II 

117TH CONGRESS 

1ST SESSION S. 584 

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

medical nutrition therapy services for individuals with eating disorders 

under the Medicare program. 

IN THE SENATE OF THE UNITED STATES 

MARCH 3, 2021 

Ms. HASSAN (for herself, Ms. MURKOWSKI, and Mrs. CAPITO) 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 

coverage of medical nutrition therapy services for individuals with eating disorders under the Medicare program. 

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 ‘‘Nutrition Counseling 

5 Aiding Recovery for Eating Disorders Act of 2021’’ or the 

6 ‘‘Nutrition CARE Act of 2021’’. 

7 SEC. 2. FINDINGS. 

8 Congress finds the following: 


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1 (1) 28,800,000 individuals in the United Sates, 

2 or 9 percent of the national population, will have an 

3 eating disorder in their lifetime. It is estimated that 

4 1,619,300 to 2,080,600 individuals on Medicare part 

5 B are affected by an eating disorder, including 

6 420,500 to 560,700 beneficiaries who identify as 

7 Black, Indigenous, or People of Color. 

8 (2) 10,200 deaths per year in the United States 

9 occur as a direct result of an eating disorder, equat10 ing to 1 death every 52 minutes. Eating disorders 

11 have one of the highest mortality rates of all mental 

12 illness due to serious medical comorbidities such as 

13 stroke, diabetes, and gastric rupture, in addition to 

14 the fact that longitudinal studies have found that 

15 the suicide risk for those with an eating disorder is 

16 23 times the expected risk. 

17 (3) Eating disorders can be successfully treated 

18 with care encompassing the 4 pillars of successful 

19 treatment: medical, psychiatric, therapy, and medical 

20 nutrition therapy. In general, Medicare provides 

21 some, but not all, care necessary for eating disorders 

22 treatment. It doesn’t cover medical nutrition therapy 

23 at the outpatient level and provides no coverage at 

24 the intensive outpatient or residential treatment lev25 els. 


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1 (4) Eating disorders are expensive. The yearly 

2 economic cost of eating disorders is 

3 $64,700,000,000, with families and individuals expe4 riencing an economic loss of $23,500,000,000 per 

5 year. Each year, eating disorders are directly re6 sponsible for 23,560 inpatient hospitalizations cost7 ing $209,700,000 and 53,918 emergency room visits 

8 costing $29,300,000. 

9 (5) Eating disorders in the elderly are particu10 larly serious because chronic disorders or diseases 

11 may already compromise a patient’s health and 

12 make a patient more prone to serious comorbidities 

13 associated with eating disorders, including cardiac, 

14 metabolic, gastric, and bone conditions. Early diag15 nosis and proper treatment of this population is es16 sential. 

17 SEC. 3. PROVIDING COVERAGE OF MEDICAL NUTRITION 

18 THERAPY SERVICES FOR INDIVIDUALS WITH 

19 EATING DISORDERS UNDER THE MEDICARE 

20 PROGRAM. 

21 Section 1861 of the Social Security Act (42 U.S.C. 

22 1395x) is amended— 

23 (1) in subsection (s)(2)(V)— 


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1 (A) by redesignating clauses (i) through 

2 (iii) as subclauses (I) through (III), respec3 tively, and adjusting the margins accordingly; 

4 (B) in subclause (III), as so redesignated, 

5 by striking the semicolon at the end and insert6 ing ‘‘; or’’; 

7 (C) by striking ‘‘beneficiary with diabetes’’ 

8 and inserting the following: ‘‘beneficiary— 

9 ‘‘(i) with diabetes’’; and 

10 (D) by adding at the end the following new 

11 clause: 

12 ‘‘(ii) beginning January 1, 2022, with an 

13 eating disorder (as defined by the Secretary in 

14 accordance with most recent edition of the Di15 agnostic and Statistical Manual of Mental Dis16 orders published by the American Psychiatric 

17 Association);’’; and 

18 (2) in subsection (vv)— 

19 (A) in paragraph (1)— 

20 (i) by inserting ‘‘(including manage21 ment of an eating disorder (as defined for 

22 purposes of subsection (s)(2)(V)(ii)))’’ 

23 after ‘‘disease management’’; and 


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1 (ii) by striking ‘‘which are furnished 

2 by’’ and all that follows through the period 

3 and inserting ‘‘which are furnished— 

4 ‘‘(A) by a registered dietitian or nutrition 

5 professional (as defined in paragraph (2)); 

6 ‘‘(B) pursuant to a referral by— 

7 ‘‘(i) a physician (as defined in sub8 section (r)(1)); or 

9 ‘‘(ii) a psychologist (or other mental 

10 health professional to the extent authorized 

11 under State law); and 

12 ‘‘(C) in the case of such services furnished 

13 to an individual for the purpose of management 

14 of such an eating disorder, at the times speci15 fied in paragraph (4).’’; and 

16 (B) by adding at the end the following new 

17 paragraph: 

18 ‘‘(4)(A) For purposes of paragraph (1)(C), the times 

19 specified in this paragraph are, with respect to medical 

20 nutrition therapy services furnished to an individual for 

21 purposes of management of an eating disorder, at least 

22 the following: 

23 ‘‘(i) 13 hours (including a 1-hour initial assess24 ment and 12 hours of reassessment and intervenVerDate Sep 11 2014 23:43 Apr 01, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S584.IS S584

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1 tion) during the 1-year period beginning on the date 

2 such individual is first furnished such services. 

3 ‘‘(ii) Subject to subparagraph (B), 4 hours dur4 ing each subsequent 1-year period. 

5 ‘‘(B) The Secretary may apply such other reasonable 

6 limitations with respect to the furnishing of medical nutri7 tion therapy services for purposes of management of an 

8 eating disorder during a period described in subparagraph 

9 (A)(ii) as the Secretary determines appropriate.’’. 

Æ 


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