``(2) Special priority.--Special priority will be given to 
        grant proposals that target communities or populations 
        disproportionately affected by overweight or obesity, including 
        Native Americans, other minorities, and women.
    ``(d) Grants To Promote Positive Health Behaviors in Populations 
Disproportionately Affected by Obesity and Overweight.--
            ``(1) In general.--The Secretary, acting through the 
        Director of the Centers for Disease Control and Prevention, may 
        award grants to eligible entities to promote health behaviors 
        for women and children in target populations, especially racial 
        and ethnic minority populations in medically underserved 
        communities.
            ``(2) Use of funds.--An award under this section shall be 
        used to carry out any of the following:
                    ``(A) To educate, promote, prevent, treat and 
                determine best practices in overweight and obese 
                populations.
                    ``(B) To address behavioral risk factors including 
                sedentary lifestyle, poor nutrition, being overweight 
                or obese, and use of tobacco, alcohol or other 
                substances that increase the risk of morbidity and 
                mortality. Special priority will be given to grant 
                applications that--
                            ``(i) propose interventions that address 
                        embedded levels of influence on behavior, 
                        including the individual, family, peers, 
                        community and society; and
                            ``(ii) utilize techniques that promote 
                        community involvement in the design and 
                        implementation of interventions including 
                        community diagnosis and community-based 
                        participatory research.
                    ``(C) To develop and implement interventions to 
                promote a balance of energy consumption and 
                expenditure, to attain healthier weight, prevent 
                obesity, and reduce morbidity and mortality associated 
                with overweight and obesity.
                    ``(D)(i) To train primary care physicians and other 
                licensed or certified health professionals on how to 
                identify, treat, and prevent obesity or eating 
                disorders and aid individuals who are overweight, 
                obese, or who suffer from eating disorders.
                    ``(ii) To use evidence-based findings or 
                recommendations that pertain to the prevention and 
                treatment of obesity, being overweight, and eating 
                disorders to conduct educational conferences, including 
                Internet-based courses and teleconferences, on--
                            ``(I) how to treat or prevent obesity, 
                        being overweight, and eating disorders;
                            ``(II) the link between obesity, being 
                        overweight, eating disorders and related 
                        serious and chronic medical conditions;
                            ``(III) how to discuss varied strategies 
                        with patients from at-risk and diverse 
                        populations to promote positive behavior change 
                        and healthy lifestyles to avoid obesity, being 
                        overweight, and eating disorders;
                            ``(IV) how to identify overweight, obese, 
                        individuals with eating disorders, and those 
                        who are at risk for obesity and being 
                        overweight or suffer from eating disorders and, 
                        therefore, at risk for related serious and 
                        chronic medical conditions; and
                            ``(V) how to conduct a comprehensive 
                        assessment of individual and familial health 
                        risk factors and evaluate the effectiveness of 
                        the training provided by such entity in 
                        increasing knowledge and changing attitudes and 
                        behaviors of trainees.
                    ``(iii) In awarding a grant to carry out an 
                activity under this subparagraph, preference shall be 
                given to an entity described in subsection (a)(4).
    ``(e) Reporting to Congress.--Not later than 3 years after the date 
of enactment of this section, the Director of the Centers for Disease 
Control and Prevention shall submit to the Secretary and Congress a 
report concerning the result of the activities conducted through the 
grants awarded under this section.
    ``(f) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, $50,000,000 for fiscal year 
2009, and such sums as may be necessary for each of fiscal years 2010 
through 2012.''.

SEC. 103. NATIONAL CENTER FOR HEALTH STATISTICS.

