II 

113TH CONGRESS 

1ST SESSION S. 1184 

To amend title XVIII of the Social Security Act to include information 

on the coverage of intensive behavioral therapy for obesity in the Medicare and You Handbook and to provide for the coordination of programs 

to prevent and treat obesity, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JUNE 19, 2013 

Mr. CARPER (for himself and Ms. MURKOWSKI) 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 include 

information on the coverage of intensive behavioral therapy for obesity in the Medicare and You Handbook and 

to provide for the coordination of programs to prevent 

and treat obesity, and for other purposes. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Treat and Reduce Obe5 sity Act of 2013’’. 

6 SEC. 2. FINDINGS. 

7 Congress makes the following findings: 


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1 (1) According to the Centers for Disease Con2 trol and Prevention, about 35 percent of adults aged 

3 65 and over were obese in the period of 2007 

4 through 2010, representing over 8 million adults 

5 aged 65 through 74. 

6 (2) Obesity increases the risk for chronic dis7 eases and conditions, including high blood pressure, 

8 heart disease, and type 2 diabetes. 

9 (3) More than half of Medicare beneficiaries are 

10 treated for 5 or more chronic conditions per year. 

11 The rate of obesity among Medicare patients dou12 bled from 1987 to 2002, and spending on those indi13 viduals more than doubled. 

14 (4) Obese men and women at age 65 have de15 creased life expectancy of 1.6 years for men and 1.4 

16 years for women. 

17 (5) The direct and indirect cost of obesity is 

18 more than $450 billion annually. 

19 (6) On average, an obese Medicare beneficiary 

20 costs $1,964 more than a normal-weight beneficiary. 

21 (7) The prevalence of obesity among older 

22 Americans is growing at a linear rate and, left un23 changed, nearly half of the elderly population will be 

24 obese in 2030 according to a Congressional Research 

25 Report on obesity. 


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1 SEC. 3. INCLUSION OF INFORMATION ON COVERAGE OF IN2 TENSIVE BEHAVIORAL THERAPY FOR OBE3 SITY IN THE MEDICARE AND YOU HANDBOOK. 

4 (a) IN GENERAL.—Section 1804(a) of the Social Se5 curity Act (42 U.S.C. 1395b–2(a)) is amended— 

6 (1) in paragraph (2), by striking ‘‘and’’ at the 

7 end; 

8 (2) in paragraph (3), by striking the period at 

9 the end and inserting ‘‘, and’’; and 

10 (3) by inserting after paragraph (3) the fol11 lowing new paragraph: 

12 ‘‘(4) information on the coverage of intensive 

13 behavioral therapy for obesity under this title, in14 cluding information regarding primary care physi15 cians and other providers of services and suppliers 

16 who are eligible to furnish such therapy.’’. 

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

18 this section shall apply to notices distributed on or after 

19 the date of enactment of this Act. 


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1 SEC. 4. PLAN FOR COORDINATION OF HHS EFFORTS; PRO2 VIDING THE SECRETARY OF HEALTH AND 

3 HUMAN SERVICES WITH AUTHORITY TO CO4 ORDINATE PROGRAMS TO PREVENT AND 

5 TREAT OBESITY AND EXPAND COVERAGE OP6 TIONS FOR OBESITY UNDER MEDICARE. 

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

8 U.S.C. 1395x(ddd)), as amended by section 3, is amended 

9 by adding at the end the following new paragraph: 

10 ‘‘(5)(A) Not later than 1 year after the date of enact11 ment of the Treat and Reduce Obesity Act of 2013, the 

12 Secretary shall develop and implement a plan to coordi13 nate the efforts of all offices and agencies of the Depart14 ment of Health and Human Services (such as the Centers 

15 for Medicare & Medicaid Services, the Centers for Disease 

16 Control and Prevention, the National Institutes of Health, 

17 the Health Resources and Services Administration, and 

18 other offices and agencies) to treat, reduce, and prevent 

19 obesity and overweight in the adult population. Beginning 

20 2 years after such date of enactment, the Secretary shall 

21 annually update such plan. 

22 ‘‘(B) In developing and implementing the plan under 

23 subparagraph (A), the Secretary shall work with at least 

24 5 representatives, selected by the Secretary, of expert or25 ganizations (such as public health associations, physician 

26 associations, key healthcare provider groups, planning and 


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1 development organizations, education associations, advo2 cacy groups, patient groups, relevant industries, State and 

3 local leadership, and other entities as determined appro4 priate by the Secretary). 

5 ‘‘(C) The Secretary shall ensure that the plan under 

6 subparagraph (A) is coordinated with the National Pre7 vention Strategy and does not duplicate the efforts of the 

8 National Prevention Council and the National Prevention 

9 Strategy. 

10 ‘‘(D) The plan under subparagraph (A) shall include 

11 the following: 

12 ‘‘(i) Strategies to comprehensively treat and re13 duce overweight and obesity. 

