[Congressional Record Volume 157, Number 31 (Thursday, March 3, 2011)]
[Senate]
[Pages S1228-S1232]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. HARKIN (for himself, Ms. Klobuchar, and Mr. Franken):
  S. 481. A bill to enhance and further research into the prevention 
and treatment of eating disorders, to improve access to treatment of 
eating disorders, and for other purposes; to the Committee on Health, 
Education, Labor, and Pensions.
  Mr. HARKIN. Mr. President, today I am pleased to join with Senators 
Klobuchar and Franken to reintroduce the Federal Response to 
Eliminating Eating Disorders Act, or the FREED Act. The FREED Act is a 
comprehensive legislative effort to confront eating disorders in the 
United States, to learn more about their devastating impact, and to 
offer support and care to those who suffer from these illnesses.
  Eating disorders such as anorexia nervosa, bulimia nervosa, and binge 
eating disorder are widespread, insidious, and too often fatal. Today, 
at least 5 million Americans suffer from eating disorders. Because 
these conditions often go undiagnosed and unreported, the actual number 
may be closer to 11 million Americans, including 1 million males. These 
disorders don't discriminate by gender, race, income, or age.
  Eating disorders are dangerous conditions, though their consequences 
are often underestimated. Eating disorders are associated with serious 
heart conditions, kidney failure, osteoporosis, infertility, 
gastrointestinal disorders, and even death. The National Institute of 
Mental Health estimates that one in 10 people with anorexia nervosa 
will die of starvation, cardiac arrest, or some other medical 
complication. Let me repeat that--one in 10. That is deeply disturbing, 
and demands a much more aggressive federal response. Moreover, 
fatalities resulting from eating disorders are grossly underreported, 
because deaths are typically recorded by listing the immediate cause of 
death, such as cardiac arrest, rather than the underlying cause, which 
is the eating disorder.
  Nonetheless, despite the prevalence and very serious health impacts 
of eating disorders, we simply do not know enough about the causes of 
eating disorders, or how to stop them from developing in the first 
place. Research suggests a genetic component to eating disorders, but 
we must learn more in order to effectively prevent these deadly 
conditions before they start.
  The good news is that eating disorders are treatable. With 
appropriate nutritional, medical, and psychotherapeutic interventions, 
those who suffer from eating disorders can be successfully and fully 
treated and go on to live full and healthy lives. But right now, only 
one in 10 people receive treatment. We know how to help people with 
eating disorders and we need a renewed commitment to do just that.
  The FREED Act takes an important step forward in authorizing 
resources for research, screening, treatment, and prevention of eating 
disorders.
  First, the FREED Act expands research efforts at the National 
Institutes of Health to examine the causes and consequences of eating 
disorders. In order to effectively prevent and treat these conditions, 
it is imperative that we understand them. The FREED Act also improves 
surveillance and data collection systems at CDC so that we will have 
accurate information and epidemiological data on eating disorders. Such 
surveillance will provide us with the necessary information to be as 
effective as possible with our interventions.
  Second, the FREED Act expands access to treatment services and 
screening for eating disorders for Medicaid beneficiaries, and 
authorizes funds for a patient advocacy network that will help 
individuals with eating disorders find treatment. Furthermore, the 
FREED Act improves the training and education of health care providers 
and educators so they know how to identify and treat individuals 
suffering from eating disorders. Too often, eating disorders go 
undiagnosed when health care providers lack the necessary training to 
identify these illnesses.
  Finally, we need to step up crucial efforts to prevent these 
disorders from occurring in the first place. As I have said so many 
times, we don't have a genuine health care system in America; we have a 
sick care system. In other words, if you get sick, you get treatment. 
But we spend just pennies on the dollar to prevent disease and illness 
in the first place and need to place a much more robust emphasis on 
wellness, nutrition, physical activity, and public health. With this in 
mind, the FREED Act authorizes funds to develop and implement evidence-
based prevention programs and promote healthy eating behaviors in 
schools, athletic programs, and other community-based programs, where 
we can reach Americans at risk of developing these conditions.
  Eating disorders touch the lives of so many of us and our families 
and friends; nearly half of all Americans personally know someone with 
an eating disorder. We must do a better job at the federal level of 
conducting research, understanding treatment, and preventing these 
conditions. The FREED Act builds on the investments we made in 
prevention, wellness, and mental health in the Affordable Care Act and 
mental health parity. Millions of American will benefit from our 
attention to this significant public health problem.
  I thank Senators Klobuchar and Franken for partnering with me on the 
reintroduction of this bill, and urge our colleagues to join us in 
supporting this important federal response to eating disorders.
  Mr. President, 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. 481

       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 ``Federal Response to 
     Eliminate Eating Disorders Act''.

     SEC. 2. FINDINGS.

