II

106TH CONGRESS

1ST SESSION S. 660

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

under part B of the medicare program of medical nutrition therapy

services furnished by registered dietitians and nutrition professionals.

IN THE SENATE OF THE UNITED STATES

MARCH 18, 1999

Mr. BINGAMAN (for himself, Mr. CRAIG, Ms. MIKULSKI, Mr. THURMOND, Mr.

DASCHLE, Ms. COLLINS, Mr. JOHNSON, Ms. SNOWE, Mr. DORGAN, Mr.

MACK, Mr. HOLLINGS, Mr. REED, Mr. CONRAD, and Mr. CRAPO) 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

for coverage under part B of the medicare program

of medical nutrition therapy services furnished by registered dietitians and nutrition professionals.

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; FINDINGS.

4 (a) SHORT TITLE.—This Act may be cited as the

5 ‘‘Medicare Medical Nutrition Therapy Act of 1999’’.

6 (b) FINDINGS.—Congress finds as follows:
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1 (1) Medical nutrition therapy is a medically

2 necessary and cost-effective way of treating and con3 trolling many diseases and medical conditions affect4 ing the elderly, including HIV, AIDS, cancer, kidney

5 disease, diabetes, heart disease, pressure ulcers, se6 vere burns, and surgical wounds.

7 (2) Medical nutrition therapy saves health care

8 costs by speeding recovery and reducing the inci9 dence of complications, resulting in fewer hos10 pitalizations, shorter hospital stays, and reduced

11 drug, surgery, and treatment needs.

12 (3) A study conducted by The Lewin Group

13 shows that, after the third year of coverage, savings

14 would be greater than costs for coverage of medical

15 nutrition therapy for all medicare beneficiaries, with

16 savings projected to grow steadily in following years.

17 (4) The Agency for Health Care Policy and Re18 search has indicated in its practice guidelines that

19 nutrition is key to both the prevention and the treat20 ment of pressure ulcers (also called bed sores) which

21 annually cost the health care system an estimated

22 $1,300,000,000 for treatment.

23 (5) Almost 17,000,000 patients each year are

24 treated for illnesses or injuries that stem from or

25 place them at risk of malnutrition.
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1 (6) Because medical nutrition therapy is not

2 covered under part B of the medicare program and

3 because more and more health care is delivered on

4 an outpatient basis, many patients are denied access

5 to the effective, low-tech treatment they need, result6 ing in an increased incidence of complications and a

7 need for higher cost treatments.

8 SEC. 2. MEDICARE COVERAGE OF MEDICAL NUTRITION

9 THERAPY SERVICES.

10 (a) COVERAGE.—Section 1861(s)(2) of the Social Se11 curity Act (42 U.S.C. 1395x(s)(2)) is amended—

12 (1) by striking ‘‘and’’ at the end of subpara13 graph (S);

14 (2) by striking the period at the end of sub15 paragraph (T) and inserting ‘‘; and’’; and

16 (3) by adding at the end the following new sub17 paragraph:

18 ‘‘(U) medical nutrition therapy services (as de19 fined in subsection (uu)(1));’’.

20 (b) SERVICES DESCRIBED.—Section 1861 of such

21 Act (42 U.S.C. 1395x) is amended by adding at the end

22 the following new subsection:
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1 ‘‘Medical Nutrition Therapy Services; Registered

2 Dietitian or Nutrition Professional

3 ‘‘(uu)(1) The term ‘medical nutrition therapy serv4 ices’ means nutritional diagnostic, therapy, and counseling

5 services for the purpose of disease management which are

6 furnished by a registered dietitian or nutrition profes7 sional (as defined in paragraph (2)) pursuant to a referral

8 by a physician (as defined in subsection (r)(1)).

9 ‘‘(2) Subject to paragraph (3), the term ‘registered

10 dietitian or nutrition professional’ means an individual

11 who—

12 ‘‘(A) holds a baccalaureate or higher degree

13 granted by a regionally accredited college or univer14 sity in the United States (or an equivalent foreign

15 degree) with completion of the academic require16 ments of a program in nutrition or dietetics, as ac17 credited by an appropriate national accreditation or18 ganization recognized by the Secretary for this pur19 pose;

20 ‘‘(B) has completed at least 900 hours of super21 vised dietetics practice under the supervision of a

22 registered dietitian or nutrition professional; and

23 ‘‘(C)(i) is licensed or certified as a dietitian or

24 nutrition professional by the State in which the serv25 ices are performed, or
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1 ‘‘(ii) in the case of an individual in a State that

2 does not provide for such licensure or certification,

3 meets such other criteria as the Secretary estab4 lishes.

5 ‘‘(3) Subparagraphs (A) and (B) of paragraph (2)

6 shall not apply in the case of an individual who, as of the

7 date of enactment of this subsection, is licensed or cer8 tified as a dietitian or nutrition professional by the State

9 in which medical nutrition therapy services are per10 formed.’’.

11 (c) PAYMENT.—Section 1833(a)(1) of such Act (42

12 U.S.C. 1395l(a)(1)) is amended—

13 (1) by striking ‘‘and’’ before ‘‘(S)’’, and

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

15 the following: ‘‘, and (T) with respect to medical nu16 trition therapy services (as defined in section

17 1861(uu)), the amount paid shall be 80 percent of

18 the lesser of the actual charge for the services or the

19 amount determined under the fee schedule estab20 lished under section 1848(b) for the same services if

21 furnished by a physician’’.

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

23 this section apply to services furnished on or after Janu24 ary 1, 2000.

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