II 

110TH CONGRESS 

2D SESSION S. 3584 

To comprehensively prevent, treat, and decrease overweight and obesity in 

our Nation’s populations. 

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 25 (legislative day, SEPTEMBER 17), 2008 

Mr. BINGAMAN introduced the following bill; which was read twice and 

referred to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To comprehensively prevent, treat, and decrease overweight 

and obesity in our Nation’s populations. 

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 ‘‘Obesity Prevention, 

5 Treatment, and Research Act of 2008’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 

8 (1) In 2001, the United States Surgeon Gen9 eral released the Call to Action to Prevent and DeVerDate Aug 31 2005 00:35 Sep 28, 2008 Jkt 069200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S3584.IS S3584

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1 crease Overweight and Obesity to bring attention to 

2 the public health problems related to obesity. 

3 (2) Since the Surgeon General’s call to action, 

4 the problems of obesity and overweight have become 

5 epidemic, occurring in all ages, ethnicities and races, 

6 and individuals in every State. 

7 (3) The United States now has the highest 

8 prevalence of obesity among the developed nations, 

9 according to 2006 data by the Organisation for Eco10 nomic Co-operation and Development. The preva11 lence of obesity in the United States (34 percent) is 

12 more than twice the average for other developed na13 tions (13 percent). The closest nation in prevalence 

14 of obesity is the United Kingdom (24 percent) which 

15 is over 25 percent less than the United States. 

16 (4) The National Health and Nutrition Exam17 ination Survey in 2006 estimated that 32 percent of 

18 children and adolescents aged 2 to 19 and an alarm19 ing 66 percent of adults are overweight or obese. 

20 (5) More than 30 percent of young people in 

21 grades 9 through 12 do not regularly engage in vig22 orous intensity physical activity, while almost 40 

23 percent of adults are sedentary and 70 percent re24 port getting less than 20 minutes of regular physical 

25 activity per day. 


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1 (6) The Institute of Medicine, in their 2005 

2 publication ‘‘Preventing Childhood Obesity: Health 

3 in the Balance’’, reported that over the last 3 dec4 ades, the rate of childhood obesity has tripled for 

5 children aged 6 to 11 years, and doubled for chil6 dren aged 2 to 5 years old and in adolescents aged 

7 12 to 19 years old. In 2004, approximately 

8 9,000,000 children over 6 years of age were obese. 

9 Only 2 percent of children eat a healthy diet con10 sistent with Federal nutrition guidelines. 

11 (7) For children born in 2000, it is estimated 

12 the lifetime risk of being diagnosed with type 2 dia13 betes is 40 percent for females and 30 percent for 

14 males. 

15 (8) Overweight and obesity disproportionately 

16 affect minority populations and women. According to 

17 the 2006 Behavioral Risk Factor Surveillance Sys18 tem of the Centers for the Disease Control and Pre19 vention, 61 percent of adults in the United States 

20 are overweight or obese. 

21 (9) The Centers for the Disease Control and 

22 Prevention estimates the annual expenditures related 

23 to overweight and obesity in the United States to be 

24 $117,000,000,000 in 2001 and rising rapidly. 


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1 (10) The Centers for the Disease Control and 

2 Prevention estimates that the increase in the num3 ber of overweight and obese Americans between 

4 1987 and 2001 resulted in a 27 percent increase in 

5 per capita health costs, and that as many as 

6 112,000 deaths per year are associated with obesity. 

7 (11) Being overweight or obese increases the 

8 risk of chronic diseases including diabetes, heart dis9 ease, stroke, certain cancers, arthritis, and other 

10 health problems. 

11 (12) According to the National Institute of Dia12 betes and Digestive and Kidney Diseases, individuals 

13 who are obese have a 50 to 100 percent increased 

14 risk of premature death. 

15 (13) Healthy People 2010 goals identify over16 weight and obesity as 1 of the Nation’s leading 

17 health problems and include objectives for increasing 

18 the proportion of adults who are at a healthy weight, 

19 reducing the proportion of adults who are obese, and 

20 reducing the proportion of children and adolescents 

21 who are overweight or obese. 

22 (14) Another Healthy People 2010 goal is to 

23 eliminate health disparities among different seg24 ments of the population. Obesity is a health problem 


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1 that disproportionally impacts medically underserved 

2 populations. 