       Congress finds as follows:
       (1) Estimates, based on current research, indicate that at 
     least 5,000,000 people in the United States suffer from 
     eating disorders including anorexia nervosa, bulimia nervosa, 
     binge eating disorder, and eating disorders not otherwise 
     specified (referred to in this Act as ``EDNOS'').
       (2) Anecdotal evidence suggests that as many as 11,000,000 
     people in the United States, including 1,000,000 males, may 
     suffer from eating disorders.
       (3) Eating disorders occur in all nations and in all 
     populations, and among people of all ages and races and of 
     both genders.
       (4) Eating disorders are diseases with grave health 
     consequences and high rates of mortality.
       (5) Health consequences associated with eating disorders 
     include heart failure and other serious cardiac conditions, 
     electrolyte imbalance, kidney failure, osteoporosis, 
     debilitating tooth decay, and gastrointestinal disorders, 
     including esophageal inflammation and rupture, gastric 
     rupture, peptic ulcers, and pancreatitis.
       (6) Anorexia nervosa has one of the highest overall 
     mortality rates of any mental illness. According to the 
     National Institute of Mental Health, 1 in 10 people with 
     anorexia nervosa will die of starvation, cardiac arrest, or 
     another medical complication.

[[Page S1229]]

       (7) The risk of death among adolescents with anorexia 
     nervosa is 11 times greater than in disease-free adolescents.
       (8) Anorexia nervosa has the highest suicide rate of all 
     mental illnesses.
       (9) New research suggests that bulimia nervosa has a much 
     higher rate of mortality than is reflected in current 
     statistics, because of the failure to identify the underlying 
     eating disorder.
       (10) Binge eating disorder is the most common eating 
     disorder, with an estimated 3.5 percent of American women and 
     2 percent of American men expected to suffer from this 
     disorder in their lifetime. Binge eating disorder is 
     characterized by frequent episodes of uncontrolled overeating 
     and is associated with obesity, heart disease, gall bladder 
     disease, and diabetes.
       (11) Research demonstrates that there is a significant 
     genetic component to the development of eating disorders.
       (12) Certain populations, including adolescent females and 
     athletes of both genders, are at higher risk of developing an 
     eating disorder.
       (13) Different types of eating disorders may affect certain 
     races and genders disproportionately.
       (14) Despite the serious health consequences and the high 
     risk of death, Federal research funding for eating disorders 
     has lagged behind research concerning other diseases, when 
     compared by the number of individuals affected by, and the 
     relative health consequences of, the diseases.
       (15) The ability of individuals suffering from eating 
     disorders, particularly bulimia nervosa, binge eating 
     disorder, and EDNOS to access appropriate treatment is 
     unacceptably low.
       (16) The development of an eating disorder is frequently 
     preceded by unhealthy weight control behaviors commonly 
     identified as disordered eating, including skipping meals, 
     using diet pills, taking laxatives, self-induced vomiting, 
     and fasting. Such disordered eating behaviors should be 
     included in enhanced research prevention and training 
     efforts.

     SEC. 3. PURPOSES.

       The purposes of this Act are--
       (1) to expand research into the prevention of eating 
     disorders;
       (2) to expand research on effective treatment and 
     intervention of eating disorders and to support evidence-
     based programs designed to prevent eating disorders;
       (3) to expand research on the causes, courses, and outcomes 
     of eating disorders;
       (4) to increase the number of people properly screened and 
     diagnosed with an eating disorder;
       (5) to improve training and education of health care and 
     behavioral care providers and of school personnel at all 
     levels of elementary and secondary education;
       (6) to improve surveillance and data systems for tracking 
     the prevalence, severity, and economic costs of eating 
     disorders; and
       (7) to enhance access to comprehensive treatment for eating 
     disorders.

            TITLE I--EATING DISORDER DETECTION AND RESEARCH

     SEC. 101. EXPANSION AND COORDINATION OF THE ACTIVITIES OF THE 
                   NATIONAL INSTITUTE OF HEALTH AND THE NATIONAL 
                   INSTITUTE OF MENTAL HEALTH WITH RESPECT TO 
                   RESEARCH ON EATING DISORDERS.

       Part B of title IV of the Public Health Service Act (42 
     U.S.C. 284 et seq.) is amended by adding at the end the 
     following:

     ``SEC. 409K. EXPANSION AND COORDINATION OF ACTIVITIES WITH 
                   RESPECT TO RESEARCH ON EATING DISORDERS.

