[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 584 Introduced in Senate (IS)]

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117th CONGRESS
  1st Session
                                 S. 584

To amend title XVIII of the Social Security Act to provide coverage of 
    medical nutrition therapy services for individuals with eating 
                 disorders under the Medicare program.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 3, 2021

Ms. Hassan (for herself, Ms. Murkowski, and Mrs. Capito) introduced the 
 following bill; which was read twice and referred to the Committee on 
                                Finance

_______________________________________________________________________

                                 A BILL


 
To amend title XVIII of the Social Security Act to provide coverage of 
    medical nutrition therapy services for individuals with eating 
                 disorders under the Medicare program.

    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 ``Nutrition Counseling Aiding Recovery 
for Eating Disorders Act of 2021'' or the ``Nutrition CARE Act of 
2021''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) 28,800,000 individuals in the United Sates, or 9 
        percent of the national population, will have an eating 
        disorder in their lifetime. It is estimated that 1,619,300 to 
        2,080,600 individuals on Medicare part B are affected by an 
        eating disorder, including 420,500 to 560,700 beneficiaries who 
        identify as Black, Indigenous, or People of Color.
            (2) 10,200 deaths per year in the United States occur as a 
        direct result of an eating disorder, equating to 1 death every 
        52 minutes. Eating disorders have one of the highest mortality 
        rates of all mental illness due to serious medical 
        comorbidities such as stroke, diabetes, and gastric rupture, in 
        addition to the fact that longitudinal studies have found that 
        the suicide risk for those with an eating disorder is 23 times 
        the expected risk.
            (3) Eating disorders can be successfully treated with care 
        encompassing the 4 pillars of successful treatment: medical, 
        psychiatric, therapy, and medical nutrition therapy. In 
        general, Medicare provides some, but not all, care necessary 
        for eating disorders treatment. It doesn't cover medical 
        nutrition therapy at the outpatient level and provides no 
        coverage at the intensive outpatient or residential treatment 
        levels.
            (4) Eating disorders are expensive. The yearly economic 
        cost of eating disorders is $64,700,000,000, with families and 
        individuals experiencing an economic loss of $23,500,000,000 
        per year. Each year, eating disorders are directly responsible 
        for 23,560 inpatient hospitalizations costing $209,700,000 and 
        53,918 emergency room visits costing $29,300,000.
            (5) Eating disorders in the elderly are particularly 
        serious because chronic disorders or diseases may already 
        compromise a patient's health and make a patient more prone to 
        serious comorbidities associated with eating disorders, 
        including cardiac, metabolic, gastric, and bone conditions. 
        Early diagnosis and proper treatment of this population is 
        essential.

SEC. 3. PROVIDING COVERAGE OF MEDICAL NUTRITION THERAPY SERVICES FOR 
              INDIVIDUALS WITH EATING DISORDERS UNDER THE MEDICARE 
              PROGRAM.

    Section 1861 of the Social Security Act (42 U.S.C. 1395x) is 
amended--
            (1) in subsection (s)(2)(V)--
                    (A) by redesignating clauses (i) through (iii) as 
                subclauses (I) through (III), respectively, and 
                adjusting the margins accordingly;
                    (B) in subclause (III), as so redesignated, by 
                striking the semicolon at the end and inserting ``; 
                or'';
                    (C) by striking ``beneficiary with diabetes'' and 
                inserting the following: ``beneficiary--
                    ``(i) with diabetes''; and
                    (D) by adding at the end the following new clause:
                    ``(ii) beginning January 1, 2022, with an eating 
                disorder (as defined by the Secretary in accordance 
                with most recent edition of the Diagnostic and 
                Statistical Manual of Mental Disorders published by the 
                American Psychiatric Association);''; and
            (2) in subsection (vv)--
                    (A) in paragraph (1)--
                            (i) by inserting ``(including management of 
                        an eating disorder (as defined for purposes of 
                        subsection (s)(2)(V)(ii)))'' after ``disease 
                        management''; and
                            (ii) by striking ``which are furnished by'' 
                        and all that follows through the period and 
                        inserting ``which are furnished--
                    ``(A) by a registered dietitian or nutrition 
                professional (as defined in paragraph (2));
                    ``(B) pursuant to a referral by--
                            ``(i) a physician (as defined in subsection 
                        (r)(1)); or
                            ``(ii) a psychologist (or other mental 
                        health professional to the extent authorized 
                        under State law); and
                    ``(C) in the case of such services furnished to an 
                individual for the purpose of management of such an 
                eating disorder, at the times specified in paragraph 
                (4).''; and
                    (B) by adding at the end the following new 
                paragraph:
    ``(4)(A) For purposes of paragraph (1)(C), the times specified in 
this paragraph are, with respect to medical nutrition therapy services 
furnished to an individual for purposes of management of an eating 
disorder, at least the following:
            ``(i) 13 hours (including a 1-hour initial assessment and 
        12 hours of reassessment and intervention) during the 1-year 
        period beginning on the date such individual is first furnished 
        such services.
            ``(ii) Subject to subparagraph (B), 4 hours during each 
        subsequent 1-year period.
    ``(B) The Secretary may apply such other reasonable limitations 
with respect to the furnishing of medical nutrition therapy services 
for purposes of management of an eating disorder during a period 
described in subparagraph (A)(ii) as the Secretary determines 
appropriate.''.
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