II 

112TH CONGRESS 

1ST SESSION S. 311 

To provide for the coverage of medically necessary food under Federal health 

programs and private health insurance. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 8, 2011 

Mr. KERRY (for himself and Mr. CASEY) introduced the following bill; which 

was read twice and referred to the Committee on Finance 

A BILL 

To provide for the coverage of medically necessary food under 

Federal health programs and private health insurance. 

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 Foods Equity 

5 Act of 2011’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 

8 (1) Newborns are screened for inborn errors of 

9 metabolism, but treatment for such conditions is not 

10 uniformly covered by insurance. 


srobinson on DSKHWCL6B1PROD with BILLS
2 

•S 311 IS

1 (2) Each year approximately 2,550 children in 

2 the United States are diagnosed with an inborn 

3 error of metabolism disorder, requiring foods modi4 fied to be void of the nutrient or nutrients the 

5 child’s body is incapable of processing, or requiring 

6 supplementation with vitamins or amino acids. 

7 (3) More than 35 States have passed laws to at 

8 least partially address the inequity in coverage for 

9 medically necessary foods, critical treatment for such 

10 disorders. 

11 (4) The cost associated with providing medically 

12 necessary foods presents a large financial burden for 

13 many families. 

14 (5) There is no current cure for inborn errors 

15 of metabolism disorders and treatment is necessary 

16 during the entire lifespan of the individual. 

17 SEC. 3. COVERAGE IN FEDERAL HEALTH PROGRAMS OF 

18 MEDICALLY NECESSARY FOOD AND FOOD 

19 MODIFIED TO BE LOW PROTEIN. 

20 (a) COVERAGE UNDER THE MEDICARE PROGRAM.— 

21 (1) COVERAGE OF MEDICALLY NECESSARY

22 FOOD UNDER THE ORIGINAL MEDICARE FEE-FOR23 SERVICE PROGRAM.— 


srobinson on DSKHWCL6B1PROD with BILLS
3 

•S 311 IS

1 (A) IN GENERAL.—Section 1861(s)(2) of 

2 the Social Security Act (42 U.S.C. 1395x(s)(2)) 

3 is amended— 

4 (i) in subparagraph (EE), by striking 

5 ‘‘and’’ at the end; 

6 (ii) in subparagraph (FF), by insert7 ing ‘‘and’’ at the end; and 

8 (iii) by adding at the end the fol9 lowing new subparagraph: 

10 ‘‘(GG) medically necessary food (as defined in 

11 subsection (iii)) and food modified to be low protein 

12 that is formulated to be consumed or administered 

13 under the supervision of a qualified medical pro14 vider, for the treatment of conditions as rec15 ommended by the Advisory Committee on Heritable 

16 Disorders in Newborns and Children, and the med17 ical equipment and supplies necessary to administer 

18 such food;’’. 

19 (B) DEFINITION.—Section 1861 of the So20 cial Security Act (42 U.S.C. 1395x) is amended 

21 by adding at the end the following new sub22 section: 

23 ‘‘(iii)(1) The term ‘medically necessary food’— 

24 ‘‘(A) means a food which is formulated to be 

25 consumed or administered enterally under the superVerDate Mar 15 2010 21:24 Feb 08, 2011 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S311.IS S311

srobinson on DSKHWCL6B1PROD with BILLS
4 

•S 311 IS

1 vision of a physician and which is intended for the 

2 specific dietary management of a disease or condi3 tion for which distinctive nutritional requirements, 

4 based on recognized scientific principles, are estab5 lished by medical evaluation; and 

6 ‘‘(B) includes nutritionally modified counter7 parts of traditional foods and other forms of foods 

8 such as formulas, pills, capsules, and bars, so long 

9 as consumed or administered enterally. 

10 ‘‘(2) For purposes of paragraph (1), the term 

11 ‘enterally’ refers to consumption or administration 

12 through the gastrointestinal tract, whether orally or by 

13 tube.’’. 

14 (C) PAYMENT.—Section 1833(a)(1) of the 

15 Social Security Act (42 U.S.C. 1395l(a)(1)) is 

16 amended— 

17 (i) by striking ‘‘and’’ before ‘‘(Z)’’; 

18 and 

19 (ii) by inserting before the semicolon 

20 at the end the following: ‘‘, and (AA) with 

21 respect to medically necessary food and 

22 pharmacological doses of vitamins and 

23 amino acids under section 1861(s)(2)(GG), 

24 the amounts paid shall be 80 percent of 

25 the lesser of the actual charge for the servVerDate Mar 15 2010 21:24 Feb 08, 2011 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S311.IS S311

srobinson on DSKHWCL6B1PROD with BILLS
5 

•S 311 IS

1 ices or 85 percent of the amount deter2 mined under the fee schedule established 

3 under section 1848(b) for the same serv4 ices if furnished by a physician’’. 