    Section 306 of the Public Health Service Act (42 U.S.C. 242k) is 
amended--
            (1) in subsection (m)(4)(B), by striking ``subsection (n)'' 
        each place it appears and inserting ``subsection (o)'';
            (2) by redesignating subsection (n) as subsection (o); and
            (3) by inserting after subsection (m) the following:
    ``(n)(1) The Secretary, acting through the Center, may provide for 
the--
            ``(A) collection of data for determining the fitness levels 
        and energy expenditure of adults, children, and youth; and
            ``(B) analysis of data collected as part of the National 
        Health and Nutrition Examination Survey and other data sources.
    ``(2) In carrying out paragraph (1), the Secretary, acting through 
the Center, may make grants to States, public entities, and nonprofit 
entities.
    ``(3) The Secretary, acting through the Center, may provide 
technical assistance, standards, and methodologies to grantees 
supported by this subsection in order to maximize the data quality and 
comparability with other studies.''.

SEC. 104. HEALTH DISPARITIES REPORT.

    Not later than 18 months after the date of enactment of this Act, 
and annually thereafter, the Director of the Agency for Healthcare 
Research and Quality shall review all research that results from the 
activities carried out under this Act (and the amendments made by this 
Act) and determine if particular information may be important to the 
report on health disparities required by section 903(c)(3) of the 
Public Health Service Act (42 U.S.C. 299a-1(c)(3)).

SEC. 105. PREVENTIVE HEALTH SERVICES BLOCK GRANT.

    Section 1904(a)(1) of the Public Health Service Act (42 U.S.C. 
300w-3(a)(1)) is amended by adding at the end the following:
            ``(H) Activities and community education programs designed 
        to address and prevent overweight, obesity, and eating 
        disorders through effective programs to promote healthy eating, 
        and exercise habits and behaviors.''.

SEC. 106. REPORT ON OBESITY AND EATING DISORDERS RESEARCH.

    (a) In General.--Not later than 1 year after the date of enactment 
of this Act, the Secretary of Health and Human Services shall submit to 
the Committee on Health, Education, Labor, and Pensions of the Senate 
and the Committee on Energy and Commerce of the House of 
Representatives a report on research conducted on causes and health 
implications (including mental health implications) of being 
overweight, obesity, and eating disorders.
    (b) Content.--The report described in subsection (a) shall 
contain--
            (1) descriptions on the status of relevant, current, 
        ongoing research being conducted in the Department of Health 
        and Human Services including research at the National 
        Institutes of Health, the Centers for Disease Control and 
        Prevention, the Agency for Healthcare Research and Quality, the 
        Health Resources and Services Administration, and other offices 
        and agencies;
            (2) information about what these studies have shown 
        regarding the causes, prevention, and treatment of, being 
        overweight, obesity, and eating disorders; and
            (3) recommendations on further research that is needed, 
        including research among diverse populations, the plan of the 
        Department of Health and Human Services for conducting such 
        research, and how current knowledge can be disseminated.

        TITLE II--FOOD AND BEVERAGE LABELING FOR HEALTHY CHOICES

SEC. 201. FOOD AND BEVERAGE LABELING FOR HEALTHY CHOICES.

    (a) USCO-OP.--In this section, the term ``USCO-OP'' means the 
United States Council on Overweight-Obesity Prevention under section 
399R of the Public Health Service Act (as added by section 101).
    (b) Reform of Food and Beverage Labeling.--The Secretary of Health 
and Human Services and the Secretary of Agriculture, in consultation 
with the USCO-OP, shall, through regulation or other appropriate 
action, update and reform Federal oversight of food and beverage 
labeling. Such reform shall include improving the transparency of such 
labeling with regard to nutritional and caloric value of food and 
beverages.

         TITLE III--HEALTHY CHOICES FOOD AND BEVERAGE PROGRAMS

SEC. 301. FRESH FRUIT AND VEGETABLE PROGRAM.

