II 

118TH CONGRESS 

1ST SESSION S. 3297 

To amend title XVIII of the Social Security Act to expand the availability 

of medical nutrition therapy services under the Medicare program. 

IN THE SENATE OF THE UNITED STATES 

NOVEMBER 14 (legislative day, NOVEMBER 13), 2023 

Ms. COLLINS (for herself and Mr. PETERS) 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 expand 

the availability of medical nutrition therapy services 

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 ‘‘Medical Nutrition 

5 Therapy Act of 2023’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 

8 (1) Over two-thirds of Medicare fee-for-service 

9 beneficiaries have 2 or more chronic conditions, 


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1 many of which can be prevented, delayed, treated, or 

2 managed through nutrition. 

3 (2) Individuals from many racial and ethnic mi4 nority backgrounds are more likely to be diagnosed 

5 with chronic diseases such as diabetes, prediabetes, 

6 chronic kidney disease, end-stage renal disease, and 

7 obesity. 

8 (3) Coverage for medical nutrition therapy is 

9 only available to Medicare Part B beneficiaries with 

10 diabetes or a renal disease, despite medical nutrition 

11 therapy being part of the standard of care, in clin12 ical guidelines, and medically necessary for many 

13 more chronic conditions. 

14 (4) Medical nutrition therapy has been shown 

15 to be a cost-effective component of treatment for 

16 obesity, diabetes, hypertension, dyslipidemia, HIV 

17 infection, unintended weight loss in older adults, and 

18 other chronic conditions. 

19 SEC. 3. EXPANDING THE AVAILABILITY OF MEDICAL NU20 TRITION THERAPY SERVICES UNDER THE 

21 MEDICARE PROGRAM. 

22 (a) IN GENERAL.—Section 1861 of the Social Secu23 rity Act (42 U.S.C. 1395x) is amended— 


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1 (1) in subsection (s)(2)(V), by striking ‘‘in the 

2 case of’’ and all that follows through ‘‘organiza3 tions’’; and 

4 (2) in subsection (vv)— 

5 (A) in paragraph (1)— 

6 (i) by striking ‘‘disease management’’ 

7 and inserting ‘‘the prevention, manage8 ment, or treatment of a disease or condi9 tion specified in paragraph (4)’’; and 

10 (ii) by striking ‘‘by a physician’’ and 

11 all that follows through the period at the 

12 end and inserting the following: ‘‘by— 

13 ‘‘(A) a physician (as defined in subsection 

14 (r)(1)); 

15 ‘‘(B) a physician assistant (as defined in 

16 subsection (aa)(5)(A)); 

17 ‘‘(C) a nurse practitioner (as defined in 

18 subsection (aa)(5)(A)); 

19 ‘‘(D) a clinical nurse specialist (as defined 

20 in subsection (aa)(5)(B)); or 

21 ‘‘(E) in the case of such services furnished 

22 to manage such a disease or condition that is 

23 an eating disorder, a clinical psychologist (as 

24 defined by the Secretary).’’; and 


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1 (iii) by adding at the end the fol2 lowing new sentence: ‘‘Such term shall not 

3 include any such services furnished to an 

4 individual for the prevention, management, 

5 or treatment of a renal disease if such in6 dividual is receiving maintenance dialysis 

7 for which payment is made under section 

8 1881.’’; and 

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

10 paragraph: 

11 ‘‘(4) For purposes of paragraph (1), the diseases and 

12 conditions specified in this paragraph are the following: 

13 ‘‘(A) Diabetes. 

14 ‘‘(B) Prediabetes. 

15 ‘‘(C) A renal disease. 

16 ‘‘(D) Obesity (as defined for purposes of sub17 section (yy)(2)(C) or as otherwise defined by the 

18 Secretary). 

19 ‘‘(E) Hypertension. 

20 ‘‘(F) Dyslipidemia. 

21 ‘‘(G) Malnutrition. 

22 ‘‘(H) Eating disorders. 

23 ‘‘(I) Cancer. 

24 ‘‘(J) Gastrointestinal diseases, including Celiac 

25 disease. 


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1 ‘‘(K) HIV. 

2 ‘‘(L) AIDS. 

3 ‘‘(M) Cardiovascular disease. 

4 ‘‘(N) Any other disease or condition— 

5 ‘‘(i) specified by the Secretary relating to 

6 unintentional weight loss; 

7 ‘‘(ii) for which the Secretary determines 

8 the services described in paragraph (1) to be 

9 medically necessary and appropriate for the 

10 prevention, management, or treatment of such 

11 disease or condition, consistent with any appli12 cable recommendations of the United States 

13 Preventive Services Task Force; or 

14 ‘‘(iii) for which the Secretary determines 

15 the services described in paragraph (1) are 

16 medically necessary, consistent either with pro17 tocols established by registered dietitian or nu18 trition professional organizations or with ac19 cepted clinical guidelines identified by the Sec20 retary.’’. 

21 (b) EXCLUSION MODIFICATION.—Section 1862(a)(1) 

22 is amended— 

23 (1) in subparagraph (O), by striking ‘‘and’’ at 

24 the end; 


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1 (2) in subparagraph (P), by striking the semi2 colon at the end and inserting ‘‘, and’’; and 

3 (3) by adding at the end the following new sub4 paragraph: 

5 ‘‘(Q) in the case of medical nutrition therapy 

6 services (as defined in section 1861(vv)), which are 

7 not furnished for the prevention, management, or 

8 treatment of a disease or condition specified in para9 graph (4) of such section;’’. 

10 (c) EFFECTIVE DATE.—The amendments made by 

11 this section shall apply with respect to items and services 

12 furnished in years beginning on or after the date that is 

13 2 years after the date of the enactment of this Act. 

Æ 


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