5 (2) INCLUSION OF PHARMACOLOGICAL DOSES

6 OF VITAMINS AND AMINO ACIDS AS A COVERED PART

7 D DRUG.— 

8 (A) IN GENERAL.—Section 1860D–2(e)(1) 

9 of the Social Security Act (42 U.S.C. 1395w– 

10 102(e)(1)) is amended— 

11 (i) in subparagraph (A), by striking 

12 ‘‘or’’ at the end; 

13 (ii) in subparagraph (B), by striking 

14 the comma at the end and inserting ‘‘; or’’; 

15 and 

16 (iii) by inserting after subparagraph 

17 (B) the following new subparagraph: 

18 ‘‘(C) pharmacological doses of vitamins 

19 and amino acids used for the treatment of in20 born errors of metabolism, for the treatment of 

21 conditions as recommended by the Advisory 

22 Committee on Heritable Disorders in Newborns 

23 and Children and as prescribed by a qualified 

24 medical provider,’’. 


srobinson on DSKHWCL6B1PROD with BILLS
6 

•S 311 IS

1 (B) EFFECTIVE DATE.—The amendments 

2 made by subparagraph (A) shall apply to plan 

3 years beginning on or after the date that is 6 

4 months after date of enactment of this Act. 

5 (b) COVERAGE UNDER THE MEDICAID PROGRAM.— 

6 (1) IN GENERAL.—Section 1905 of the Social 

7 Security Act (42 U.S.C. 1396d) is amended— 

8 (A) in subsection (a)— 

9 (i) in paragraph (12), by inserting 

10 ‘‘including pharmacological doses of vita11 mins and amino acids used for the treat12 ment of inborn errors of metabolism, for 

13 the treatment of conditions as rec14 ommended by the Advisory Committee on 

15 Heritable Disorders in Newborns and Chil16 dren and as prescribed by a qualified med17 ical provider,’’ after ‘‘prescribed drugs,’’; 

18 (ii) in paragraph (28), by striking 

19 ‘‘and’’ at the end; 

20 (iii) in paragraph (29), by striking the 

21 comma at the end and inserting ‘‘; and’’; 

22 and 

23 (iv) by inserting after paragraph (29) 

24 the following new paragraph: 


srobinson on DSKHWCL6B1PROD with BILLS
7 

•S 311 IS

1 ‘‘(30) medically necessary food (as defined in 

2 subsection (ee)) and food modified to be low protein 

3 that is formulated to be consumed or administered 

4 under the supervision of a qualified medical pro5 vider, for the treatment of conditions as rec6 ommended by the Advisory Committee on Heritable 

7 Disorders in Newborns and Children, and the med8 ical equipment and supplies necessary to administer 

9 such food,’’; and 

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

11 subsection: 

12 ‘‘(ee) MEDICALLY NECESSARY FOOD DEFINED.— 

13 ‘‘(1) IN GENERAL.—For purposes of subsection 

14 (a)(30), the term ‘medically necessary food’— 

15 ‘‘(A) means a food which is formulated to 

16 be consumed or administered enterally under 

17 the supervision of a physician and which is in18 tended for the specific dietary management of 

19 a disease or condition for which distinctive nu20 tritional requirements, based on recognized sci21 entific principles, are established by medical 

22 evaluation; and 

23 ‘‘(B) includes nutritionally modified coun24 terparts of traditional foods and other forms of 

25 foods such as formulas, pills, capsules, and 


srobinson on DSKHWCL6B1PROD with BILLS
8 

•S 311 IS

1 bars, so long as consumed or administered 

2 enterally. 

3 ‘‘(2) ENTERALLY.—For purposes of paragraph 

4 (1), the term ‘enterally’ refers to consumption or ad5 ministration through the gastrointestinal tract, 

6 whether orally or by tube.’’. 

7 (2) EXCEPTION TO REBATE EXCLUSION.—Sec8 tion 1927(d)(2)(E) of the Social Security Act (42 

9 U.S.C. 1396r–8(d)(2)(E)) is amended by inserting 

10 ‘‘, pharmacological doses of vitamins and amino 

11 acids used for the treatment of inborn errors of me12 tabolism, for the treatment of conditions as rec13 ommended by the Advisory Committee on Heritable 

14 Disorders in Newborns and Children and as pre15 scribed by a qualified medical provider,’’ after ‘‘pre16 natal vitamins’’. 

