I 

113TH CONGRESS 

1ST SESSION H. R. 2101 

To amend the Public Health Service Act with respect to eating disorders, 

and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 22, 2013 

Mr. DEUTCH (for himself, Mr. CONNOLLY, Mr. CONYERS, Mr. ELLISON, Ms. 

FRANKEL of Florida, Mr. HASTINGS of Florida, Mr. JOHNSON of Georgia, Mrs. MCCARTHY of New York, Mr. MORAN, Mr. NOLAN, Ms. PINGREE of Maine, Mr. POLIS, Ms. SCHWARTZ, Ms. WASSERMAN SCHULTZ, 

Mrs. CAROLYN B. MALONEY of New York, and Mr. MURPHY of Florida) 

introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and 

Means, Oversight and Government Reform, and Education and the Workforce, 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 amend the Public Health Service Act with respect to 

eating disorders, 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 ‘‘Federal Response to 

5 Eliminate Eating Disorders Act of 2013’’. 


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1 SEC. 2. TABLE OF CONTENTS. 

2 The table of contents of this Act is as follows: 

Sec. 1. Short title. 

Sec. 2. Table of contents. 

Sec. 3. Findings. 

Sec. 4. Definition. 

TITLE I—RESEARCH 

Sec. 101. Activities to improve eating disorder-related research and funding. 

Sec. 102. Eating disorders surveillance and research program. 

TITLE II—EDUCATION AND PREVENTION 

Sec. 201. Study of mandatory BMI reporting in school. 

Sec. 202. Training and education. 

Sec. 203. Health professional education and training. 

Sec. 204. Education and training for all health professionals. 

Sec. 205. Education and training for school and higher education professionals. 

Sec. 206. Eating disorder research and report. 

Sec. 207. Public service announcements. 

Sec. 208. Sense of Congress. 

TITLE III—TREATMENT 

Sec. 301. Coverage for treatment for eating disorders under group health plans, 

individual health insurance coverage, and FEHBP. 

TITLE IV—IMPROVING AVAILABILITY AND ACCESS TO 

TREATMENT 

Sec. 401. Medicaid coverage for eating disorder treatment services. 

Sec. 402. Grants to support patient advocacy. 

3 SEC. 3. FINDINGS. 

4 The Congress finds as follows: 

5 (1) Risk of death among individuals with ano6 rexia nervosa is 18 times greater than their same 

7 age peers without anorexia. 

8 (2) Health consequences such as osteoporosis 

9 (brittle bones), gastrointestinal complications, and 

10 dental problems are significant health and financial 

11 burdens throughout life. 


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1 (3) An estimated 14 million people suffer from 

2 earing disorders, including anorexia nervosa, bulimia 

3 nervosa, and eating disorders not otherwise specified 

4 (EDNOS) (including binge eating disorder). The 

5 lifetime prevalence of all eating disorders in America 

6 is 0.6 to 4.5 percent. 

7 (4) Eating disorders are real, treatable medical 

8 illnesses. They frequently coexist with other illnesses 

9 such as depression, substance abuse, or anxiety dis10 orders. Eating disorders can become life-threatening 

11 if a person does not receive treatment. 

12 (5) Anorexia nervosa is an eating disorder char13 acterized by self-starvation and excessive weight loss. 

14 An estimated 0.9 percent of American women and 

15 0.3 percent of American men will suffer from ano16 rexia nervosa in their lifetime. 

17 (6) Anorexia nervosa is associated with serious 

18 health consequences including heart failure, kidney 

19 failure, osteoporosis, and death. 

20 (7) Bulimia nervosa is an eating disorder char21 acterized by excessive food consumption followed by 

22 inappropriate compensatory behaviors, such as self23 induced vomiting, misuse of laxatives, fasting, or ex24 cessive exercise. An estimated 1.5 percent of AmerVerDate Mar 15 2010 20:44 May 28, 2013 Jkt 029200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2101.IH H2101

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1 ican women and 0.5 percent of American men will 

2 suffer from this disorder in their lifetime. 

3 (8) Bulimia nervosa is associated with cardiac, 

4 gastrointestinal, and dental problems including ir5 regular heartbeats, gastric rupture, peptic ulcer, 

6 tooth decay, and death. 

7 (9) Binge eating disorder is characterized by 

8 frequent episodes of uncontrolled overeating. Binge 

9 eating disorder is common: an estimated 3.5 percent 

10 of American women and 2.0 percent of American 

11 men will suffer from this disorder in their lifetime. 

12 (10) Binge eating is associated with obesity, 

13 heart disease, gall bladder disease, and diabetes. 

14 (11) Many more suffer from some, but not all, 

15 of the symptoms of anorexia nervosa, bulimia 

16 nervosa, or binge eating disorder, which is referred 

17 to as eating disorders not otherwise specified 

18 (EDNOS). Between 4 percent and 20 percent of 

19 young women practice unhealthy patterns of dieting, 

20 purging, and binge eating. 

21 (12) Eating disorders are more common in 

22 women, but they do occur in men. Rates of binge 

23 eating disorder are similar in females and males. 

24 (13) Eating disorders usually appear in adoles25 cence and are associated with substantial psychoVerDate Mar 15 2010 20:44 May 28, 2013 Jkt 029200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2101.IH H2101

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1 logical problems, including depression, substance 

2 abuse, and suicide. Eating disorders also develop in 

3 younger children and adults, compromising health 

4 and daily functioning. For children 12 years of age 

5 and younger, hospitalizations for eating disorders in6 creased by 119 percent between 1999 and 2006. 

7 (14) Eating disorders are found across races, 

8 ethnicities, and socioeconomic groups in the United 

9 States. White females are more likely to suffer from 

10 anorexia, while African-American girls are especially 

11 vulnerable to developing eating disorders that involve 

12 binge eating. Body dissatisfaction in young girls has 

13 been shown in White, African-American, Hispanic, 

14 and Asian girls. 

15 SEC. 4. DEFINITION. 

16 In this Act, the term ‘‘eating disorder’’ includes ano17 rexia nervosa, bulimia nervosa, binge eating disorder, and 

18 eating disorders not otherwise specified (EDNOS), as de19 fined in the fifth edition of ‘‘Diagnostic and Statistical 

20 Manual of Mental Disorders’’ or, if applicable, the most 

21 recent successor edition. 


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1 TITLE I—RESEARCH 

2 SEC. 101. ACTIVITIES TO IMPROVE EATING DISORDER-RE3 LATED RESEARCH AND FUNDING. 

4 Title IV of the Public Health Service Act (42 U.S.C. 

5 281 et seq.) is amended by adding at the end the fol6 lowing: 

7 ‘‘PART J—EATING DISORDER-RELATED 

8 ACTIVITIES 

9 ‘‘SEC. 499A. AUTHORITY OF THE DIRECTOR OF THE NA10 TIONAL INSTITUTES OF HEALTH RELATING 

11 TO EATING DISORDERS. 

12 ‘‘(a) IDENTIFYING TOTAL EXPENDITURES ON EAT13 ING DISORDERS.—The Director of NIH, in coordination 

14 with the National Institute of Mental Health, the Office 

15 of Research on Women’s Health, and other institutes of 

16 the National Institutes of Health, shall identify the total 

17 amount of expenditures, both intramural and extramural, 

18 by the National Institutes of Health for eating disorders 

19 for each of fiscal years 2011 and 2012. 

20 ‘‘(b) BUDGET FOR EATING DISORDERS RESEARCH

21 AND COORDINATION OF ACTIVITIES AND PROGRAMS.— 

22 The Director of NIH, based on the strategic plan devel23 oped under subsection (c), shall— 


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1 ‘‘(1) develop and oversee the implementation of 

2 a scientifically justified budget for research on eat3 ing disorders at the National Institutes of Health; 

4 ‘‘(2) coordinate all research activities and pro5 grams on eating disorders at the institutes, centers, 

6 and divisions of the National Institutes of Health; 

7 and 

8 ‘‘(3) evaluate all such activities and programs. 

9 ‘‘(c) STRATEGIC PLAN FOR EATING DISORDERS RE10 SEARCH.— 

11 ‘‘(1) IN GENERAL.—Not later than 1 year after 

12 the date of the enactment of this section, the Direc13 tor of NIH shall develop, in consultation with lead14 ing eating disorder researchers, and oversee the im15 plementation of a comprehensive, long-range plan 

16 for the conduct and support of research on eating 

17 disorders by the institutes, centers, and divisions of 

18 the National Institutes of Health. 

