[Congressional Record Volume 145, Number 43 (Thursday, March 18, 1999)]
[Senate]
[Pages S2941-S2942]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BINGAMAN (for himself, Mr. Craig, Ms. Mikulski, Mr. 
        Thurmond, Mr. Daschle, Ms. Collins, Mr. Johnson, Ms. Snowe, Mr. 
        Dorgan, Mr. Mack, Mr. Hollings, Mr. Reed, Mr. Conrad, and Mr. 
        Crapo):
  S. 660. 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.
  Mr. BINGAMAN. Mr. President, I rise today to introduce the Medical 
Nutrition Therapy Act of 1999 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 
dietician. 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 hospital stays, decreasing the number 
of complications, and reducing the need for physician follow-up visits.
  The treatment of patients with diabetes and cardiovascular disease 
accounts for a full 60% 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 
United 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 
dieticians 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 five 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 our 
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. 660

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

     SECTION 1. SHORT TITLE; FINDINGS.

       (a) Short Title.--This Act may be cited as the ``Medicare 
     Medical Nutrition Therapy Act of 1999''.
       (b) Findings.--Congress finds as follows:
       (1) Medical nutrition therapy is a medically necessary and 
     cost-effective way of treating and controlling many diseases 
     and medical conditions affecting the elderly, including HIV, 
     AIDS, cancer, kidney disease, diabetes, heart disease, 
     pressure ulcers, severe burns, and surgical wounds.
       (2) Medical nutrition therapy saves health care costs by 
     speeding recovery and reducing the incidence of 
     complications, resulting in fewer hospitalizations, shorter 
     hospital stays, and reduced drug, surgery, and treatment 
     needs.
       (3) A study conducted by The Lewin Group shows that, after 
     the third year of coverage, savings would be greater than 
     costs for coverage of medical nutrition therapy for all 
     medicare beneficiaries, with savings projected to grow 
     steadily in following years.
       (4) The Agency for Health Care Policy and Research has 
     indicated in its practice guidelines that nutrition is key to 
     both the prevention and the treatment of pressure ulcers 
     (also called bed sores) which annually cost the health care 
     system an estimated $1,300,000,000 for treatment.
       (5) Almost 17,000,000 patients each year are treated for 
     illnesses or injuries that stem from or place them at risk of 
     malnutrition.
       (6) Because medical nutrition therapy is not covered under 
     part B of the medicare program and because more and more 
     health care is delivered on an outpatient basis, many 
     patients are denied access to the effective, low-tech 
     treatment they need, resulting in an increased incidence of 
     complications and a need for higher cost treatments.

     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--

[[Page S2942]]

       (1) by striking ``and'' at the end of subparagraph (S);
       (2) by striking the period at the end of subparagraph (T) 
     and inserting ``; and''; and
       (3) by adding at the end the following new subparagraph:
       ``(U) medical nutrition therapy services (as defined in 
     subsection (uu)(1));''.
       (b) Services Described.--Section 1861 of such 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

       ``(uu)(1) The term `medical nutrition therapy services' 
     means nutritional diagnostic, therapy, and counseling 
     services for the purpose of disease management 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 
     regionally 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 organization recognized by the Secretary for 
     this 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 that 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 
     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 such Act (42 U.S.C. 
     1395l(a)(1)) is amended--
       (1) by striking ``and'' before ``(S)'', and
       (2) by inserting before the semicolon at the end the 
     following: ``, and (T) with respect to medical nutrition 
     therapy services (as defined in section 1861(uu)), 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 
     apply to services furnished on or after January 1, 2000.

  Mr. CRAIG. Mr. President, today Senator Bingaman and I join to 
introduce a very important piece of legislation, the Medical Nutrition 
Therapy Act. I'm pleased to have the support of a number of Senators in 
introducing this legislation: Senators Mack, Thurmond, Mikulski, Snowe, 
Daschle, Collins, Johnson, Crapo, Dorgan, Hollings, Reed, and Conrad. 
This bill simply expands Medicare Part B coverage to give seniors 
access to medical nutrition therapy services by registered dietitians 
and other nutrition professionals. Currently there is no direct 
coverage for services provided by registered dietitians, and, because 
they are uniquely qualified to provide medical nutrition therapy, 
beneficiaries are essentially denied access to this cost effective and 
efficacious form of care.
  Nutrition is one of the most basic elements of life. From the moment 
we are born to the moment we die, nutrition plays a critical role. It 
influences how we grow, how our brain develops, how we feel, and how 
our bodies prevent and fight disease. For decades we have known that 
nutrition can influence the most serious life threatening diseases, 
such as cancer, heart disease, stroke, diabetes, and high blood 
cholesterol.
  Experts have proven that proper nutrition may not only help prevent 
disease, but also is central to controlling and treating disease.
  Medical nutrition therapy plays a major role in treating some of the 
most threatening illnesses. It significantly improves the quality of 
life of seriously ill patients. It also saves health care costs by 
speeding recovery and reducing the incidence of complications, 
resulting in fewer hospitalizations, shorter hospital stays, and 
reduced drug, surgery, and treatment needs.
  Because medical nutrition therapy is not currently covered by 
Medicare Part B and because more and more health care is delivered on 
an outpatient basis, many patients are denied access to the effective, 
low-tech treatment they need, resulting in an increased incidence of 
complications and a need for higher cost treatments.
  Medical nutritional therapy is an integral part of cost effective 
health care.
  Our legislation would remedy this defect in Medicare Part B, 
improving health care and lowering costs. I invite all our colleagues 
to join Senator Bingaman and myself in working for this important 
reform.
                                 ______