[Congressional Record Volume 153, Number 63 (Thursday, April 19, 2007)]
[Senate]
[Pages S4754-S4755]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BINGAMAN (for himself, Mr. Craig, Mr. Conrad, Mr. Schumer, 
        and Ms. Cantwell):
  S. 1161. A bill to amend title XVIII of the Social Security Act to 
authorize the expansion of medicare coverage of medical nutrition 
therapy services; to the Committee on Finance.
  Mr. BINGAMAN. Mr. President, I am pleased today to join with my 
colleagues Senators Craig and Conrad and others in introducing the 
Medicare Medical Nutrition Therapy Act of 2007. This marks the fourth 
consecutive Congress that Senator Craig and I have joined together in 
introducing a bill to expand the current Medicare Medical Nutrition 
Therapy (MNT) benefit.
  In 2000, the Congress passed a bill authorizing Medicare payment for 
MNT services, but only for patients with diabetes and renal diseases. 
Recognizing that many other diseases also have a nutrition component to 
their treatment, Congress asked the Centers for Medicare and Medicaid 
services to report back to Congress their recommendations on MNT 
coverage. That report was submitted to Congress in 2004 and recommended 
that patients with conditions such as hypertension, dyslipidemia, and 
certain cancers be eligible to receive MNT therapy.
  Medical Nutrition Therapy is not nutrition counseling, it is much 
more. It involves a specific diagnosis of a disease, condition, or 
disorder that can be treated with nutrition intervention. That is why 
Congress limited MNT provider status to Registered Dietitians; they 
have the specific training necessary to address nutritional 
interventions as part of a diseased related therapy.
  As we all know, Medicare is under tremendous financial stress. It is 
therefore critically important that bills designed to expand Medicare's 
coverage be both necessary and cost effective. This is exactly why 
Senator Craig and I have been such consistent supporters of expanding 
the MNT benefit.
  Under our current bill, there is no mandated expansion of the 
benefit. Instead, we simply give the Centers for Medicare and Medicaid 
Services the authority to expand coverage using the National Coverage 
Determination process. The Congress has mandated that the criteria used 
in that process is necessary and reasonable.
  As a result, the MNT benefit will not be expanded beyond diabetes and 
renal diseases unless such expansion is proven to be cost effective. 
This is likely not a difficult test for MNT to meet.

[[Page S4755]]

There is considerable evidence that MNT is cost effective in the 
treatment of conditions such as pre-diabetes, which surprisingly is not 
eligible for MNT.
  Five years ago, in March of 2002, then HHS Secretary Tommy G. 
Thompson warned Americans of the risks of ``pre-diabetes,'' a condition 
affecting nearly 16 million Americans that sharply raises the risk for 
developing type 2 diabetes and increases the risk of heart disease by 
50 percent.
  HHS-supported research that shows most people with pre-diabetes will 
likely develop diabetes within a decade unless they make modest changes 
in their diet and level of physical activity, which can help them 
reduce their risks and avoid the debilitating disease.
  Secretary Thompson called for physicians to begin screening 
overweight people age 45 and older for pre-diabetes. When Congress 
passed the Medicare Modernization Act in December 2003, it included 
diabetes (and pre-diabetes) screening in the Welcome to Medicare 
physical. So Medicare now covers diabetes screening and will pay for 
MNT for beneficiaries diagnosed with diabetes, but it will not pay for 
nutrition counseling for beneficiaries diagnosed with pre-diabetes. 
This makes no sense.
  The last Congress recognized the critical role that MNT can play in 
the treatment of HIV/AIDS by making MNT one of the Core Medical 
Services under the Ryan White CARE Act. According to the American 
Dietetic Association, ``The importance of nutrition and especially 
medical nutrition therapy to the treatment and management of HIV 
disease cannot be overstated. MNT has become a critical element of 
disease management for persons living with HIV/AIDS.'' Many HIV/AIDs 
patients are eligible for Medicare and these patients are in need of 
MNT to help them manage their disease.
  Since the current MNT benefit is limited under statute to just 
beneficiaries with diabetes and renal diseases, CMS lacks the authority 
to expand the benefit regardless of how cost effective it is or how 
many lives it might save. This makes no sense.
  The bill that Senator Craig and I are introducing today gives the 
experts at CMS the authority to make those decisions. Choosing to rely 
on the National Coverage Determination (NCD) process would allow CMS to 
make decisions based upon the science, and establish the extent to 
which Medicare will cover specific services, procedures or technologies 
on a national basis. This is what the NCD is designed to do. This 
approach also recognizes the importance of saving Medicare dollars.
  I urge my colleagues to join with me today in supporting this bill.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 1161

       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 2007''.

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

       (a) Authorizing Expanded Eligible Population.--Section 
     1861(s)(2)(V) of the Social Security Act (42 U.S.C. 
     1395x(s)(2)(V)) is amended--
       (1) by redesignating clauses (i) through (iii) as 
     subclauses (I) through (III), respectively, and indenting 
     each such clause an additional 2 ems;
       (2) by striking ``in the case of a beneficiary with 
     diabetes or a renal disease who--'' and inserting ``in the 
     case of a beneficiary--
       ``(i) with diabetes or a renal disease 
     who--'';
       (3) by adding ``or'' at the end of subclause (III) of 
     clause (i), as so redesignated; and
       (4) by adding at the end the following new clause:
       ``(ii) who is not described in clause (i) but who has 
     another disease, condition, or disorder for which the 
     Secretary has made a national coverage determination (as 
     defined in section 1869(f)(1)(B)) for the coverage of such 
     services;''.
       (b) Coverage of Services Furnished by Physicians.--Section 
     1861(vv)(1) of the Social Security Act (42 U.S.C. 
     1395x(vv)(1)) is amended by inserting ``or which are 
     furnished by a physician'' before the period at the end.
       (c) National Coverage Determination Process.--In making a 
     national coverage determination described in section 
     1861(s)(2)(V)(ii) of the Social Security Act, as added by 
     subsection (a)(4), the Secretary of Health and Human 
     Services, acting through the Administrator of the Centers for 
     Medicare & Medicaid Services, shall--
       (1) consult with dietetic and nutrition professional 
     organizations in determining appropriate protocols for 
     coverage of medical nutrition therapy services for 
     individuals with different diseases, conditions, and 
     disorders; and
       (2) consider the degree to which medical nutrition therapy 
     interventions prevent or help prevent the onset or 
     progression of more serious diseases, conditions, or 
     disorders.
       (d) Effective Date.--The amendments made by this section 
     shall apply to services furnished on or after January 1, 
     2008.
                                 ______