19 ‘‘(2) REQUIREMENTS.—The plan developed 

20 under paragraph (1) shall— 

21 ‘‘(A) be updated on an annual basis; 

22 ‘‘(B) identify critical scientific questions 

23 related to eating disorders and establish prior24 ities among such questions; 


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1 ‘‘(C) based on the priorities established 

2 under subparagraph (B), specify the short- and 

3 long-range objectives to be achieved, and esti4 mate the resources needed to achieve these ob5 jectives; 

6 ‘‘(D) evaluate the sufficiency of existing re7 search programs on eating disorders to meet 

8 the objectives specified under subparagraph (C), 

9 and establish objectives, timelines, and criteria 

10 for evaluating future research programs; 

11 ‘‘(E) be coordinated with the activities of 

12 the Centers of Excellence receiving funds under 

13 section 499B(b); and 

14 ‘‘(F) make recommendations for changes 

15 to existing research programs on eating dis16 orders. 

17 ‘‘(d) BUDGETARY AUTHORITY.— 

18 ‘‘(1) IN GENERAL.—The Director of NIH 

19 shall— 

20 ‘‘(A) in accordance with the strategic plan 

21 developed under subsection (c), annually pre22 pare and submit to Congress a scientifically jus23 tified budget estimate for research on eating 

24 disorders to be conducted within the agencies of 

25 the National Institutes of Health, which shall 


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1 include the amount of funds that will be re2 quired for— 

3 ‘‘(i) the continued funding of ongoing 

4 discretionary program initiatives at the in5 stitutes, centers, and divisions of the Na6 tional Institutes of Health; and 

7 ‘‘(ii) the funding of new and com8 plementary program initiatives; and 

9 ‘‘(B) receive all research funds for eating 

10 disorders described in subparagraph (A), and 

11 allocate those funds to the institutes, centers, 

12 and divisions of the National Institutes of 

13 Health. 

14 ‘‘(2) EFFECTIVE DATE.—Paragraph (1)(B) 

15 shall become effective in the fiscal year following the 

16 submission of the first eating disorder budget de17 scribed in paragraph (1)(A). 

18 ‘‘(e) EVALUATION AND REPORT.— 

19 ‘‘(1) EVALUATION.—The Director of NIH shall 

20 evaluate the effect of this section on the planning 

21 and coordination of research programs on eating dis22 orders at the institutes, centers, and divisions of the 

23 National Institutes of Health, and the extent to 

24 which funding mandated under this section has folVerDate Mar 15 2010 20:44 May 28, 2013 Jkt 029200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H2101.IH H2101

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1 lowed the recommendation of the strategic plan de2 veloped under subsection (c). 

3 ‘‘(2) REPORT.—Not later than 1 year after the 

4 date of enactment of this section, the Director of 

5 NIH shall prepare and submit to the Committee on 

6 Energy and Commerce and the Committee on Ap7 propriations of the House of Representatives, and 

8 the Committee on Health, Education, Labor, and 

9 Pensions and the Committee on Appropriations of 

10 the Senate, a report based on the evaluation de11 scribed in paragraph (1). 

12 ‘‘(f) DEFINITIONS.—In this part, the term ‘eating 

13 disorder’ includes anorexia nervosa, bulimia nervosa, binge 

14 eating disorder, and eating disorders not otherwise speci15 fied (EDNOS), as defined in the fifth edition of ‘Diag16 nostic and Statistical Manual of Mental Disorders’ or, if 

17 applicable, the most recent successor edition. 

18 ‘‘SEC. 499B. EXPANSION, INTENSIFICATION, AND COORDI19 NATION OF ACTIVITIES OF NATIONAL INSTI20 TUTES OF HEALTH WITH RESPECT TO RE21 SEARCH ON EATING DISORDERS. 

22 ‘‘(a) IN GENERAL.— 

23 ‘‘(1) EXPANSION OF ACTIVITIES.—The Director 

24 of NIH shall expand, intensify, and coordinate the 


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1 activities of the National Institutes of Health with 

2 respect to research on eating disorders. 

3 ‘‘(2) ADMINISTRATION OF PROGRAM; COORDI4 NATION AMONG AGENCIES.—The Director of NIH 

5 shall carry out this section acting through the Direc6 tor of the National Institute of Mental Health, and 

7 in collaboration with the Director of the Eunice 

8 Kennedy Shriver National Institute of Child Health 

9 and Human Development, the Director of the Na10 tional Institute of Diabetes and Digestive and Kid11 ney Diseases, the Director of the Office of Research 

12 on Women’s Health, and any other agencies or of13 fices of the National Institutes of Health that the 

14 Director determines appropriate. 

15 ‘‘(3) TASK FORCE.— 

16 ‘‘(A) ESTABLISHMENT.—Before making 

17 grants under subsection (b) for Centers of Ex18 cellence, the Director of NIH shall establish a 

19 task force (in this paragraph referred to as the 

20 ‘task force’) consisting of— 

21 ‘‘(i) representatives of the institutes, 

22 centers, and divisions of the National Insti23 tutes of Health, as determined appropriate 

24 by the Director; 


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1 ‘‘(ii) eating disorders researchers, cli2 nicians, and patient advocacy groups; and 

3 ‘‘(iii) the general public. 

4 ‘‘(B) DUTIES.—The task force shall— 

5 ‘‘(i) assist researchers in developing 

6 applications and applying for grants and 

7 contracts to be awarded for Centers of Ex8 cellence under subsection (b); 

9 ‘‘(ii) conduct a thorough examination 

10 of the field of eating disorders, create a list 

11 of priorities for eating disorders research, 

12 and develop a matrix of action items for 

13 such research; and 

14 ‘‘(iii) conduct meetings to address 

15 issues with respect to eating disorders re16 search, including guiding principles of Cen17 ters of Excellence under subsection (b); de18 velopment of strategic research priorities; 

19 strategies for recruiting new scientists into 

20 the field of eating disorders and providing 

21 them with high-quality training; priorities 

22 and best practices for basic research, clin23 ical research, treatment research, and pre24 vention research; and development of a re25 search infrastructure nationwide. 


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1 ‘‘(b) CENTERS OF EXCELLENCE.— 

2 ‘‘(1) GRANTS.— 

3 ‘‘(A) IN GENERAL.—In carrying out sub4 section (a)(1), the Director of NIH shall award 

5 grants and contracts to public or nonprofit pri6 vate entities, including universities, to— 

7 ‘‘(i) conduct research on eating dis8 orders designed to improve understanding 

9 of the etiology, early identification, preven10 tion, best treatment, medical and psycho11 logical sequelae of and recovery from eat12 ing disorders; 

13 ‘‘(ii) conduct training to perform such 

14 research; and 

15 ‘‘(iii) pay all or part of the cost of 

16 planning, establishing, improving, and pro17 viding basic operating support for such re18 search and training. 

19 ‘‘(B) CENTERS OF EXCELLENCE.—For 

20 purposes of this section, an entity that receives 

21 a grant or contract under subparagraph (A) 

22 shall be referred to as a Center of Excellence. 

23 ‘‘(2) RESEARCH.— 


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1 ‘‘(A) IN GENERAL.—Each Center of Excel2 lence shall conduct basic research, clinical re3 search, or both into eating disorders. 

4 ‘‘(B) REQUIREMENTS.—The research con5 ducted by a Center of Excellence pursuant to 

6 subparagraph (A)— 

7 ‘‘(i) shall be designed to improve un8 derstanding of the etiology, early identi9 fication, prevention, best treatment, med10 ical and psychological sequelae of and re11 covery from eating disorders; 

12 ‘‘(ii) shall be conducted in the fields of 

13 basic, clinical, prevention, and intervention 

14 sciences; and 

15 ‘‘(iii) should include— 

16 ‘‘(I) studies clarifying the 

17 nosology and assessment of eating dis18 orders; 

19 ‘‘(II) investigations to determine 

20 the biological, psychosocial, and be21 havioral risk factors that might ap22 pear in early childhood; 

23 ‘‘(III) studies of promising treat24 ments for eating disorders; 


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1 ‘‘(IV) evaluation of prevention 

2 programs for eating disorders; and 

3 ‘‘(V) studies of the medical, psy4 chological, and social sequelae of eat5 ing disorders. 

6 ‘‘(C) EQUAL REPRESENTATION OF RE7 SEARCH AREAS.—In awarding grants and con8 tracts under paragraph (1), the Director of 

9 NIH shall, to the extent practicable and appro10 priate, ensure that each of the research areas 

11 required by clauses (i) and (ii) of subparagraph 

12 (B) are equally represented. 

13 ‘‘(3) TRAINING TO PERFORM EATING DIS14 ORDERS RESEARCH.—Each Center of Excellence 

15 shall provide at least 3 positions for doctoral level 

16 and post-doctoral level research trainees. 