       ``(a) In General.--The Director of NIH, pursuant to the 
     general authority of such director, shall expand, intensify, 
     and coordinate the activities of the National Institutes of 
     Health with respect to research on eating disorders.
       ``(b) Grants.--The Director of NIH may award grants to 
     public or private entities to pay all or part of the cost of 
     planning, establishing, improving, and providing basic 
     operating support for such entities to establish consortia in 
     eating disorder research and to carry out the activities 
     described in subsection (e).
       ``(c) Eligible Entities.--To be eligible to receive a grant 
     under this section, an entity shall--
       ``(1) be public or nonprofit private entity (including a 
     health department of a State, a political subdivision of a 
     State, or an institution of higher education); and
       ``(2) submit to the Secretary an application at such time, 
     in such manner, and containing such information as the 
     Secretary may require.
       ``(d) Requirements of Consortia.--
       ``(1) In general.--Each consortium established as described 
     in subsection (b) may use the facilities of a single lead 
     institution, or may be formed from several cooperating 
     institutions, meeting such requirements as may be prescribed 
     by the Director of NIH.
       ``(2) Coordination of consortia.--The Director of NIH--
       ``(A) may, as appropriate, provide for the coordination of 
     information among consortia established under subsection (b); 
     and
       ``(B) shall ensure regular communication between members of 
     the various consortia established using grants awarded under 
     this section.
       ``(3) Reports.--The Director of NIH shall require each 
     consortium to prepare and submit to such director annual 
     reports on the activities of such consortium.
       ``(e) Activities.--Each consortium receiving a grant under 
     subsection (b) shall conduct basic, clinical, 
     epidemiological, population-based, or translational research 
     regarding eating disorders, which may include research 
     related to--
       ``(1) the identification and classification of eating 
     disorders and disordered eating;
       ``(2) the causes, diagnosis, and early detection of eating 
     disorders;
       ``(3) the treatment of eating disorders, including the 
     development and evaluation of new treatments and best 
     practices;
       ``(4) the conditions or diseases related to, or arising 
     from, an eating disorder; and
       ``(5) the evaluation of existing prevention programs and 
     the development of reliable prevention and screening 
     programs.
       ``(f) Collaboration.--The Secretary, acting through the 
     Director of NIH and the Director of the National Institute of 
     Mental Health, shall identify relevant Federal agencies 
     (including the other institutes and centers of the National 
     Institutes of Health, the Centers for Medicare & Medicaid 
     Services, the Centers for Disease Control and Prevention, the 
     Agency for Healthcare Research and Quality, the Substance 
     Abuse and Mental Health Services Administration, the Health 
     Resources and Services Administration, and the Office on 
     Women's Health) that shall collaborate with respect to 
     activities conducted under subsection (d).
       ``(g) Public Input.--The Director of NIH shall provide for 
     a mechanism--
       ``(1) to educate and disseminate information on the 
     existing and planned programs and research activities of the 
     National Institutes of Health with respect to eating 
     disorders; and
       ``(2) through which the Director of NIH may receive 
     comments from the public regarding such programs and 
     activities.
       ``(h) Dissemination of Information.--The Director of NIH 
     shall provide for a mechanism for making the results and 
     information generated by the consortia publicly available, 
     such as through the Internet.
       ``(i) Definition.--For purposes of this section, the term 
     `eating disorder' has the meaning given such term in section 
     399OO(e).
       ``(j) Authorization of Appropriations.--To carry out this 
     section, there are authorized to be appropriated such sums as 
     may be necessary for each of fiscal years 2012 through 
     2016.''.

     SEC. 102. INTERAGENCY COORDINATING COUNCIL; SURVEILLANCE AND 
                   RESEARCH PROGRAM; STUDY ON ECONOMIC COST.

       Title III of the Public Health Service Act (42 U.S.C. 241 
     et seq.) is amended by adding at the end the following:

            ``PART W--PROGRAMS RELATING TO EATING DISORDERS

     ``SEC. 399OO. INTERAGENCY EATING DISORDERS COORDINATING 
                   COUNCIL.

       ``(a) Establishment.--There is established within the 
     Department of Health and Human Services the Interagency 
     Eating Disorders Coordinating Council (referred to in this 
     section as the `Coordinating Council').
       ``(b) Responsibilities.--The Coordinating Council shall--
       ``(1) develop and annually update a summary of advances in 
     eating disorder research concerning causes of, prevention of, 
     early screening for, treatment and access to services related 
     to, and supports for individuals affected by, eating 
     disorders;
       ``(2) monitor Federal activities with respect to eating 
     disorders;
       ``(3) make recommendations to the Secretary regarding any 
     appropriate changes to such activities, and to the Director 
     of NIH, with respect to the strategic plan developed under 
     paragraph (4);
       ``(4) develop and annually update a strategic plan for the 
     conduct of, and support for, eating disorder research, 
     including proposed budgetary recommendations; and
       ``(5) submit annually to the Committee on Health, 
     Education, Labor, and Pensions of the Senate and the 
     Committee on Energy and Commerce of the House of 
     Representatives the strategic plan developed under paragraph 
     (4) and all updates to such plan.
       ``(c) Membership.--
       ``(1) Chairperson.--The Director of NIH shall serve as the 
     chairperson of the Coordinating Council and shall be 
     responsible for the leadership and oversight of the 
     activities of the Coordinating Council.
       ``(2) Members in general.--The Coordinating Council shall 
     be composed of--
       ``(A) representatives of--
       ``(i) the Agency for Healthcare Research and Quality;
       ``(ii) the Substance Abuse and Mental Health 
     Administration;
       ``(iii) the research institutes at the National Institutes 
     of Health, as the Director of NIH determines appropriate;
       ``(iv) the Health Resources and Services Administration;
       ``(v) the Centers for Medicare & Medicaid Services;
       ``(vi) the Office on Women's Health;
       ``(vii) the Centers for Disease Control and Prevention;
       ``(viii) the Department of Education; and
       ``(ix) any other Federal agency that the chairperson 
     determines is appropriate; and
       ``(B) the additional members appointed under paragraph (3).
       ``(3) Additional members.--Not fewer than \1/3\ of the 
     total membership of the Coordinating Council shall be 
     composed of non-Federal public members to be appointed by the 
     Secretary, including representatives of--
       ``(A) academic medical centers or schools of medicine, 
     nursing, or other health professions;

