[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1193 Introduced in House (IH)]
111th CONGRESS
1st Session
H. R. 1193
To amend the Public Health Service Act with respect to eating
disorders, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
February 25, 2009
Mr. Kennedy (for himself and Mr. Courtney) introduced the following
bill; which was referred to the Committee on Energy and Commerce, and
in addition to the Committees on Oversight and Government Reform,
Education and Labor, and 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 the Public Health Service Act with respect to eating
disorders, and for other purposes.
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 ``Federal Response to Eliminate Eating
Disorders Act of 2009''.
SEC. 2. TABLE OF CONTENTS.
The table of contents of this Act is as follows:
Sec. 1. Short title.
Sec. 2. Table of contents.
Sec. 3. Findings.
Sec. 4. Definition.
TITLE I--RESEARCH
Sec. 101. Activities to improve eating disorder-related research and
funding.
Sec. 102. Eating disorders surveillance and research program.
TITLE II--EDUCATION AND PREVENTION
Sec. 201. Study of mandatory BMI reporting in school.
Sec. 202. Training and education.
Sec. 203. Health professional education and training.
Sec. 204. Education and training for all health professionals.
Sec. 205. Education and training for school and higher education
professionals.
Sec. 206. Eating disorder research and report.
Sec. 207. Public service announcements.
Sec. 208. Sense of Congress.
TITLE III--TREATMENT
Sec. 301. Coverage for treatment for eating disorders under group
health plans, individual health insurance
coverage, and FEHBP.
SEC. 3. FINDINGS.
The Congress finds as follows:
(1) Risk of death among individuals with anorexia nervosa
is 11 times greater than their same age peers without anorexia.
(2) Health consequences such as osteoporosis (brittle
bones), gastrointestinal complications, and dental problems are
significant health and financial burdens throughout life.
(3) An estimated 5,000,000 to 10,000,000 women and girls
and 1,000,000 men and boys suffer from eating disorders,
including anorexia nervosa, bulimia nervosa, and eating
disorders not otherwise specified (EDNOS) (including binge
eating disorder). The lifetime prevalence of all eating
disorders in America is 0.6 to 4.5 percent.
(4) Anorexia nervosa is an eating disorder characterized by
self-starvation and excessive weight loss. An estimated 0.9
percent of American women and 0.3 percent of American men will
suffer from anorexia nervosa in their lifetime.
(5) Anorexia nervosa is associated with serious health
consequences including heart failure, kidney failure,
osteoporosis, and death.
(6) Bulimia nervosa is an eating disorder characterized by
excessive food consumption followed by inappropriate
compensatory behaviors, such as self-induced vomiting, misuse
of laxatives, fasting, or excessive exercise. An estimated 1.5
percent of American women and 0.5 percent of American men will
suffer from this disorder in their lifetime.
(7) Bulimia nervosa is associated with cardiac,
gastrointestinal, and dental problems including irregular
heartbeats, gastric rupture, peptic ulcer, tooth decay, and
death.
(8) Binge eating disorder is characterized by frequent
episodes of uncontrolled overeating. Binge eating disorder is
common: an estimated 3.5 percent of American women and 2.0
percent of American men will suffer from this disorder in their
lifetime.
(9) Binge eating is associated with obesity, heart disease,
gall bladder disease, and diabetes.
(10) Many more suffer from some, but not all, of the
symptoms of anorexia nervosa, bulimia nervosa, or binge eating
disorder, which is referred to as eating disorders not
otherwise specified (EDNOS). Between 4 percent and 20 percent
of young women practice unhealthy patterns of dieting, purging,
and binge eating.
(11) Eating disorders are more common in women, but they do
occur in men. Rates of binge eating disorder are similar in
females and males.
(12) Eating disorders usually appear in adolescence and are
associated with substantial psychological problems, including
depression, substance abuse, and suicide. Eating disorders also
develop in younger children and adults, compromising health and
daily functioning.
(13) Eating disorders are found across races, ethnicities,
and socioeconomic groups in the United States. White females
are more likely to suffer from anorexia, while African-American
girls are especially vulnerable to developing eating disorders
that involve binge eating. Body dissatisfaction in young girls
has been shown in white, African-American, Hispanic, and Asian
girls.
SEC. 4. DEFINITION.
In this Act, the term ``eating disorder'' includes anorexia
nervosa, bulimia nervosa, and eating disorders not otherwise specified
(EDNOS) (including binge eating disorder), as defined in the fourth
edition of ``Diagnostic and Statistical Manual of Mental Disorders'' or
such later edition as the Secretary may specify.
TITLE I--RESEARCH
SEC. 101. ACTIVITIES TO IMPROVE EATING DISORDER-RELATED RESEARCH AND
FUNDING.
Title IV of the Public Health Service Act (42 U.S.C. 281 et seq.)
is amended by adding at the end the following:
``PART J--EATING DISORDER-RELATED ACTIVITIES
``SEC. 499A. AUTHORITY OF THE DIRECTOR OF THE NATIONAL INSTITUTES OF
HEALTH RELATING TO EATING DISORDERS.
``(a) Identifying Total Expenditures on Eating Disorders.--The
Director of NIH, in coordination with the National Institute of Mental
Health, the Office of Research on Women's Health, and other institutes
of the National Institutes of Health, shall identify the total amount
of expenditures, both intramural and extramural, by the National
Institutes of Health for eating disorders for each of fiscal years 2007
and 2008.
``(b) Budget for Eating Disorders Research and Coordination of
Activities and Programs.--The Director of NIH, based on the strategic
plan developed under subsection (c), shall--
``(1) develop and oversee the implementation of a
scientifically justified budget for research on eating
disorders at the National Institutes of Health;
``(2) coordinate all research activities and programs on
eating disorders at the institutes, centers, and divisions of
the National Institutes of Health; and
``(3) evaluate all such activities and programs.
