II 

111TH CONGRESS 

1ST SESSION S. 1640 

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

intensive lifestyle treatment. 

IN THE SENATE OF THE UNITED STATES 

AUGUST 6, 2009 

Mr. WYDEN (for himself, Mr. CORNYN, and Mr. HARKIN) introduced the 

following bill; which was read twice and referred to the Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to provide 

coverage of intensive lifestyle treatment. 

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 ‘‘Take Back Your 

5 Health Act of 2009’’. 

6 SEC. 2. COVERAGE OF INTENSIVE LIFESTYLE TREATMENT. 

7 (a) INTENSIVE LIFESTYLE TREATMENT PROGRAM.— 

8 (1) IN GENERAL.—Section 1861 of the Social 

9 Security Act (42 U.S.C. 1395x) is amended— 

10 (A) in subsection (s)(2)— 


tjames on DSK5CLS3C1PROD with BILLS
2 

•S 1640 IS

1 (i) in subparagraph (DD) by striking 

2 ‘‘and’’ at the end; 

3 (ii) in subparagraph (EE) by inserting 

4 ‘‘and’’ at the end; and 

5 (iii) by adding at the end the fol6 lowing new subparagraph: 

7 ‘‘(FF) items and services furnished under 

8 an intensive lifestyle treatment program (as de9 fined in paragraph (hhh)(1)) to eligible bene10 ficiaries (as defined in paragraph (hhh)(4));’’; 

11 and 

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

13 subsection: 

14 ‘‘Intensive Lifestyle Treatment Program 

15 ‘‘(hhh)(1) The term ‘intensive lifestyle treatment pro16 gram’ means a physician-supervised program (as defined 

17 in paragraph (2)) that furnishes the items and services 

18 described in paragraph (3) intended to beneficially affect 

19 the progression of chronic diseases to eligible beneficiaries 

20 (as defined in paragraph (4)). 

21 ‘‘(2) A program described in this paragraph is a pro22 gram under which— 

23 ‘‘(A) items and services under the program are 

24 delivered— 

25 ‘‘(i) in a physician’s office or clinic; 


tjames on DSK5CLS3C1PROD with BILLS
3 

•S 1640 IS

1 ‘‘(ii) in a hospital on an outpatient basis; 

2 or 

3 ‘‘(iii) in other settings determined appro4 priate by the Secretary; 

5 ‘‘(B) a physician (as defined in section 

6 1861(r)(1)) is immediately available and accessible 

7 for medical consultation and medical emergencies at 

8 all times items and services are being furnished 

9 under the program, except that, in the case of items 

10 and services furnished under such a program in a 

11 hospital, such availability shall be presumed; 

12 ‘‘(C) individualized treatment is furnished 

13 under a written plan established and designed by a 

14 physician (as so defined) in advance of the start of 

15 the program and reviewed and signed by a physician 

16 every 60 days that describes— 

17 ‘‘(i) the individual’s diagnosis; 

18 ‘‘(ii) the type, amount, frequency, and du19 ration of the items and services furnished under 

20 the plan; and 

21 ‘‘(iii) the goals set for the individual under 

22 the plan; 

23 ‘‘(D) items and services may be provided in a 

24 series of 72 one-hour sessions (as defined in section 

25 1848(b)(6)), up to 6 sessions per day, over a period 


tjames on DSK5CLS3C1PROD with BILLS
4 

•S 1640 IS

1 of 18 weeks, and may include group sessions with up 

2 to 15 other eligible beneficiaries; and 

3 ‘‘(E) items and services may be provided— 

4 ‘‘(i) by an intensive lifestyle team; 

5 ‘‘(ii) under the direction of a physician (as 

6 so defined); and 

7 ‘‘(iii) if determined appropriate by the Sec8 retary, in the case of such items and services 

9 provided in underserved areas, by a physician 

10 assistant, nurse practitioner, or clinical nurse 

11 specialist as provided under State law. 

12 ‘‘(3) The items and services described in this para13 graph are— 

14 ‘‘(A) exercise; 

15 ‘‘(B) risk factor modification, including edu16 cation, counseling, and behavioral intervention (to 

17 the extent such education, counseling, and behav18 ioral intervention is closely related to the individual’s 

19 care and treatment and is tailored to the individual’s 

20 needs); 

21 ‘‘(C) psychosocial assessment; 

22 ‘‘(D) provider consultation; 

23 ‘‘(E) care coordination; 

24 ‘‘(F) medication management; 

25 ‘‘(G) medical nutritional therapy; 


tjames on DSK5CLS3C1PROD with BILLS
5 

•S 1640 IS

1 ‘‘(H) tobacco cessation; 

2 ‘‘(I) outcomes assessment; and 

3 ‘‘(J) such other items and services as the Sec4 retary determines appropriate, but only if such items 

5 and services are— 

6 ‘‘(i) reasonable and necessary for the diag7 nosis or active treatment of the individual’s 

8 condition; 

9 ‘‘(ii) reasonably expected to improve or 

10 maintain the individual’s condition and func11 tional level; and 

12 ‘‘(iii) furnished under such guidelines re13 lating to the frequency and duration of such 

14 items and services as the Secretary shall estab15 lish, taking into account accepted norms of 

16 medical practice and the reasonable expectation 

17 of improvement of the individual. 