3 (15) Food and beverage advertisers are esti4 mated to spend $10,000,000 to $12,000,000,000 per 

5 year to target children and youth. 

6 (16) The United States spends less than 2 per7 cent of its annual health expenditures on prevention. 

8 (17) Employer health promotion investments 

9 net a return of $3 for every $1 invested. 

10 (18) High-energy dense and low-nutrient dense 

11 foods represent 30 percent of American’s total cal12 orie intake. Fast food company menus are twice the 

13 energy density of recommended healthful diets. 

14 (19) Research suggests that individuals eat too 

15 much high-energy dense foods without feeling full 

16 because the brain’s pathways that regulate hunger 

17 and influence normal food intake are not triggered 

18 by these foods. 

19 (20) Packaging, product placement, and high20 energy dense food content manipulation contribute 

21 to the overweight and obesity epidemic in the United 

22 States. 

23 (21) Such marketing and content manipulation 

24 techniques have been used by other industries to en25 courage consumption at the expense of health. To 


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1 help individuals make healthy choices, education and 

2 information must be available with clear, consistent, 

3 and accurate labeling. 

4 TITLE I—OBESITY TREATMENT, 

5 PREVENTION, AND REDUCTION 

6 SEC. 101. UNITED STATES COUNCIL ON OVERWEIGHT-OBE7 SITY PREVENTION. 

8 Part P of title III of the Public Health Service Act 

9 (42 U.S.C. 280g et seq.) is amended by adding at the end 

10 the following: 

11 ‘‘SEC. 399R. UNITED STATES COUNCIL ON OVERWEIGHT12 OBESITY PREVENTION. 

13 ‘‘(a) ESTABLISHMENT.—The Secretary shall convene 

14 a United States Council on Overweight-Obesity Prevention 

15 (referred to in this section as ‘USCO–OP’). 

16 ‘‘(b) MEMBERSHIP.— 

17 ‘‘(1) IN GENERAL.—USCO–OP shall be com18 posed of 20 members, which shall consist of— 

19 ‘‘(A) the Secretary; 

20 ‘‘(B) the Secretary (or his or her designee) 

21 of— 

22 ‘‘(i) the Department of Agriculture; 

23 ‘‘(ii) the Department of Education; 

24 ‘‘(iii) the Department of Housing and 

25 Urban Development; 


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1 ‘‘(iv) the Department of the Interior 

2 ‘‘(v) the Federal Trade Commission; 

3 ‘‘(vi) the Department of Transpor4 tation; and 

5 ‘‘(vii) any other Federal agency that 

6 the Secretary of Health and Human Serv7 ices determines appropriate; 

8 ‘‘(C) the Chairman (or his or her designee) 

9 of the Federal Communications Commission; 

10 ‘‘(D) the Director (or his or her designee) 

11 of the Centers for Disease Control and Preven12 tion, the National Institutes of Health, and the 

13 Agency for Healthcare Research and Quality; 

14 ‘‘(E) the Administrator of the Centers for 

15 Medicare and Medicaid Services (or his or her 

16 designee); 

17 ‘‘(F) the Commissioner of Food and Drugs 

18 (or his or her designee); and 

19 ‘‘(G) a minimum of 5 representatives, ap20 pointed by the Secretary, of expert organiza21 tions such as public health associations, key 

22 healthcare provider groups, planning and devel23 opment organizations, education associations, 

24 advocacy groups, relevant industries, State and 


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1 local leadership, and other entities as deter2 mined appropriate by the Secretary. 

3 ‘‘(2) APPOINTMENTS.—The Secretary shall ac4 cept nominations for representation on USCO–OP 

5 through public comment before the initial appoint6 ment of members of USCO–OP under paragraph 

7 (1)(G), and on a regular basis for open positions 

8 thereafter, but not less than every 2 years. 

9 ‘‘(3) CHAIRPERSON.—The chairperson of 

10 USCO–OP shall be— 

11 ‘‘(A) an individual appointed by the Presi12 dent; and 

13 ‘‘(B) until the date that an individual is 

14 appointed under subparagraph (A), the Sec15 retary. 

