II 

116TH CONGRESS 

1ST SESSION S. 595 

To amend title XVIII of the Social Security Act to provide for the 

coordination of programs to prevent and treat obesity, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 28, 2019 

Mr. CASSIDY (for himself, Mr. CARPER, Mrs. CAPITO, Mr. COONS, Mrs. 

BLACKBURN, Mr. HEINRICH, Ms. MURKOWSKI, and Ms. KLOBUCHAR) introduced the following bill; which was read twice and referred to the Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to provide 

for the coordination of programs to prevent and treat 

obesity, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Treat and Reduce Obe5 sity Act of 2019’’. 

6 SEC. 2. FINDINGS. 

7 Congress makes the following findings: 

8 (1) According to the Centers for Disease Con9 trol and Prevention, about 41 percent of adults aged 


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1 60 and over had obesity in the period of 2015 

2 through 2016, representing more than 27 million 

3 people. 

4 (2) The National Institutes of Health has re5 ported that obesity and overweight are now the sec6 ond leading cause of death nationally, with an esti7 mated 300,000 deaths a year attributed to the epi8 demic. 

9 (3) Obesity increases the risk for chronic dis10 eases and conditions, including high blood pressure, 

11 heart disease, certain cancers, arthritis, mental ill12 ness, lipid disorders, sleep apnea, and type 2 diabe13 tes. 

14 (4) More than half of Medicare beneficiaries are 

15 treated for 5 or more chronic conditions per year. 

16 The rate of obesity among Medicare beneficiaries 

17 doubled from 1987 to 2002 and nearly doubled 

18 again by 2016, with Medicare spending on individ19 uals with obesity during that time rising proportion20 ately to reach $50 billion in 2014. 

21 (5) Men and women with obesity at age 65 have 

22 decreased life expectancy of 1.6 years for men and 

23 1.4 years for women. 

24 (6) The direct and indirect cost of obesity was 

25 more than $427.8 billion in 2014 and is growing. 


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1 (7) On average, a Medicare beneficiary with 

2 obesity costs $2,018 (in 2019 dollars) more than a 

3 healthy-weight beneficiary. 

4 (8) The prevalence of obesity among older indi5 viduals in the United States is growing at a linear 

6 rate and, if nothing changes, nearly one in two (47 

7 percent) Medicare beneficiaries aged 65 and over 

8 will have obesity in 2030, up from slightly more 

9 than one in four (28 percent) in 2010. 

10 SEC. 3. AUTHORITY TO EXPAND HEALTH CARE PROVIDERS 

11 QUALIFIED TO FURNISH INTENSIVE BEHAV12 IORAL THERAPY. 

13 Section 1861(ddd) of the Social Security Act (42 

14 U.S.C. 1395x(ddd)) is amended by adding at the end the 

15 following new paragraph: 

16 ‘‘(4)(A) Subject to subparagraph (B), the Sec17 retary may, in addition to qualified primary care 

18 physicians and other primary care practitioners, 

19 cover intensive behavioral therapy for obesity fur20 nished by any of the following: 

21 ‘‘(i) A physician (as defined in subsection 

22 (r)(1)) who is not a qualified primary care phy23 sician. 

24 ‘‘(ii) Any other appropriate health care 

25 provider (including a physician assistant, nurse 


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1 practitioner, or clinical nurse specialist (as 

2 those terms are defined in subsection (aa)(5)), 

3 a clinical psychologist, a registered dietitian or 

4 nutrition professional (as defined in subsection 

5 (vv))). 

6 ‘‘(iii) An evidence-based, community-based 

7 lifestyle counseling program approved by the 

8 Secretary. 

9 ‘‘(B) In the case of intensive behavioral therapy 

10 for obesity furnished by a provider described in 

11 clause (ii) or (iii) of subparagraph (A), the Secretary 

12 may only cover such therapy if such therapy is fur13 nished— 

14 ‘‘(i) upon referral from, and in coordina15 tion with, a physician or primary care practi16 tioner operating in a primary care setting or 

17 any other setting specified by the Secretary; 

18 and 

19 ‘‘(ii) in an office setting, a hospital out20 patient department, a community-based site 

21 that complies with the Federal regulations con22 cerning the privacy of individually identifiable 

23 health information promulgated under section 

24 264(c) of the Health Insurance Portability and 


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1 Accountability Act of 1996, or another setting 

2 specified by the Secretary. 

3 ‘‘(C) In order to ensure a collaborative effort, 

4 the coordination described in subparagraph (B)(i) 

5 shall include the health care provider or lifestyle 

6 counseling program communicating to the referring 

7 physician or primary care practitioner any rec8 ommendations or treatment plans made regarding 

9 the therapy.’’. 

10 SEC. 4. MEDICARE PART D COVERAGE OF OBESITY MEDI11 CATION. 

12 (a) IN GENERAL.—Section 1860D–2(e)(2)(A) of the 

13 Social Security Act (42 U.S.C. 1395w–102(e)(2)(A)) is 

14 amended, in the first sentence— 

15 (1) by striking ‘‘and other than’’ and inserting 

16 ‘‘other than’’; and 

17 (2) by inserting after ‘‘benzodiazepines),’’ the 

18 following: ‘‘and other than subparagraph (A) of such 

19 section if the drug is used for the treatment of obe20 sity (as defined in section 1861(yy)(2)(C)) or for 

21 weight loss management for an individual who is 

22 overweight (as defined in section 1861(yy)(2)(F)(i)) 

23 and has one or more related comorbidities,’’. 

24 (b) EFFECTIVE DATE.—The amendments made by 

25 subsection (a) shall apply to plan years beginning on or 


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1 after the date that is 2 years after the date of the enact2 ment of this Act. 

3 SEC. 5. REPORT TO CONGRESS. 

4 Not later than the date that is 1 year after the date 

5 of the enactment of this Act, and every 2 years thereafter, 

6 the Secretary of Health and Human Services shall submit 

7 a report to Congress describing the steps the Secretary 

8 has taken to implement the provisions of, and amend9 ments made by, this Act. Such report shall also include 

10 recommendations for better coordination and leveraging of 

11 programs within the Department of Health and Human 

12 Services and other Federal agencies that relate in any way 

13 to supporting appropriate research and clinical care (such 

14 as any interactions between physicians and other health 

15 care providers and their patients) to treat, reduce, and 

16 prevent obesity in the adult population. 

Æ 


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