[Congressional Record Volume 153, Number 102 (Friday, June 22, 2007)]
[Extensions of Remarks]
[Page E1386]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




   INTRODUCTION OF THE MEDICARE MEDICAL NUTRITION THERAPY ACT OF 2007

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                          HON. XAVIER BECERRA

                               of nevada

                    in the house of representatives

                        Thursday, June 21, 2007

  Mr. BECERRA. Madam Speaker, I rise today to introduce the bipartisan 
Medicare Medical Nutrition Therapy Act (MMNTA) of 2007. This 
legislation is cosponsored by my friends and colleagues Representatives 
Michael Castle (R-DE), Diana DeGette (D-CO) and Mark Kirk (R-IL).
  The MMNTA of 2007 authorizes Medicare to expand the use of medical 
nutrition therapy to treat any disease for which empirical research has 
shown clinical value. The American Dietetic Association has endorsed 
this important legislation.
  In 2000, the Institute of Medicine (IOM) of the National Academy of 
Sciences found that medical nutrition therapy is effective as part of a 
comprehensive approach to the treatment and management of the following 
conditions: diabetes, heart failure, kidney failure, dyslipidemia (a 
total cholesterol condition as well as other abnormalities in blood 
lipid levels) and hypertension. In response to this study, Congress 
allowed Medicare to reimburse medical nutrition therapy for 
beneficiaries with diabetes and renal diseases.
  Specifically, the benefit Congress added includes an initial 
assessment of a beneficiary's nutrition and lifestyle, nutrition 
counseling, information regarding managing lifestyle factors that 
affect diet and follow-up visits to monitor the beneficiary's progress. 
Medicare covers three hours of one-on-one counseling services the first 
year, and two hours each year after that. The benefit provides 
additional treatment hours when the beneficiary's condition, treatment, 
or diagnosis changes and a physician refers the beneficiary. A 
physician must prescribe these services and renew them yearly if 
continuing treatment is needed.
  In 2004, the Department of Health and Human Services (HHS) released a 
report that reiterated that medical nutrition therapy is effective as 
part of a comprehensive approach to the management and treatment of 
dyslipidemia (referred to as hyperlidemia in the HHS report) and 
hypertension. This study's corroboration of 10M's earlier findings 
demonstrates that many Medicare beneficiaries who could benefit from 
this treatment cannot access it through Medicare.
  Moreover, expanding the use of medical nutrition therapy has the 
potential to be a cost effective means of providing health care. 
Recently, the Pfizer Corporation piloted a 6-month nutrition and 
exercise intervention program for employees with hyperlipidemia. The 
study concluded that this intervention reduced Low-density Lipoprotein 
(LDL) cholesterol 12 months later. And, the participating employees had 
their risk for heart disease reduced by 19 percent. The intervention 
could save an estimated $728,722 annually if offered to the entire 
Pfizer population.
  Unfortunately, the method that Congress established to determine 
eligibility for medical nutrition therapy is flawed. Congress specified 
in law which diseases should receive medical nutrition therapy instead 
of leaving that judgment to the Center for Medicare and Medicaid 
Services (CMS) as is the custom for other benefits provided by the 
program.
  CMS has the experts and infrastructure to make these important 
decisions based on empirical research. As part of its administration of 
the Medicare program, CMS determines the items and services that are 
reasonable and necessary for the diagnosis or treatment of an illness 
or injury suffered by Medicare beneficiaries. CMS makes national 
coverage determinations by evaluating medical literature and data and 
information on the effectiveness and appropriateness of medical items 
and services that are being considered for Medicare coverage. During 
this process, the public has the opportunity to provide comments. In 
some cases, CMS' own research is supplemented by an outside assessment 
and/or consultation with a Medicare Evidence Development & Coverage 
Advisory Committee (MedCAC). A MedCAC consists of outside experts who 
supplement CMS career staff examination of an issue. These committees 
examine the strength of available evidence and make recommendations to 
CMS on coverage decisions.
  By passing this legislation, Congress would increase access to 
medical nutrition therapy to Medicare beneficiaries through a 
thoughtful and scientific approach. I urge my colleagues to support 
this bill and ensure that Medicare beneficiaries have the appropriate 
access to medical nutrition therapy.

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