``(c) Strategic Plan for Eating Disorders Research.--
``(1) In general.--The Director of NIH shall develop, in
consultation with leading eating disorder researchers, and
oversee the implementation of a comprehensive, long-range plan
for the conduct and support of research on eating disorders by
the institutes, centers, and divisions of the National
Institutes of Health.
``(2) Requirements.--The plan developed under paragraph (1)
shall--
``(A) be updated on an annual basis;
``(B) identify critical scientific questions
related to eating disorders and establish priorities
among such questions;
``(C) based on the priorities established under
subparagraph (B), specify the short- and long-range
objectives to be achieved, and estimate the resources
needed to achieve these objectives;
``(D) evaluate the sufficiency of existing research
programs on eating disorders to meet the objectives
specified under subparagraph (C), and establish
objectives, timelines, and criteria for evaluating
future research programs;
``(E) be coordinated with the activities of the
centers of excellence receiving funds under section
499B(b); and
``(F) make recommendations for changes to existing
research programs on eating disorders.
``(d) Budgetary Authority.--
``(1) In general.--The Director of NIH shall--
``(A) in accordance with the strategic plan
developed under subsection (c), annually prepare and
submit to Congress a scientifically justified budget
estimate for research on eating disorders to be
conducted within the agencies of the National
Institutes of Health, which shall include the amount of
funds that will be required for--
``(i) the continued funding of ongoing
discretionary program initiatives at the
institutes, centers, and divisions of the
National Institutes of Health; and
``(ii) the funding of new and complementary
program initiatives; and
``(B) receive all research funds for eating
disorders described in subparagraph (A), and allocate
those funds to the institutes, centers, and divisions
of the National Institutes of Health.
``(2) Effective date.--Paragraph (1)(B) shall become
effective in the fiscal year following the submission of the
eating disorder budget described in paragraph (1)(A).
``(e) Evaluation and Report.--
``(1) Evaluation.--The Director of NIH shall evaluate the
effect of this section on the planning and coordination of
research programs on eating disorders at the institutes,
centers, and divisions of the National Institutes of Health,
and the extent to which funding mandated under this section has
followed the recommendation of the strategic plan developed
under subsection (c).
``(2) Report.--Not later than 1 year after the date of
enactment of this section, the Director of NIH shall prepare
and submit to the Committee on Energy and Commerce and the
Committee on Appropriations of the House of Representatives,
and the Committee on Health, Education, Labor, and Pensions and
the Committee on Appropriations of the Senate, a report based
on the evaluation described in paragraph (1).
``(f) Definitions.--In this part, the term `eating disorder'
includes anorexia nervosa, bulimia nervosa, binge eating disorder, and
eating disorders not otherwise specified (EDNOS), as defined in the
fourth edition of `Diagnostic and Statistical Manual of Mental
Disorders'.
``SEC. 499B. EXPANSION, INTENSIFICATION, AND COORDINATION OF ACTIVITIES
OF NATIONAL INSTITUTES OF HEALTH WITH RESPECT TO RESEARCH
ON EATING DISORDERS.
``(a) In General.--
``(1) Expansion of activities.--The Director of NIH shall
expand, intensify, and coordinate the activities of the
National Institutes of Health with respect to research on
eating disorders.
``(2) Administration of program; coordination among
agencies.--The Director of NIH shall carry out this section
acting through the Director of the National Institute of Mental
Health, and in collaboration with the Director of the Eunice
Kennedy Shriver National Institute of Child Health and Human
Development, the Director of the National Institute of Diabetes
and Digestive and Kidney Diseases, the Director of the Office
of Research on Women's Health, and any other agencies or
offices of the National Institutes of Health that the Director
determines appropriate.
``(3) Task force.--
``(A) Establishment.--Before making grants under
subsection (b) for centers of excellence, the Director
of NIH shall establish a task force (in this paragraph
referred to as the `task force') consisting of--
``(i) representatives of the institutes,
centers, and divisions of the National
Institutes of Health, as determined appropriate
by the Director;
``(ii) eating disorders researchers,
clinicians, and patient advocacy groups; and
``(iii) the general public.
``(B) Duties.--The task force shall--
``(i) assist researchers in developing
applications and applying for grants and
contracts to be awarded by centers of
excellence described in subsection (b);
``(ii) conduct a thorough examination of
the field of eating disorders, create a list of
priorities for eating disorders research, and
develop a matrix of action items for such
research; and
``(iii) conduct meetings to address issues
with respect to eating disorders research,
including guiding principles of centers of
excellence under subsection (b); development of
strategic research priorities; strategies for
recruiting new scientists into the field of
eating disorders and providing them with high-
quality training; priorities and best practices
for basic research, clinical research,
treatment research, and prevention research;
and development of a research infrastructure
nationwide.
``(b) Centers of Excellence.--
``(1) In general.--In carrying out subsection (a)(1), the
Director of NIH shall award grants and contracts to public or
nonprofit private entities, including universities, to pay all
or part of the cost of planning, establishing, improving, and
providing basic operating support for centers of excellence
regarding research on eating disorders and training to perform
research on eating disorders.
``(2) Research.--
``(A) In general.--Each center of excellence that
receives funding under paragraph (1) shall conduct
basic research, clinical research, or both into eating
disorders.
``(B) Requirements.--The research conducted by a
center of excellence pursuant to subparagraph (A)--
``(i) shall be designed to improve
understanding of the etiology, early
identification, prevention, best treatment,
medical and psychological sequelae of and
recovery from eating disorders;
``(ii) shall be conducted in the fields of
basic, clinical, prevention, and intervention
sciences; and
``(iii) should include--
``(I) studies clarifying the
nosology and assessment of eating
disorders;
``(II) investigations to determine
the biological, psychosocial, and
behavioral risk factors that might
appear in early childhood;
``(III) studies of promising
treatments for eating disorders;
``(IV) evaluation of prevention
programs for eating disorders; and
``(V) studies of the medical,
psychological, and social sequelae of
eating disorders.
