I

106TH CONGRESS

1ST SESSION H. R. 1187

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 HOUSE OF REPRESENTATIVES

MARCH 18, 1999

Mrs. JOHNSON of Connecticut (for herself, Mr. BROWN of Ohio, Mr. UPTON,

Mrs. THURMAN, Mr. SERRANO, Mr. MCCRERY, Mr. KLECZKA, Ms.

DUNN, Mr. COYNE, Mr. ENGLISH, Mr. MATSUI, Mr. FOLEY, Mr. NEAL

of Massachusetts, Mr. NUSSLE, Mr. TANNER, Mr. PORTMAN, Mr.

MCNULTY, Mr. TAUZIN, Mr. WAXMAN, Mr. LAZIO, Mr. TOWNS, Mr.

PICKERING, Ms. ESHOO, Mr. BOUCHER, Ms. DEGETTE, Mr. GREEN of

Texas, Mr. PALLONE, Mr. SAWYER, Mr. STRICKLAND, Ms. PRYCE of

Ohio, Mr. FROST, Mr. SESSIONS, Mr. HALL of Ohio, Ms. SLAUGHTER,

Mr. ACKERMAN, Mr. ALLEN, Mr. BAIRD, Mr. BAKER, Mr. BALDACCI,

Mr. BARCIA, Mr. BENTSEN, Ms. BERKLEY, Mr. BISHOP, Mr. BOEHLERT,

Mr. BONIOR, Mr. BORSKI, Ms. BROWN of Florida, Mr. BROWN of California, Mr. CANADY of Florida, Mr. CLAY, Ms. DANNER, Mr. DEFAZIO,

Mr. DELAHUNT, Ms. DELAURO, Mr. EHLERS, Mr. FARR of California,

Mr. FILNER, Mr. FRANK of Massachusetts, Mr. GEJDENSON, Mr. GIBBONS, Mr. GILLMOR, Mr. GONZALEZ, Mr. GRAHAM, Mr. GUTIERREZ, Mr.

HILLEARY, Mr. HILLIARD, Mr. HINCHEY, Mr. HOEFFEL, Mr. ISTOOK,

Mr. JENKINS, Ms. EDDIE BERNICE JOHNSON of Texas, Ms. KAPTUR,

Mrs. KELLY, Mr. KENNEDY of Rhode Island, Mr. KIND, Mr. KING, Mr.

KUCINICH, Mr. LAFALCE, Mr. LAMPSON, Mr. LARSON, Mr. LEACH, Mr.

LUCAS of Oklahoma, Mr. LUCAS of Kentucky, Mrs. MALONEY of New

York, Mr. MALONEY of Connecticut, Mr. MASCARA, Mrs. MCCARTHY of

New York, Mr. MCGOVERN, Mr. GEORGE MILLER of California, Mrs.

MORELLA, Mr. NADLER, Mr. NEY, Mr. OBERSTAR, Mr. OLVER, Mr.

ORTIZ, Mr. PAUL, Mr. PAYNE, Mr. PETERSON of Pennsylvania, Mr.

POMEROY, Mr. PRICE of North Carolina, Ms. RIVERS, Mr. RODRIGUEZ,

Ms. ROYBAL-ALLARD, Mr. SABO, Mr. SANDERS, Mr. SANDLIN, Mr.

SCHAFFER, Mr. SHAYS, Mr. SHOWS, Mr. SIMPSON, Ms. STABENOW, Mrs.

TAUSCHER, Mr. TAYLOR of North Carolina, Mr. THUNE, Mr. VENTO,

Mr. WALSH, Mr. WAMP, Mr. WATKINS, Mr. WATT of North Carolina,

Mr. WEYGAND, Mr. WISE, and Mr. CAMP) introduced the following bill;

which was referred to the Committee on Commerce, and in addition to

the Committee on Ways and Means, for a period to be subsequently de-
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termined 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

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:

7 (1) Medical nutrition therapy is a medically

8 necessary and cost-effective way of treating and con9 trolling many diseases and medical conditions affect10 ing the elderly, including HIV/AIDS, cancer, kidney

11 disease, diabetes, heart disease, pressure ulcers, se12 vere burns, and surgical wounds.