[[Page S1230]]

       ``(B) health care professionals who are actively involved 
     in the treatment of eating disorders;
       ``(C) researchers with expertise in eating disorders; and
       ``(D) at least 2 individuals with a past or present 
     diagnosis of an eating disorder or parents of individuals 
     with a past or present diagnosis of an eating disorder.
       ``(d) Administrative Support; Terms of Service; Other 
     Provisions.--
       ``(1) Administrative support.--The Coordinating Council 
     shall receive necessary and appropriate administrative 
     support from the Secretary.
       ``(2) Terms of service.--Members of the Coordinating 
     Council appointed under subsection (c)(2) shall serve for a 
     term of 4 years, and may be reappointed for one or more 
     additional 4 year-terms. Any member appointed to fill a 
     vacancy for an unexpired term shall be appointed for the 
     remainder of such term. A member may serve after the 
     expiration of the member's term until a successor has taken 
     office.
       ``(3) Meetings.--
       ``(A) In general.--The Coordinating Council shall meet at 
     the call of the chairperson or upon the request of the 
     Secretary. The Coordinating Council shall meet not fewer than 
     2 times each year.
       ``(B) Notice.--Notice of any upcoming meeting of the 
     Coordinating Council shall be published in the Federal 
     Register.
       ``(C) Public access.--Each meeting of the Coordinating 
     Council shall be open to the public and shall include 
     appropriate periods of time for questions by the public.
       ``(4) Subcommittees.--In carrying out its functions the 
     Coordinating Council may establish subcommittees and convene 
     workshops and conferences.
       ``(e) Eating Disorder.--In this part, the term `eating 
     disorder' includes anorexia nervosa, bulimia nervosa, binge 
     eating disorder, and eating disorders not otherwise 
     specified, as defined in the fourth edition of the Diagnostic 
     and Statistical Manual of Mental Disorders or any subsequent 
     edition.
       ``(f) Authorization of Appropriations.--To carry out this 
     section, there are authorized to be appropriated such sums as 
     may be necessary for each of fiscal years 2012 through 2016.

     ``SEC. 399OO-1. EATING DISORDER SURVEILLANCE AND RESEARCH 
                   PROGRAM.

       ``(a) In General.--The Secretary, acting through the 
     Director of the Centers for Disease Control and Prevention, 
     shall award grants or cooperative agreements to eligible 
     entities for the purpose of improving the collection, 
     analysis and reporting of State epidemiological data on 
     eating disorders.
       ``(b) Activities.--An eligible entity shall assist with the 
     development and coordination of eating disorder surveillance 
     efforts within a region and may--
       ``(1) provide for the collection, analysis, and reporting 
     of epidemiological data on eating disorders through the 
     existing surveillance programs;
       ``(2) develop recommendations to enhance existing 
     surveillance programs to more accurately collect 
     epidemiological data on disordered eating and eating 
     disorders, including the prevalence, incidence, trends, 
     correlates, mortality, and causes of eating disorders and the 
     effects of eating disorders on quality of life;
       ``(3) develop recommendations to improve requirements for 
     ensuring that eating disorders are accurately recorded as 
     underlying and contributing causes of death; and
       ``(4) assist with the development and coordination of 
     surveillance efforts within a region.
       ``(c) Eligible Entities.--To be eligible to receive an 
     award under this section, an entity shall--
       ``(1) be a public or nonprofit private entity (including a 
     health department of a State, a political subdivision of a 
     State, or an institution of higher education); and
       ``(2) submit to the Secretary an application at such time, 
     in such manner, and containing such information as the 
     Secretary may require.
       ``(d) Technical Assistance.--In making awards under this 
     section, the Secretary may provide direct technical 
     assistance in lieu of cash.
       ``(e) Reports.--Each entity awarded a grant or cooperative 
     agreement under this section shall annually submit to the 
     Secretary a report describing the activities conducted using 
     grant funds and providing recommendations for improving the 
     collection, analysis, and reporting of epidemiological data 
     on eating disorders.
       ``(f) Authorization of Appropriations.--To carry out this 
     section, there are authorized to be appropriated such sums as 
     may be necessary for each of fiscal years 2012 through 2016.

