[Congressional Record Volume 169, Number 188 (Tuesday, November 14, 2023)]
[Senate]
[Pages S5509-S5510]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Ms. COLLINS (for herself and Mr. Peters):
  S. 3297. 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. Madam President, I rise today to introduce the Medical 
Nutrition Therapy Act of 2023, along with my colleague from Michigan, 
Senator Peters. Our bill would 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 the increased prevalence of diet-related chronic 
conditions is contributing to poor health outcomes and growing 
healthcare expenditures, increasing access to MNT should be part of the 
strategy to improve disease management and prevention for America's 
seniors. The Medical Nutrition Therapy Act 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, HIV/AIDS, 
gastrointestinal diseases including celiac disease, and cardiovascular 
disease. 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 dietician nutritionists, 
RDNs, as part of a collaborative healthcare team. It is evidenced-based 
and proven to positively affect weight, blood pressure, blood lipids, 
and blood sugar control. Nutritional counseling by RDNs is 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. Follow up visits 
help reinforce important behavior and lifestyle changes and increase 
compliance.
  Older Americans 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, has seen 
many patients denied access to medically necessary MNT. One of her 
patients 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. That same week, this patient turned 65 and transitioned onto 
Medicare. You can imagine his surprise upon arriving for his 
appointment and learning that MNT would not be covered.
  Another unfortunate example from Maine was a patient with a new 
celiac disease diagnosis complicated by severe weight loss. His private 
insurance covered MNT as celiac disease is a controllable disease with 
proper nutrition. But when transitioning from private insurance to 
Medicare, this patient, too, lost his access to MNT. The saddest 
situation this RDN has confronted is when an older cancer patient 
experiences such side effects from cancer treatment as severe weight 
loss or nausea, which could be prevented with MNT. As with prediabetes 
and celiac disease, however, Medicare does not cover MNT for cancer 
patients. This truly is a lost opportunity since we know early 
treatment with MNT can prevent future and more serious health 
complications and chronic conditions in older adults. These conditions 
should be covered.
  In addition to leading to confusion and potential delays in care for 
patients seeking needed healthcare services, we must also consider the 
staggering economic impact of chronic diseases. According to the U.S. 
Centers for Disease Control and Prevention, 90 percent of the $3.8 
trillion that the United States spends annually on healthcare 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 dietitian 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.''

[[Page S5510]]

  MNT can help prevent chronic disease, such as type 2 diabetes. It can 
better control celiac and other gastrointestinal ailments. It can 
improve outcomes and the quality of life for those with cancer and 
other devastating diagnoses. The current Medicare restrictions on 
medical nutrtition therapy coverage can be detrimental for older adults 
at a critical juncture in their journey to better health and should be 
changed.
  The Medical Nutrition Therapy Act of 2023 is supported by more than 
40 expert national organizations, including the Academy of Nutrition 
and Dietetics, the American Diabetes Association, the Endocrine 
Society, and UsAgainstAlzheimer's.
  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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