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[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9631 Introduced in House (IH)]

<DOC>

118th CONGRESS
  2d Session
                                H. R. 9631

   To provide for the establishment or expansion of Food as Medicine 
                   programs, and for other purposes.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                           September 17, 2024

Ms. Lee of California introduced the following bill; which was referred 
    to the Committee on Energy and Commerce, and in addition to the 
Committee on Agriculture, for a period to be subsequently determined by 
the Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL

 
   To provide for the establishment or expansion of Food as Medicine 
                   programs, and for other purposes.

    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 ``National Food as Medicine Program 
Act of 2024''.

SEC. 2. FOOD AS MEDICINE MEDICAID WAIVER GRANT PROGRAM.

    (a) In General.--The Secretary of Health and Human Services (in 
this section referred to as the ``Secretary'') shall establish a 
program under which the Secretary shall award grants to States to plan, 
implement, expand, or evaluate Food as Medicine programs.
    (b) Application.--A State seeking a grant under this section shall 
submit an application to the Secretary at such time, in such manner, 
and containing such information as the Secretary may require.
    (c) Priority.--In awarding grants under this section, the Secretary 
shall give priority to States that have, as of the date of submission 
of the application for a grant under this section, a partnership with--
            (1) a network of health care providers that includes 
        public, nonprofit, and community-based organizations or 
        entities, and community health clinics, including Federally 
        qualified health centers (as defined in section 1861 of the 
        Social Security Act (42 U.S.C. 1395x)); or
            (2) public, nonprofit, socially disadvantaged, and 
        community-based organizations or entities that provide locally-
        sourced (or regionally-sourced, if locally-sourced produce is 
        not available) agricultural products (as defined in section 207 
        of the Agricultural Marketing Act of 1946 (7 U.S.C. 1626)) 
        grown, or working to transition to, a covered method of 
        production.
     (d) Use of Funds.--A State that receives a grant under this 
section shall use funds received through the grant to establish, 
implement, and expand Food as Medicine interventions to reduce 
nutrition-related chronic conditions, address food and nutrition 
insecurity, and improve health through providing locally-sourced (or 
regionally-sourced, if locally-sourced produce is not available) 
agricultural products grown, or working to transition to, a covered 
method of production.
    (e) Report to the Secretary.--Not less than 3 years after the date 
on which a State receives a grant under this section, such State shall 
provide to the Secretary a report that contains--
            (1) an evaluation of the impact of the Food as Medicine 
        program established or expanded in such State, including 
        relevant data collected under the Medicaid program under title 
        XIX of the Social Security Act (42 U.S.C. 1396 et seq.);
            (2) the impact of the Food as Medicine program on, with 
        respect to individuals participating in such program, the 
        appropriate health, nutrition, and associated behavioral 
        outcome baseline information for such individuals that is 
        relevant to the stated goals and desired outcomes of the pilot 
        project;
            (3) to the extent possible, the Food as Medicine Program's 
        impact on hospital admissions and readmissions, admissions into 
        long-term care facilities, medication utilization, emergency 
        room utilization rates, primary care, specialty care, primary 
        care medical home engagement, patient experience, and health 
        care team engagement;
            (4) other relevant findings, including recommendations on 
        strengthening the administration of the program and resources 
        needed to support and strengthen the Food as Medicine program.
    (f) Definitions.--In this section:
            (1) The term ``covered method of production'' means, with 
        respect to an agricultural product, that the product is--
                    (A) regeneratively produced;
                    (B) organically produced; or
                    (C) regeneratively and organically produced.
            (2) The term ``Food as Medicine program'' means a program 
        under which a State pursuant to a waiver under section 1115 of 
        the Social Security Act (42 U.S.C. 1315) provides to 
        individuals eligible to receive medical assistance under such 
        waiver medically supportive food and nutrition interventions.
            (3) The term ``food hub'' means a business or organization 
        that actively manages the aggregation, distribution, and 
        marketing of source-identified food products primarily from 
        local and regional producers to strengthen their ability to 
        satisfy wholesale, retail, and institutional demand.
            (4)(A) The term ``medically supportive food and nutrition 
        interventions'' means interventions that provide culturally-
