[Congressional Record Volume 166, Number 140 (Thursday, August 6, 2020)]
[Senate]
[Page S5275]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. COLLINS (for herself and Mr. Peters):
  S. 4504. A bill to amend title XVIII of the Social Security Act to 
expand the availability of medical nutrition therapy services under the 
Medicare program; to the Committee on Finance.
  Ms. COLLINS. Mr. President, I rise today to join my colleague from 
Michigan, Senator Peters, in introducing legislation to expand Medicare 
beneficiaries' access to Medical Nutrition Therapy, or MNT, which is a 
cost-effective component of treatment for obesity, diabetes, 
hypertension, dyslipidemia, and other chronic conditions. At a time 
when we are seeing many diet-related chronic conditions contribute to 
poor COVID-19 outcomes, increasing access to MNT should be part of the 
strategy to improve disease management and prevention for America's 
seniors. Our legislation, the Medical Nutrition Therapy Act of 2020, 
would make two important changes to support patients, improve health 
outcomes, and reduce unnecessary healthcare costs.
  First, it would expand Medicare Part B coverage of outpatient medical 
nutrition therapy services to a number of currently uncovered diseases 
or conditions--including prediabetes, obesity, high blood pressure, 
high cholesterol, malnutrition, eating disorders, cancer, celiac 
disease, and HIV/AIDS. Currently, Medicare Part B only covers 
outpatient MNT for diabetes, renal disease, and post-kidney transplant. 
Second, the bill would allow more types of providers--including nurse 
practitioners, physician assistants, clinical nurse specialists, and 
psychologists--to refer patients to MNT. This is especially critical 
for a rural State like Maine, where a NP or PA may be one's trusted 
primary care provider.
  MNT counseling is provided by registered dietitian nutritionists, 
RDNs, as part of a collaborative healthcare team. It is evidenced-based 
and proven to positively impact weight, blood pressure, blood lipids, 
and blood sugar control, and nutritional counseling by RDNs is even 
recommended by the National Lipid Association to promote long-term 
adherence to an individualized, heart-healthy diet. Through MNT, 
individuals benefit from in-depth individualized nutrition assessments 
and trusted followup visits for the repeated reinforcement necessary to 
aid with behavior and lifestyle changes.
  Seniors deserve improved access to this cost-effective medical 
treatment, but many older adults are missing out under the current 
Medicare policy. Marcy Kyle, a RDN from Rockport, ME, shared numerous 
stories of patients being denied access to medically necessary MNT that 
illustrate why this legislation is needed. In one story, a patient with 
prediabetes was referred by his primary care physician for MNT at age 
64. At that time, his private insurance covered the service and he 
booked the first available appointment the following week. But this 
patient turned 65 that week and transitioned onto Medicare. You can 
imagine his surprise upon arriving for his appointment that MNT would 
not be covered. While the outpatient facility changed its process after 
this case in order to prevent similar situations, it demonstrates how 
the current restrictions are detrimental for older adults at a critical 
juncture in their health journey.
  Another example from Maine was a patient with a new diagnosis of 
celiac disease complicated by severe weight loss. His private insurance 
covered MNT as celiac disease is a very controllable disease with 
proper nutrition. But when transitioning from private insurance to 
Medicare, this patient lost his opportunity for MNT. We know that early 
treatment with MNT can prevent future and more serious health 
complications and chronic conditions in older adults, and conditions 
such as prediabetes and celiac disease should be covered.
  The health and financial crisis brought on by the COVID-19 pandemic 
makes access to MNT even more important. Seniors with diet-related 
conditions are suffering more than any other population in terms of the 
worst health outcomes, including death. Data from the Centers for 
Medicare & Medicaid Services, CMS, in June confirmed elevated risk for 
seniors with underlying health conditions. Among those hospitalized 
with COVID-19, 79 percent of patients had hypertension, 60 percent had 
hyperlipidemia, 50 percent of patients either presented with chronic 
kidney disease or diabetes. Tragically, of those hospitalized, 28 
percent were never able to leave the hospital because they passed away.
  In addition to the significant health impacts, the economic impact of 
chronic diseases is staggering. According to the U.S. Centers for 
Disease Control and Prevention, 90 percent of the $3.5 trillion the 
United States spends annually on health care goes to the treatment of 
people with chronic diseases and mental health conditions. Preventing 
chronic diseases, or managing symptoms when prevention is not possible, 
is one way to reduce these costs. This is particularly important for 
the Medicare Program as more than two-thirds of seniors on Medicare 
live with multiple chronic conditions. As one registered dietition 
nutritionist in Maine told me, ``We all know a dollar spent on 
prevention saves many health care dollars in the long run and is the 
right thing to do for our seniors at a time when they have limited 
budgets.''
  The Medical Nutrition Therapy Act of 2020 is supported by more than 
30 national organizations, including the Academy of Nutrition and 
Dietetics, the American Diabetes Association, the Endocrine Society, 
the American Cancer Society Cancer Action Network, and the National 
Kidney Foundation.
  I urge my colleagues to support this important legislation to improve 
access to cost-effective medical treatment for Medicare patients with 
chronic diseases.
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