``(C) Equal representation of research areas.--In
awarding grants and contracts under paragraph (1), the
Director of NIH shall, to the extent practicable and
appropriate, ensure that each of the research areas
required by clauses (i) and (ii) of subparagraph (B)
are equally represented.
``(3) Training to perform eating disorders research.--Each
center of excellence that receives funding under paragraph (1)
shall provide at least 3 positions for doctoral level and post-
doctoral level research trainees.
``(4) Services for patients.--
``(A) In general.--A center of excellence that
receives funding under paragraph (1) may expend amounts
provided under a grant or contract under such paragraph
to carry out a program to make individuals aware of
opportunities to participate as subjects in research
conducted by the centers.
``(B) Referrals and costs.--A program carried out
under subparagraph (A) may, in accordance with such
criteria as the Director of NIH may establish, provide
to the subjects described in such subparagraph,
referrals for health, mental health, and other
services, and such patient care costs as are required
for research.
``(C) Availability and access.--The extent to which
a center of excellence that receives funding under
paragraph (1) can demonstrate availability and access
to clinical services shall be considered by the
Director of NIH in decisions about awarding grants or
contracts to applicants that meet the scientific
criteria for funding under this section.
``(5) Coordination of centers of excellence.--
``(A) In general.--The Director of the National
Institute of Mental Health shall, as appropriate,
provide for the coordination of information among
centers of excellence that receive funding under
paragraph (1) and ensure regular communication between
such centers.
``(B) Periodic reports.--The Director of the
National Institute of Mental Health may require the
periodic preparation of reports on the activities of
centers of excellence that receive funding under
paragraph (1) and the submission of such reports to the
Director.
``(C) Collection and storage of data.--The Director
of the National Institute of Mental Health shall
establish and fund mechanisms and entities for
collecting, storing, and coordinating data collected by
centers of excellence that receive funding under
paragraph (1) and data generated from public and
private research partnerships.
``(6) Organization.--Each center of excellence that
receives funding under paragraph (1) shall use the facilities
of a single institution, or be formed from a consortium of
cooperating institutions, meeting such requirements as may be
prescribed by the Director of NIH.
``(7) Number; duration; additional periods.--
``(A) In general.--The Director of NIH shall
provide for the establishment of not fewer than 3
centers of excellence under paragraph (1).
``(B) Duration.--Except as provided in subparagraph
(C), a grant or contract awarded under paragraph (1)
shall not exceed a period of 5 years.
``(C) Additional periods.--
``(i) Extension.--The period of a grant or
contract awarded under paragraph (1) may be
extended 1 or more additional periods not
exceeding a total of 5 years if the operations
of the center of excellence involved have been
reviewed by an appropriate technical and
scientific peer review group (including
investigators from the field of eating
disorders) established by the Director of NIH
and the group has recommended to the Director
that such period should be extended.
``(ii) Amount.--The amount of any grant or
contract under paragraph (1) for an additional
period described in clause (i) shall not exceed
$2,000,000 per fiscal year.
``(D) Public input.--In carrying out this section,
the Director of NIH shall provide for a means through
which the public can obtain information on the existing
and planned programs and activities of the National
Institutes of Health with respect to eating disorders
and through which the Director can receive comments
from the public regarding such programs and activities.
``(c) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, $20,000,000 for each of fiscal
years 2010 through 2014. Amounts appropriated under this subsection
shall be in addition to any other amounts appropriated for such
purpose.
``SEC. 499C. COLLABORATIVE PROGRAMS OF RESEARCH IN EATING DISORDERS.
``(a) In General.--The Director of NIH, acting through the Director
of the National Institute of Mental Health, the Director of the
National Institute of Diabetes and Digestive and Kidney Diseases, the
Director of the Eunice Kennedy Shriver National Institute of Child
Health and Human Development, the Director of the Office of Research on
Women's Health, and any other agencies or offices of the National
Institutes of Health that the Director determines appropriate, in
consultation with leading eating disorders researchers and clinicians,
shall award grants and contracts to public or nonprofit private
entities to pay all or part of the cost of planning, establishing,
improving, and providing basic operating support for collaborative
programs of research in eating disorders.
``(b) Research.--Each program established under subsection (a)--
``(1) shall conduct basic research, clinical research, or
both into eating disorders; and
``(2) should conduct investigations into the cause,
diagnosis, early detection, prevention and treatment of and
recovery from eating disorders.
``(c) Coordination of Programs.--
``(1) In general.--The Director of NIH shall, as
appropriate, provide for the coordination of information among
programs established under subsection (a), and centers of
excellence that receive funding under section 499B, and ensure
regular communication between such programs and centers.
``(2) Periodic reports.--The Director of NIH may require
the periodic preparation of reports on the activities of the
programs established under subsection (a) and the submission of
such reports to the Director.
``(3) Collection and storage of data.--The Director of NIH
shall establish and fund mechanisms and entities for
collecting, storing, and coordinating data collected by the
programs established under subsection (a) and data generated
from public and private research partnerships.
``(d) Organization.--Each program that receives funding under
subsection (a) shall be formed from a consortium of cooperating
institutions, meeting such requirements as may be prescribed by the
Director of NIH.
``(e) Number and Duration.--
``(1) In general.--The Director shall provide for the
establishment of not fewer than 4 programs under subsection
(a).
``(2) Duration.--Except as provided in paragraph (3), a
grant or contract awarded under subsection (a) shall not exceed
a period of 5 years.
``(3) Additional periods.--
``(A) Extension.--The period of a grant or contract
awarded under subsection (a) may be extended for 1 or
more additional periods not exceeding 5 years if the
operations of the program involved have been reviewed
by an appropriate technical and scientific peer review
group established by the Director of NIH and the group
has recommended to the Director that such period should
be extended.