     ``SEC. 399OO-2. STUDY REGARDING ECONOMIC COSTS OF EATING 
                   DISORDERS.

       ``Not later than 18 months after the date of enactment of 
     the Federal Response to Eliminate Eating Disorders Act, the 
     Secretary, acting through the Director of the Centers for 
     Disease Control and Prevention, shall conduct a study 
     evaluating the economic costs of eating disorders. Such study 
     may examine years of productive life lost, missed days of 
     work, reduced work productivity, costs of medical and mental 
     health treatment, costs to family, and costs to society as a 
     result of eating disorders.''.

 TITLE II--EATING DISORDER EDUCATION AND PREVENTION; STUDIES ON EATING 
      DISORDERS AND BODY MASS INDEX; PUBLIC SERVICE ANNOUNCEMENTS

     SEC. 201. GRANTS TO PREVENT EATING DISORDERS.

       Title III of the Public Health Service Act (42 U.S.C. 241 
     et seq.), as amended by section 102, is further amended by 
     adding at the end the following:

     ``SEC. 399OO-3. GRANTS TO PREVENT EATING DISORDERS.

       ``(a) In General.--The Secretary, acting through the 
     Director of the Centers for Disease Control and Prevention 
     and in coordination with the Administrator of the Health 
     Resources and Services Administration, shall award grants to 
     eligible entities to plan, implement, and evaluate programs 
     to prevent eating disorders and obesity and the acute and 
     chronic medical conditions that accompany such conditions, 
     and to promote healthy body image and appropriate nutrition-
     based eating behaviors.
       ``(b) Eligibility.--To be eligible to receive a grant under 
     this section, an entity shall--
       ``(1) be a State, local or tribal educational agency, an 
     accredited institution of higher education, a State or local 
     health department, or a community based organization; and
       ``(2) submit an application to the Secretary at such time, 
     in such manner, and containing such information as the 
     Secretary may require.
       ``(c) Use of Funds.--An entity receiving a grant under this 
     section shall fund development and testing of school-, 
     clinic-, community-, or health department-based programs 
     designed to promote healthy eating behaviors and to prevent 
     eating disorders including--
       ``(1) developing evidence-based interventions to prevent 
     eating disorders, including educational or intervention 
     programs regarding nutritional content, understanding and 
     responding to hunger and satiety, positive body image 
     development, positive self-esteem development, and life 
     skills, that take into account cultural and developmental 
     issues and the role of family, school, and community;
       ``(2) planning and implementing a healthy lifestyle 
     curriculum or program with an emphasis on healthy eating 
     behaviors, physical activity, and emotional wellness, the 
     connection between emotional and physical health, and the 
     prevention of bullying based on body size, shape, and weight;
       ``(3) forming partnerships with parents and caregivers to 
     educate adults about identifying unhealthy eating behaviors 
     and promoting healthy eating behaviors, physical activity, 
     and emotional wellness; and
       ``(4) integrating eating disorder prevention and awareness 
     in physical education, health, education, athletic training 
     programs, and after-school recreational sports programs, to 
     the extent possible.
       ``(d) Requirements of Grant Recipients.--
       ``(1) Limitation on administrative expenses.--A recipient 
     of a grant under this section shall not use more than 10 
     percent of the amounts received under a grant under this 
     section for administrative expenses.
       ``(2) Contribution of funds.--A recipient of a grant under 
     this section, and any entity receiving assistance under the 
     grant for training and education, shall contribute non-
     Federal funds, either directly or through in-kind 
     contributions, to the costs of the activities to be funded 
     under the grant in an amount that is not less than 10 percent 
     of the total cost of such activities.
       ``(3) Evaluation.--Each recipient of a grant under this 
     section shall provide to the Secretary, in such form and 
     manner as the Secretary shall specify, relevant data and an 
     evaluation of the activities of the grant recipient in 
     promoting healthy eating behaviors and preventing eating 
     disorders. Evaluation reports shall be made publicly 
     available, such as through the Internet.
       ``(e) Technical Assistance.--The Secretary may set aside an 
     amount not to exceed 1 percent of the total amount 
     appropriated for a fiscal year to provide grantees with 
     technical support in the development, implementation, and 
     evaluation of programs under this section and to disseminate 
     information about preventing and treating eating disorders 
     and obesity.

