[Congressional Record Volume 147, Number 73 (Thursday, May 24, 2001)]
[Senate]
[Pages S5636-S5637]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BINGAMAN (for himself, Mr. Craig, Mr. Cochran, Ms. 
        Collins, Mr. Daschle, Mr. Dorgan, Mr. Ensign, Mrs. Murray, Ms. 
        Stabenow, and Mr. Warner):
  S. 960. A bill to amend title XVIII of the Social Security Act to 
expand coverage of medical nutrition therapy services under the 
Medicare program for beneficiaries with cardiovascular diseases; to the 
Committee on Finance.
  Mr. BINGAMAN. Mr. President, I rise today to introduce bipartisan 
legislation with my good friend and colleague from Idaho, Senator Craig 
and a bipartisan group of additional Senators. This legislation, 
entitled the ``Medicare Medical Nutrition Therapy Amendment Act of 
2001,'' provides for the coverage of nutrition therapy for 
cardiovascular disease under Part B of the Medicare program by a 
registered dietitian.
  This bill builds on provisions in the ``Medicare, Medicaid and SCHIP 
Benefits Improvement and Protection Act,'' otherwise known as BIPA, 
which included coverage of Medicare nutrition therapy for diabetes and 
renal disease taken from my legislation last year, S. 660, the 
``Medicare Medical Nutrition Therapy Act of 1999.''
  This bipartisan legislation is necessary because there is currently 
no consistent Medicare Part B coverage policy for medical nutrition 
therapy, despite the fact that poor nutrition is a major problem in 
older Americans. Nutrition therapy in the ambulatory or outpatient 
settings has been considered by Medicare to be a preventive service, 
and therefore, not explicitly covered.
  While it was significant that nutrition therapy coverage was added to 
Part B of the Medicare program for diabetes and renal disease, it is 
critical that the Congress also takes action to cover cardiovascular 
disease through passage of this legislation, as recommended by the 
Institute of Medicine in its report, The Role of Nutrition in 
Maintaining Health in the Nation's Elderly: Evaluating Coverage of 
Nutrition Services for the Medicare Population.
  The report, which had been requested by Congress in the Balanced 
Budget Act of 1997, found that nutrition therapy has been shown to be 
effective in the management and treatment of many chronic conditions 
which affect Medicare beneficiaries, including diabetes and chronic 
renal insufficiency, but also cardiovascular disease. As the IOM notes, 
``Cardiovascular diseases are the leading cause of death and major 
contributors to medical utilization and disability . . . Furthermore, 
there is a striking age-related rise in mortality from heart disease 
such that the vast majority of deaths due to heart disease occur in 
persons age 65 and older.''
  In addition, the costs associated with cardiovascular disease are 
substantial with regard to the Medicare program. According to the IOM, 
``. . . in 1995, Medicare spent $24.6 billion for hospital expenses 
related to [cardiovascular diseases], an amount that corresponds to 33 
percent of its hospitalization expenditures.''
  Providing nutrition therapy to Medicare beneficiaries could 
positively impact the Medicare Part A Trust Fund if hospitalization 
could be reduced or avoided. The IOM found this would likely occur. As 
the report notes, ``Such programs can prevent readmissions for heart 
failure, reduce subsequent length of stay, and improve functional 
status and quality-of-life . . . In view of the high costs of managing 
heart failure, particular admissions for heart failure exacerbations, 
and the rapid response to therapies, there is a real potential for cost 
savings from multidisciplinary heart failure programs that include 
nutrition therapy.''
  It is exactly the type of cost effective care that we should 
encourage in the Medicare program. As the American Heart Association 
adds in their letter of support for this legislation, Dr. Robert Eckel 
points out that, in one study, ``for every dollar spent on [Medicare 
nutrition therapy] there is a three to ten dollar cost savings realized 
by reducing the need for drug therapy.'' With drug costs increasing 
dramatically, this could potentially result in significant cost savings 
to Medicare beneficiaries.
  Therefore, both the Medicare program and beneficiaries would benefit

[[Page S5637]]

from this expanded benefit. As the IOM concludes, ``Expanded coverage 
for nutrition therapy is likely to generate economically significant 
benefits to beneficiaries, and in the short term to the Medicare 
program itself, through reduced healthcare expenditures. . . .''
  Most importantly, it would also improve the quality of care of 
Medicare beneficiaries. As the IOM report adds, ``Whether or not 
expanded coverage reduces overall Medicare expenditures, it is 
recommended that these services be reimbursed given the reasonable 
evidence of improved patient outcomes associated with such care.''
  For these reasons, I am pleased to be introducing the ``Medicare 
Medical Nutrition Therapy Amendment Act of 2001'' today with Senator 
Craig.
  However, as this legislation is introduced, I do want to note that 
the IOM also recommended nutrition therapy be covered based on 
physician referral rather than a specific medical condition. The 
original legislation introduced in the last Congress by Senator Craig 
and myself did just that but was made disease-specific in conference 
last year. While I am pleased to introduce this legislation to include 
cardiovascular disease, I do believe that we need to move toward 
eliminating this disease-specific approach in the near future. For 
example, I believe that Medicare should also provide Medicare nutrition 
therapy for HIV/AIDS, cancer, and osteoporosis, among other things.
  In the meantime, I urge the Congress to expand Medicare nutrition 
therapy benefits to cover cardiovascular diseases as soon as possible.
  I request unanimous consent that the text of the bill be printed in 
the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                 S. 960

  [Data not available at time of printing.]
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