17 ‘‘(4) SERVICES FOR PATIENTS.— 

18 ‘‘(A) IN GENERAL.—A Center of Excel19 lence may expend amounts provided under a 

20 grant or contract under such paragraph to 

21 carry out a program to make individuals aware 

22 of opportunities to participate as subjects in re23 search conducted by such Centers. 

24 ‘‘(B) REFERRALS AND COSTS.—A program 

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1 cordance with such criteria as the Director of 

2 NIH may establish, provide to the subjects de3 scribed in such subparagraph, referrals for 

4 health, mental health, and other services, and 

5 such patient care costs as are required for re6 search. 

7 ‘‘(C) AVAILABILITY AND ACCESS.—The ex8 tent to which a Center of Excellence can dem9 onstrate availability and access to clinical serv10 ices shall be considered by the Director of NIH 

11 in decisions about awarding grants or contracts 

12 to applicants that meet the scientific criteria for 

13 funding under this section. 

14 ‘‘(5) COORDINATION OF CENTERS OF EXCEL15 LENCE.— 

16 ‘‘(A) IN GENERAL.—The Director of the 

17 National Institute of Mental Health shall, as 

18 appropriate, provide for the coordination of in19 formation among Centers of Excellence and en20 sure regular communication between such Cen21 ters. 

22 ‘‘(B) PERIODIC REPORTS.—The Director 

23 of the National Institute of Mental Health may 

24 require the periodic preparation of reports on 


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1 the activities of Centers of Excellence and the 

2 submission of such reports to the Director. 

3 ‘‘(C) COLLECTION AND STORAGE OF

4 DATA.—The Director of the National Institute 

5 of Mental Health shall establish and fund 

6 mechanisms and entities for collecting, storing, 

7 and coordinating data collected by Centers of 

8 Excellence and data generated from public and 

9 private research partnerships. 

10 ‘‘(6) ORGANIZATION.—Each Center of Excel11 lence shall use the facilities of a single institution, 

12 or be formed from a consortium of cooperating insti13 tutions, meeting such requirements as may be pre14 scribed by the Director of NIH. 

15 ‘‘(7) NUMBER; DURATION; ADDITIONAL PERI16 ODS.— 

17 ‘‘(A) IN GENERAL.—The Director of NIH 

18 shall award grants and contracts to not fewer 

19 than 3 entities under paragraph (1). 

20 ‘‘(B) DURATION.—Except as provided in 

21 subparagraph (C), a grant or contract awarded 

22 under paragraph (1) shall not exceed a period 

23 of 5 years. 

24 ‘‘(C) ADDITIONAL PERIODS.— 


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1 ‘‘(i) EXTENSION.—The period of a 

2 grant or contract awarded under para3 graph (1) may be extended one or more 

4 additional periods not exceeding a total of 

5 5 years if the operations of the Center of 

6 Excellence involved have been reviewed by 

7 an appropriate technical and scientific peer 

8 review group (including investigators from 

9 the field of eating disorders) established by 

10 the Director of NIH and the group has 

11 recommended to the Director that such pe12 riod should be extended. 

13 ‘‘(ii) AMOUNT.—The amount of any 

14 grant or contract under paragraph (1) for 

15 an additional period described in clause (i) 

16 shall not exceed $2,000,000 per fiscal year. 

17 ‘‘(D) PUBLIC INPUT.—In carrying out this 

18 section, the Director of NIH shall provide for a 

19 means through which the public can obtain in20 formation on the existing and planned pro21 grams and activities of the National Institutes 

22 of Health with respect to eating disorders and 

23 through which the Director can receive com24 ments from the public regarding such programs 

25 and activities. 


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1 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 

2 is authorized to be appropriated to carry out this section, 

3 $20,000,000 for each of fiscal years 2014 through 2018. 

4 Amounts appropriated under this subsection shall be in 

5 addition to any other amounts appropriated for such pur6 pose. 

7 ‘‘SEC. 499C. COLLABORATIVE PROGRAMS OF RESEARCH IN 

8 EATING DISORDERS. 

9 ‘‘(a) IN GENERAL.—The Director of NIH, acting 

10 through the Director of the National Institute of Mental 

11 Health, the Director of the National Institute of Diabetes 

12 and Digestive and Kidney Diseases, the Director of the 

13 Eunice Kennedy Shriver National Institute of Child 

14 Health and Human Development, the Director of the Of15 fice of Research on Women’s Health, and any other agen16 cies or offices of the National Institutes of Health that 

17 the Director determines appropriate, in consultation with 

18 leading eating disorders researchers and clinicians, shall 

19 award grants and contracts to public or nonprofit private 

20 entities to pay all or part of the cost of planning, estab21 lishing, improving, and providing basic operating support 

22 for collaborative programs of research in eating disorders. 

23 ‘‘(b) RESEARCH.—Each program established under 

24 subsection (a)— 


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1 ‘‘(1) shall conduct basic research, clinical re2 search, or both into eating disorders; and 

3 ‘‘(2) should conduct investigations into the 

4 cause, diagnosis, early detection, prevention and 

5 treatment of and recovery from eating disorders. 

6 ‘‘(c) COORDINATION OF PROGRAMS.— 

7 ‘‘(1) IN GENERAL.—The Director of NIH shall, 

8 as appropriate, provide for the coordination of infor9 mation among programs established under sub10 section (a), and Centers of Excellence receiving 

11 funding under section 499B, and ensure regular 

12 communication between such programs and Centers. 

13 ‘‘(2) PERIODIC REPORTS.—The Director of 

14 NIH may require the periodic preparation of reports 

15 on the activities of the programs established under 

16 subsection (a) and the submission of such reports to 

17 the Director. 

18 ‘‘(3) COLLECTION AND STORAGE OF DATA.— 

19 The Director of NIH shall establish and fund mech20 anisms and entities for collecting, storing, and co21 ordinating data collected by the programs estab22 lished under subsection (a) and data generated from 

23 public and private research partnerships. 

24 ‘‘(d) ORGANIZATION.—Each program that receives 

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1 sortium of cooperating institutions, meeting such require2 ments as may be prescribed by the Director of NIH. 

3 ‘‘(e) NUMBER AND DURATION.— 

4 ‘‘(1) IN GENERAL.—The Director shall provide 

5 for the establishment of not fewer than 4 programs 

6 under subsection (a). 

7 ‘‘(2) DURATION.—Except as provided in para8 graph (3), a grant or contract awarded under sub9 section (a) shall not exceed a period of 5 years. 

10 ‘‘(3) ADDITIONAL PERIODS.— 

11 ‘‘(A) EXTENSION.—The period of a grant 

12 or contract awarded under subsection (a) may 

13 be extended for one or more additional periods 

14 not exceeding 5 years if the operations of the 

15 program involved have been reviewed by an ap16 propriate technical and scientific peer review 

17 group established by the Director of NIH and 

18 the group has recommended to the Director 

19 that such period should be extended. 

20 ‘‘(B) AMOUNT.—The amount of any grant 

21 or contract under subsection (a) for an addi22 tional period described in subparagraph (A) 

23 shall not exceed $2,000,000 per fiscal year. 

24 ‘‘(f) RULE OF CONSTRUCTION.—Nothing in this sec25 tion shall be construed as precluding or otherwise affecting 


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1 funding for any research on eating disorders in addition 

2 to the research funded under this section. 

3 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 

4 is authorized to be appropriated to carry out this section, 

5 $20,000,000 for each of fiscal years 2014 through 2018. 

6 Amounts appropriated under this subsection shall be in 

7 addition to any other amounts appropriated for such pur8 pose.’’. 

9 SEC. 102. EATING DISORDERS SURVEILLANCE AND RE10 SEARCH PROGRAM. 

11 Title III of the Public Health Service Act (42 U.S.C. 

12 241 et seq.) is amended by adding at the end thereof the 

13 following: 

14 ‘‘PART W—PROGRAMS RELATING TO EATING 

15 DISORDERS 

16 ‘‘SEC. 399OO. EATING DISORDERS SURVEILLANCE AND RE17 SEARCH PROGRAM. 

18 ‘‘(a) NATIONAL EATING DISORDERS SURVEILLANCE

19 PROGRAM.— 

20 ‘‘(1) IN GENERAL.—The Secretary, acting 

21 through the Director of the Centers for Disease 

22 Control and Prevention and in consultation with 

23 leading eating disorders researchers and clinicians— 

24 ‘‘(A) shall provide for the collection, anal25 ysis, and reporting of epidemiological data on 


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1 eating disorders through the existing surveil2 lance programs of the Centers, such as the Be3 havioral Risk Factor Surveillance System; 

4 ‘‘(B) shall make recommendations to en5 hance existing surveillance programs of the 

6 Centers, such as the Behavioral Risk Factor 

7 Surveillance System, to more accurately collect 

8 epidemiological data on disordered eating and 

9 eating disorders; 

10 ‘‘(C) may award grants and cooperative 

11 agreements and may provide direct technical as12 sistance to eligible entities for the collection, 

13 analysis, and reporting of such data; and 

14 ‘‘(D) shall examine and improve require15 ments for reporting deaths on death certificates 

16 to accurately account for those cases in which 

17 an eating disorder is the underlying or contrib18 uting cause of death. 