16 ‘‘(c) MEETINGS.— 

17 ‘‘(1) IN GENERAL.—USCO–OP shall meet— 

18 ‘‘(A) not later than 180 days after the date 

19 of enactment of the Obesity Prevention, Treat20 ment, and Research Act of 2008; and 

21 ‘‘(B) at the call of the chairperson there22 after, but in no case less often than 2 times per 

23 year. 

24 ‘‘(2) MEETINGS OF FEDERAL AGENCIES.—The 

25 representatives of the Federal agencies on USCO– 


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1 OP shall meet on a regular basis, as determined by 

2 the Secretary, to develop strategies to coordinate 

3 budgets and discuss other issues that are not other4 wise permitted to be discussed in a public forum. 

5 The purpose of such meetings shall be to allow more 

6 rapid interagency strategic planning and interven7 tion implementation to address the overweight and 

8 obesity epidemic. 

9 ‘‘(d) DUTIES OF USCO–OP.—USCO–OP shall— 

10 ‘‘(1) develop strategies to comprehensively pre11 vent, treat, and reduce overweight and obesity; 

12 ‘‘(2) coordinate interagency cooperation and ac13 tion related to the prevention, treatment, and reduc14 tion of overweight and obesity in the United States; 

15 ‘‘(3) identify best practices in communities to 

16 address overweight and obesity; 

17 ‘‘(4) work with appropriate entities to evaluate 

18 the effectiveness of obesity and overweight interven19 tions; 

20 ‘‘(5) update the National Institutes of Health 

21 1998 ‘Clinical Guidelines on the Identification, Eval22 uation, and Treatment of Overweight and Obesity in 

23 Adults: The Evidence Report’ and include sections 

24 on childhood obesity in such updated report; 


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1 ‘‘(6) conduct ongoing surveillance and moni2 toring using tools such as the National Health and 

3 Nutrition Examination Survey and the Behavioral 

4 Risk Factor Surveillance System and assure ade5 quate and consistent funding to support data collec6 tion and analysis to inform policy; 

7 ‘‘(7) make recommendations to coordinate 

8 budgets, grant and pilot programs, policies, and pro9 grams across Federal agencies to cohesively address 

10 overweight and obesity, including with respect to the 

11 grant programs carried out under sections 306(n), 

12 399S, and 1904(a)(1)(H); 

13 ‘‘(8) make recommendations to update and im14 prove the daily physical activity requirements for 

15 students under the Elementary and Secondary Edu16 cation Act of 1965 (20 U.S.C. 6301 et seq.) and in17 clude recommendations about physical activities that 

18 families can do together, and involving parents in 

19 these activities; 

20 ‘‘(9) make recommendations about coverage for 

21 obesity-related services and for an early and periodic 

22 screening, diagnostic, and treatment services pro23 gram under the State Children’s Health Insurance 

24 Program established under title XXI of the Social 

25 Security Act; and 


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1 ‘‘(10) provide guidelines for childhood obesity 

2 health care related treatment under the early and 

3 periodic screening, diagnostic, and treatment serv4 ices program under the Medicaid program estab5 lished under title XIX of the Social Security Act and 

6 otherwise described in section 2103(c)(5) of such 

7 Act. 

8 ‘‘(e) REPORT.—Not later than 18 months after the 

9 date of enactment of the Obesity Prevention, Treatment, 

10 and Research Act of 2008, and on an annual basis there11 after, USCO–OP shall submit to the President and to the 

12 relevant committees of Congress, a report that— 

13 ‘‘(1) summarizes the activities and efforts of 

14 USCO–OP under this section to coordinate inter15 agency prevention, treatment, and reduction of obe16 sity and overweight, including a detailed strategic 

17 plan with recommendations for each Federal agency; 

18 ‘‘(2) evaluates the effectiveness of these coordi19 nated interventions and conducts interim assess20 ments and reporting of health outcomes, achieve21 ment of milestones, and implementation of strategic 

22 plan goals starting with the second report, and year23 ly thereafter; and 


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1 ‘‘(3) makes recommendations for the following 

2 year’s strategic plan based on data and findings 

3 from the previous year. 

4 ‘‘(f) TECHNICAL ASSISTANCE.—The Department of 

5 Health and Human Services may provide technical assist6 ance to USCO–OP to carry out the activities under this 

7 section. 