     ``SEC. 399OO-4. STUDY OF EATING DISORDERS IN ELEMENTARY 
                   SCHOOLS, SECONDARY SCHOOLS, AND INSTITUTIONS OF 
                   HIGHER EDUCATION.

       ``Not later than 18 months after the date of enactment of 
     the Federal Response to Eliminate Eating Disorders Act, the 
     National Center for Health Statistics of the Centers for 
     Disease Control and Prevention and the National Center for 
     Education Statistics of the Department of Education shall 
     conduct a joint study, or enter into a contract to have a 
     study conducted, on the impact eating disorders have on 
     educational advancement and achievement. The study shall--
       ``(1) determine the incidence of eating disorders and 
     disordered eating among students, and the morbidity and 
     mortality rates associated with eating disorders;
       ``(2) evaluate the extent to which students with eating 
     disorders are more likely to miss school, have delayed rates 
     of development, or have reduced cognitive skills;
       ``(3) report on current State and local programs to 
     increase awareness about the dangers of eating disorders 
     among youth and to prevent eating disorders and the risk 
     factors for eating disorders, and evaluate the value of such 
     programs; and
       ``(4) make recommendations on measures that could be 
     undertaken by Congress, the Department of Education, States, 
     and local educational agencies to strengthen eating

[[Page S1231]]

     disorder prevention and awareness programs including 
     development of best practices.

     ``SEC. 399OO-5. STUDY OF THE SUITABILITY OF MANDATING BODY 
                   MASS INDEX REPORTING IN ELEMENTARY SCHOOLS AND 
                   SECONDARY SCHOOLS.

       ``Not later than 18 months after the date of enactment of 
     the Federal Response to Eliminate Eating Disorders Act, the 
     Director of the Centers for Disease Control and Prevention, 
     in consultation with the Secretary of Education, shall 
     conduct a study on mandatory reporting of body mass index, 
     including--
       ``(1) how many schools are currently conducting mandatory 
     reporting of body mass index;
       ``(2) how schools are assessing the impacts of such 
     mandatory reporting on body mass index; and
       ``(3) how schools are assessing potential unintended 
     consequences of such mandatory reporting on students, 
     including those related to parent and peer relations.

     ``SEC. 399OO-6. PUBLIC SERVICE ADVERTISEMENTS.

       ``The Secretary, in consultation with the Director of the 
     National Institutes of Health and the Secretary of Education, 
     shall carry out a program to develop, distribute, and promote 
     the broadcasting of public service announcements to improve 
     public awareness of, and to promote the identification and 
     prevention, of eating disorders.

     ``SEC. 399OO-7. AUTHORIZATION OF APPROPRIATIONS.

       ``To carry out sections 399OO-3, 399OO-4, 399OO-5, and 
     399OO-6, there are authorized to be appropriated such sums as 
     may be necessary for each of fiscal years 2012 through 
     2016.''.

     SEC. 202. SENSE OF THE SENATE.

       It is the sense of the Senate that critically necessary 
     programs to reduce obesity in children may also 
     unintentionally increase the unhealthy weight control 
     behaviors that can lead to development of eating disorders, 
     and that federally funded programs to combat obesity should 
     take this connection into consideration.

  TITLE III--IMPROVING TRAINING IN HEALTH PROFESSIONS, EDUCATION, AND 
                             RELATED FIELDS

     SEC. 301. GRANTS FOR HEALTH PROFESSIONALS.

       Part D of title VII of the Public Health Service Act (42 
     U.S.C. 294 et seq.) is amended by adding at the end the 
     following:

     ``SEC. 760. GRANTS FOR HEALTH PROFESSIONALS.