19 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 

20 grant or cooperative agreement under paragraph 

21 (1)(C), an entity shall be a public or nonprofit pri22 vate entity (including a health department of a State 

23 or political subdivisions of a State, a university, or 

24 any other educational institution), and submit to the 

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1 ner, and containing such information as the Sec2 retary may require. 

3 ‘‘(b) CENTER OF EATING DISORDERS EPIDEMI4 OLOGY.— 

5 ‘‘(1) IN GENERAL.—The Secretary, acting 

6 through the Director of the Centers for Disease 

7 Control and Prevention, shall establish a Center of 

8 Eating Disorders Epidemiology for the purpose of 

9 collecting and analyzing information on— 

10 ‘‘(A) the number, incidence, incidence 

11 trends over time, correlates, mortality, and 

12 causes of eating disorders; 

13 ‘‘(B) the effects of eating disorders on 

14 quality of life, including disability adjusted life 

15 years (DALY) and quality adjusted life years 

16 (QALY); and 

17 ‘‘(C) economic analysis of the costs of eat18 ing disorders in the United States, including 

19 years of productive life lost, missed days of 

20 work, reduced work productivity, costs of med21 ical and mental health treatment, prescriptions, 

22 other medications, hospitalizations, costs of 

23 medical and psychiatric comorbidities, costs to 

24 family, and costs to society. 


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1 ‘‘(2) GRANTS; COOPERATIVE AGREEMENTS.— 

2 The Center of Eating Disorders Epidemiology under 

3 paragraph (1) shall be established and operated 

4 through the awarding of grants or cooperative agree5 ments to one or more public or nonprofit private en6 tities that conduct research, which may include a 

7 university or other educational entity. 

8 ‘‘(3) REQUIREMENTS.—To be eligible to receive 

9 a grant or cooperative agreement under paragraph 

10 (2), an entity shall submit to the Secretary an appli11 cation containing such agreements and information 

12 as the Secretary may require, including an agree13 ment that the Center of Eating Disorders Epidemi14 ology will operate in accordance with the following: 

15 ‘‘(A) The Center will collect, analyze, and 

16 report eating disorders data according to guide17 lines prescribed by the Director of the Centers 

18 for Disease Control and Prevention, after con19 sultation with relevant State and local public 

20 health officials, private sector eating disorder 

21 researchers and clinicians, and advocates for 

22 those with eating disorders. 

23 ‘‘(B) The Center will assist with the devel24 opment and coordination of State eating dis25 orders surveillance efforts within a region. 


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1 ‘‘(C) The Center will identify eligible cases 

2 and controls through its surveillance systems 

3 and conduct research into factors which may 

4 cause or increase the risk of eating disorders. 

5 ‘‘(D) The Center will develop or extend an 

6 area of special research expertise (including ge7 netics, environmental exposures, and other rel8 evant research specialty areas). 

9 ‘‘(c) CLEARINGHOUSE.—The Secretary, acting 

10 through the Director of the Centers for Disease Control 

11 and Prevention and in consultation with leading eating 

12 disorders researchers and clinicians, shall carry out the 

13 following: 

14 ‘‘(1) ESTABLISHMENT.—The Secretary shall es15 tablish a clearinghouse within the Centers for Dis16 ease Control and Prevention for the collection and 

17 storage of data generated from the monitoring pro18 grams established under this section and part J of 

19 title IV. Through the clearinghouse, the Centers for 

20 Disease Control and Prevention shall serve as the 

21 coordinating agency for eating disorders surveillance 

22 activities. The functions of such clearinghouse shall 

23 include facilitating the coordination of research and 

24 policy development relating to the prevention, treat25 ment, and epidemiology of eating disorders. 


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1 ‘‘(2) FACILITATION OF RESEARCH.—The Sec2 retary shall provide for the establishment of a pro3 gram under which samples of tissues and genetic 

4 and other biological materials that are of use in re5 search on eating disorders are donated, collected, 

6 preserved, and made available for such research. 

7 Such program shall be carried out in accordance 

8 with accepted scientific and medical standards for 

9 the donation, collection, and preservation of such 

10 samples, and shall be conducted so that the tissues 

11 and other materials saved, as well as any database 

12 compiled from such tissues and materials, are avail13 able to researchers at a reasonable cost. 

14 ‘‘(3) COORDINATION.—The Centers for Disease 

15 Control and Prevention shall coordinate research 

16 and surveillance activities of such Centers with the 

17 National Institutes of Health, other appropriate 

18 Federal agencies, and interested nonprofit private 

19 entities, which shall be updated as determined ap20 propriate by the Secretary. 

21 ‘‘(d) DEFINITION.—In this section, the term ‘eating 

22 disorder’ includes anorexia nervosa, bulimia nervosa, binge 

23 eating disorder, and eating disorders not otherwise speci24 fied (EDNOS), as defined in the fifth edition of ‘DiagVerDate Mar 15 2010 20:44 May 28, 2013 Jkt 029200 PO 00000 Frm 00027 Fmt 6652 Sfmt 6201 E:\BILLS\H2101.IH H2101

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1 nostic and Statistical Manual of Mental Disorders’ or, if 

2 applicable, the most recent successor edition. 

3 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

4 is authorized to be appropriated to carry out this section, 

5 $2,000,000 for each of fiscal years 2014 through 2018.’’. 

6 TITLE II—EDUCATION AND 

7 PREVENTION 

8 SEC. 201. STUDY OF MANDATORY BMI REPORTING IN 

9 SCHOOL. 

10 Not later than 1 year after the date of the enactment 

11 of this Act, the Director of the Centers for Disease Control 

12 and Prevention, in consultation with the Secretary of Edu13 cation and leading eating disorders researchers and clini14 cians, shall conduct a study and submit a report to the 

15 Congress on— 

16 (1) measuring the body mass index (in this sec17 tion referred to as ‘‘BMI’’) of students for those 

18 schools (at any level including pre-schools, kinder19 gartens, elementary schools, secondary schools, and 

20 institutions of higher education) that are measuring 

21 the BMI of students; 

22 (2) the impacts (both positive and negative) on 

23 students of such measures, including unhealthy 

24 weight control behaviors, perceptions of body image, 


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1 eating disorder symptoms, and the incidence of teas2 ing or bullying based on body size; and 

3 (3) the impacts (both positive and negative) of 

4 reporting the results of such measures to the par5 ents of such students. 

6 SEC. 202. TRAINING AND EDUCATION. 

7 (a) IN GENERAL.—The Secretary of Health and 

8 Human Services, acting through the Director of the Office 

9 on Women’s Health of the Department of Health and 

10 Human Services and in consultation with the Secretary 

11 of Education and with the Task Force for Health Profes12 sions established under section 399Z(b) of the Public 

13 Health Service Act (as added by section 203(a)(2) of this 

14 Act), shall— 

15 (1) expand the BodyWise Handbook and re16 lated fact sheets and resource lists available on the 

17 public Internet site of the National Women’s Health 

18 Information Center sponsored by the Office on 

19 Women’s Health, to include— 

20 (A) updated findings and conclusions as 

21 needed; and 

22 (B) thorough information about eating dis23 orders relating to males as well as females; 

24 (2) incorporate, as appropriate, information 

25 from such BodyWise Handbook and related facts 


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1 sheets and resource lists into the curriculum of the 

2 BodyWorks obesity prevention program developed by 

3 the Office on Women’s Health and training modules 

4 used in such obesity prevention program; and 

5 (3) promote and make publicly available 

6 (whether through a public Internet site or other 

7 method that does not impose a fee on users) the 

8 BodyWise Handbook and related fact sheets and re9 source lists, as updated under paragraph (1), and 

10 the BodyWorks obesity prevention program, as up11 dated under paragraph (2), including for purposes of 

12 educating universities and nonprofit entities on eat13 ing disorders. 

14 (b) AUTHORIZATION OF APPROPRIATIONS.—There is 

15 authorized to be appropriated $1,000,000 to carry out 

16 subsection (a). 