``(B) Amount.--The amount of any grant or contract
under subsection (a) for an additional period described
in subparagraph (A) shall not exceed $2,000,000 per
fiscal year.
``(f) Rule of Construction.--Nothing in this section shall be
construed as precluding or otherwise affecting funding for any research
on eating disorders in addition to the research funded under this
section.
``(g) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, $20,000,000 for each of fiscal
years 2010 through 2014. Amounts appropriated under this subsection
shall be in addition to any other amounts appropriated for such
purpose.''.
SEC. 102. EATING DISORDERS SURVEILLANCE AND RESEARCH PROGRAM.
Title III of the Public Health Service Act (42 U.S.C. 241 et seq.)
is amended by adding at the end thereof the following:
``PART S--PROGRAMS RELATING TO EATING DISORDERS
``SEC. 399FF. EATING DISORDERS SURVEILLANCE AND RESEARCH PROGRAM.
``(a) National Eating Disorders Surveillance Program.--
``(1) In general.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention and
in consultation with leading eating disorders researchers and
clinicians--
``(A) shall provide for the collection, analysis,
and reporting of epidemiological data on eating
disorders through the existing surveillance programs of
the Centers, such as the Behavioral Risk Factor
Surveillance System;
``(B) shall make recommendations to enhance
existing surveillance programs of the Centers, such as
the Behavioral Risk Factor Surveillance System, to more
accurately collect epidemiological data on disordered
eating and eating disorders;
``(C) may award grants and cooperative agreements
and may provide direct technical assistance to eligible
entities for the collection, analysis, and reporting of
such data; and
``(D) shall examine and improve requirements for
reporting deaths on death certificates to accurately
account for those cases in which an eating disorder is
the underlying or contributing cause of death.
``(2) Eligibility.--To be eligible to receive a grant or
cooperative agreement under paragraph (1)(B), an entity shall
be a public or nonprofit private entity (including a health
department of a State or political subdivisions of a State, a
university, or any other educational institution), and submit
to the Secretary an application at such time, in such manner,
and containing such information as the Secretary may require.
``(b) Center of Eating Disorders Epidemiology.--
``(1) In general.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention,
shall establish a Center of Eating Disorders Epidemiology for
the purpose of collecting and analyzing information on--
``(A) the number, incidence, incidence trends over
time, correlates, mortality, and causes of eating
disorders;
``(B) the effects of eating disorders on quality of
life, including disability adjusted life years (DALY)
and quality adjusted life years (QALY); and
``(C) economic analysis of the costs of eating
disorders in the United States, including years of
productive life lost, missed days of work, reduced work
productivity, costs of medical and mental health
treatment, prescriptions, other medications,
hospitalizations, costs of medical and psychiatric
comorbidities, costs to family, and costs to society.
``(2) Grants; cooperative agreements.--The Center of Eating
Disorders Epidemiology under paragraph (1) shall be established
and operated through the awarding of grants or cooperative
agreements to one or more public or nonprofit private entities
that conduct research, which may include a university or other
educational entity.
``(3) Requirements.--To be eligible to receive a grant or
cooperative agreement under paragraph (2), an entity shall
submit to the Secretary an application containing such
agreements and information as the Secretary may require,
including an agreement that the Center of Eating Disorders
Epidemiology will operate in accordance with the following:
``(A) The Center will collect, analyze, and report
eating disorders data according to guidelines
prescribed by the Director of the Centers for Disease
Control and Prevention, after consultation with
relevant State and local public health officials,
private sector eating disorder researchers and
clinicians, and advocates for those with eating
disorders.
``(B) The Center will assist with the development
and coordination of State eating disorders surveillance
efforts within a region.
``(C) The Center will identify eligible cases and
controls through its surveillance systems and conduct
research into factors which may cause or increase the
risk of eating disorders.
``(D) The Center will develop or extend an area of
special research expertise (including genetics,
environmental exposures, and other relevant research
specialty areas).
``(c) Clearinghouse.--The Secretary, acting through the Director of
the Centers for Disease Control and Prevention and in consultation with
leading eating disorders researchers and clinicians, shall carry out
the following:
``(1) Establishment.--The Secretary shall establish a
clearinghouse within the Centers for Disease Control and
Prevention for the collection and storage of data generated
from the monitoring programs established under this section and
part J of title IV. Through the clearinghouse, the Centers for
Disease Control and Prevention shall serve as the coordinating
agency for eating disorders surveillance activities. The
functions of such clearinghouse shall include facilitating the
coordination of research and policy development relating to the
prevention, treatment, and epidemiology of eating disorders.
``(2) Facilitation of research.--The Secretary shall
provide for the establishment of a program under which samples
of tissues and genetic and other biological materials that are
of use in research on eating disorders are donated, collected,
preserved, and made available for such research. Such program
shall be carried out in accordance with accepted scientific and
medical standards for the donation, collection, and
preservation of such samples, and shall be conducted so that
the tissues and other materials saved, as well as any database
compiled from such tissues and materials, are available to
researchers at a reasonable cost.
``(3) Coordination.--The Centers for Disease Control and
Prevention shall coordinate research and surveillance
activities of such Centers with the National Institutes of
Health, other appropriate Federal agencies, and interested
nonprofit private entities, which shall be updated as
determined appropriate by the Secretary.
``(d) Definition.--In this section, the term `eating disorder'
includes anorexia nervosa, bulimia nervosa, binge eating disorder, and
eating disorders not otherwise specified (EDNOS), as defined in the
fourth edition of `Diagnostic and Statistical Manual of Mental
Disorders'.
``(e) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, $2,000,000 for each of fiscal
years 2010 through 2014.''.
TITLE II--EDUCATION AND PREVENTION
SEC. 201. STUDY OF MANDATORY BMI REPORTING IN SCHOOL.