8 ‘‘(g) PERMANENCE OF COMMITTEE.—Section 14 of 

9 the Federal Advisory Committee Act (5 U.S.C. App.) shall 

10 not apply to USCO–OP.’’. 

11 SEC. 102. GRANTS AND DEMONSTRATION PROGRAMS TO 

12 PROMOTE POSITIVE HEALTH BEHAVIORS IN 

13 POPULATIONS DISPROPORTIONATELY AF14 FECTED BY OBESITY AND OVERWEIGHT. 

15 Part P of title III of the Public Health Service Act 

16 (42 U.S.C. 280g et seq.), as amended by section 101, is 

17 amended by adding at the end the following: 

18 ‘‘SEC. 399S. GRANTS AND DEMONSTRATION PROGRAMS TO 

19 PROMOTE POSITIVE HEALTH BEHAVIORS IN 

20 POPULATIONS DISPROPORTIONATELY AF21 FECTED BY OBESITY AND OVERWEIGHT. 

22 ‘‘(a) ELIGIBLE ENTITY.—For purposes of this sec23 tion, the term ‘eligible entity’ means— 

24 ‘‘(1) a city, county, Indian tribe, tribal organi25 zation, territory, or State; 


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1 ‘‘(2) a local, tribal, or State educational agency; 

2 ‘‘(3) a Federal medical facility, including a fed3 erally qualified health center (as defined in section 

4 1861(aa)(4) of the Social Security Act), an Indian 

5 Health Service hospital or clinic, any health facility 

6 or program operated by or pursuant to a contractor 

7 grant from the Indian Health Service, an Indian 

8 Health Service entity, an urban Indian center, an 

9 Indian tribal clinic, a health care for the homeless 

10 center, a rural health center, migrant health center, 

11 and any other Federal medical facility; 

12 ‘‘(4) any entity meeting the criteria for medical 

13 home under section 204 of the Tax Relief and 

14 Health Care Act of 2006 (Public Law 109–432); 

15 ‘‘(5) a nonprofit organization (such as an aca16 demic health center or community health center); 

17 ‘‘(6) a health department; 

18 ‘‘(7) any licensed or certified health provider; 

19 ‘‘(8) an accredited university or college; 

20 ‘‘(9) a community-based organization; 

21 ‘‘(10) a local city planning agency; and 

22 ‘‘(11) any other entity determined appropriate 

23 by the Secretary. 

24 ‘‘(b) APPLICATION.—An eligible entity that desires a 

25 grant under this section shall submit an application at 


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1 such time, in such manner, and containing such informa2 tion as the Secretary may require, including a plan for 

3 the use of funds that may be awarded and an evaluation 

4 of any training that will be provided under such grant. 

5 ‘‘(c) GRANT DEMONSTRATION AND PILOT PRO6 GRAM.— 

7 ‘‘(1) IN GENERAL.—The Secretary, acting 

8 through the Director of the Centers for Disease 

9 Control and Prevention, and in consultation with the 

10 United States Council on Overweight-Obesity Pre11 vention under section 399R, shall establish and 

12 evaluate a grant demonstration and pilot program 

13 for entities to— 

14 ‘‘(A) prevent, treat, or otherwise reduce 

15 overweight and obesity; 

16 ‘‘(B) increase the number of children and 

17 adults who safely walk or bike to school or 

18 work; 

19 ‘‘(C) increase the availability and afford20 ability of fresh fruits and vegetables in the com21 munity; 

22 ‘‘(D) expand safe and accessible walking 

23 paths and recreational facilities to encourage 

24 physical activity, and other interventions to cre25 ate healthy communities; 


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1 ‘‘(E) create advertising, social marketing, 

2 and public health campaigns promoting 

3 healthier food choices, increased physical activ4 ity, and healthier lifestyles targeted to individ5 uals and to families; 

6 ‘‘(F) promote increased rates and duration 

7 of breastfeeding; and 

8 ‘‘(G) increase worksite and employer pro9 motion of and involvement in community initia10 tives that prevent, treat, or otherwise reduce 

11 overweight and obesity. 