18 ‘‘(4) The term ‘eligible beneficiary’ means an indi19 vidual who is entitled to, or enrolled for, benefits under 

20 part A and enrolled under this part and who has been 

21 diagnosed with 1 or more of the following conditions: 

22 ‘‘(A) Coronary heart disease. 

23 ‘‘(B) Type 2 diabetes. 

24 ‘‘(C) Metabolic syndrome. 

25 ‘‘(D) Prostate cancer. 


tjames on DSK5CLS3C1PROD with BILLS
6 

•S 1640 IS

1 ‘‘(E) Breast cancer.’’. 

2 (2) PAYMENT FOR INTENSIVE LIFESTYLE

3 TREATMENT PROGRAMS.— 

4 (A) INCLUSION IN PHYSICIANS’ SERV5 ICES.—Section 1848(j)(3) of the Social Security 

6 Act (42 U.S.C. 1395w–4(j)(3)) is amended by 

7 inserting ‘‘(2)(FF),’’ after ‘‘(2)(EE).’’. 

8 (B) CONFORMING AMENDMENT.—Section 

9 1848(b) of the Social Security Act (42 U.S.C. 

10 1395w–4(b)) is amended by adding at the end 

11 the following new paragraph: 

12 ‘‘(6) TREATMENT OF INTENSIVE LIFESTYLE

13 TREATMENT PROGRAM.— 

14 ‘‘(A) IN GENERAL.—In the case of an in15 tensive lifestyle treatment program described in 

16 section 1861(hhh)(2), the Secretary shall estab17 lish an aggregate payment for items and serv18 ices furnished under such program (as de19 scribed in section 1861(hhh)(3)) not to exceed 

20 the cost to the program under this title for a 

21 hospitalization for a similarly situated eligible 

22 beneficiary, subject to the limitation under sub23 paragraph (C). 

24 ‘‘(B) PAYMENT SCHEDULE.—The Sec25 retary shall— 


tjames on DSK5CLS3C1PROD with BILLS
7 

•S 1640 IS

1 ‘‘(i) make a payment to such a pro2 gram in an amount that is equal to 50 per3 cent of the amount established under sub4 paragraph (A) upon completion of the ini5 tial consultation under the program; and 

6 ‘‘(ii) subject to the limitation de7 scribed in subparagraph (C), make a sec8 ond payment to a program for the balance 

9 of the amount defined in subparagraph (A) 

10 upon completion of treatment under the 

11 program. 

12 ‘‘(C) LIMITATION.— 

13 ‘‘(i) IN GENERAL.—Notwithstanding 

14 the provisions of subparagraph (B), an in15 tensive lifestyle treatment program shall 

16 not receive the payment described in sub17 paragraph (B)(ii) unless it documents, 

18 upon the completion of the program by an 

19 eligible beneficiary, that services provided 

20 to such beneficiary under the program are 

21 beneficially affecting the progression of 

22 chronic disease or diseases in the bene23 ficiary, as measured under clause (ii) with 

24 respect to 2 or more of the following meas25 ures: 


tjames on DSK5CLS3C1PROD with BILLS
8 

•S 1640 IS

1 ‘‘(I) Measures described in sub2 clauses (I) through (V) of section 

3 1861(eee)(4)(A)(ii). 

4 ‘‘(II) High density lipoprotein. 

5 ‘‘(III) Hemoglobin A1C. 

6 ‘‘(IV) C-reactive protein. 

7 ‘‘(V) Waist size. 

8 ‘‘(VI) Elimination of cotinine 

9 level as evidence that the eligible ben10 eficiary no longer uses tobacco. 

11 ‘‘(VII) Prostate specific antigen 

12 or other prognostic biomarkers of 

13 prostate cancer. 

14 ‘‘(VIII) Prognostic biomarkers of 

15 breast cancer. 

16 ‘‘(ii) MEASUREMENT.—The Secretary 

17 shall determine the beneficial progression 

18 of chronic disease or diseases under clause 

19 (i), using the level of 2 or more of the 

20 measures described in subclause (i) before 

21 receiving services under such program and 

22 such levels after completion of treatment 

23 under the program— 

24 ‘‘(I) by normalization (as defined 

25 by the Secretary); and 


tjames on DSK5CLS3C1PROD with BILLS
9 

•S 1640 IS

1 ‘‘(II) in the case of— 

2 ‘‘(aa) measures described in 

3 subclauses (I) through (V), (VII), 

4 and (VIII), by at least 10 percent 

5 reduction; or 

6 ‘‘(bb) the measure described 

7 in subclause (VI), by elimination. 