    Section 19(i) of the Richard B. Russell National School Lunch Act 
(42 U.S.C. 1769a(i)) is amended--
            (1) by redesignating paragraphs (3) through (7) as 
        paragraphs (4) through (8); and
            (2) by inserting after paragraph (2) the following:
            ``(3) Additional mandatory funding.--
                    ``(A) In general.--Out of any funds in the Treasury 
                not otherwise appropriated, the Secretary of the 
                Treasury shall transfer to the Secretary of Agriculture 
                to carry out and expand the program under this section, 
                to remain available until expended--
                            ``(i) on October 1, 2008, $80,000,000;
                            ``(ii) on July 1, 2009, $130,000,000;
                            ``(iii) on July 1, 2010, $202,000,000;
                            ``(iv) on July 1, 2011, $300,000,000; and
                            ``(v) on July 1, 2012, and on each July 1 
                        thereafter, the amount made available for the 
                        previous fiscal year, as adjusted under 
                        subparagraph (B).
                    ``(B) Adjustment.--On July 1, 2012, and on each 
                July 1 thereafter the amount made available under 
                subparagraph (A)(v) shall be calculated by adjusting 
                the amount made available for the previous fiscal year 
                to reflect changes in the Consumer Price Index of the 
                Bureau of Labor Statistics for fresh fruits and 
                vegetables, with the adjustment--
                            ``(i) rounded down to the nearest dollar 
                        increment; and
                            ``(ii) based on the unrounded amounts for 
                        the preceding 12-month period.
                    ``(C) Allocation.--Funds made available under this 
                paragraph shall be allocated among the States and the 
                District of Columbia in the same manner as funds made 
                available under paragraph (1).''.

            TITLE IV--AMENDMENTS TO THE SOCIAL SECURITY ACT

SEC. 401. COVERAGE OF EVIDENCE-BASED PREVENTIVE SERVICES UNDER 
              MEDICARE, MEDICAID, AND SCHIP.

    (a) Medicare.--Section 1861(ddd) of the Social Security Act, as 
added by section 101 of the Medicare Improvements for Patients and 
Providers Act of 2008, is amended--
            (1) in paragraph (2), by striking ``paragraph (1)'' and 
        inserting ``paragraphs (1) and (3)''; and
            (2) by adding at the end the following new paragraph:
            ``(3) The term `additional preventive services' includes 
        any evidence-based preventive services which the Secretary has 
        determined are reasonable and necessary, including, as so 
        determined, smoking cessation and prevention services, diet and 
        exercise counseling, and healthy weight and obesity 
        counseling.''.
    (b) State Option To Provide Medical Assistance for Evidence-Based 
Preventive Services.--
            (1) In general.--Section 1905 of the Social Security Act 
        (42 U.S.C. 1396d) is amended--
                    (A) in subsection (a)--
                            (i) in paragraph (27), by striking ``and'' 
                        at the end;
                            (ii) by redesignating paragraph (28) as 
                        paragraph (29); and
                            (iii) by inserting after paragraph (27) the 
                        following:
            ``(28) evidence-based preventive services described in 
        subsection (y); and''; and
                    (B) by adding at the end the following:
    ``(y)(1) For purposes of subsection (a)(28), evidence-based 
preventive services described in this subsection are any preventive 
services which the Secretary has determined are reasonable and 
necessary through the process for making national coverage 
determinations (as defined in section 1869(f)(1)(B)) under title XVIII, 
including, as so determined, smoking cessation and prevention services, 
diet and exercise counseling, and healthy weight and obesity 
counseling.''.
            (2) Conforming amendment.--Section 1902(a)(10)(C)(iv) of 
        such Act is amended by inserting ``and (28)'' after ``(24)''.
    (c) State Option To Provide Child Health Assistance for Evidence-
Based Preventive Services.--Section 2110(a) of the Social Security Act 
(42 U.S.C. 1397jj(a)) is amended--
            (1) by redesignating paragraph (28) as paragraph (29); and
            (2) by inserting after paragraph (27) the following:
            ``(28) Evidence-based preventive services described in 
        section 1905(y).''.

SEC. 402. COVERAGE OF MEDICAL NUTRITION COUNSELING UNDER MEDICARE, 
              MEDICAID, AND SCHIP.