17 (3) CONFORMING AMENDMENT.—Section 

18 1902(a)(10)(A) of the Social Security Act (42 

19 U.S.C. 1396a(a)(10)(A)) is amended, in the matter 

20 preceding clause (i), by striking ‘‘and (28)’’ and in21 serting ‘‘(28), and (30)’’. 

22 (4) EXCEPTION TO EFFECTIVE DATE IF STATE

23 LEGISLATION REQUIRED.—In the case of a State 

24 plan for medical assistance under title XIX of the 

25 Social Security Act which the Secretary of Health 


srobinson on DSKHWCL6B1PROD with BILLS
9 

•S 311 IS

1 and Human Services (referred to in this Act as the 

2 ‘‘Secretary’’) determines requires State legislation 

3 (other than legislation appropriating funds) in order 

4 for the plan to meet the additional requirement im5 posed by the amendments made by this subsection, 

6 the State plan shall not be regarded as failing to 

7 comply with the requirements of such title solely on 

8 the basis of its failure to meet this additional re9 quirement before the first day of the first calendar 

10 quarter beginning after the close of the first regular 

11 session of the State legislature that begins after the 

12 date of the enactment of this Act. For purposes of 

13 the previous sentence, in the case of a State that has 

14 a 2-year legislative session, each year of such session 

15 shall be deemed to be a separate regular session of 

16 the State legislature. 

17 (c) COVERAGE UNDER CHIP.— 

18 (1) IN GENERAL.— 

19 (A) MEDICALLY NECESSARY FOOD.—Sec20 tion 2103(c) of the Social Security Act (42 

21 U.S.C. 1397cc(c)) is amended by adding at the 

22 end the following: 

23 ‘‘(9) MEDICALLY NECESSARY FOOD.— 

24 ‘‘(A) IN GENERAL.—The child health as25 sistance provided to a targeted low-income child 


srobinson on DSKHWCL6B1PROD with BILLS
10 

•S 311 IS

1 under the plan shall include coverage of medi2 cally necessary food and food modified to be low 

3 protein that is formulated to be consumed or 

4 administered under the supervision of a quali5 fied medical provider, for the treatment of con6 ditions as recommended by the Advisory Com7 mittee on Heritable Disorders in Newborns and 

8 Children, and the medical equipment and sup9 plies necessary to administer such food. 

10 ‘‘(B) DEFINITIONS.—In this paragraph— 

11 ‘‘(i) the term ‘medically necessary 

12 food’— 

13 ‘‘(I) means a food which is for14 mulated to be consumed or adminis15 tered enterally under the supervision 

16 of a physician and which is intended 

17 for the specific dietary management of 

18 a disease or condition for which dis19 tinctive nutritional requirements, 

20 based on recognized scientific prin21 ciples, are established by medical eval22 uation; and 

23 ‘‘(II) includes nutritionally modi24 fied counterparts of traditional foods 

25 and other forms of foods such as forVerDate Mar 15 2010 21:24 Feb 08, 2011 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S311.IS S311

srobinson on DSKHWCL6B1PROD with BILLS
11 

•S 311 IS

1 mulas, pills, capsules, and bars, so 

2 long as consumed or administered 

3 enterally; and 

4 ‘‘(ii) the term ‘enterally’ refers to con5 sumption or administration through the 

6 gastrointestinal tract, whether orally or by 

7 tube.’’. 

8 (B) VITAMINS AND AMINO ACIDS.—Section 

9 2110(a)(6) of the Social Security Act (42 

10 U.S.C. 1397jj(a)(6)) is amended by striking 

11 ‘‘and biologicals and the administration of such 

12 drugs and biologicals, only if such drugs and 

13 biologicals’’ and inserting ‘‘, pharmacological 

14 doses of vitamins and amino acids used for the 

15 treatment of inborn errors of metabolism, for 

16 the treatment of conditions as recommended by 

17 the Advisory Committee on Heritable Disorders 

18 in Newborns and Children and as prescribed by 

19 a qualified medical provider, and biologicals, 

20 and the administration of such drugs, vitamins 

21 and amino acids, and biologicals, only if such 

22 drugs, vitamins and amino acids, and 

23 biologicals’’. 