8 ‘‘(iii) REFUND OF PAYMENTS OR

9 COSTS IN CERTAIN CIRCUMSTANCES.—In 

10 the case of an eligible beneficiary who, 

11 within 1 year of receiving an initial con12 sultation under the program, receives any 

13 other treatment covered under part A or 

14 this part for any condition that relates to 

15 the initial diagnosis resulting in eligibility 

16 for the intensive lifestyle treatment pro17 gram, except for a physician office visit for 

18 the purpose of making adjustments to 

19 medication prescribed to the eligible bene20 ficiary, such program shall refund to the 

21 Secretary the lesser of— 

22 ‘‘(I) any payments made under 

23 paragraph (B) for services provided to 

24 the eligible beneficiary under the pro25 gram; or 


tjames on DSK5CLS3C1PROD with BILLS
10 

•S 1640 IS

1 ‘‘(II) the cost of such other treat2 ment covered under part A or this 

3 part such condition. 

4 ‘‘(D) COVERAGE OF SESSIONS.— 

5 ‘‘(i) IN GENERAL.—Items and services 

6 provided under the program in a series of 

7 72 one-hour sessions (as defined in clause 

8 (ii)), up to 6 sessions per day, over a pe9 riod of 18 weeks shall, subject to the limi10 tation under subparagraph (C), be eligible 

11 for the aggregate payment established 

12 under subparagraph (A). 

13 ‘‘(ii) DEFINITION OF SESSION.—Each 

14 of the services described in subparagraphs 

15 (A) through (J) of section 1861(hhh)(3), 

16 when furnished for 1 hour, is a separate 

17 session under an intensive lifestyle treat18 ment program.’’. 

19 (b) COPAYMENTS FOR INTENSIVE LIFESTYLE

20 TREATMENT ITEMS AND SERVICES.—Section 1833(a)(1) 

21 of the Social Security Act (42 U.S.C. 1395l(a)(1)) is 

22 amended— 

23 (1) by striking ‘‘and’’ before (W); 

24 (2) by inserting before the semicolon at the end 

25 the following: ‘‘, and (X) with respect to items and 


tjames on DSK5CLS3C1PROD with BILLS
11 

•S 1640 IS

1 services furnished under an intensive lifestyle treat2 ment program (as defined in section 1861(hhh)(2)), 

3 the amount paid shall be 100 percent of the lesser 

4 of the actual charge for the services or the amount 

5 determined under section 1848(b)(6)(A)’’. 

6 (c) LIFESTYLE REWARDS PROGRAM.—Title XVIII of 

7 the Social Security Act is amended by adding at the end 

8 the following new section: 

9 ‘‘SEC. 1899. LIFESTYLE REWARDS PROGRAMS. 

10 ‘‘(a) ESTABLISHMENT.—The Secretary shall estab11 lish a Lifestyle Rewards Program (in this section referred 

12 to as the ‘program’) for eligible beneficiaries (as defined 

13 in section 1861(s)(2)(hhh)(4)) who have successfully com14 pleted an intensive lifestyle treatment program (as defined 

15 in section 1861(hhh)(2)) and meet the requirements de16 scribed in subsection (b). 

17 ‘‘(b) REQUIREMENTS.—In order to receive an award 

18 under the program, an eligible beneficiary must— 

19 ‘‘(1) demonstrate that the program has bene20 ficially affected the progression of chronic disease or 

21 diseases in the beneficiary upon completion of the 

22 program, as measured under clause (ii) of section 

23 1848(b)(6)(C) with respect to 2 or more of the 

24 measures described in clause (i) of such section; and 


tjames on DSK5CLS3C1PROD with BILLS
12 

•S 1640 IS

1 ‘‘(2) during the 1 year period beginning on the 

2 date of an initial consultation under the lifestyle 

3 treatment program, receive no other treatment 

4 under part A or this part for any condition that re5 lates to the initial diagnosis resulting in eligibility 

6 for the intensive lifestyle treatment program, except 

7 for a physician office visit for the purpose of making 

8 adjustments to medication prescribed to the eligible 

9 beneficiary. 

10 ‘‘(c) FORM OF REWARD.—The Secretary shall make 

11 such award to eligible beneficiaries described in subsection 

12 (a) in such form and manner as the Secretary, by regula13 tion, shall prescribe. 

14 ‘‘(d) AMOUNT OF REWARD.—The amount of such 

15 award for each such eligible beneficiary shall be $200.’’. 

16 (d) EFFECTIVE DATE.—The amendments made by 

17 this section shall apply to items and services furnished on 

18 or after January 1, 2010. 

19 SEC. 3. SENSE OF THE CONGRESS. 

20 It is the sense of the Congress that the services pro21 vided under a intensive lifestyle treatment program (as de22 fined in section 1861(hhh)(2) of the Social Security Act, 

23 as added by section 2(a))— 


tjames on DSK5CLS3C1PROD with BILLS
13 

•S 1640 IS

1 (1) would benefit individuals with chronic dis2 eases who are not enrolled in the Medicare Program 

3 under title XVIII of the Social Security Act; and 

4 (2) should be covered by all public and private 

5 payers. 

Æ 


tjames on DSK5CLS3C1PROD with BILLS