    (a) Medicare Coverage of Medical Nutrition Therapy Services for 
People With Pre-Diabetes.--Section 1861(s)(2)(V) of the Social Security 
Act (42 U.S.C. 1395x(s)(2)(V)) is amended by inserting after 
``beneficiary with diabetes'' the following ``, pre-diabetes or its 
risk factors (including hypertension, dyslipidemia, obesity, or 
overweight),''.
    (b) State Option To Provide Medical Assistance for Medical Therapy 
Services.--
            (1) In general.--Section 1905(a) of the Social Security Act 
        (42 U.S.C. 1396d), as amended by section 401(b), is amended--
                    (A) in paragraph (28), by striking ``and'' at the 
                end;
                    (B) by redesignating paragraph (29) as paragraph 
                (30); and
                    (C) by inserting after paragraph (28) the 
                following:
            ``(29) medical nutrition therapy services (as defined in 
        section 1861(vv)(1)) for individuals with pre-diabetes or 
        obesity, or who are overweight (as defined by the Secretary); 
        and''.
            (2) Conforming amendment.--Section 1902(a)(10)(C)(iv) of 
        such Act, as amended by section 401(b)(2), is amended by 
        striking ``and (28)'' and inserting ``, (28) and (29)''.
    (c) State Option To Provide Child Health Assistance for Medical 
Nutrition Therapy Services.--Section 2110(a) of the Social Security Act 
(42 U.S.C. 1397jj(a)), as amended by section 401(c), is amended--
            (1) by redesignating paragraph (29) as paragraph (30); and
            (2) by inserting after paragraph (28) the following:
            ``(29) Medical nutrition therapy services (as defined in 
        section 1861(vv)(1)) for individuals with pre-diabetes or 
        obesity, or who are overweight (as defined by the 
        Secretary).''.

SEC. 403. AUTHORIZING EXPANSION OF MEDICARE COVERAGE OF MEDICAL 
              NUTRITION THERAPY SERVICES.

    (a) Authorizing Expanded Eligible Population.--Section 
1861(s)(2)(V) of the Social Security Act (42 U.S.C. 1395x(s)(2)(V)), as 
amended by section 402, is amended--
            (1) by redesignating clauses (i) through (iii) as 
        subclauses (I) through (III), respectively, and indenting each 
        such clause an additional 2 ems;
            (2) by striking ``in the case of a beneficiary with 
        diabetes, pre-diabetes or its risk factors (including 
        hypertension, dyslipidemia, obesity, overweight), or a renal 
        disease who--'' and inserting ``in the case of a beneficiary--
                    ``(i) with diabetes, pre-diabetes or its risk 
                factors (including hypertension, dyslipidemia, obesity, 
                overweight), or a renal disease 
                who--'';
            (3) by adding ``or'' at the end of subclause (III) of 
        clause (i), as so redesignated; and
            (4) by adding at the end the following new clause:
                    ``(ii) who is not described in clause (i) but who 
                has another disease, condition, or disorder for which 
                the Secretary has made a national coverage 
                determination (as defined in section 1869(f)(1)(B)) for 
                the coverage of such services;''.
    (b) Coverage of Services Furnished by Physicians.--Section 
1861(vv)(1) of the Social Security Act (42 U.S.C. 1395x(vv)(1)) is 
amended by inserting ``or which are furnished by a physician'' before 
the period at the end.
    (c) National Coverage Determination Process.--In making a national 
coverage determination described in section 1861(s)(2)(V)(ii) of the 
Social Security Act, as added by subsection (a)(4), the Secretary of 
Health and Human Services, acting through the Administrator of the 
Centers for Medicare & Medicaid Services, shall--
            (1) consult with dietetic and nutrition professional 
        organizations in determining appropriate protocols for coverage 
        of medical nutrition therapy services for individuals with 
        different diseases, conditions, and disorders; and
            (2) consider the degree to which medical nutrition therapy 
        interventions prevent or help prevent the onset or progression 
        of more serious diseases, conditions, or disorders.

