[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[S. 1865 Introduced in Senate (IS)]

114th CONGRESS
  1st Session
                                S. 1865

     To amend the Public Health Service Act with respect to eating 
                   disorders, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             July 27, 2015

 Ms. Klobuchar (for herself, Ms. Ayotte, Mrs. Capito, and Ms. Baldwin) 
introduced the following bill; which was read twice and referred to the 
          Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 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 ``Anna Westin Act of 2015''.

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.
Sec. 5. Training and education.
Sec. 6. Education and training for health professionals.
Sec. 7. Education and training for school and higher education 
                            professionals.
Sec. 8. Public service announcements.
Sec. 9. Clarifying application of existing parity law.
Sec. 10. Prohibition on new appropriations.

SEC. 3. FINDINGS.

    The Congress finds the following:
            (1) Risk of death among individuals with anorexia nervosa 
        is 18 times greater than among individuals of the same age 
        without anorexia. It is estimated that at least one person dies 
        every 62 minutes from an eating disorder: at least 23 persons 
        each day.
            (2) Health consequences such as osteoporosis (brittle 
        bones), gastrointestinal complications, cardiac, and dental 
        problems are significant health and financial burdens 
        throughout life.
            (3) At lowest estimate, 14,500,000 people in the United 
        States suffer from eating disorders. One percent of adolescent 
        boys and 2 percent of adolescent girls suffer from eating 
        disorders. Eating disorders account for at least 4 percent of 
        all childhood hospitalizations.
            (4) Eating disorders are treatable biopsychosocial 
        illnesses. There is a high rate of comorbidity with other 
        illnesses such as depression, substance abuse, or anxiety 
        disorders.
            (5) Anorexia nervosa is an eating disorder characterized by 
        self-starvation, weight loss, fear of gaining weight, and 
        disturbances in the way in which one's body weight or shape is 
        experienced.
            (6) Anorexia nervosa is associated with serious health 
        consequences including heart failure, kidney failure, 
        osteoporosis, and death. People who suffer anorexia nervosa are 
        57 times more likely to die of suicide than their peers.
            (7) Current estimates of the lifetime prevalence of bulimia 
        nervosa are between 0.9 and 1.5 percent among women and between 
        0.1 and 0.5 percent among men.
            (8) Bulimia nervosa is associated with serious health 
        consequences, including cardiac, gastrointestinal, and dental 
        problems including irregular heartbeats, gastric rupture, 
        peptic ulcer, tooth decay, and death.
            (9) Binge eating disorder is characterized by frequent 
        episodes of uncontrolled overeating. Binge eating disorder is 
        common: at lowest estimate, 3.5 percent of women in the United 
        States and 2.0 percent of men in the United States will suffer 
        from this disorder in their lifetimes.
            (10) Binge eating is often associated with obesity, high 
        blood pressure, elevated cholesterol levels, elevated 
        triglyceride levels, increased risk of bowel, breast, and 
        reproductive cancers, increased risk of diabetes, and increased 
        risk of arthritic damage to the joints.
            (11) Many suffer from some, but not all, of the symptoms of 
        anorexia nervosa, bulimia nervosa, or binge eating disorder, 
        which is referred to as other specified feeding or eating 
        disorder or ``OSFED''. Between 4 percent and 20 percent of 
        young women practice unhealthy patterns of dieting, purging, 
        and binge eating.
            (12) Eating disorders are more common in women, but they do 
        occur in men. Rates of binge eating disorder are similar in 
        females and males.
            (13) Academic evidence has demonstrated a connection 
        between the use of very thin models in advertising and consumer 
        attitudes toward a brand based on such advertising, as well as 
        a material influence of the use of such models on consumer 
        purchase intent, conduct, and reliance.
            (14) Eating disorders appear across all age groups, races, 
        ethnicities, and socioeconomic groups in the United States and 
        are associated with substantial psychological problems, 
        including depression, substance abuse, and suicide. For 
        children 12 years of age and younger, hospitalizations for 
        eating disorders increased by 119 percent between 1999 and 
        2006.

SEC. 4. DEFINITIONS.

    In this Act--
            (1) the term ``eating disorder'' includes anorexia nervosa, 
        bulimia nervosa, binge eating disorder, and other specified 
        feeding or eating disorders, as defined in the fifth edition of 
        ``Diagnostic and Statistical Manual of Mental Disorders'', 
        published by the American Psychiatric Association or, if 
        applicable, the most recent successor edition; and
            (2) the term ``Secretary'' means the Secretary of Health 
        and Human Services.

SEC. 5. TRAINING AND EDUCATION.

    Subject to section 10, the Secretary, 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, shall--
            (1) revise and then reinstate the BodyWise Handbook of the 
        Department of Education and related fact sheets and resource 
        lists available on the public Internet Website 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 and females;
            (2) incorporate, as appropriate, information from such 
        BodyWise Handbook and related fact 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 (through a public 
        Internet Website 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.

SEC. 6. EDUCATION AND TRAINING FOR HEALTH PROFESSIONALS.