17 SEC. 203. HEALTH PROFESSIONAL EDUCATION AND TRAIN18 ING. 

19 Section 399Z of the Public Health Service Act (42 

20 U.S.C. 280h–3) is amended— 

21 (1) by redesignating subsection (b) as sub22 section (d); and 

23 (2) by inserting after subsection (a) the fol24 lowing new subsections: 

25 ‘‘(b) TASK FORCE ON EATING DISORDERS.— 


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1 ‘‘(1) ESTABLISHMENT.—The Secretary, acting 

2 through the Administrator of the Health Resources 

3 and Services Administration and one or more of the 

4 Centers of Excellence receiving funds under section 

5 499B(b), shall establish a Task Force for Health 

6 Professions (in this subsection referred to as the 

7 ‘task force’) comprised of experts in the field of eat8 ing disorders (including researchers, clinicians, care 

9 providers, and experts in eating disorders education 

10 and prevention), individuals with eating disorders, 

11 and individuals with family members who have eat12 ing disorders. 

13 ‘‘(2) DUTIES.—The task force shall— 

14 ‘‘(A) develop, based on the BodyWise 

15 Handbook and related fact sheets and resource 

16 lists available on the public Internet site of the 

17 National Women’s Health Information Center 

18 sponsored by the Office on Women’s Health of 

19 the Department of Health and Human Services 

20 and updated under section 202(a)(1) of the 

21 Federal Response to Eliminate Eating Dis22 orders Act of 2013, an evidence-based or 

23 emerging best-practices training program for 

24 health professionals on eating disorders; 


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1 ‘‘(B) award grants for implementation of 

2 such evidence-based training program; and 

3 ‘‘(C) provide training and technical assist4 ance to grant recipients. 

5 ‘‘(3) REPORT.—Not later than 6 years after the 

6 date of the enactment of this subsection, the task 

7 force shall submit to the Congress and make publicly 

8 available a report on the training program developed 

9 under paragraph (2) and the results achieved 

10 through grants awarded for implementation of such 

11 program. 

12 ‘‘(c) DEFINITION.—In this section, the term ‘eating 

13 disorder’ has the meaning given such term in section 

14 399OO(d).’’; and 

15 (3) by amending subsection (d) (as so redesig16 nated) to read as follows: 

17 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

18 are authorized to be appropriated— 

19 ‘‘(1) to carry out subsection (a), $1,000,000 for 

20 fiscal year 2014 and $500,000 for each of fiscal 

21 years 2015 through 2018; and 

22 ‘‘(2) to carry out subsection (b), $10,000,000 

23 for each of fiscal years 2014 through 2018.’’. 


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1 SEC. 204. EDUCATION AND TRAINING FOR ALL HEALTH 

2 PROFESSIONALS. 

3 Section 399Z of the Public Health Service Act (42 

4 U.S.C. 280h–3), as amended by section 203(a), is further 

5 amended— 

6 (1) by redesignating subsections (c) and (d) as 

7 subsections (d) and (e), respectively; 

8 (2) by inserting after subsection (b) the fol9 lowing new subsection: 

10 ‘‘(c) GRANTS REGARDING EATING DISORDERS.— 

11 ‘‘(1) IN GENERAL.—The Secretary may award 

12 grants to eligible entities to integrate training into 

13 existing curricula for primary care physicians and 

14 other licensed or certified health and mental health 

15 professionals on how to identify, refer, treat, and 

16 prevent eating disorders and aid individuals who suf17 fer from eating disorders. 

18 ‘‘(2) APPLICATION.—An entity that desires a 

19 grant under this subsection shall submit to the Sec20 retary an application at such time, in such manner, 

21 and containing such information as the Secretary 

22 may require, including a plan for the use of funds 

23 that may be awarded and an evaluation of the train24 ing that will be provided. 


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1 ‘‘(3) USE OF FUNDS.—An entity that receives 

2 a grant under this subsection shall use the funds 

3 made available through such grant to— 

4 ‘‘(A) use the training program developed 

5 by the Task Force for Health Professions under 

6 subsection (b)(2)(A), evidence-based findings, 

7 promising emerging best practices, or rec8 ommendations that pertain to the prevention 

9 and treatment of eating disorders to conduct 

10 educational training and conferences, including 

11 Internet-based courses and teleconferences, 

12 on— 

13 ‘‘(i) how to treat or prevent eating 

14 disorders; 

15 ‘‘(ii) how to discuss varied strategies 

16 with patients from at-risk and diverse pop17 ulations to promote positive behavior 

18 change and healthy lifestyles to prevent 

19 eating disorders; 

20 ‘‘(iii) how to identify individuals with 

21 eating disorders, and those who are at risk 

22 for suffering from eating disorders and, 

23 therefore, at risk for related serious and 

24 chronic medical and mental health condi25 tions; and 


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1 ‘‘(iv) how to conduct a comprehensive 

2 assessment of individual and familial 

3 health risk factors; and 

4 ‘‘(B) evaluate and report to the Task 

5 Force for Health Professions on the effective6 ness of the training provided by such entity in 

7 increasing knowledge and changing attitudes 

8 and behaviors of trainees.’’; and 

9 (3) in subsection (e) (as so redesignated)— 

10 (A) in paragraph (1), at the end by strik11 ing ‘‘and’’; 

12 (B) in paragraph (2), at the end by strik13 ing the period and inserting ‘‘; and’’; and 

14 (C) by adding at the end the following new 

15 paragraph: 

16 ‘‘(3) to carry out subsection (c), $10,000,000 

17 for each of fiscal years 2014 through 2018.’’. 

18 SEC. 205. EDUCATION AND TRAINING FOR SCHOOL AND 

19 HIGHER EDUCATION PROFESSIONALS. 

20 (a) TASK FORCE ON EATING DISORDERS PREVEN21 TION IN EDUCATIONAL INSTITUTIONS.— 

22 (1) ESTABLISHMENT.—Not later than 1 year 

23 after the date of the enactment of this Act, the Sec24 retary of Health and Human Services, in consulta25 tion with Centers of Excellence receiving funds 


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1 under section 499B of the Public Health Service Act 

2 (as added by section 101 of this Act) and experts in 

3 eating disorder prevention and treatment, shall es4 tablish a Task Force on Eating Disorders Preven5 tion in Educational Institutions (in this subsection 

6 referred to as the ‘‘task force’’). 

7 (2) DUTIES.—The task force shall— 

8 (A) expand upon and incorporate informa9 tion from the BodyWise eating disorder initia10 tive implemented by the Office on Women’s 

11 Health of the Department of Health and 

12 Human Services to develop and provide training 

13 on eating disorders identification and preven14 tion for students, faculty, coaches, and staff in 

15 kindergartens, elementary schools, secondary 

16 schools, and institutions of higher education; 

17 (B) develop a program of educational semi18 nars on eating disorders identification and pre19 vention for use by grant recipients under sub20 section (b); and 

21 (C) provide training to grant recipients 

22 under subsection (b) on implementing such a 

23 program, including by integration into existing 

24 applicable training curricula. 

25 (b) GRANTS.— 


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1 (1) AUTHORIZATION.—The Secretary of Health 

2 and Human Services, acting through the Adminis3 trator of the Substance Abuse and Mental Health 

4 Services Administration, shall award grants to eligi5 ble entities— 

6 (A) to conduct educational seminars on 

7 eating disorders identification and prevention; 

8 and 

9 (B) to make resources available to individ10 uals affected by eating disorders. 

11 (2) EDUCATIONAL SEMINARS.—As a condition 

12 on the receipt of a grant under this subsection, an 

13 eligible entity shall agree to conduct educational 

14 seminars under paragraph (1)(A)— 

15 (A) in accordance with the program devel16 oped under subsection (a)(2)(B) by the Task 

17 Force on Eating Disorders Prevention in Edu18 cational Institutions; and 

19 (B) taking into consideration educational 

20 materials made available through the BodyWise 

21 eating disorder initiative of the Department of 

22 Health and Human Services and relevant re23 search on eating disorders. 

24 (3) ELIGIBLE ENTITY.—In this subsection, the 

25 term ‘‘eligible entity’’ means any State, territory, or 


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1 possession of the United States, the District of Co2 lumbia, any Indian tribe or tribal organization (as 

3 defined in subsections (e) and (l), respectively, of 

4 section 4 of the Indian Self-Determination and Edu5 cation Assistance Act (25 U.S.C. 450b)), or a public 

6 or private educational institution, including an insti7 tution of higher education. 