        appropriate, nutrient-rich whole food (including any fresh 
        vegetables and fruit, legume, nut, seed, whole grain, low-
        mercury and high-omega-3 fatty acid seafood, or lean animal 
        protein) prescribed by a health care professional for the 
        prevention, reversal, or treatment of certain health 
        conditions.
            (B) Such term includes the following interventions:
                    (i) Meals that are--
                            (I) tailored to a recipient's health 
                        conditions by a registered dietitian 
                        nutritionist and adhere to standards informed 
                        by available dietary recommendations for 
                        specific health conditions or dietary 
                        therapies. based on evidence-based nutritional 
                        practice guidelines; and
                            (II) consistent with the Dietary Guidelines 
                        for Americans established under section 301 of 
                        the National Nutrition Monitoring and Related 
                        Research Act of 1990 (7 U.S.C. 5341).
                    (ii) Produce (vegetables and fruit) prescriptions, 
                delivered or procured from in a grocery store, farm, 
                farmers' market, or food hub, that are consistent with 
                the Dietary Guidelines for Americans established under 
                section 301 of the National Nutrition Monitoring and 
                Related Research Act of 1990 (7 U.S.C. 5341).
                    (iii) Nutrition coaching or counseling, group 
                medical visits, cooking education and tools, health 
                coaching, and other behavioral supports based on a 
                recipient's medical conditions, when paired with the 
                interventions described in subparagraphs (A) and (B).
            (5) The term ``organically produced'' means, with respect 
        to an agricultural product, that the product is--
                    (A) certified under the Organic Foods Production 
                Act of 1990 (7 U.S.C. 6501 et seq.) as organically 
                produced; or
                    (B) verified through a community-based, culturally-
                appropriate verification program under the Organic 
                Foods Production Act of 1990 as organically produced.
            (6) The term ``regeneratively produced'' means, with 
        respect to an agricultural product, that the product is 
        produced--
                    (A) using an integrated approach to farming and 
                ranching rooted in the principles of soil health 
                leading to improved target outcomes, including--
                            (i) building soil health;
                            (ii) restoring and maintaining water 
                        resources;
                            (iii) protecting air quality;
                            (iv) sequestering greenhouse gas emissions;
                            (v) using sustainable and integrated pest 
                        management to eliminate reliance on pesticides;
                            (vi) improving nutrient cycling to reduce 
                        use of external fertilizers;
                            (vii) supporting Native-led stewardship 
                        practices (as described in Order No. 3403 
                        entitled ``Joint Secretarial Order on 
                        Fulfilling the Trust Responsibility to Indian 
                        Tribes in the Stewardship of Federal Lands and 
                        Waters'' published jointly by the Secretary of 
                        Agriculture and the Secretary of the Interior 
                        on November 15, 2021); and
                            (viii) fostering wildlife and animal 
                        welfare; and
                    (B) in a manner that fosters community and social 
                wellness, including--
                            (i) improving human health in rural and 
                        urban communities;
                            (ii) creating supportive livelihoods 
                        (worker conditions, safety) and durable 
                        solutions for a healthy food and agriculture 
                        workforce;
                            (iii) creating economic vitality for 
                        farmers, ranchers, and a healthy food and 
                        agriculture workforce; and
                            (iv) optimizing the above target outcomes 
                        to ensure that there is minimal negative impact 
                        on other target outcomes.
            (7) The term ``regeneratively-organically produced'' means, 
        with respect to an agricultural product, that the product is 
        produced--
                    (A) using some organic methods, as described in the 
                Organic Foods Production Act of 1990 (7 U.S.C. 6501 et 
                seq.); and
                    (B) using some methods included in the integrated 
                approach described in paragraph (5).
            (8) The term ``State'' each of the several States and each 
        territory and possession of the United States.

SEC. 3. DEPARTMENT OF AGRICULTURE FOOD AS MEDICINE TECHNICAL ASSISTANCE 
              PROGRAM.

