I 

118TH CONGRESS 

1ST SESSION H. R. 6407 

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

of medical nutrition therapy services under the Medicare program. 

IN THE HOUSE OF REPRESENTATIVES 

NOVEMBER 14, 2023 

Ms. KELLY of Illinois (for herself and Mrs. KIGGANS of Virginia) introduced 

the following bill; which was referred to the Committee on Energy and 

Commerce, and in addition to the Committee on Ways and Means, 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 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: 


lotter on DSK11XQN23PROD with BILLS
2 

•HR 6407 IH

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

2 beneficiaries have 2 or more chronic conditions, 

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

4 managed through nutrition. 

5 (2) Individuals from many racial and ethnic mi6 nority backgrounds are more likely to be diagnosed 

7 with chronic diseases such as diabetes, prediabetes, 

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

9 obesity. 

10 (3) Coverage for medical nutrition therapy is 

11 only available to Medicare Part B beneficiaries with 

12 diabetes or a renal disease, despite medical nutrition 

13 therapy being part of the standard of care, in clin14 ical guidelines, and medically necessary for many 

15 more chronic conditions. 

16 (4) Medical nutrition therapy has been shown 

17 to be a cost-effective component of treatment for 

18 obesity, diabetes, hypertension, dyslipidemia, HIV 

19 infection, unintended weight loss in older adults, and 

20 other chronic conditions. 

21 SEC. 3. EXPANDING THE AVAILABILITY OF MEDICAL NU22 TRITION THERAPY SERVICES UNDER THE 

23 MEDICARE PROGRAM. 

24 (a) IN GENERAL.—Section 1861 of the Social Secu25 rity Act (42 U.S.C. 1395x) is amended— 


lotter on DSK11XQN23PROD with BILLS
3 

•HR 6407 IH

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)’’; 

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 sub16 section (aa)(5)); 

17 ‘‘(C) a nurse practitioner (as defined in sub18 section (aa)(5)); 

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

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

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

22 manage such a disease or condition that is an eating 

23 disorder, a clinical psychologist (as defined by the 

24 Secretary).’’; and 


lotter on DSK11XQN23PROD with BILLS
4 

•HR 6407 IH

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 dis12 eases and conditions specified in this paragraph are 

13 the following: 

14 ‘‘(A) Diabetes. 

15 ‘‘(B) Prediabetes. 

16 ‘‘(C) A renal disease. 

17 ‘‘(D) Obesity (as defined for purposes of 

18 subsection (yy)(2)(C) or as otherwise defined by 

19 the Secretary). 

20 ‘‘(E) Hypertension. 

21 ‘‘(F) Dyslipidemia. 

22 ‘‘(G) Malnutrition. 

23 ‘‘(H) Eating disorders. 

24 ‘‘(I) Cancer. 


lotter on DSK11XQN23PROD with BILLS
5 

•HR 6407 IH

1 ‘‘(J) Gastrointestinal diseases, including 

2 Celiac disease. 

3 ‘‘(K) HIV. 

4 ‘‘(L) AIDS. 

5 ‘‘(M) Cardiovascular disease. 

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

7 ‘‘(i) specified by the Secretary relating 

8 to unintentional weight loss; 

9 ‘‘(ii) for which the Secretary deter10 mines the services described in paragraph 

11 (1) to be medically necessary and appro12 priate for the prevention, management, or 

13 treatment of such disease or condition, 

14 consistent with any applicable rec15 ommendations of the United States Pre16 ventive Services Task Force; or 

17 ‘‘(iii) for which the Secretary deter18 mines the services described in paragraph 

19 (1) are medically necessary, consistent ei20 ther with protocols established by reg21 istered dietitian or nutrition professional 

22 organizations or with accepted clinical 

23 guidelines identified by the Secretary.’’. 

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

25 is amended— 


lotter on DSK11XQN23PROD with BILLS
6 

•HR 6407 IH

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

2 the end; 

3 (2) in subparagraph (P), by striking the semi4 colon at the end and inserting ‘‘, and’’; and 

5 (3) by adding at the end the following new sub6 paragraph: 

7 ‘‘(Q) in the case of medical nutrition ther8 apy services (as defined in section 1861(vv)), 

9 which are not furnished for the prevention, 

10 management, or treatment of a disease or con11 dition specified in paragraph (4) of such sec12 tion;’’. 

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

14 this section shall apply with respect to items and services 

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

16 2 years after the date of the enactment of this Act. 

Æ 


lotter on DSK11XQN23PROD with BILLS