Not later than 1 year after the date of the enactment of this Act,
the Director of the Centers for Disease Control and Prevention, in
consultation with the Secretary of Education and leading eating
disorders researchers and clinicians, shall conduct a study and submit
a report to the Congress on--
(1) measuring the body mass index (in this section referred
to as ``BMI'') of students for those schools (at any level
including pre-schools, kindergartens, elementary schools,
secondary schools, and institutions of higher education) that
are measuring the BMI of students;
(2) the impacts (both positive and negative) on students of
such measures, including unhealthy weight control behaviors,
perceptions of body image, eating disorder symptoms, and the
incidence of teasing or bullying based on body size; and
(3) the impacts (both positive and negative) of reporting
the results of such measures to the parents of such students.
SEC. 202. TRAINING AND EDUCATION.
(a) In General.--The Secretary of Health and Human Services, acting
through the Director of the Office on Women's Health of the Department
of Health and Human Services and in consultation with the Secretary of
Education and with the Task Force for Health Professions established
under section 399Z(b) of the Public Health Service Act (as added by
section 203(a)(2) of this Act), shall--
(1) expand the BodyWise Handbook and related fact sheets
and resource lists available on the public Internet site of the
National Women's Health Information Center sponsored by the
Office on Women's Health, to include--
(A) updated findings and conclusions as needed; and
(B) thorough information about eating disorders
relating to males as well as females;
(2) incorporate, as appropriate, information from such
BodyWise Handbook and related facts sheets and resource lists
into the curriculum of the BodyWorks obesity prevention program
developed by the Office on Women's Health and training modules
used in such obesity prevention program; and
(3) promote and make publicly available (whether through a
public Internet site or other method that does not impose a fee
on users) the BodyWise Handbook and related fact sheets and
resource lists, as updated under paragraph (1), and the
BodyWorks obesity prevention program, as updated under
paragraph (2), including for purposes of educating universities
and nonprofit entities on eating disorders.
(b) Authorization of Appropriations.--There is authorized to be
appropriated such sums as may be necessary to carry out subsection (a).
SEC. 203. HEALTH PROFESSIONAL EDUCATION AND TRAINING.
(a) Task Force on Eating Disorders.--Section 399Z of the Public
Health Service Act (42 U.S.C. 280h-3) is amended--
(1) by redesignating subsection (b) as subsection (d); and
(2) by inserting after subsection (a) the following new
subsections:
``(b) Task Force on Eating Disorders.--
``(1) Establishment.--The Secretary, acting through the
Administrator of the Health Resources and Services
Administration and one or more of the centers of excellence
receiving funds under section 499B(b), shall establish a Task
Force for Health Professions (in this subsection referred to as
the `task force') comprised of experts in the field of eating
disorders (including researchers, clinicians, care providers,
and experts in eating disorders education and prevention),
individuals with eating disorders, and individuals with family
members who have eating disorders.
``(2) Duties.--The task force shall--
``(A) develop, based on the BodyWise Handbook and
related fact sheets and resource lists available on the
public Internet site of the National Women's Health
Information Center sponsored by the Office on Women's
Health of the Department of Health and Human Services
and updated under section 202(a)(1) of the Federal
Response to Eliminate Eating Disorders Act of 2009, an
evidence-based or emerging best-practices training
program for health professionals on eating disorders;
and
``(B) award grants for implementation of such
evidence-based training program; and
``(C) provide training and technical assistance to
grant recipients.
``(3) Report.--Not later than 6 years after the date of the
enactment of this subsection, the task force shall submit to
the Congress and make publicly available a report on the
training program developed under paragraph (2) and the results
achieved through grants awarded for implementation of such
program.
``(c) Definition.--In this section, the term `eating disorder' has
the meaning given such term in section 399F.''; and
(3) by amending subsection (d) (as so redesignated) to read
as follows:
``(d) Authorization of Appropriations.--There are authorized to be
appropriated--
``(1) to carry out subsection (a), such sums as may be
necessary for each of fiscal years 2010 through 2014; and
``(2) to carry out subsection (b), $10,000,000 for fiscal
year 2010 and such sums as may be necessary for each of fiscal
years 2011 through 2014.''.
(b) Preference in Making Grants to Schools of Medicine.--Section
747(c)(3) of the Public Health Service Act (42 U.S.C. 293k(c)(3)) is
amended by striking ``and victims of domestic violence'' and inserting
``victims of domestic violence, and individuals who suffer from eating
disorders (as such term is defined in section 399FF)''.
SEC. 204. EDUCATION AND TRAINING FOR ALL HEALTH PROFESSIONALS.
Section 399Z of the Public Health Service Act (42 U.S.C. 280h-3),
as amended by section 203(a), is further amended--
(1) by redesignating subsections (c) and (d) as subsections
(d) and (e), respectively;
(2) by inserting after subsection (b) the following new
subsection:
``(c) Grants Regarding Eating Disorders.--
``(1) In general.--The Secretary may award grants to
eligible entities to integrate training into existing curricula
for primary care physicians and other licensed or certified
health and mental health professionals on how to identify,
refer, treat, and prevent eating disorders and aid individuals
who suffer from eating disorders.
``(2) Application.--An entity that desires a grant under
this subsection shall submit to the Secretary 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 the training
that will be provided.