24 (2) CONFORMING AMENDMENT.—Section 

25 2103(a) of the Social Security Act (42 U.S.C. 


srobinson on DSKHWCL6B1PROD with BILLS
12 

•S 311 IS

1 1397cc(a)) is amended, in the matter preceding 

2 paragraph (1), by striking ‘‘, and (7)’’ and inserting 

3 ‘‘, (7), and (9)’’. 

4 (d) AVAILABILITY OF MEDICALLY NECESSARY FOOD, 

5 FOOD MODIFIED TO BE LOW PROTEIN, AND RELATED

6 ITEMS UNDER THE TRICARE PROGRAM.—Section 

7 1077(a)(8) of title 10, United States Code, is amended 

8 by striking ‘‘including’’ and all that follows and inserting 

9 ‘‘including the following: 

10 ‘‘(A) Well-baby care that includes one 

11 screening of an infant for the level of lead in 

12 the blood of the infant. 

13 ‘‘(B) Medically necessary food (as defined 

14 in section 1861(iii) of the Social Security Act) 

15 and food modified to be low protein that is for16 mulated to be consumed or administered under 

17 the supervision of a qualified medical provider, 

18 for the treatment of conditions as recommended 

19 by the Advisory Committee on Heritable Dis20 orders in Newborns and Children, and the med21 ical equipment and supplies necessary to admin22 ister such food. 

23 ‘‘(C) Pharmacological doses of vitamins 

24 and amino acids used for the treatment of in25 born errors of metabolism and other conditions 


srobinson on DSKHWCL6B1PROD with BILLS
13 

•S 311 IS

1 as recommended by the Advisory Committee on 

2 Heritable Disorders in Newborns and Chil3 dren.’’. 

4 SEC. 4. COVERAGE IN THE PRIVATE INSURANCE MARKET 

5 OF MEDICALLY NECESSARY FOOD AND FOOD 

6 MODIFIED TO BE LOW PROTEIN. 

7 (a) GROUP HEALTH PLANS.— 

8 (1) AMENDMENTS TO ERISA.— 

9 (A) IN GENERAL.—Subpart B of part 7 of 

10 title I of the Employee Retirement Income Se11 curity Act of 1974 (29 U.S.C. 1185 et seq.) is 

12 amended by adding at the end the following: 

13 ‘‘SEC. 716. COVERAGE OF MEDICALLY NECESSARY FOOD 

14 AND FOOD MODIFIED TO BE LOW PROTEIN. 

15 ‘‘(a) DEFINITION.—In this section— 

16 ‘‘(1) the term ‘medically necessary food’— 

17 ‘‘(A) means a food which is formulated to 

18 be consumed or administered enterally under 

19 the supervision of a physician and which is in20 tended for the specific dietary management of 

21 a disease or condition for which distinctive nu22 tritional requirements, based on recognized sci23 entific principles, are established by medical 

24 evaluation; and 


srobinson on DSKHWCL6B1PROD with BILLS
14 

•S 311 IS

1 ‘‘(B) includes nutritionally modified coun2 terparts of traditional foods and other forms of 

3 foods such as formulas, pills, capsules, and 

4 bars, so long as consumed or administered 

5 enterally; and 

6 ‘‘(2) the term ‘enterally’ refers to consumption 

7 or administration through the gastrointestinal tract, 

8 whether orally or by tube. 

9 ‘‘(b) COVERAGE.— 

10 ‘‘(1) MEDICALLY NECESSARY FOOD AND FOOD

11 MODIFIED TO BE LOW PROTEIN.—A group health 

12 plan, or a health insurance issuer that provides 

13 health insurance coverage in connection with a group 

14 health plan, shall provide coverage for medically nec15 essary food and food modified to be low protein that 

16 is formulated to be consumed or administered under 

17 the supervision of a qualified medical provider, for 

18 the treatment of conditions as recommended by the 

19 Advisory Committee on Heritable Disorders in 

20 Newborns and Children, and the medical equipment 

21 and supplies necessary to administer such food. 

22 ‘‘(2) VITAMINS AND AMINO ACIDS.—A group 

23 health plan, or a health insurance issuer that pro24 vides health insurance coverage in connection with a 

25 group health plan, that provides prescription drug 


srobinson on DSKHWCL6B1PROD with BILLS
15 

•S 311 IS

1 coverage shall provide coverage for pharmacological 

2 doses of vitamins and amino acids used for the 

3 treatment of inborn errors of metabolism, for the 

4 treatment of conditions as recommended by the Ad5 visory Committee on Heritable Disorders in 

6 Newborns and Children and as prescribed by a 

7 qualified medical provider, to the same extent as 

8 other prescription drug coverage under such plan or 

9 coverage.’’. 