8 SEC. 206. EATING DISORDER RESEARCH AND REPORT. 

9 Not later than 18 months after the date of the enact10 ment of this Act, the National Center for Education Sta11 tistics and the National Center for Health Statistics shall 

12 conduct a study on the impact of eating disorders on edu13 cational advancement and achievement. The study shall— 

14 (1) determine the prevalence of eating disorders 

15 among students and the morbidity and mortality 

16 rates associated with eating disorders; 

17 (2) evaluate the extent to which students with 

18 eating disorders are more likely to miss school, have 

19 delayed rates of social, emotional, and physical de20 velopment, or have reduced academic performance; 

21 (3) report on current State and local programs 

22 to prevent eating disorders, as well as evaluate the 

23 value of such programs; and 

24 (4) make recommendations on measures that 

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1 ment of Education, States, and local educational 

2 agencies to strengthen eating disorder prevention 

3 and awareness programs. 

4 SEC. 207. PUBLIC SERVICE ANNOUNCEMENTS. 

5 (a) IN GENERAL.—The Director of the National In6 stitute of Mental Health shall conduct a program of public 

7 service announcements to educate the public on— 

8 (1) the types of eating disorders; 

9 (2) the seriousness of eating disorders (includ10 ing prevalence, comorbidities, and physical and men11 tal health consequences); 

12 (3) how to detect, address, refer for help, and 

13 prevent eating disorders; 

14 (4) discrimination and bullying based on body 

15 size; 

16 (5) the effects of media on self esteem and body 

17 image; and 

18 (6) the signs and symptoms of eating disorders. 

19 (b) COLLABORATION.—The Director of the National 

20 Institute of Mental Health shall conduct the program 

21 under subsection (a) in collaboration with— 

22 (1) Centers of Excellence receiving funds under 

23 section 499B of the Public Health Service Act, as 

24 added by section 101; and 


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1 (2) community-based national nonprofit re2 sources that— 

3 (A) support individuals affected by eating 

4 disorders; and 

5 (B) work to prevent eating disorders and 

6 address body image and weight issues. 

7 (c) ANNOUNCEMENT REQUIREMENTS.—In carrying 

8 out the program of public service announcements required 

9 by subsection (a), the Director of the National Institute 

10 of Mental Health shall ensure that such announcements— 

11 (1) address the full spectrum of eating dis12 orders for both sexes and a variety of ethnicities and 

13 age groups; 

14 (2) do not promote or aggravate eating dis15 orders, such as by incorporating images, specific be16 haviors, or statistics that make eating disorders 

17 seem attractive; 

18 (3) feature— 

19 (A) real people who are or were affected by 

20 eating disorders, including individuals who have 

21 died of such disorders; and 

22 (B) not actors or models in place of such 

23 people; 

24 (4) make clear that— 


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1 (A) eating disorders are not a choice, but 

2 are serious and often deadly illnesses; and 

3 (B) individuals affected by eating disorders 

4 need to seek help; and 

5 (5) provide information on how and where to 

6 seek help for the treatment of eating disorders. 

7 SEC. 208. SENSE OF CONGRESS. 

8 It is the sense of the Congress that— 

9 (1) federally funded campaigns to fight obesity 

10 should address eating disorders; and 

11 (2) federally funded studies on obesity should 

12 include questions relating to eating disorders. 

13 TITLE III—TREATMENT 

14 SEC. 301. COVERAGE FOR TREATMENT FOR EATING DIS15 ORDERS UNDER GROUP HEALTH PLANS, IN16 DIVIDUAL HEALTH INSURANCE COVERAGE, 

17 AND FEHBP. 

18 (a) PUBLIC HEALTH SERVICE ACT AMENDMENTS.— 

19 (1) IN GENERAL.—Title XXVII of the Public 

20 Health Service Act is amended by inserting after 

21 section 2728 (42 U.S.C. 300gg–28), as redesignated 

22 by section 1001(2) of the Patient Protection and Af23 fordable Care Act (Public Law 111–148), the fol24 lowing new section: 


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1 ‘‘SEC. 2729. COVERAGE FOR TREATMENT FOR EATING DIS2 ORDERS. 

3 ‘‘(a) COVERAGE.—A group health plan, and a health 

4 insurance issuer offering group or individual health insur5 ance coverage, that provides medical and surgical benefits 

6 shall provide coverage for treatment for eating disorders 

7 consistent with the provisions of this section. 

8 ‘‘(b) PROHIBITIONS.—A group health plan, and a 

9 health insurance issuer offering group or individual health 

10 insurance coverage, shall not— 

11 ‘‘(1) deny to an individual eligibility, or contin12 ued eligibility, to enroll or to renew coverage under 

13 the terms of the plan, solely for the purpose of 

14 avoiding the requirement of this section; 

15 ‘‘(2) deny coverage for treatment of eating dis16 orders, including coverage for residential treatment 

17 of eating disorders, if such treatment is medically 

18 necessary in accordance with the Practice Guidelines 

19 for the Treatment of Patients with Eating Dis20 orders, as most recently published by the American 

21 Psychiatric Association; 

22 ‘‘(3) provide monetary payments, rebates, or 

23 other benefits to individuals to encourage such indi24 viduals to accept less than the minimum protections 

25 available under this section; 


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1 ‘‘(4) penalize or otherwise reduce or limit the 

2 reimbursement of a provider because such provider 

3 provided care to an individual participant or bene4 ficiary in accordance with this section; 

5 ‘‘(5) provide incentives (monetary or otherwise) 

6 to a provider to induce such provider to provide care 

7 to an individual participant or beneficiary in a man8 ner inconsistent with this section; or 

9 ‘‘(6) deny to an individual participant or bene10 ficiary continued eligibility to enroll or to renew cov11 erage under the terms of the plan, solely because the 

12 individual was previously found to have an eating 

13 disorder or to have received treatment for an eating 

14 disorder. 

15 ‘‘(c) OUT-OF-NETWORK PROVIDERS.—In the case of 

16 a group health plan, or health insurance issuer offering 

17 group or individual health insurance coverage, that pro18 vides both medical and surgical benefits and coverage for 

19 treatment for eating disorders, if the plan or coverage pro20 vides coverage for medical or surgical benefits provided by 

21 out-of-network providers, the plan or coverage shall pro22 vide coverage for treatment for eating disorders provided 

23 by out-of-network providers in a manner that is consistent 

24 with the requirements of this section. 


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1 ‘‘(d) RULE OF CONSTRUCTION.—Nothing in this sec2 tion shall be construed as preventing a group health plan 

3 or issuer from imposing deductibles, coinsurance, or other 

4 cost-sharing in relation to treatment for eating disorders, 

5 except that such deductibles, coinsurance, or other cost6 sharing may not be greater than the deductibles, coinsur7 ance, or other cost-sharing imposed on other comparable 

8 medical or surgical services covered under the plan. 

9 ‘‘(e) PREEMPTION.—Nothing in this section shall be 

10 construed to preempt any State law in effect on the date 

11 of enactment of this section with respect to health insur12 ance coverage that requires coverage of at least the cov13 erage for treatment for eating disorders otherwise re14 quired under this section. 

15 ‘‘(f) EATING DISORDERS DEFINED.—For purposes 

16 of this section, the term ‘eating disorder’ includes anorexia 

17 nervosa, bulimia nervosa, binge eating disorder, and eat18 ing disorders not otherwise specified (EDNOS), as defined 

19 in the fifth edition of ‘Diagnostic and Statistical Manual 

20 of Mental Disorders’ or, if applicable, the most recent suc21 cessor edition.’’. 

22 (2) TREATMENT OF INDIVIDUAL MARKET BE23 FORE 2014.—For purposes of applying section 2729 

24 of the Public Health Service Act, as inserted by 

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1 erage before 2014, the provisions of such section 

2 shall be treated as also included under part B of 

3 title XXVII of the Public Health Service Act. 

4 (b) ERISA AMENDMENTS.— 

5 (1) IN GENERAL.—Subpart B of part 7 of sub6 title B of title I of the Employee Retirement Income 

7 Security Act of 1974 (29 U.S.C. 1185 et seq.) is 

8 amended by adding at the end the following new sec9 tion: 

10 ‘‘SEC. 716. COVERAGE FOR TREATMENT FOR EATING DIS11 ORDERS. 

12 ‘‘(a) COVERAGE.—A group health plan, and a health 

13 insurance issuer offering group health insurance coverage 

14 in connection with a group health plan, that provides med15 ical and surgical benefits shall provide coverage for treat16 ment for eating disorders consistent with the provisions 

17 of this section. 