``(3) Use of funds.--An entity that receives a grant under
this subsection shall use the funds made available through such
grant to--
``(A) use the training program developed by the
Task Force for Health Professions under subsection
(b)(2)(A), evidence-based findings, promising emerging
best practices, or recommendations that pertain to the
prevention and treatment of eating disorders to conduct
educational training and conferences, including
Internet-based courses and teleconferences, on--
``(i) how to treat or prevent eating
disorders;
``(ii) how to discuss varied strategies
with patients from at-risk and diverse
populations to promote positive behavior change
and healthy lifestyles to prevent eating
disorders;
``(iii) how to identify individuals with
eating disorders, and those who are at risk for
suffering from eating disorders and, therefore,
at risk for related serious and chronic medical
and mental health conditions; and
``(iv) how to conduct a comprehensive
assessment of individual and familial health
risk factors; and
``(B) evaluate and report to the Task Force for
Health Professions on the effectiveness of the training
provided by such entity in increasing knowledge and
changing attitudes and behaviors of trainees.''; and
(3) in subsection (e) (as so redesignated)--
(A) in paragraph (1), at the end by striking
``and'';
(B) in paragraph (2), at the end by striking the
period and inserting ``; and''; and
(C) by adding at the end the following new
paragraph:
``(3) to carry out subsection (c), $10,000,000 for fiscal
year 2010 and such sums as may be necessary for each of fiscal
years 2011 through 2014.''.
SEC. 205. EDUCATION AND TRAINING FOR SCHOOL AND HIGHER EDUCATION
PROFESSIONALS.
(a) Task Force on Eating Disorders Prevention in Educational
Institutions.--
(1) Establishment.--Not later than 1 year after the date of
the enactment of this Act, the Secretary of Health and Human
Services, in consultation with centers of excellence receiving
funds under section 499B of the Public Health Service Act (as
added by section 101 of this Act) and experts in eating
disorder prevention and treatment, shall establish a Task Force
on Eating Disorders Prevention in Educational Institutions (in
this subsection referred to as the ``task force'').
(2) Duties.--The task force shall--
(A) expand upon and incorporate information from
the BodyWise eating disorder initiative implemented by
the Office on Women's Health of the Department of
Health and Human Services to develop and provide
training on eating disorders identification and
prevention for students, faculty, coaches, and staff in
kindergartens, elementary schools, secondary schools,
and institutions of higher education;
(B) develop a program of educational seminars on
eating disorders identification and prevention for use
by grant recipients under subsection (b); and
(C) provide training to grant recipients under
subsection (b) on implementing such a program,
including by integration into existing applicable
training curricula.
(b) Grants.--
(1) Authorization.--The Secretary of Health and Human
Services, acting through the Administrator of the Substance
Abuse and Mental Health Services Administration, shall award
grants to eligible entities--
(A) to conduct educational seminars on eating
disorders identification and prevention; and
(B) to make resources available to individuals
affected by eating disorders.
(2) Educational seminars.--As a condition on the receipt of
a grant under this subsection, an eligible entity shall agree
to conduct educational seminars under paragraph (1)(A)--
(A) in accordance with the program developed under
subsection (a)(2)(B) by the Task Force on Eating
Disorders Prevention in Educational Institutions; and
(B) taking into consideration educational materials
made available through the BodyWise eating disorder
initiative of the Department of Health and Human
Services and relevant research on eating disorders.
(3) Eligible entity.--In this subsection, the term
``eligible entity'' means any State, territory, or possession
of the United States, the District of Columbia, any Indian
tribe or tribal organization (as defined in subsections (e) and
(l), respectively, of section 4 of the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450b)),
or a public or private educational institution, including an
institution of higher education.
SEC. 206. EATING DISORDER RESEARCH AND REPORT.
Not later than 18 months after the date of the enactment of this
Act, the National Center for Education Statistics and the National
Center for Health Statistics shall conduct a study on the impact of
eating disorders on educational advancement and achievement. The study
shall--
(1) determine the prevalence of eating disorders among
students and the morbidity and mortality rates associated with
eating disorders;
(2) evaluate the extent to which students with eating
disorders are more likely to miss school, have delayed rates of
social, emotional, and physical development, or have reduced
academic performance;
(3) report on current State and local programs to prevent
eating disorders, as well as evaluate the value of such
programs; and
(4) make recommendations on measures that could be
undertaken by the Congress, the Department of Education,
States, and local educational agencies to strengthen eating
disorder prevention and awareness programs.
SEC. 207. PUBLIC SERVICE ANNOUNCEMENTS.
(a) In General.--The Director of the National Institute of Mental
Health shall conduct a program of public service announcements to
educate the public on--
(1) the types of eating disorders;
(2) the seriousness of eating disorders (including
prevalence, comorbidities, and physical and mental health
consequences);
(3) how to detect, address, refer for help, and prevent
eating disorders;
(4) discrimination and bullying based on body size;
(5) the effects of media on self esteem and body image; and
(6) the signs and symptoms of eating disorders.
(b) Collaboration.--The Director of the National Institute of
Mental Health shall conduct the program under subsection (a) in
collaboration with--
(1) centers of excellence receiving funds under section
499B of the Public Health Service Act, as added by section 101;
and
(2) community-based national nonprofit resources that--
(A) support individuals affected by eating
disorders; and
(B) work to prevent eating disorders and address
body image and weight issues.
(c) Announcement Requirements.--In carrying out the program of
public service announcements required by subsection (a), the Director
of the National Institute of Mental Health shall ensure that such
announcements--
(1) address the full spectrum of eating disorders for both
sexes and a variety of ethnicities and age groups;
(2) do not promote or aggravate eating disorders, such as
by incorporating images, specific behaviors, or statistics that
make eating disorders seem attractive;
(3) feature--
(A) real people who are or were affected by eating
disorders, including individuals who have died of such
disorders; and
(B) not actors or models in place of such people;
(4) make clear that--
(A) eating disorders are not a choice, but are
serious and often deadly illnesses; and
(B) individuals affected by eating disorders need
to seek help; and
(5) provide information on how and where to seek help for
the treatment of eating disorders.
SEC. 208. SENSE OF CONGRESS.
It is the sense of the Congress that--
(1) federally funded campaigns to fight obesity should
address eating disorders; and
(2) federally funded studies on obesity should include
questions relating to eating disorders.