       ``(a) Grants.--The Secretary, acting through the 
     Administrator of the Health Resources and Services 
     Administration, in collaboration with the Director of the 
     Centers for Disease Control and Prevention, shall award 
     grants under this section to develop interdisciplinary 
     training and education programs that provide undergraduate, 
     graduate, post-graduate medical, nursing (including advanced 
     practice nursing students), dental, mental and behavioral 
     health, pharmacy, and other health professions students or 
     residents with an understanding of, and clinical skills 
     pertinent to identifying and treating, eating disorders.
       ``(b) Eligibility.--To be eligible to receive a grant under 
     this section an entity shall--
       ``(1) be an accredited school of allopathic or osteopathic 
     medicine, or an accredited school of nursing, public health, 
     social work, dentistry, behavioral and mental health, or 
     pharmacy, or an accredited medical, dental, or nursing 
     residency program;
       ``(2) prepare and submit to the Secretary an application at 
     such time, in such manner, and containing such information as 
     the Secretary may require.
       ``(c) Use of Funds.--
       ``(1) Required uses.--Amounts provided under a grant 
     awarded under this section shall be used to fund 
     interdisciplinary training and education projects that are 
     designed to train medical, nursing, and other health 
     professions students and residents to--
       ``(A) better identify patients at-risk of becoming 
     overweight or obese or developing an eating disorder;
       ``(B) detect overweight or obesity or eating disorders 
     among a diverse patient population;
       ``(C) counsel, refer, or treat patients with overweight or 
     obesity or an eating disorder;
       ``(D) educate patients and the families of patients about 
     effective strategies to establish healthy eating habits and 
     appropriate levels of physical activity; and
       ``(E) assist in the creation and administration of 
     community-based overweight and obesity and eating disorder 
     prevention efforts.''
       ``(2) Permissive use.--Amounts provided under a grant under 
     this section may be used to offer community-based training 
     opportunities in rural areas for medical, nursing, and other 
     health professions students and residents on eating 
     disorders, which may include the use of distance learning 
     networks and other available technologies needed to reach 
     isolated rural areas.
       ``(d) Requirements of Grantees.--
       ``(1) Limitation on administrative expenses.--A grantee 
     shall not use more than 10 percent of the amounts received 
     under a grant under this section for administrative expenses.
       ``(2) Contribution of funds.--A grantee under this section, 
     and any entity receiving assistance under the grant for 
     training and education, shall contribute non-Federal funds, 
     either directly or through in-kind contributions, to the 
     costs of the activities to be funded under the grant in an 
     amount that is not less than 10 percent of the total cost of 
     such activities.
       ``(e) Eating Disorder.--In this section, the term `eating 
     disorder' has the meaning given such term in section 
     399OO(e).
       ``(f) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section such 
     sums as may be necessary for fiscal years 2012 through 
     2016.''.

     SEC. 302. TRAINING IN ELEMENTARY AND SECONDARY SCHOOLS.

       Section 5131(a) of the Elementary and Secondary Education 
     Act of 1965 (20 U.S.C. 7215(a)) is amended by adding at the 
     end the following:
       ``(28) Programs to improve the identification of students 
     with eating disorders (as defined in section 399OO of the 
     Public Health Service Act), increase awareness of such 
     disorders among parents and students, and train educators 
     (including teachers, school nurses, school social workers, 
     coaches, school counselors, and administrators) on effective 
     eating disorder prevention, screening, detection and 
     assistance methods.''.

        TITLE IV--IMPROVING AVAILABILITY AND ACCESS TO TREATMENT

     SEC. 401. MEDICAID COVERAGE FOR EATING DISORDER TREATMENT 
                   SERVICES.

       (a) In General.--Section 1905 of the Social Security Act 
     (42 U.S.C. 1396d(a)) is amended--
       (1) in subsection (a)--
       (A) in paragraph (28), by striking ``and'' at the end;
       (B) by redesignating paragraph (29) as paragraph (30); and
       (C) by inserting after paragraph (28) the following new 
     paragraph:
       ``(29) eating disorder treatment services (as defined in 
     subsection (ee)(1)); and''; and
       (2) by adding at the end the following new subsection:
       ``(ee) Eating Disorder Treatment Services.--
       ``(1) Definition.--The term `eating disorder treatment 
     services' means services relating to diagnosis and treatment 
     of an eating disorder (as defined in section 399OO of the 
     Public Health Service Act), including screening, counseling, 
     pharmacotherapy (including coverage of drugs described in 
     paragraph (2)), and other necessary health care services.
       ``(2) Coverage for pharmacological treatment of eating 
     disorders.--For purposes of paragraph (1), eating disorder 
     treatment services shall include drugs provided as part of 
     care in an inpatient setting, covered outpatient drugs (as 
     defined in section 1927(k)(2)), and non-prescription drugs 
     described in section 1927(d)(2)(A) that are prescribed, in 
     accordance with generally accepted medical guidelines, for 
     treatment of an eating disorder.''.
       (b) Increased FMAP for Eating Disorder Treatment 
     Services.--
       (1) Effective until january 1, 2013.--Section 1905(b) of 
     the Social Security Act (42 U.S.C. 1396d(b)) is amended in 
     the first sentence--
       (A) by striking ``and'' before ``(4)''; and
       (B) by inserting before the period at the end the 
     following: ``, and (5) the Federal medical assistance 
     percentage shall be equal to the enhanced FMAP described in 
     section 2105(b) with respect to medical assistance for eating 
     disorder treatment services (as defined in subsection 
     (ee)(1)) provided to an individual who is eligible for such 
     assistance and has an eating disorder (as defined in section 
     399OO of the Public Health Service Act)''.
       (2) Effective january 1, 2013.--Section 4106(b) of the 
     Patient Protection and Affordable Care Act (Public Law 111-
     148) is amended--
       (A) in paragraph (1), by striking ``(4)'' each time such 
     term appears and inserting ``(5)''; and
       (B) in paragraph (2), by striking ``, and (5)'' and 
     inserting ``, and (6)''.
       (c) Inclusion in EPSDT Services.--Section 1905(r)(1)(B) of 
     such Act (42 U.S.C. 1396d(r)(1)(B)) is amended--
       (1) in clause (iv), by striking ``and'' at the end;
       (2) in clause (v), by striking the period at the end and 
     inserting ``; and''; and
       (3) by inserting after clause (v) the following new clause:
       ``(vi) appropriate diagnostic services relating to eating 
     disorders (as defined in section 399OO of the Public Health 
     Service Act).''.
       (d) Exception From Optional Restriction Under Medicaid Drug 
     Coverage.--Section 1927(d)(2)(A) of such Act (42 U.S.C. 
     1396r-8(d)(2)(A)) is amended by inserting before the period 
     at the end the following: ``, except for drugs that are 
     prescribed, in accordance with generally accepted medical 
     guidelines, for the purpose of treatment of an individual who 
     is eligible for medical assistance under the State plan and 
     has an eating disorder (as defined in section 399OO of the 
     Public Health Service Act)''.
       (e) Effective Date.--The amendments made by this section 
     shall apply to drugs and services furnished on or after 
     January 1, 2012.

