[Congressional Record Volume 143, Number 45 (Wednesday, April 16, 1997)]
[Senate]
[Page S3288]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BINGAMAN (for himself, Mr. Craig, Mr. Hollings, Mr. Reid, 
        Mr. Akaka, Mr. Cochran, Mr. Dorgan, Mr. Inouye, Mrs. Boxer, Ms. 
        Snowe, Mr. Torricelli, and Mr. Mack):
  S. 597. A bill to amend title XVIII of the Social Security Act to 
provide for coverage under part B of the Medicare Program of medical 
nutrition therapy services furnished by registered dietitians and 
nutrition professionals; to the Committee on Finance.


               the medical nutrition therapy act of 1997

  Mr. BINGAMAN. Mr. President, I rise today to introduce the Medical 
Nutrition Therapy Act of 1997 on behalf of myself, my friend and 
colleague from Idaho, Senator Craig, and a bipartisan group of 
additional Senators.
  This bipartisan measure provides for coverage under part B of the 
Medicare Program for medical nutrition therapy services by a registered 
dietitian. Medical nutrition therapy is generally defined as the 
assessment of patient nutritional status followed by therapy, ranging 
from diet modification to administration of specialized nutrition 
therapies such as intravenous or tube feedings. It has proven to be a 
medically necessary and cost-effective way of treating and controlling 
many disease entities such as diabetes, renal disease, cardiovascular 
disease, and severe burns.
  Currently, there is no consistent part B coverage policy for medical 
nutrition and this legislation will bring needed uniformity to the 
delivery of this important care, as well as save taxpayer money. 
Coverage for medical nutrition therapy can save money by reducing 
hospital admissions, shortening hospitals stays, decreasing the number 
of complications, and reducing the need for physician followup visits.
  The treatment of patients with diabetes and cardiovascular disease 
account for a full 60 percent of Medicare expenditures. I want to use 
diabetes as an example for the need for this legislation. There are 
very few families who are not touched by diabetes. The burden of 
diabetes is disproportionately high among ethnic minorities in the 
Unites States. According to the American Journal of Epidemiology, 
mortality due to diabetes is higher nationwide among blacks than 
whites. It is higher among American Indians than among any other ethnic 
group.
  In my State of New Mexico, native Americans are experiencing an 
epidemic of type II diabetes. Medical nutrition therapy is integral to 
their diabetes care. In fact, information from the Indian Health 
Service shows that medical nutrition therapy provided by professional 
dietitians results in significant improvements in medical outcomes in 
people with type II diabetes. For example, complications of diabetes 
such as end stage renal failure that leads to dialysis can be prevented 
with adequate intervention. Currently, the number of dialysis patients 
in the Navajo population is doubling every 5 years. Mr. President, we 
must place our dollars in the effective, preventive treatment of 
medical nutrition therapy rather than face the grim reality of having 
to continue to build new dialysis units.
  Ensuring the solvency of the Medicare part A trust fund is one of the 
most difficult challenges and one that calls for creative, effective 
solutions. Coverage for medical nutrition therapy is one important way 
to help address that challenge. It is exactly the type of cost-
effective care we should encourage. It will satisfy two of our most 
important priorities in Medicare: Providing program savings while 
maintaining a high level of quality care.
  Mr. President, I ask unanimous consent that the text of this bill be 
printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                 S. 597

       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 ``Medicare Medical Nutrition 
     Therapy Act of 1997''.