TITLE III--TREATMENT
SEC. 301. COVERAGE FOR TREATMENT FOR EATING DISORDERS UNDER GROUP
HEALTH PLANS, INDIVIDUAL HEALTH INSURANCE COVERAGE, AND
FEHBP.
(a) Group Health Plans.--
(1) Public health service act amendments.--Subpart 2 of
part A of title XXVII of the Public Health Service Act is
amended by adding at the end the following new section:
``SEC. 2708. COVERAGE FOR TREATMENT FOR EATING DISORDERS.
``(a) Coverage.--A group health plan, and a health insurance issuer
offering group health insurance coverage in connection with a group
health plan, that provides medical and surgical benefits shall provide
coverage for treatment for eating disorders consistent with the
provisions of this section.
``(b) Prohibitions.--A group health plan, and a health insurance
issuer offering group health insurance coverage in connection with a
group health plan, shall not--
``(1) deny to an individual eligibility, or continued
eligibility, to enroll or to renew coverage under the terms of
the plan, solely for the purpose of avoiding the requirement of
this section;
``(2) deny coverage for treatment of eating disorders,
including coverage for residential treatment of eating
disorders, if such treatment is medically necessary in
accordance with the Practice Guidelines for the Treatment of
Patients with Eating Disorders, as most recently published by
the American Psychiatric Association;
``(3) provide monetary payments, rebates, or other benefits
to individuals to encourage such individuals to accept less
than the minimum protections available under this section;
``(4) penalize or otherwise reduce or limit the
reimbursement of a provider because such provider provided care
to an individual participant or beneficiary in accordance with
this section;
``(5) provide incentives (monetary or otherwise) to a
provider to induce such provider to provide care to an
individual participant or beneficiary in a manner inconsistent
with this section; or
``(6) deny to an individual participant or beneficiary
continued eligibility to enroll or to renew coverage under the
terms of the plan, solely because the individual was previously
found to have an eating disorder or to have received treatment
for an eating disorder.
``(c) Out-of-Network Providers.--In the case of a group health
plan, or health insurance issuer offering group health insurance
coverage in connection with a group health plan, that provides both
medical and surgical benefits and coverage for treatment for eating
disorders, if the plan or coverage provides coverage for medical or
surgical benefits provided by out-of-network providers, the plan or
coverage shall provide coverage for treatment for eating disorders
provided by out-of-network providers in a manner that is consistent
with the requirements of this section.
``(d) Rule of Construction.--Nothing in this section shall be
construed as preventing a group health plan or issuer from imposing
deductibles, coinsurance, or other cost-sharing in relation to
treatment for eating disorders, except that such deductibles,
coinsurance, or other cost-sharing may not be greater than the
deductibles, coinsurance, or other cost-sharing imposed on other
comparable medical or surgical services covered under the plan.
``(e) Preemption.--Nothing in this section shall be construed to
preempt any State law in effect on the date of enactment of this
section with respect to health insurance coverage that requires
coverage of at least the coverage for treatment for eating disorders
otherwise required under this section.
``(f) Eating Disorders Defined.--For purposes of this section the
term `eating disorder' includes anorexia nervosa, bulimia nervosa, and
eating disorders not otherwise specified (EDNOS) (including binge
eating disorder), as defined in the fourth edition of `Diagnostic and
Statistical Manual of Mental Disorders' or such later edition as the
Secretary may specify.''.
(2) ERISA amendments.--(A) Subpart B of part 7 of subtitle
B of title I of the Employee Retirement Income Security Act of
1974 is amended by adding at the end the following new section:
``SEC. 714. COVERAGE FOR TREATMENT FOR EATING DISORDERS.
``(a) Coverage.--A group health plan, and a health insurance issuer
offering group health insurance coverage in connection with a group
health plan, that provides medical and surgical benefits shall provide
coverage for treatment for eating disorders consistent with the
provisions of this section.
``(b) Prohibitions.--A group health plan, and a health insurance
issuer offering group health insurance coverage in connection with a
group health plan, shall not--
``(1) deny to an individual eligibility, or continued
eligibility, to enroll or to renew coverage under the terms of
the plan, solely for the purpose of avoiding the requirement of
this section;
``(2) deny coverage for treatment of eating disorders,
including coverage for residential treatment of eating
disorders, if such treatment is medically necessary in
accordance with the Practice Guidelines for the Treatment of
Patients with Eating Disorders, as most recently published by
the American Psychiatric Association;
``(3) provide monetary payments, rebates, or other benefits
to individuals to encourage such individuals to accept less
than the minimum protections available under this section;
``(4) penalize or otherwise reduce or limit the
reimbursement of a provider because such provider provided care
to an individual participant or beneficiary in accordance with
this section;
``(5) provide incentives (monetary or otherwise) to a
provider to induce such provider to provide care to an
individual participant or beneficiary in a manner inconsistent
with this section; or
``(6) deny to an individual participant or beneficiary
continued eligibility to enroll or to renew coverage under the
terms of the plan, solely because the individual was previously
found to have an eating disorder or to have received treatment
for an eating disorder.
``(c) Out-of-Network Providers.--In the case of a group health
plan, or health insurance issuer offering group health insurance
coverage in connection with a group health plan, that provides both
medical and surgical benefits and coverage for treatment for eating
disorders, if the plan or coverage provides coverage for medical or
surgical benefits provided by out-of-network providers, the plan or
coverage shall provide coverage for treatment for eating disorders
provided by out-of-network providers in a manner that is consistent
with the requirements of this section.
``(d) Rule of Construction.--Nothing in this section shall be
construed as preventing a group health plan or issuer from imposing
deductibles, coinsurance, or other cost-sharing in relation to
treatment for eating disorders, except that such deductibles,
coinsurance, or other cost-sharing may not be greater than the
deductibles, coinsurance, or other cost-sharing imposed on other
comparable medical or surgical services covered under the plan.