12 ‘‘(2) SPECIAL PRIORITY.—Special priority will 

13 be given to grant proposals that target communities 

14 or populations disproportionately affected by over15 weight or obesity, including Native Americans, other 

16 minorities, and women. 

17 ‘‘(d) GRANTS TO PROMOTE POSITIVE HEALTH BE18 HAVIORS IN POPULATIONS DISPROPORTIONATELY AF19 FECTED BY OBESITY AND OVERWEIGHT.— 

20 ‘‘(1) IN GENERAL.—The Secretary, acting 

21 through the Director of the Centers for Disease 

22 Control and Prevention, may award grants to eligi23 ble entities to promote health behaviors for women 

24 and children in target populations, especially racial 


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1 and ethnic minority populations in medically under2 served communities. 

3 ‘‘(2) USE OF FUNDS.—An award under this 

4 section shall be used to carry out any of the fol5 lowing: 

6 ‘‘(A) To educate, promote, prevent, treat 

7 and determine best practices in overweight and 

8 obese populations. 

9 ‘‘(B) To address behavioral risk factors in10 cluding sedentary lifestyle, poor nutrition, being 

11 overweight or obese, and use of tobacco, alcohol 

12 or other substances that increase the risk of 

13 morbidity and mortality. Special priority will be 

14 given to grant applications that— 

15 ‘‘(i) propose interventions that ad16 dress embedded levels of influence on be17 havior, including the individual, family, 

18 peers, community and society; and 

19 ‘‘(ii) utilize techniques that promote 

20 community involvement in the design and 

21 implementation of interventions including 

22 community diagnosis and community-based 

23 participatory research. 

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1 tion and expenditure, to attain healthier weight, 

2 prevent obesity, and reduce morbidity and mor3 tality associated with overweight and obesity. 

4 ‘‘(D)(i) To train primary care physicians 

5 and other licensed or certified health profes6 sionals on how to identify, treat, and prevent 

7 obesity or eating disorders and aid individuals 

8 who are overweight, obese, or who suffer from 

9 eating disorders. 

10 ‘‘(ii) To use evidence-based findings or rec11 ommendations that pertain to the prevention 

12 and treatment of obesity, being overweight, and 

13 eating disorders to conduct educational con14 ferences, including Internet-based courses and 

15 teleconferences, on— 

16 ‘‘(I) how to treat or prevent obesity, 

17 being overweight, and eating disorders; 

18 ‘‘(II) the link between obesity, being 

19 overweight, eating disorders and related se20 rious and chronic medical conditions; 

21 ‘‘(III) how to discuss varied strategies 

22 with patients from at-risk and diverse pop23 ulations to promote positive behavior 

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1 sity, being overweight, and eating dis2 orders; 

3 ‘‘(IV) how to identify overweight, 

4 obese, individuals with eating disorders, 

5 and those who are at risk for obesity and 

6 being overweight or suffer from eating dis7 orders and, therefore, at risk for related 

8 serious and chronic medical conditions; and 

9 ‘‘(V) how to conduct a comprehensive 

10 assessment of individual and familial 

11 health risk factors and evaluate the effec12 tiveness of the training provided by such 

13 entity in increasing knowledge and chang14 ing attitudes and behaviors of trainees. 

15 ‘‘(iii) In awarding a grant to carry out an 

16 activity under this subparagraph, preference 

17 shall be given to an entity described in sub18 section (a)(4). 

19 ‘‘(e) REPORTING TO CONGRESS.—Not later than 3 

20 years after the date of enactment of this section, the Di21 rector of the Centers for Disease Control and Prevention 

22 shall submit to the Secretary and Congress a report con23 cerning the result of the activities conducted through the 

24 grants awarded under this section. 


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1 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated to carry out this section, 

3 $50,000,000 for fiscal year 2009, and such sums as may 

4 be necessary for each of fiscal years 2010 through 2012.’’. 