13 (2) Medical nutrition therapy saves health care

14 costs by speeding recovery and reducing the inci15 dence of complications, resulting in fewer hos16 pitalizations, shorter hospital stays, and reduced

17 drug, surgery, and treatment needs.
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1 (3) A study conducted by The Lewin Group

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

3 would be greater than costs for coverage of medical

4 nutrition therapy for all medicare beneficiaries, with

5 savings projected to grow steadily in following years.

6 (4) The Agency for Health Care Policy and Re7 search has indicated in its practice guidelines that

8 nutrition is key to both the prevention and the treat9 ment of pressure ulcers (also called bed sores) which

10 annually cost the health care system an estimated

11 $1.3 billion for treatment.

12 (5) Almost 17 million patients each year are

13 treated for illnesses or injuries that stem from or

14 place them at risk of malnutrition.

15 (6) Because medical nutrition therapy is not

16 covered under part B of the medicare program and

17 because more and more health care is delivered on

18 an outpatient basis, many patients are denied access

19 to the effective, low-tech treatment they need, result20 ing in an increased incidence of complications and a

21 need for higher cost treatments.

22 SEC. 2. MEDICARE COVERAGE OF MEDICAL NUTRITION

23 THERAPY SERVICES.

24 (a) COVERAGE.—Section 1861(s)(2) of the Social Se25 curity Act (42 U.S.C. 1395x(s)(2)) is amended—
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1 (1) by striking ‘‘and’’ at the end of subpara2 graph (S);

3 (2) by striking the period at the end of sub4 paragraph (T) and inserting ‘‘; and’’; and

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

7 ‘‘(U) medical nutrition therapy services (as de8 fined in subsection (uu)(1));’’.

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

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

11 the following new subsection:

12 ‘‘Medical Nutrition Therapy Services; Registered

13 Dietitian or Nutrition Professional

14 ‘‘(uu)(1) The term ‘medical nutrition therapy serv15 ices’ means nutritional diagnostic, therapy, and counseling

16 services for the purpose of disease management which are

17 furnished by a registered dietitian or nutrition profes18 sional (as defined in paragraph (2)) pursuant to a referral

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

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

21 dietitian or nutrition professional’ means an individual

22 who—

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

24 granted by a regionally accredited college or univer25 sity in the United States (or an equivalent foreign
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1 degree) with completion of the academic require2 ments of a program in nutrition or dietetics, as ac3 credited by an appropriate national accreditation or4 ganization recognized by the Secretary for this pur5 pose;

6 ‘‘(B) has completed at least 900 hours of super7 vised dietetics practice under the supervision of a

8 registered dietitian or nutrition professional; and

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

10 nutrition professional by the State in which the serv11 ices are performed, or

12 ‘‘(ii) in the case of an individual in a State

13 which does not provide for such licensure or certifi14 cation, meets such other criteria as the Secretary es15 tablishes.

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

17 shall not apply in the case of an individual who as of the

18 date of the enactment of this subsection is licensed or cer19 tified as a dietitian or nutrition professional by the State

20 in which medical nutrition therapy services are per21 formed.’’.

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

23 U.S.C. 1395l(a)(1)) is amended—

24 (1) by striking ‘‘and’’ before ‘‘(S)’’, and
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1 (2) by inserting before the semicolon at the end

2 the following: ‘‘, and (T) with respect to medical nu3 trition therapy services (as defined in section

4 1861(uu)), the amount paid shall be 80 percent of

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

6 amount determined under the fee schedule estab7 lished under section 1848(b) for the same services if

8 furnished by a physician’’.

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

10 this section apply to services furnished on or after Janu11 ary 1, 2000.

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