     SEC. 402. GRANTS TO SUPPORT PATIENT ADVOCACY.

       Subpart II of part D of title IX of the Public Health 
     Service Act is amended by adding at the end the following:

     ``SEC. 938. GRANTS TO SUPPORT PATIENT ADVOCACY.

       ``(a) Grants.--The Secretary, acting through the Director, 
     shall award grants under this section to develop and support 
     patient advocacy work to help individuals with eating 
     disorders obtain adequate health care services and insurance 
     coverage.

[[Page S1232]]

       ``(b) Eligibility.--To be eligible to receive a grant under 
     this section, an entity shall--
       ``(1) be a public or nonprofit private entity (including a 
     health department of a State or tribal agency, a community-
     based organization, or an institution of higher education);
       ``(2) prepare and submit to the Secretary an application at 
     such time, in such manner, and containing such information as 
     the Secretary may require, including--
       ``(A) comprehensive strategies for advocating on behalf of, 
     and working with, individuals with eating disorders or at 
     risk for developing eating disorders;
       ``(B) a plan for consulting with community-based 
     coalitions, treatment centers, or eating disorder research 
     experts who have experience and expertise in issues related 
     to eating disorders or patient advocacy in providing services 
     under a grant awarded under this section; and
       ``(C) a plan for financial sustainability involving State, 
     local, and private contributions.
       ``(c) Use of Funds.--Amounts provided under a grant awarded 
     under this section shall be used to support patient advocacy 
     work, including--
       ``(1) providing education and outreach in community 
     settings regarding eating disorders and associated health 
     problems, especially among low-income, minority, and 
     medically underserved populations;
       ``(2) facilitating access to appropriate, adequate, and 
     timely health care for individuals with eating disorders and 
     associated health problems;
       ``(3) assisting in communication and cooperation between 
     patients and providers;
       ``(4) representing the interests of patients in managing 
     health insurance claims and plans;
       ``(5) providing education and outreach regarding enrollment 
     in health insurance, including enrollment in the Medicare 
     program under title XVIII of the Social Security Act, the 
     Medicaid program under title XIX of such Act, and the 
     Children's Health Insurance Program under title XXI of such 
     Act;
       ``(6) identifying, referring, and enrolling underserved 
     populations in appropriate health care agencies and 
     community-based programs and organizations in order to 
     increase access to high-quality health care services;
       ``(7) providing technical assistance, training, and 
     organizational support for patient advocates; and
       ``(8) creating, operating, and participating in State or 
     regional networks of patient advocates.
       ``(d) Requirements of Grantees.--
       ``(1) Limitation on administrative expenses.--A grantee 
     shall not use more than 5 percent of the amounts received 
     under a grant under this section for administrative expenses.
       ``(2) Contribution of funds.--A grantee under this section, 
     and any entity receiving assistance under the grant for 
     training and education, shall contribute non-Federal funds, 
     either directly or through in-kind contributions, to the 
     costs of the activities to be funded under the grant in an 
     amount that is not less than 75 percent of the total cost of 
     such activities.
       ``(3) Reporting to secretary.--A grantee under this section 
     shall annually submit to the Secretary a report, at such 
     time, in such manner, and containing such information as the 
     Secretary may require, including a description and evaluation 
     of the activities described in subsection (c) carried out by 
     such entity.
       ``(e) Eating Disorder.--In this section, the term `eating 
     disorder' has the meaning given such term in section 
     399OO(e).
       ``(f) Authorization of Appropriations.--To carry out this 
     section, there are authorized to be appropriated such sums as 
     may be necessary for fiscal years 2012 through 2016.''.
                                 ______