5 SEC. 103. NATIONAL CENTER FOR HEALTH STATISTICS. 

6 Section 306 of the Public Health Service Act (42 

7 U.S.C. 242k) is amended— 

8 (1) in subsection (m)(4)(B), by striking ‘‘sub9 section (n)’’ each place it appears and inserting 

10 ‘‘subsection (o)’’; 

11 (2) by redesignating subsection (n) as sub12 section (o); and 

13 (3) by inserting after subsection (m) the fol14 lowing: 

15 ‘‘(n)(1) The Secretary, acting through the Center, 

16 may provide for the— 

17 ‘‘(A) collection of data for determining the fit18 ness levels and energy expenditure of adults, chil19 dren, and youth; and 

20 ‘‘(B) analysis of data collected as part of the 

21 National Health and Nutrition Examination Survey 

22 and other data sources. 

23 ‘‘(2) In carrying out paragraph (1), the Secretary, 

24 acting through the Center, may make grants to States, 

25 public entities, and nonprofit entities. 


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1 ‘‘(3) The Secretary, acting through the Center, may 

2 provide technical assistance, standards, and methodologies 

3 to grantees supported by this subsection in order to maxi4 mize the data quality and comparability with other stud5 ies.’’. 

6 SEC. 104. HEALTH DISPARITIES REPORT. 

7 Not later than 18 months after the date of enactment 

8 of this Act, and annually thereafter, the Director of the 

9 Agency for Healthcare Research and Quality shall review 

10 all research that results from the activities carried out 

11 under this Act (and the amendments made by this Act) 

12 and determine if particular information may be important 

13 to the report on health disparities required by section 

14 903(c)(3) of the Public Health Service Act (42 U.S.C. 

15 299a–1(c)(3)). 

16 SEC. 105. PREVENTIVE HEALTH SERVICES BLOCK GRANT. 

17 Section 1904(a)(1) of the Public Health Service Act 

18 (42 U.S.C. 300w–3(a)(1)) is amended by adding at the 

19 end the following: 

20 ‘‘(H) Activities and community education pro21 grams designed to address and prevent overweight, 

22 obesity, and eating disorders through effective pro23 grams to promote healthy eating, and exercise habits 

24 and behaviors.’’. 


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1 SEC. 106. REPORT ON OBESITY AND EATING DISORDERS 

2 RESEARCH. 

3 (a) IN GENERAL.—Not later than 1 year after the 

4 date of enactment of this Act, the Secretary of Health and 

5 Human Services shall submit to the Committee on Health, 

6 Education, Labor, and Pensions of the Senate and the 

7 Committee on Energy and Commerce of the House of 

8 Representatives a report on research conducted on causes 

9 and health implications (including mental health implica10 tions) of being overweight, obesity, and eating disorders. 

11 (b) CONTENT.—The report described in subsection 

12 (a) shall contain— 

13 (1) descriptions on the status of relevant, cur14 rent, ongoing research being conducted in the De15 partment of Health and Human Services including 

16 research at the National Institutes of Health, the 

17 Centers for Disease Control and Prevention, the 

18 Agency for Healthcare Research and Quality, the 

19 Health Resources and Services Administration, and 

20 other offices and agencies; 

21 (2) information about what these studies have 

22 shown regarding the causes, prevention, and treat23 ment of, being overweight, obesity, and eating dis24 orders; and 

25 (3) recommendations on further research that 

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1 lations, the plan of the Department of Health and 

2 Human Services for conducting such research, and 

3 how current knowledge can be disseminated. 

4 TITLE II—FOOD AND BEVERAGE 

5 LABELING FOR HEALTHY 

6 CHOICES 

7 SEC. 201. FOOD AND BEVERAGE LABELING FOR HEALTHY 

8 CHOICES. 

9 (a) USCO–OP.—In this section, the term ‘‘USCO– 

10 OP’’ means the United States Council on Overweight-Obe11 sity Prevention under section 399R of the Public Health 

12 Service Act (as added by section 101). 

13 (b) REFORM OF FOOD AND BEVERAGE LABELING.— 

14 The Secretary of Health and Human Services and the Sec15 retary of Agriculture, in consultation with the USCO–OP, 

16 shall, through regulation or other appropriate action, up17 date and reform Federal oversight of food and beverage 

18 labeling. Such reform shall include improving the trans19 parency of such labeling with regard to nutritional and 

20 caloric value of food and beverages. 