10 (B) CONFORMING AMENDMENT.—The 

11 table of contents in section 1 of such Act is 

12 amended by inserting after the item relating to 

13 section 714 the following new items: 

‘‘Sec. 715. Additional market reforms. 

‘‘Sec. 716. Coverage of medically necessary food and food modified to be low 

protein.’’. 

14 (2) AMENDMENTS TO THE PUBLIC HEALTH

15 SERVICE ACT.—Subpart 2 of part A of title XXVII 

16 of the Public Health Service Act (42 U.S.C. 300gg– 

17 4 et seq.) is amended by adding at the end the fol18 lowing new section: 

19 ‘‘SEC. 2729. COVERAGE OF MEDICALLY NECESSARY FOOD 

20 AND FOOD MODIFIED TO BE LOW PROTEIN. 

21 ‘‘(a) DEFINITIONS.—In this section— 

22 ‘‘(1) the term ‘medically necessary food’— 

23 ‘‘(A) means a food which is formulated to 

24 be consumed or administered enterally under 


srobinson on DSKHWCL6B1PROD with BILLS
16 

•S 311 IS

1 the supervision of a physician and which is in2 tended for the specific dietary management of 

3 a disease or condition for which distinctive nu4 tritional requirements, based on recognized sci5 entific principles, are established by medical 

6 evaluation, and 

7 ‘‘(B) includes nutritionally modified coun8 terparts of traditional foods and other forms of 

9 foods such as formulas, pills, capsules, and 

10 bars, so long as consumed or administered 

11 enterally; and 

12 ‘‘(2) the term ‘enterally’ refers to consumption 

13 or administration through the gastrointestinal tract, 

14 whether orally or by tube. 

15 ‘‘(b) COVERAGE.— 

16 ‘‘(1) MEDICALLY NECESSARY FOOD AND FOOD

17 MODIFIED TO BE LOW PROTEIN.—A group health 

18 plan, or a health insurance issuer that provides 

19 health insurance coverage in connection with a group 

20 health plan, shall provide coverage for medically nec21 essary food and food modified to be low protein that 

22 is formulated to be consumed or administered under 

23 the supervision of a qualified medical provider, for 

24 the treatment of conditions as recommended by the 

25 Advisory Committee on Heritable Disorders in 


srobinson on DSKHWCL6B1PROD with BILLS
17 

•S 311 IS

1 Newborns and Children, and the medical equipment 

2 and supplies necessary to administer such food. 

3 ‘‘(2) VITAMINS AND AMINO ACIDS.—A group 

4 health plan, or a health insurance issuer that pro5 vides health insurance coverage in connection with a 

6 group health plan, that provides prescription drug 

7 coverage, shall provide coverage for pharmacological 

8 doses of vitamins and amino acids used for the 

9 treatment of inborn errors of metabolism, for the 

10 treatment of conditions as recommended by the Ad11 visory Committee on Heritable Disorders in 

12 Newborns and Children and as prescribed by a 

13 qualified medical provider, to the same extent as 

14 other prescription drug coverage under such plan or 

15 coverage.’’. 

16 (3) AMENDMENTS TO THE INTERNAL REVENUE

17 CODE.— 

18 (A) IN GENERAL.—Subchapter B of chap19 ter 100 of the Internal Revenue Code of 1986 

20 (relating to other group health plan require21 ments) is amended by inserting after section 

22 9813 the following new section: 

23 ‘‘SEC. 9814. COVERAGE OF MEDICALLY NECESSARY FOOD 

24 AND FOOD MODIFIED TO BE LOW PROTEIN. 

25 ‘‘(a) DEFINITIONS.—In this section— 


srobinson on DSKHWCL6B1PROD with BILLS
18 

•S 311 IS

1 ‘‘(1) the term ‘medically necessary food’— 

2 ‘‘(A) means a food which is formulated to 

3 be consumed or administered enterally under 

4 the supervision of a physician and which is in5 tended for the specific dietary management of 

6 a disease or condition for which distinctive nu7 tritional requirements, based on recognized sci8 entific principles, are established by medical 

9 evaluation; and 

10 ‘‘(B) includes nutritionally modified coun11 terparts of traditional foods and other forms of 

12 foods such as formulas, pills, capsules, and 

13 bars, so long as consumed or administered 

14 enterally; and 

15 ‘‘(2) the term ‘enterally’ refers to consumption 

16 or administration through the gastrointestinal tract, 

17 whether orally or by tube. 

