I 

116TH CONGRESS 

1ST SESSION H. R. 3711 

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

medical nutrition therapy services for individuals with eating disorders 

under the Medicare program. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 11, 2019 

Ms. JUDY CHU of California (for herself, Mr. CA ́RDENAS, Ms. CLARKE of New 

York, Mr. FITZPATRICK, Mrs. LEE of Nevada, Mr. RASKIN, Mr. ROUDA, 

Mr. TONKO, Ms. CASTOR of Florida, and Mr. YOUNG) 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 provide 

coverage of medical nutrition therapy services for individuals with eating disorders 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 ‘‘Nutrition Counseling 

5 Aiding Recovery for Eating Disorders Act of 2019’’ or the 

6 ‘‘Nutrition CARE Act of 2019’’. 


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1 SEC. 2. FINDINGS. 

2 Congress finds the following: 

3 (1) Eating disorders, including the specific dis4 orders of anorexia nervosa, bulimia nervosa, binge 

5 eating disorder, avoidant/restrictive food intake dis6 order, and other specified feeding or eating dis7 orders, are severe biologically based mental illnesses 

8 caused by a complex interaction of genetic, biologi9 cal, social, behavioral, and psychological factors. 

10 (2) Over 30,000,000 individuals in the United 

11 States of all ages, races, sizes, sexual orientations, 

12 ethnicities, and socioeconomic statuses, are affected 

13 by eating disorders during their lifetimes. 

14 (3) Eating disorders have one of the highest 

15 mortality rates of all mental illnesses, as eating dis16 orders can become fatal due to heart failure, kidney 

17 failure, stroke, hypoglycemia, and gastric rupture. 

18 Additionally, longitudinal studies have found that 

19 the suicide risk for those with an eating disorder is 

20 23 times the expected risk. 

21 (4) Eating disorders can be successfully treated 

22 with interventions at the appropriate durations and 

23 levels of care, yet only one-third of persons with eat24 ing disorders receive any medical, psychiatric, or 

25 therapeutic care. Best practice treatment of eating 

26 disorders includes patients, their families, and a 


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1 comprehensive team of professionals such as social 

2 workers, mental health counselors, primary care 

3 practitioners, psychiatrists, psychologists, dietitians, 

4 art therapists, and other specialty providers. 

5 (5) Studies examining the prevalence of eating 

6 disorders and insulin restriction among people with 

7 diabetes show that up to 35 percent of women with 

8 diabetes restrict insulin in order to lose weight at 

9 some point in their life. 

10 (6) Research shows that disordered eating 

11 among older adults consistently find that rates of 

12 disordered eating among the elderly are similar to 

13 those of younger persons. 

14 (7) Weight loss in the elderly may signal an 

15 undiagnosed medical illness or may be the result of 

16 a known medical condition and/or its pharmacologic 

17 treatment. 

18 (8) Eating disorders in the elderly are associ19 ated with significant morbidity and mortality, and a 

20 wide range of health issues arise secondary to eating 

21 disorders, including cardiac, metabolic, gastric, and 

22 bone conditions; diagnosis and proper treatment of 

23 this population are essential. 

24 (9) Eating disorders in the elderly are particu25 larly serious because chronic disorders or diseases 


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1 may already compromise a patient’s health. Inad2 equate nutrition can result in memory deficits, cog3 nitive decline, decubitus ulcers, impaired healing of 

4 sores, wounds, or infections, and dizziness, dis5 orientation, and falls. 

6 (10) Studies find that individuals with chronic 

7 illnesses and/or disabilities are four times more likely 

8 to have anorexia nervosa or bulimia nervosa com9 pared to the general population. 

10 SEC. 3. PROVIDING COVERAGE OF MEDICAL NUTRITION 

11 THERAPY SERVICES FOR INDIVIDUALS WITH 

12 EATING DISORDERS UNDER THE MEDICARE 

13 PROGRAM. 

14 Section 1861 of the Social Security Act (42 U.S.C. 

15 1395x) is amended— 

16 (1) in subsection (s)(2)(V)— 

17 (A) by redesignating clauses (i) through 

18 (iii) as subclauses (I) through (III), respec19 tively, and adjusting the margins accordingly; 

20 (B) in subclause (III), as so redesignated, 

21 by striking the semicolon at the end and insert22 ing ‘‘; and’’; 

23 (C) by striking ‘‘beneficiary with diabetes’’ 

24 and inserting the following: ‘‘beneficiary— 

25 ‘‘(i) with diabetes’’; and 


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1 (D) by adding at the end the following new 

2 clause: 

3 ‘‘(ii) beginning January 1, 2020, with an 

4 eating disorder (as defined by the Secretary in 

5 accordance with most recent edition of the Di6 agnostic and Statistical Manual of Mental Dis7 orders published by the American Psychiatric 

8 Association);’’; and 

9 (2) in subsection (vv)— 

10 (A) in paragraph (1)— 

11 (i) by inserting ‘‘(including manage12 ment of an eating disorder (as defined for 

13 purposes of subsection (s)(2)(V)(ii)))’’ 

14 after ‘‘disease management’’; and 

15 (ii) by inserting ‘‘or psychologist (or 

16 other mental health professional to the ex17 tent authorized under State law) and, in 

18 the case of such services furnished to an 

19 individual for the purpose of management 

20 of such an eating disorder, at the times 

21 specified in paragraph (4)’’ before the pe22 riod at the end; and 

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

24 paragraph: 


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1 ‘‘(4)(A) For purposes of paragraph (1), the times 

2 specified in this paragraph are, with respect to medical 

3 nutrition therapy services furnished to an individual for 

4 purposes of management of an eating disorder, the fol5 lowing: 

6 ‘‘(i) 13 hours (including a 1 hour initial assess7 ment and 12 hours of reassessment and interven8 tion) during the 1-year period beginning on the date 

9 such individual is first furnished such services. 

10 ‘‘(ii) Subject to subparagraph (B), 4 hours dur11 ing each subsequent 1-year period. 

12 ‘‘(B) In the case that the physician or psychologist 

13 (or other mental health professional to the extent author14 ized under State law) treating such individual determines 

15 that there has been a change with respect to the diagnosis, 

16 medical condition, or treatment regimen relating to the 

17 eating disorder of such individual that requires the fur18 nishing of medical nutrition therapy services beyond the 

19 times specified in subparagraph (A)(ii), the Secretary may 

20 provide for an additional number of hours to be available 

21 to such individual with respect to a period described in 

22 such subparagraph. 

23 ‘‘(C) The Secretary may apply such other reasonable 

24 limitations with respect to the furnishing of medical nutri25 tion therapy services for purposes of management of an 


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1 eating disorder during a period described in subparagraph 

2 (A)(ii) as the Secretary determines appropriate.’’. 

Æ 


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