    (a) In General.--Subject to section 10, the Secretary, acting 
through the Administrator of the Substance Abuse and Mental Health 
Services Administration, shall award grants to eligible entities to 
integrate training into existing curricula for primary care physicians, 
other licensed or certified health and mental health professionals, and 
public health professionals that may include--
            (1) early intervention and identification of eating 
        disorders;
            (2) levels of treatment (including family-based, in-
        patient, residential, partial hospitalization programming, and 
        intensive outpatient and outpatient treatment);
            (3) how to properly refer patients to treatment;
            (4) steps to aid in the prevention of the development of 
        eating disordered behaviors; and
            (5) how to treat individuals with eating disorders.
    (b) Application.--An entity desiring a grant under this section 
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.
    (c) Use of Funds.--An entity that receives a grant under this 
section shall use the funds made available through such grant to--
            (1) develop a training program containing evidence-based 
        findings, promising emerging best practices, or recommendations 
        that pertain to the identification of, early intervention in, 
        prevention of the development of, and treatment of, eating 
        disorders to conduct educational training and conferences, 
        which may include Internet-based courses and teleconferences, 
        on--
                    (A) how to help prevent the development of eating 
                disordered behaviors, identify, intervene early, and 
                appropriately and adequately treat eating disordered 
                patients;
                    (B) how to identify individuals with eating 
                disorders, and those who are at risk for suffering from 
                eating disorders and, therefore, at risk for related 
                severe medical and mental health conditions;
                    (C) how to conduct a comprehensive assessment of 
                individual and familial health risk factors; and
                    (D) how to conduct a comprehensive assessment of a 
                treatment plan; and
            (2) evaluate and report to the Secretary on the 
        effectiveness of the training provided by such entity in 
        increasing knowledge and changing attitudes and behaviors of 
        trainees.

SEC. 7. EDUCATION AND TRAINING FOR SCHOOL AND HIGHER EDUCATION 
              PROFESSIONALS.

    (a) Grants.--Subject to section 10, the Secretary, acting through 
the Administrator of the Substance Abuse and Mental Health Services 
Administration, shall award grants to eligible entities--
            (1) to conduct educational seminars for school personnel on 
        early identification of, intervention in, and prevention of, 
        behaviors that are often associated with the development of 
        eating disordered behaviors; and
            (2) to make resources available to individuals affected by 
        eating disorders.
    (b) Educational Seminars.--As a condition on the receipt of a grant 
under this subsection, an eligible entity shall agree to conduct 
educational seminars under subsection (a)(1), 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.
    (c) Eligible Entity.--In this section, 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. 8. PUBLIC SERVICE ANNOUNCEMENTS.

    (a) In General.--Subject to section 10, 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 identify, intervene, refer for treatment, and 
        prevent behaviors that often lead to the development of eating 
        disordered behaviors;
            (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; and
            (2) community-based national nonprofit resources that 
        support individuals affected by eating disorders and work to 
        prevent eating disorders and address body image and weight 
        issues.

SEC. 9. CLARIFYING APPLICATION OF EXISTING PARITY LAW.

    (a) PHSA.--Section 2726 of the Public Health Service Act (42 U.S.C. 
300gg-26) is amended--
            (1) in subsection (a)(3), by adding at the end the 
        following new subparagraph:
                    ``(C) Treatment of permanent exclusions under 
                mental health and substance use disorder benefits.--A 
                group health plan or health insurance issuer offering 
                group or individual health insurance coverage to which 
                subparagraph (A) applies shall be considered in 
                violation of subparagraph (A)(ii) if the mental health 
                or substance use disorder benefits under such plan or 
                coverage provides for a permanent exclusion from such 
                benefits for a particular condition or disorder.''; and
            (2) by adding at the end the following new subsection:
    ``(f) Residential Treatment.--For purposes of this section, mental 
health and substance use disorder benefits include residential 
treatment.''.
    (b) ERISA.--Section 712 of the Employee Retirement Income Security 
Act of 1974 (29 U.S.C. 1185a) is amended--
            (1) in subsection (a)(3), by adding at the end the 
        following new subparagraph:
                    ``(C) Treatment of permanent exclusions under 
                mental health and substance use disorder benefits.--A 
                group health plan (or health insurance coverage offered 
                in connection with such a plan) to which subparagraph 
                (A) applies shall be considered in violation of 
                subparagraph (A)(ii) if the mental health or substance 
                use disorder benefits under such plan (or coverage) 
                provides for a permanent exclusion from such benefits 
                for a particular condition or disorder.''; and
            (2) by adding at the end the following new subsection:
    ``(h) Residential Treatment.--For purposes of this section, mental 
health and substance use disorder benefits include residential 
treatment.''.
    (c) IRC.--Section 9812 of the Internal Revenue Code of 1986 is 
amended--
            (1) in subsection (a)(3), by adding at the end the 
        following new subparagraph:
                    ``(C) Treatment of permanent exclusions under 
                mental health and substance use disorder benefits.--A 
                group health plan to which subparagraph (A) applies 
                shall be considered in violation of subparagraph 
                (A)(ii) if the mental health or substance use disorder 
                benefits under such plan provides for a permanent 
                exclusion from such benefits for a particular condition 
                or disorder.''; and
            (2) by adding at the end the following new subsection:
    ``(f) Residential Treatment.--For purposes of this section, mental 
health and substance use disorder benefits include residential 
treatment.''.
    (d) Limitation.--Nothing in this section or the amendments made by 
this section shall be construed as adding or expanding the scope of 
mental health or addiction services included under section 2726 of the 
Public Health Service Act (42 U.S.C. 300gg-26), section 712 of the 
Employee Retirement Income Security Act of 1974 (29 U.S.C. 1185a), or 
section 9812 of the Internal Revenue Code of 1986.

SEC. 10. PROHIBITION ON NEW APPROPRIATIONS.

    No additional funds are authorized to be appropriated to carry out 
this Act or the amendments made by this Act. This Act and such 
amendments shall be carried out using amounts otherwise made available 
for such purposes.
                                 <all>