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1 TITLE III—HEALTHY CHOICES 

2 FOOD AND BEVERAGE PRO3 GRAMS 

4 SEC. 301. FRESH FRUIT AND VEGETABLE PROGRAM. 

5 Section 19(i) of the Richard B. Russell National 

6 School Lunch Act (42 U.S.C. 1769a(i)) is amended— 

7 (1) by redesignating paragraphs (3) through 

8 (7) as paragraphs (4) through (8); and 

9 (2) by inserting after paragraph (2) the fol10 lowing: 

11 ‘‘(3) ADDITIONAL MANDATORY FUNDING.— 

12 ‘‘(A) IN GENERAL.—Out of any funds in 

13 the Treasury not otherwise appropriated, the 

14 Secretary of the Treasury shall transfer to the 

15 Secretary of Agriculture to carry out and ex16 pand the program under this section, to remain 

17 available until expended— 

18 ‘‘(i) on October 1, 2008, $80,000,000; 

19 ‘‘(ii) on July 1, 2009, $130,000,000; 

20 ‘‘(iii) on July 1, 2010, $202,000,000; 

21 ‘‘(iv) on July 1, 2011, $300,000,000; 

22 and 

23 ‘‘(v) on July 1, 2012, and on each 

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1 able for the previous fiscal year, as ad2 justed under subparagraph (B). 

3 ‘‘(B) ADJUSTMENT.—On July 1, 2012, 

4 and on each July 1 thereafter the amount made 

5 available under subparagraph (A)(v) shall be 

6 calculated by adjusting the amount made avail7 able for the previous fiscal year to reflect 

8 changes in the Consumer Price Index of the 

9 Bureau of Labor Statistics for fresh fruits and 

10 vegetables, with the adjustment— 

11 ‘‘(i) rounded down to the nearest dol12 lar increment; and 

13 ‘‘(ii) based on the unrounded amounts 

14 for the preceding 12-month period. 

15 ‘‘(C) ALLOCATION.—Funds made available 

16 under this paragraph shall be allocated among 

17 the States and the District of Columbia in the 

18 same manner as funds made available under 

19 paragraph (1).’’. 


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1 TITLE IV—AMENDMENTS TO THE 

2 SOCIAL SECURITY ACT 

3 SEC. 401. COVERAGE OF EVIDENCE-BASED PREVENTIVE 

4 SERVICES UNDER MEDICARE, MEDICAID, AND 

5 SCHIP. 

6 (a) MEDICARE.—Section 1861(ddd) of the Social Se7 curity Act, as added by section 101 of the Medicare Im8 provements for Patients and Providers Act of 2008, is 

9 amended— 

10 (1) in paragraph (2), by striking ‘‘paragraph 

11 (1)’’ and inserting ‘‘paragraphs (1) and (3)’’; and 

12 (2) by adding at the end the following new 

13 paragraph: 

14 ‘‘(3) The term ‘additional preventive services’ 

15 includes any evidence-based preventive services 

16 which the Secretary has determined are reasonable 

17 and necessary, including, as so determined, smoking 

18 cessation and prevention services, diet and exercise 

19 counseling, and healthy weight and obesity coun20 seling.’’. 

21 (b) STATE OPTION TO PROVIDE MEDICAL ASSIST22 ANCE FOR EVIDENCE-BASED PREVENTIVE SERVICES.— 

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

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

25 (A) in subsection (a)— 


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1 (i) in paragraph (27), by striking 

2 ‘‘and’’ at the end; 

3 (ii) by redesignating paragraph (28) 

4 as paragraph (29); and 

5 (iii) by inserting after paragraph (27) 

6 the following: 

7 ‘‘(28) evidence-based preventive services de8 scribed in subsection (y); and’’; and 

9 (B) by adding at the end the following: 

10 ‘‘(y)(1) For purposes of subsection (a)(28), evidence11 based preventive services described in this subsection are 

12 any preventive services which the Secretary has deter13 mined are reasonable and necessary through the process 

14 for making national coverage determinations (as defined 

15 in section 1869(f)(1)(B)) under title XVIII, including, as 

16 so determined, smoking cessation and prevention services, 

17 diet and exercise counseling, and healthy weight and obe18 sity counseling.’’. 

19 (2) CONFORMING AMENDMENT.—Section 

20 1902(a)(10)(C)(iv) of such Act is amended by in21 serting ‘‘and (28)’’ after ‘‘(24)’’. 