18 ‘‘(b) PROHIBITIONS.—A group health plan, and a 

19 health insurance issuer offering group health insurance 

20 coverage in connection with a group health plan, shall 

21 not— 

22 ‘‘(1) deny to an individual eligibility, or contin23 ued eligibility, to enroll or to renew coverage under 

24 the terms of the plan, solely for the purpose of 

25 avoiding the requirement of this section; 


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1 ‘‘(2) deny coverage for treatment of eating dis2 orders, including coverage for residential treatment 

3 of eating disorders, if such treatment is medically 

4 necessary in accordance with the Practice Guidelines 

5 for the Treatment of Patients with Eating Dis6 orders, as most recently published by the American 

7 Psychiatric Association; 

8 ‘‘(3) provide monetary payments, rebates, or 

9 other benefits to individuals to encourage such indi10 viduals to accept less than the minimum protections 

11 available under this section; 

12 ‘‘(4) penalize or otherwise reduce or limit the 

13 reimbursement of a provider because such provider 

14 provided care to an individual participant or bene15 ficiary in accordance with this section; 

16 ‘‘(5) provide incentives (monetary or otherwise) 

17 to a provider to induce such provider to provide care 

18 to an individual participant or beneficiary in a man19 ner inconsistent with this section; or 

20 ‘‘(6) deny to an individual participant or bene21 ficiary continued eligibility to enroll or to renew cov22 erage under the terms of the plan, solely because the 

23 individual was previously found to have an eating 

24 disorder or to have received treatment for an eating 

25 disorder. 


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1 ‘‘(c) OUT-OF-NETWORK PROVIDERS.—In the case of 

2 a group health plan, or health insurance issuer offering 

3 group health insurance coverage in connection with a 

4 group health plan, that provides both medical and surgical 

5 benefits and coverage for treatment for eating disorders, 

6 if the plan or coverage provides coverage for medical or 

7 surgical benefits provided by out-of-network providers, the 

8 plan or coverage shall provide coverage for treatment for 

9 eating disorders provided by out-of-network providers in 

10 a manner that is consistent with the requirements of this 

11 section. 

12 ‘‘(d) RULE OF CONSTRUCTION.—Nothing in this sec13 tion shall be construed as preventing a group health plan 

14 or issuer from imposing deductibles, coinsurance, or other 

15 cost-sharing in relation to treatment for eating disorders, 

16 except that such deductibles, coinsurance, or other cost17 sharing may not be greater than the deductibles, coinsur18 ance, or other cost-sharing imposed on other comparable 

19 medical or surgical services covered under the plan. 

20 ‘‘(e) PREEMPTION.—Nothing in this section shall be 

21 construed to preempt any State law in effect on the date 

22 of enactment of this section with respect to health insur23 ance coverage that requires coverage of at least the cov24 erage for treatment for eating disorders otherwise re25 quired under this section. 


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1 ‘‘(f) EATING DISORDERS DEFINED.—For purposes 

2 of this section, the term ‘eating disorder’ includes anorexia 

3 nervosa, bulimia nervosa, binge eating disorder, and eat4 ing disorders not otherwise specified (EDNOS), as defined 

5 in the fifth edition of ‘Diagnostic and Statistical Manual 

6 of Mental Disorders’ or, if applicable, the most recent suc7 cessor edition.’’. 

8 (2) CONFORMING AMENDMENTS.— 

9 (A) Section 732(a) of such Act (29 U.S.C. 

10 1191a(a)) is amended by striking ‘‘section 711’’ 

11 and inserting ‘‘sections 711 and 716’’. 

12 (B) The table of contents in section 1 of 

13 such Act is amended by inserting after the item 

14 relating to section 714 the following new items: 

‘‘Sec. 715. Additional market reforms. 

‘‘Sec. 716. Coverage for treatment for eating disorders.’’. 

15 (1) IN GENERAL.—Subchapter B of chapter 

16 100 of the Internal Revenue Code of 1986, as 

17 amended by subsection (f) of section 1563 (relating 

18 to conforming amendments) of the Patient Protec19 tion and Affordable Care Act (Public Law 111–148), 

20 is amended by inserting after section 9815 the fol21 lowing: 


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1 ‘‘SEC. 9816. COVERAGE FOR TREATMENT FOR EATING DIS2 ORDERS. 

3 ‘‘(a) COVERAGE.—A group health plan that provides 

4 medical and surgical benefits shall provide coverage for 

5 treatment for eating disorders consistent with the provi6 sions of this section. 

7 ‘‘(b) PROHIBITIONS.—A group health plan shall 

8 not— 

9 ‘‘(1) deny to an individual eligibility, or contin10 ued eligibility, to enroll or to renew coverage under 

11 the terms of the plan, solely for the purpose of 

12 avoiding the requirement of this section; 

13 ‘‘(2) deny coverage for treatment of eating dis14 orders, including coverage for residential treatment 

15 of eating disorders, if such treatment is medically 

16 necessary in accordance with the Practice Guidelines 

17 for the Treatment of Patients with Eating Dis18 orders, as most recently published by the American 

19 Psychiatric Association; 

20 ‘‘(3) provide monetary payments, rebates, or 

21 other benefits to individuals to encourage such indi22 viduals to accept less than the minimum protections 

23 available under this section; 

24 ‘‘(4) penalize or otherwise reduce or limit the 

25 reimbursement of a provider because such provider 


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1 provided care to an individual participant or bene2 ficiary in accordance with this section; 

3 ‘‘(5) provide incentives (monetary or otherwise) 

4 to a provider to induce such provider to provide care 

5 to an individual participant or beneficiary in a man6 ner inconsistent with this section; or 

7 ‘‘(6) deny to an individual participant or bene8 ficiary continued eligibility to enroll or to renew cov9 erage under the terms of the plan, solely because the 

10 individual was previously found to have an eating 

11 disorder or to have received treatment for an eating 

12 disorder. 

13 ‘‘(c) OUT-OF-NETWORK PROVIDERS.—In the case of 

14 a group health plan that provides both medical and sur15 gical benefits and coverage for treatment for eating dis16 orders, if the plan provides coverage for medical or sur17 gical benefits provided by out-of-network providers, the 

18 plan or coverage shall provide coverage for treatment for 

19 eating disorders provided by out-of-network providers in 

20 a manner that is consistent with the requirements of this 

21 section. 

22 ‘‘(d) RULE OF CONSTRUCTION.—Nothing in this sec23 tion shall be construed as preventing a group health plan 

24 or issuer from imposing deductibles, coinsurance, or other 

25 cost-sharing in relation to treatment for eating disorders, 


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1 except that such deductibles, coinsurance, or other cost2 sharing may not be greater than the deductibles, coinsur3 ance, or other cost-sharing imposed on other comparable 

4 medical or surgical services covered under the plan. 

5 ‘‘(e) EATING DISORDERS DEFINED.—For purposes 

6 of this section, the term ‘eating disorder’ includes anorexia 

7 nervosa, bulimia nervosa, binge eating disorder, and eat8 ing disorders not otherwise specified (EDNOS), as defined 

9 in the fifth edition of ‘Diagnostic and Statistical Manual 

10 of Mental Disorders’ or, if applicable, the most recent suc11 cessor edition.’’. 

12 (2) CLERICAL AMENDMENT.—The table of sec13 tions of such subchapter is amended by adding at 

14 the end the following new items: 

‘‘Sec. 9815. Additional market reforms. 

‘‘Sec. 9816. Coverage for treatment for eating disorders.’’. 

15 (3) CONFORMING AMENDMENT.—Section 

16 4980D(d)(1) of the Internal Revenue Code of 1986 

17 is amended by striking ‘‘section 9811’’ and inserting 

18 ‘‘sections 9811 and 9816’’. 

19 (d) APPLICATION UNDER FEDERAL EMPLOYEES

20 HEALTH BENEFITS PROGRAM (FEHBP).—Section 8902 

21 of title 5, United States Code, is amended by adding at 

22 the end the following new subsection: 


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1 ‘‘(p) A contract may not be made or a plan approved 

2 which does not comply with the requirements of section 

3 2729 of the Public Health Service Act.’’. 

4 (e) EFFECTIVE DATES.—The amendments made by 

5 this section shall apply with respect to group health plans 

6 and health benefit plans for plan years beginning on or 

7 after the date that is 6 months after the date of the enact8 ment of this Act, and with respect to health insurance cov9 erage offered, sold, issued, renewed, in effect, or operated 

10 in the individual market on or after such date that is 6 

11 months after such date of enactment. 

12 (f) COORDINATION OF ADMINISTRATION.—The Sec13 retary of Labor, the Secretary of Health and Human Serv14 ices, and the Secretary of the Treasury shall ensure, 

15 through the execution of an interagency memorandum of 

16 understanding among such Secretaries, that— 

17 (1) regulations, rulings, and interpretations 

18 issued by such Secretaries relating to the same mat19 ter over which two or more such Secretaries have re20 sponsibility under the provisions of this section (and 

21 the amendments made thereby) are administered so 

22 as to have the same effect at all times; and 

23 (2) coordination of policies relating to enforcing 

24 the same requirements through such Secretaries in 

25 order to have a coordinated enforcement strategy 


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1 that avoids duplication of enforcement efforts and 

2 assigns priorities in enforcement. 