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

       (a) Coverage.--Section 1861(s)(2) of the Social Security 
     Act (42 U.S.C. 1395x(s)(2)) is amended--
       (1) by striking ``and'' at the end of subparagraphs (N) and 
     (O); and
       (2) by inserting after subparagraph (O) the following:
       ``(P) medical nutrition therapy services (as defined in 
     subsection (oo)(1));''.
       (b) Services Described.--Section 1861 of the Social 
     Security Act (42 U.S.C. 1395x) is amended by adding at the 
     end the following new subsection:

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

       ``(oo)(1) The term `medical nutrition therapy services' 
     means nutritional diagnostic, therapy, and counseling 
     services which are furnished by a registered dietitian or 
     nutrition professional (as defined in paragraph (2)) pursuant 
     to a referral by a physician (as defined in subsection 
     (r)(1)).
       ``(2) Subject to paragraph (3), the term `registered 
     dietitian or nutrition professional' means an individual 
     who--
       ``(A) holds a baccalaureate or higher degree granted by a 
     regional accredited college or university in the United 
     States (or an equivalent foreign degree) with completion of 
     the academic requirements of a program in nutrition or 
     dietetics, as accredited by an appropriate national 
     accreditation organizations recognized by the Secretary for 
     the purpose;
       ``(B) has completed at least 900 hours of supervised 
     dietetics practice under the supervision of a registered 
     dietitian or nutrition professional; and
       ``(C)(i) is licensed or certified as a dietitian or 
     nutrition professional by the State in which the services are 
     performed; or
       ``(ii) in the case of an individual in a State which does 
     not provide for such licensure or certification, meets such 
     other criteria as the Secretary establishes.
       ``(3) Subparagraphs (A) and (B) of paragraph (2) shall not 
     apply in the case of an individual who as of the date of the 
     enactment of this subsection is licensed or certified as a 
     dietitian or nutrition professional by the State in which 
     medical nutrition therapy services are performed.''.
       (c) Payment.--Section 1833(a)(1) of the Social Security Act 
     (42 U.S.C. 13951(a)(1)) is amended--
       (1) by striking ``and'' before ``(P)''; and
       (2) by inserting before the semicolon at the end the 
     following: ``, and (Q) with respect to medical nutrition 
     therapy services (as defined in section 1861(oo)), the amount 
     paid shall be 80 percent of the lesser of the actual charge 
     for the services or the amount determined under the fee 
     schedule established under section 1848(b) for the same 
     services if furnished by a physician''.
       (d) Effective Date.--The amendments made by this section 
     shall apply to services furnished on or after January 1, 
     1998.

  Mr. CRAIG. Mr. President, this morning, I stand to introduce with my 
colleague from New Mexico, Jeff Bingaman, legislation that will be 
called the Medical Nutrition Therapy Act of 1997. I think we have all 
heard of the old adage that ``an ounce of prevention is worth a pound 
of cure.'' That is very true in the legislation that we are proposing 
today, along with our colleagues from the House.
  Simply stated, medical nutrition therapy involves the assessment of 
the nutritional status of patients with a condition, illness, or injury 
that puts them at nutritional risk. Once a problem is identified, a 
registered dietitian can work with the patient to develop a personal 
therapy or treatment. Almost 17 million Americans each year, mostly the 
elderly, are treated for chronic illnesses or injuries that place them 
at risk of malnutrition. But because of medical nutrition therapy, in 
many instances, this can be resolved. The only problem today is that 
these preventive measures are not covered by Medicare.
  Our legislation would simply provide coverage under Medicare part B 
for medical nutrition therapy services furnished by registered 
dietitians and nutrition professionals. This is necessary so that the 
elderly are not denied effective low-technology treatment of their 
needs. I had the privilege of touring several hospitals in Idaho where 
medical nutrition therapy is now being used, and the results are 
dramatic.
  As we begin to closely examine our Medicare system, we must focus on 
the modernization of a 30-year-old health insurance system for the 
elderly. We need to make sure that it is truly modern, not only in its 
payment, its application, its style, but in the broad array of health 
care services that it responds to. Today, many private health insurance 
programs recognize medical nutrition therapy. Now, it is time that 
Medicare did.
  I hope my colleagues will join with Senator Bingaman and myself, as 
we introduce the Medical Nutrition Therapy Act. It is important that we 
begin to recognize these services and provide coverage under Medicare 
part B.
  I yield the floor.
                                 ______