``(e) Preemption.--Nothing in this section shall be construed to
preempt any State law in effect on the date of enactment of this
section with respect to health insurance coverage that requires
coverage of at least the coverage for treatment for eating disorders
otherwise required under this section.
``(f) Eating Disorders Defined.--For purposes of this section the
term `eating disorder' includes anorexia nervosa, bulimia nervosa, and
eating disorders not otherwise specified (EDNOS) (including binge
eating disorder), as defined in the fourth edition of `Diagnostic and
Statistical Manual of Mental Disorders' or such later edition as the
Secretary may specify.''.
(B) Section 732(a) of such Act (29 U.S.C. 1191a(a)) is
amended by striking ``section 711'' and inserting ``sections
711 and 714''.
(C) The table of contents in section 1 of such Act is
amended by inserting after the item relating to section 713 the
following new item:
``Sec. 714. Coverage for treatment for eating disorders.''.
(3) Internal revenue code amendments.--(A) Subchapter B of
chapter 100 of the Internal Revenue Code of 1986 is amended by
inserting after section 9812 the following:
``SEC. 9813. COVERAGE FOR TREATMENT FOR EATING DISORDERS.
``(a) Coverage.--A group health plan that provides medical and
surgical benefits shall provide coverage for treatment for eating
disorders consistent with the provisions of this section.
``(b) Prohibitions.--A group health plan shall not--
``(1) deny to an individual eligibility, or continued
eligibility, to enroll or to renew coverage under the terms of
the plan, solely for the purpose of avoiding the requirement of
this section;
``(2) deny coverage for treatment of eating disorders,
including coverage for residential treatment of eating
disorders, if such treatment is medically necessary in
accordance with the Practice Guidelines for the Treatment of
Patients with Eating Disorders, as most recently published by
the American Psychiatric Association;
``(3) provide monetary payments, rebates, or other benefits
to individuals to encourage such individuals to accept less
than the minimum protections available under this section;
``(4) penalize or otherwise reduce or limit the
reimbursement of a provider because such provider provided care
to an individual participant or beneficiary in accordance with
this section;
``(5) provide incentives (monetary or otherwise) to a
provider to induce such provider to provide care to an
individual participant or beneficiary in a manner inconsistent
with this section; or
``(6) deny to an individual participant or beneficiary
continued eligibility to enroll or to renew coverage under the
terms of the plan, solely because the individual was previously
found to have an eating disorder or to have received treatment
for an eating disorder.
``(c) Out-of-Network Providers.--In the case of a group health plan
that provides both medical and surgical benefits and coverage for
treatment for eating disorders, if the plan provides coverage for
medical or surgical benefits provided by out-of-network providers, the
plan or coverage shall provide coverage for treatment for eating
disorders provided by out-of-network providers in a manner that is
consistent with the requirements of this section.
``(d) Rule of Construction.--Nothing in this section shall be
construed as preventing a group health plan or issuer from imposing
deductibles, coinsurance, or other cost-sharing in relation to
treatment for eating disorders, except that such deductibles,
coinsurance, or other cost-sharing may not be greater than the
deductibles, coinsurance, or other cost-sharing imposed on other
comparable medical or surgical services covered under the plan.
``(e) Eating Disorders Defined.--For purposes of this section the
term `eating disorder' includes anorexia nervosa, bulimia nervosa, and
eating disorders not otherwise specified (EDNOS) (including binge
eating disorder), as defined in the fourth edition of `Diagnostic and
Statistical Manual of Mental Disorders' or such later edition as the
Secretary may specify.''.
(B) The table of sections of such subchapter is amended by
inserting after the item relating to section 9812 the following
new item:
``Sec. 9813. Coverage for treatment for eating disorders.''.
(C) Section 4980D(d)(1) of such Code is amended by striking
``section 9811'' and inserting ``sections 9811 and 9813''.
(b) Application to Individual Health Insurance Coverage.--(1) Part
B of title XXVII of the Public Health Service Act is amended by
inserting after section 2753 the following new section:
``SEC. 2754. COVERAGE FOR TREATMENT FOR EATING DISORDERS.
``The provisions of section 2708 shall apply to health insurance
coverage offered by a health insurance issuer in the individual market
in the same manner as it applies to health insurance coverage offered
by a health insurance issuer in connection with a group health plan in
the small or large group market.''.
(2) Section 2762(b)(2) of such Act (42 U.S.C. 300gg-62(b)(2)) is
amended by striking ``section 2751'' and inserting ``sections 2751 and
2754''.
(c) Application Under Federal Employees Health Benefits Program
(FEHBP).--Section 8902 of title 5, United States Code, is amended by
adding at the end the following new subsection:
``(p) A contract may not be made or a plan approved which does not
comply with the requirements of section 2708 of the Public Health
Service Act.''.
(d) Effective Dates.--
(1) The amendments made by subsections (a) and (c) shall
apply with respect to group health plans and health benefit
plans for plan years beginning on or after the date that is 6
months after the date of the enactment of this Act.
(2) The amendments made by subsection (b) shall apply with
respect to health insurance coverage offered, sold, issued,
renewed, in effect, or operated in the individual market on or
after the date that is 6 months after the date of the enactment
of this Act.
(e) Coordination of Administration.--The Secretary of Labor, the
Secretary of Health and Human Services, and the Secretary of the
Treasury shall ensure, through the execution of an interagency
memorandum of understanding among such Secretaries, that--
(1) regulations, rulings, and interpretations issued by
such Secretaries relating to the same matter over which two or
more such Secretaries have responsibility under the provisions
of this section (and the amendments made thereby) are
administered so as to have the same effect at all times; and
(2) coordination of policies relating to enforcing the same
requirements through such Secretaries in order to have a
coordinated enforcement strategy that avoids duplication of
enforcement efforts and assigns priorities in enforcement.
<all>