3 TITLE IV—IMPROVING AVAIL4 ABILITY AND ACCESS TO 

5 TREATMENT 

6 SEC. 401. MEDICAID COVERAGE FOR EATING DISORDER 

7 TREATMENT SERVICES. 

8 (a) IN GENERAL.—Section 1905 of the Social Secu9 rity Act (42 U.S.C. 1396d(a)), as amended by section 

10 2301(a)(1) of the Patient Protection and Affordable Care 

11 Act (Public Law 111–148) and section 1202(b) of the 

12 Health Care and Education Reconciliation Act of 2010 

13 (Public Law 111–152), is amended— 

14 (1) in subsection (a)— 

15 (A) in paragraph (28), by striking ‘‘and’’ 

16 at the end; 

17 (B) by redesignating paragraph (29) as 

18 paragraph (30); and 

19 (C) by inserting after paragraph (28) the 

20 following new paragraph: 

21 ‘‘(29) eating disorder treatment services (as de22 fined in subsection (ee)(1)); and’’; 

23 and 

24 (2) by adding at the end the following new sub25 section: 


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1 ‘‘(ee) EATING DISORDER TREATMENT SERVICES.— 

2 ‘‘(1) DEFINITION.—The term ‘eating disorder 

3 treatment services’ means services relating to diag4 nosis and treatment of an eating disorder (as de5 fined in section 399OO of the Public Health Service 

6 Act), including screening, counseling, 

7 pharmacotherapy (including coverage of drugs de8 scribed in paragraph (2)), and other necessary 

9 health care services. 

10 ‘‘(2) COVERAGE FOR PHARMACOLOGICAL

11 TREATMENT OF EATING DISORDERS.—For purposes 

12 of paragraph (1), eating disorder treatment services 

13 shall include drugs provided as part of care in an in14 patient setting, covered outpatient drugs (as defined 

15 in section 1927(k)(2)), and non-prescription drugs 

16 described in section 1927(d)(2)(A) that are pre17 scribed, in accordance with generally accepted med18 ical guidelines, for treatment of an eating disorder.’’. 

19 (b) INCREASED FMAP FOR EATING DISORDER

20 TREATMENT SERVICES.—Section 1905(b) of the Social 

21 Security Act (42 U.S.C. 1396d(b)), as amended by section 

22 4106(b) of the Patient Protection and Affordable Care 

23 Act, is amended— 

24 (1) by striking ‘‘and’’ before ‘‘(5)’’; and 


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1 (2) by inserting before the period at the end the 

2 following: ‘‘, and (6) the Federal medical assistance 

3 percentage shall be equal to the enhanced FMAP de4 scribed in section 2105(b) with respect to medical 

5 assistance for eating disorder treatment services (as 

6 defined in subsection (ee)(1)) provided to an indi7 vidual who is eligible for such assistance and has an 

8 eating disorder (as defined in section 399OO of the 

9 Public Health Service Act)’’. 

10 (c) INCLUSION IN EPSDT SERVICES.—Section 

11 1905(r)(1)(B) of such Act (42 U.S.C. 1396d(r)(1)(B)) is 

12 amended— 

13 (1) in clause (iv), by striking ‘‘and’’ at the end; 

14 (2) in clause (v), by striking the period at the 

15 end and inserting ‘‘, and’’; and 

16 (3) by inserting after clause (v) the following 

17 new clause: 

18 ‘‘(vi) appropriate diagnostic services 

19 relating to eating disorders (as defined in 

20 section 399OO of the Public Health Serv21 ice Act).’’. 

22 (d) EXCEPTION FROM OPTIONAL RESTRICTION

23 UNDER MEDICAID DRUG COVERAGE.—Section 

24 1927(d)(2)(A) of such Act (42 U.S.C. 1396r–8(d)(2)(A)) 

25 is amended by inserting before the period at the end the 


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1 following: ‘‘, except for drugs that are prescribed, in ac2 cordance with generally accepted medical guidelines, for 

3 the purpose of treatment of an individual who is eligible 

4 for medical assistance under the State plan and has an 

5 eating disorder (as defined in section 399OO of the Public 

6 Health Service Act)’’. 

7 (e) EFFECTIVE DATE.—The amendments made by 

8 this section shall apply to drugs and services furnished 

9 on or after the date of the enactment of this Act. 

10 SEC. 402. GRANTS TO SUPPORT PATIENT ADVOCACY. 

11 Subpart II of part D of title IX of the Public Health 

12 Service Act (42 U.S.C. 299b–33 et seq.), as amended by 

13 section 6301(b) of the Patient Protection and Affordable 

14 Care Act (Public Law 111–148), is further amended by 

15 adding at the end the following: 

16 ‘‘SEC. 938. GRANTS TO SUPPORT PATIENT ADVOCACY. 

17 ‘‘(a) GRANTS.—The Secretary, acting through the 

18 Director, shall award grants under this section to develop 

19 and support patient advocacy work to help individuals with 

20 eating disorders obtain adequate health care services and 

21 insurance coverage. 

22 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 

23 under this section, an entity shall— 

24 ‘‘(1) be a public or nonprofit private entity (in25 cluding a health department of a State or tribal 


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1 agency, a community-based organization, or an insti2 tution of higher education); 

3 ‘‘(2) prepare and submit to the Secretary an 

4 application at such time, in such manner, and con5 taining such information as the Secretary may re6 quire, including— 

7 ‘‘(A) comprehensive strategies for advo8 cating on behalf of, and working with, individ9 uals with eating disorders or at risk for devel10 oping eating disorders; 

11 ‘‘(B) a plan for consulting with commu12 nity-based coalitions, treatment centers, or eat13 ing disorder research experts who have experi14 ence and expertise in issues related to eating 

15 disorders or patient advocacy in providing serv16 ices under a grant awarded under this section; 

17 and 

18 ‘‘(C) a plan for financial sustainability in19 volving State, local, and private contributions. 

20 ‘‘(c) USE OF FUNDS.—Amounts provided under a 

21 grant awarded under this section shall be used to support 

22 patient advocacy work, including— 

23 ‘‘(1) providing education and outreach in com24 munity settings regarding eating disorders and assoVerDate Mar 15 2010 20:44 May 28, 2013 Jkt 029200 PO 00000 Frm 00057 Fmt 6652 Sfmt 6201 E:\BILLS\H2101.IH H2101

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1 ciated health problems, especially among low-income, 

2 minority, and medically underserved populations; 

3 ‘‘(2) facilitating access to appropriate, ade4 quate, and timely health care for individuals with 

5 eating disorders and associated health problems; 

6 ‘‘(3) assisting in communication and coopera7 tion between patients and providers; 

8 ‘‘(4) representing the interests of patients in 

9 managing health insurance claims and plans; 

10 ‘‘(5) providing education and outreach regard11 ing enrollment in health insurance, including enroll12 ment in the Medicare program under title XVIII of 

13 the Social Security Act, the Medicaid program under 

14 title XIX of such Act, and the Children’s Health In15 surance Program under title XXI of such Act; 

16 ‘‘(6) identifying, referring, and enrolling under17 served populations in appropriate health care agen18 cies and community-based programs and organiza19 tions in order to increase access to high-quality 

20 health care services; 

21 ‘‘(7) providing technical assistance, training, 

22 and organizational support for patient advocates; 

23 and 

24 ‘‘(8) creating, operating, and participating in 

25 State or regional networks of patient advocates. 


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1 ‘‘(d) REQUIREMENTS OF GRANTEES.— 

2 ‘‘(1) LIMITATION ON ADMINISTRATIVE EX3 PENSES.—A grantee shall not use more than 5 per4 cent of the amounts received under a grant under 

5 this section for administrative expenses. 

6 ‘‘(2) CONTRIBUTION OF FUNDS.—A grantee 

7 under this section, and any entity receiving assist8 ance under the grant for training and education, 

9 shall contribute non-Federal funds, either directly or 

10 through in-kind contributions, to the costs of the ac11 tivities to be funded under the grant in an amount 

12 that is not less than 50 percent of the total cost of 

13 such activities. 

14 ‘‘(3) REPORTING TO SECRETARY.—A grantee 

15 under this section shall submit to the Secretary a re16 port, at such time, in such manner, and containing 

17 such information as the Secretary may require, in18 cluding a description and evaluation of the activities 

19 described in subsection (c) carried out by such enti20 ty. 

21 ‘‘(e) EATING DISORDER.—In this section, the term 

22 ‘eating disorder’ has the meaning given such term in sec23 tion 399OO(e). 

24 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—To 

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1 priated $1,000,000 for each of fiscal years 2014 through 

2 2018.’’. 

Æ 


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