    (a) In General.--The Secretary of Agriculture (referred to in this 
section as the ``Secretary'') shall enter into cooperative agreements 
with eligible entities to provide technical assistance and 
infrastructure support to producers to enable such producers to connect 
with local health care providers for purposes of providing nutritious 
food under a Food is Medicine program established or expanded pursuant 
to section 2. An eligible entity may work in collaboration with a 
Regional Food Business Center of the Department of Agriculture to 
provide such technical assistance under a cooperative agreement.
    (b) Application.--An eligible entity seeking to enter into a 
cooperative agreement under this section shall submit to the Secretary 
an application at such time, in such manner, and containing such 
information as the Secretary may require.
    (c) Priority.--In selecting eligible entities with which to enter 
into cooperative agreements under this section, the Secretary shall 
give priority to applications containing proposals--
            (1) to provide technical assistance and infrastructure 
        support to beginning farmers and ranchers (as defined in 
        section 343(a) of the Consolidated Farm and Rural Development 
        Act (7 U.S.C. 1991(a))) and socially disadvantaged farmers and 
        ranchers (as defined in section 355(e) of the Consolidated Farm 
        and Rural Development Act (7 U.S.C. 2003(e))); and
            (2) to provide technical assistance and infrastructure 
        support to producers that produce agricultural products (as 
        defined in section 207 of the Agricultural Marketing Act of 
        1946 (7 U.S.C. 1626)) that are produced using a covered method 
        of production (as defined in section 2) or verified through 
        community-based, culturally appropriate verification programs.
    (d) Definitions.--In this section:
            (1) The term ``Food is Medicine program'' has the meaning 
        given such term in section 2.
            (2) The term ``eligible entity'' means--
                    (A) a land-grant college or university;
                    (B) a food hub (as defined in section 2); or
                    (C) a Regional Food Business Center supported by 
                the Department of Agriculture. 
            (3) The term ``land-grant college or university'' has the 
        meaning given the term ``land-grant colleges and universities'' 
        in section 1404 of the National Agricultural Research, 
        Extension, and Teaching Policy Act of 1977 (7 U.S.C. 3103).

SEC. 4. REPORT TO CONGRESS.

    Not later than one year after the date on which the first grant is 
awarded under section 2, the Secretary of Health and Human Services, in 
consultation with the Secretary of Agriculture, shall submit to 
Congress a report that includes the information received from the 
States under section 2 and the Secretary's recommendations with respect 
to best practices for carrying out a Food is Medicine program.

SEC. 5. FOOD AS MEDICINE GUIDANCE.

    (a) In General.--Not later than one year after the date of the 
enactment of this Act, the Secretary of Health and Human Services, in 
consultation with the officials and stakeholders described in 
subsection (c), shall develop and issue--
            (1) recommendations for States and counties to implement or 
        expand a Food as Medicine program (as defined in section 2), 
        clinical nutrition training for health care providers, and 
        nutritional and behavioral support for patients to integrate 
        food interventions into daily habits; and
            (2) guidance related to--
                    (A) how a State may include food insecurity and or 
                nutrition insecurity as conditions making an individual 
                eligible to participate in Food as Medicine programs, 
                in addition to eligible populations with chronic 
                conditions;
                    (B) eligible populations that address food 
                insecurity, nutrition insecurity, and chronic 
                conditions;
                    (C) the duration and dosage of medically supportive 
                food and nutrition intervention plans;
                    (D) the value-based procurement of food through a 
                managed care rate setting process that includes minimum 
                percentages and tier-based incentives to increase the 
                procurement of products grown using covered methods of 
                production (as defined in section 2) by socially 
                disadvantaged farmers and ranchers (as defined in 
                section 2501 of the Food, Agriculture, Conservation, 
                and Trade Act of 1990 (7 U.S.C. 2279));
                    (E) determination of providers permitted to provide 
                medically supportive food and nutrition interventions 
                (as defined in section 2); and
                    (F) continuing education for health care providers 
                prescribing medically supportive food and nutrition 
                interventions.
    (b) Public Comment Period.--The Secretary shall provide for 30-day 
public comment period with respect to any proposed guidance issued 
under this section. Such guidance shall not be finalized until the date 
that is 60 days after the close of such public comment period.
    (c) Officials and Stakeholders Described.--The officials and 
stakeholders described in this subsection include the following:
            (1) The heads of appropriate Federal agencies within the 
        Department of Health and Human Services.
            (2) The Secretary of Agriculture.
            (3) Diverse stakeholders from community-based 
        organizations, small- to medium-sized farms operated by 
        socially disadvantaged farmers and ranchers, food hubs, health 
        care providers, and Medicaid managed care organizations who 
        have helped to implement Food as Medicine programs.
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