SEC. 404. CLARIFICATION OF EPSDT INCLUSION OF PREVENTION, SCREENING, 
              AND TREATMENT SERVICES FOR OBESITY AND OVERWEIGHT; SCHIP 
              COVERAGE.

    (a) In General.--Section 1905(r)(5) of the Social Security Act (42 
U.S.C. 1396d(r)(5)) is amended by inserting ``, including weight and 
BMI measurement and monitoring, as well as appropriate treatment 
services (including but not limited to) medical nutrition therapy 
services (as defined in section 1861(vv)(1)), physical therapy or 
exercise training, and behavioral health counseling, based on 
recommendations of the United States Council on Overweight-Obesity 
Prevention under section 399R of the Public Health Service Act and such 
other expert recommendations and studies as determined by the 
Secretary'' before the period.
    (b) SCHIP.--
            (1) Required coverage.--Section 2103 (42 U.S.C. 1397cc) is 
        amended--
                    (A) in subsection (a), in the matter before 
                paragraph (1), by striking ``subsection (c)(5)'' and 
                inserting ``paragraphs (5) and (7) of subsection (c)''; 
                and
                    (B) in subsection (c)--
                            (i) by redesignating paragraph (5) as 
                        paragraph (7); and
                            (ii) by inserting after paragraph (4), the 
                        following:
            ``(5) Prevention, screening, and treatment services for 
        obesity and overweight.--The child health assistance provided 
        to a targeted low-income child shall include coverage of weight 
        and BMI measurement and monitoring, as well as appropriate 
        treatment services (including but not limited to) medical 
        nutrition therapy services (as defined in section 1861(vv)(1)), 
        physical therapy or exercise training, and behavioral health 
        counseling, based on recommendations of the United States 
        Council on Overweight-Obesity Prevention under section 399R of 
        the Public Health Service Act and such other expert 
        recommendations and studies as determined by the Secretary.''.
            (2) Conforming amendment.--Section 2102(a)(7)(B) (42 U.S.C. 
        1397bb(c)(2)) is amended by inserting ``and services described 
        in section 2103(c)(5)'' after ``emergency services''.

SEC. 405. INCLUSION OF PREVENTIVE SERVICES IN QUALITY MATERNAL AND 
              CHILD HEALTH SERVICES.

    Section 501(b) of the Social Security Act (42 U.S.C. 701(b)) is 
amended by adding at the end the following new paragraph:
            ``(5) The term `quality maternal and child health services' 
        includes the following:
                    ``(A) Evidence-based preventive services described 
                in section 1905(y).
                    ``(B) Medical nutrition counseling for individuals 
                with pre-diabetes or obesity, or who are overweight (as 
                defined by the Secretary).
                    ``(C) Weight and BMI measurement and monitoring, as 
                well as appropriate treatment services (including but 
                not limited to) medical nutrition therapy services (as 
                defined in section 1861(vv)(1)), physical therapy or 
                exercise training, and behavioral health counseling, 
                based on recommendations of the United States Council 
                on Overweight-Obesity Prevention under section 399R of 
                the Public Health Service Act and such other expert 
                recommendations and studies as determined by the 
                Secretary.''.

SEC. 406. EFFECTIVE DATE.

    (a) In General.--Except as provided in subsection (b), the 
amendments made by this title take effect on October 1, 2009.
    (b) Extension of Effective Date for State Law Amendment.--In the 
case of a State plan under title XIX or XXI of the Social Security Act 
(42 U.S.C. 1396 et seq., 1397aa et seq.) which the Secretary of Health 
and Human Services determines requires State legislation in order for 
the plan to meet the additional requirements imposed by the amendments 
made by this section, the State plan shall not be regarded as failing 
to comply with the requirements of such title solely on the basis of 
its failure to meet these additional requirements before the first day 
of the first calendar quarter beginning after the close of the first 
regular session of the State legislature that begins after the date of 
enactment of this Act. For purposes of the previous sentence, in the 
case of a State that has a 2-year legislative session, each year of the 
session is considered to be a separate regular session of the State 
legislature.
                                 <all>