14 ‘‘(ii) A description of— 

15 ‘‘(I) the coordination of interagency co16 operation under the plan; and 

17 ‘‘(II) actions under the plan related to the 

18 treatment and reduction of overweight and obe19 sity in the United States. 

20 ‘‘(iii) Identification of best practices in States, 

21 communities, organizations, businesses, and other 

22 entities as appropriate, regarding treatment of over23 weight and obesity. 

24 ‘‘(iv) A description of collaboration with States, 

25 communities, organizations, businesses, and other 


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1 appropriate entities to evaluate the effectiveness of 

2 obesity and overweight interventions under the plan. 

3 ‘‘(v) Research initiatives, including ongoing sur4 veillance and monitoring using tools such as the Na5 tional Health and Nutrition Examination Survey 

6 and the Behavioral Risk Factor Surveillance System 

7 and assurances for adequate and consistent funding 

8 to support data collection and analysis to inform pol9 icy under the plan. 

10 ‘‘(vi) Recommendations for the coordination of 

11 budgets, grant and pilot programs, policies, and pro12 grams across Federal agencies to cohesively treat 

13 overweight and obesity. 

14 ‘‘(E) Not later than 24 months after the date of en15 actment of the Treat and Reduce Obesity Act of 2013, 

16 and on an annual basis thereafter, the Secretary shall sub17 mit to the President and to the relevant committees of 

18 Congress, a report that— 

19 ‘‘(i) summarizes the plan under subparagraph 

20 (A) to coordinate interagency efforts surrounding 

21 the treatment, reduction, and prevention of obesity 

22 and overweight, including a detailed strategic plan 

23 with recommendations for each office and agency in24 volved; 


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1 ‘‘(ii) in the case of the second report submitted 

2 under this subparagraph (and each subsequent re3 port), evaluates the effectiveness of those coordi4 nated interventions and conducts interim assess5 ments and reporting of health outcomes, achieve6 ment of milestones, and implementation of strategic 

7 plan goals; and 

8 ‘‘(iii) makes recommendations for updating the 

9 plan for the following year based on data and find10 ings from the previous year.’’. 

11 SEC. 5. AUTHORITY TO EXPAND HEALTH CARE PROVIDERS 

12 QUALIFIED TO FURNISH INTENSIVE BEHAV13 IORAL THERAPY. 

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

15 U.S.C. 1395x(ddd)), as amended by sections 3 and 4, is 

16 amended by adding at the end the following new para17 graph: 

18 ‘‘(6)(A) The Secretary may, in addition to qualified 

19 primary care physicians and other primary care practi20 tioners, cover intensive behavioral therapy for obesity— 

21 ‘‘(i) furnished by a physician (as defined in sub22 section (r)(1)) who is not a qualified primary care 

23 physician; 

24 ‘‘(ii) furnished— 


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1 ‘‘(I) by any other appropriate health care 

2 provider (including a physician assistant, nurse 

3 practitioner, or clinical nurse specialist (as 

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

5 a clinical psychologist, and a registered dietitian 

6 or nutrition professional (as defined in sub7 section (vv)); 

8 ‘‘(II) upon referral from, and in coordina9 tion with, a physician or primary care practi10 tioner operating in a primary care setting or 

11 any other setting specified by the Secretary; 

12 and 

13 ‘‘(III) in an office setting, a hospital out14 patient department, or another setting specified 

15 by the Secretary; or 

16 ‘‘(iii) furnished by an evidence-based, commu17 nity-based lifestyle counseling program certified by 

18 the Secretary. 

19 ‘‘(B) In order to ensure a collaborative effort, the co20 ordination described in subparagraph (A)(ii)(II) may in21 clude the health care provider communicating to the physi22 cian or primary care practitioner making the referral any 

23 recommendations or treatment plans made regarding the 

24 therapy.’’. 


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1 SEC. 6. MEDICARE PART D COVERAGE OF OBESITY MEDI2 CATION. 

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

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

5 amended by inserting after ‘‘restricted under section 

6 1927(d)(2),’’ the following, ‘‘other than subparagraph (A) 

7 of such section if the drug is used for the treatment of 

8 obesity (as defined for purposes of section 1861(yy)(2)(C)) 

9 or for being overweight (as defined for purposes of section 

10 1861(yy)(2)(F)(i)) and if the individual has one or more 

11 comorbidities,’’. 

12 (b) EFFECTIVE DATE.—The amendment made by 

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

14 after the date that is 2 years after the date of enactment 

15 of this Act. 

Æ 


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