18 ‘‘(b) COVERAGE.— 

19 ‘‘(1) MEDICALLY NECESSARY FOOD AND FOOD

20 MODIFIED TO BE LOW PROTEIN.—A group health 

21 plan, or a health insurance issuer that provides 

22 health insurance coverage in connection with a group 

23 health plan, shall provide coverage for necessary 

24 medically necessary food and food modified to be low 

25 protein that is formulated to be consumed or adminVerDate Mar 15 2010 21:59 Feb 08, 2011 Jkt 099200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 E:\BILLS\S311.IS S311

srobinson on DSKHWCL6B1PROD with BILLS
19 

•S 311 IS

1 istered under the supervision of a qualified medical 

2 provider, for the treatment of conditions as rec3 ommended by the Advisory Committee on Heritable 

4 Disorders in Newborns and Children, and the med5 ical equipment and supplies necessary to administer 

6 such food. 

7 ‘‘(2) VITAMINS AND AMINO ACIDS.—A group 

8 health plan, or a health insurance issuer that pro9 vides health insurance coverage in connection with a 

10 group health plan, that provides prescription drug 

11 coverage, shall provide coverage for pharmacological 

12 doses of vitamins and amino acids used for the 

13 treatment of inborn errors of metabolism, for the 

14 treatment of conditions as recommended by the Ad15 visory Committee on Heritable Disorders in 

16 Newborns and Children and as prescribed by a 

17 qualified medical provider, to the same extent as 

18 other prescription drug coverage under such plan or 

19 coverage.’’. 

20 (B) CONFORMING AMENDMENT.—The 

21 table of sections for subchapter B of chapter 

22 100 of such Code is amended by inserting after 

23 the item relating to section 9813 the following 

24 new item: 

‘‘Sec. 9814. Coverage of medically necessary food and food modified to be low 

protein.’’. 


srobinson on DSKHWCL6B1PROD with BILLS
20 

•S 311 IS

1 (b) INDIVIDUAL MARKET.—Subpart 2 of part B of 

2 title XXVII of the Public Health Service Act (42 U.S.C. 

3 300gg–51 et seq.) is amended by adding at the end the 

4 following new section: 

5 ‘‘SEC. 2754. COVERAGE OF MEDICALLY NECESSARY FOOD 

6 AND FOOD MODIFIED TO BE LOW PROTEIN. 

7 ‘‘The provisions of section 2729 shall apply to health 

8 insurance coverage offered by a health insurance issuer 

9 in the individual market in the same manner as they apply 

10 to health insurance coverage offered by a health insurance 

11 issuer in connection with a group health plan in the small 

12 or large group market.’’. 

13 (c) AMENDMENT TO PPACA.—Section 1302(b)(1) of 

14 the Patient Protection and Affordable Care Act (42 

15 U.S.C. 18022(b)(1)) is amended by adding at the end the 

16 following: 

17 ‘‘(K) Medically necessary food, as defined 

18 in section 2729 of the Public Health Service 

19 Act.’’. 

20 SEC. 5. EFFECTIVE DATE; DETERMINATION OF MINIMUM 

21 YEARLY COVERAGE. 

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

23 sections 3 and 4 shall apply to plan years beginning after 

24 the date that is 180 days after the date of enactment of 

25 this Act. 


srobinson on DSKHWCL6B1PROD with BILLS
21 

•S 311 IS

1 (b) DETERMINATION BY SECRETARY.— 

2 (1) IN GENERAL.—Prior to the date described 

3 under subsection (a), the Secretary of Health and 

4 Human Services (referred to in this Act as the ‘‘Sec5 retary’’) shall determine the minimum yearly cov6 erage for all health insurance plans pursuant to the 

7 amendments made by this Act. Such minimum year8 ly coverage shall apply to an individual during any 

9 period when the individual is covered under the plan 

10 and for as long as deemed medically necessary. The 

11 Secretary may establish age-specific minimum levels 

12 of coverage and periodically update these levels 

13 based on a standard cost of living index, the actual 

14 cost of treatment, and other appropriate measures 

15 as determined by the Secretary. 

16 (2) NO PREEMPTION.—The minimum yearly 

17 coverage determined by the Secretary under para18 graph (1) shall not preempt any State standards 

19 that require a higher minimum yearly coverage level 

20 for the same services and benefits. 

Æ 


srobinson on DSKHWCL6B1PROD with BILLS