22 (c) STATE OPTION TO PROVIDE CHILD HEALTH AS23 SISTANCE FOR EVIDENCE-BASED PREVENTIVE SERV24 ICES.—Section 2110(a) of the Social Security Act (42 

25 U.S.C. 1397jj(a)) is amended— 


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•S 3584 IS

1 (1) by redesignating paragraph (28) as para2 graph (29); and 

3 (2) by inserting after paragraph (27) the fol4 lowing: 

5 ‘‘(28) Evidence-based preventive services de6 scribed in section 1905(y).’’. 

7 SEC. 402. COVERAGE OF MEDICAL NUTRITION COUNSELING 

8 UNDER MEDICARE, MEDICAID, AND SCHIP. 

9 (a) MEDICARE COVERAGE OF MEDICAL NUTRITION

10 THERAPY SERVICES FOR PEOPLE WITH PRE-DIABE11 TES.—Section 1861(s)(2)(V) of the Social Security Act 

12 (42 U.S.C. 1395x(s)(2)(V)) is amended by inserting after 

13 ‘‘beneficiary with diabetes’’ the following ‘‘, pre-diabetes 

14 or its risk factors (including hypertension, dyslipidemia, 

15 obesity, or overweight),’’. 

16 (b) STATE OPTION TO PROVIDE MEDICAL ASSIST17 ANCE FOR MEDICAL THERAPY SERVICES.— 

18 (1) IN GENERAL.—Section 1905(a) of the So19 cial Security Act (42 U.S.C. 1396d), as amended by 

20 section 401(b), is amended— 

21 (A) in paragraph (28), by striking ‘‘and’’ 

22 at the end; 

23 (B) by redesignating paragraph (29) as 

24 paragraph (30); and 


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•S 3584 IS

1 (C) by inserting after paragraph (28) the 

2 following: 

3 ‘‘(29) medical nutrition therapy services (as de4 fined in section 1861(vv)(1)) for individuals with 

5 pre-diabetes or obesity, or who are overweight (as 

6 defined by the Secretary); and’’. 

7 (2) CONFORMING AMENDMENT.—Section 

8 1902(a)(10)(C)(iv) of such Act, as amended by sec9 tion 401(b)(2), is amended by striking ‘‘and (28)’’ 

10 and inserting ‘‘, (28) and (29)’’. 

11 (c) STATE OPTION TO PROVIDE CHILD HEALTH AS12 SISTANCE FOR MEDICAL NUTRITION THERAPY SERV13 ICES.—Section 2110(a) of the Social Security Act (42 

14 U.S.C. 1397jj(a)), as amended by section 401(c), is 

15 amended— 

16 (1) by redesignating paragraph (29) as para17 graph (30); and 

18 (2) by inserting after paragraph (28) the fol19 lowing: 

20 ‘‘(29) Medical nutrition therapy services (as de21 fined in section 1861(vv)(1)) for individuals with 

22 pre-diabetes or obesity, or who are overweight (as 

23 defined by the Secretary).’’. 


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•S 3584 IS

1 SEC. 403. AUTHORIZING EXPANSION OF MEDICARE COV2 ERAGE OF MEDICAL NUTRITION THERAPY 

3 SERVICES. 

4 (a) AUTHORIZING EXPANDED ELIGIBLE POPU5 LATION.—Section 1861(s)(2)(V) of the Social Security 

6 Act (42 U.S.C. 1395x(s)(2)(V)), as amended by section 

7 402, is amended— 

8 (1) by redesignating clauses (i) through (iii) as 

9 subclauses (I) through (III), respectively, and in10 denting each such clause an additional 2 ems; 

11 (2) by striking ‘‘in the case of a beneficiary 

12 with diabetes, pre-diabetes or its risk factors (includ13 ing hypertension, dyslipidemia, obesity, overweight), 

14 or a renal disease who—’’ and inserting ‘‘in the case 

15 of a beneficiary— 

16 ‘‘(i) with diabetes, pre-diabetes or its risk 

17 factors (including hypertension, dyslipidemia, 

18 obesity, overweight), or a renal disease 

19 who—’’; 

20 (3) by adding ‘‘or’’ at the end of subclause (III) 

21 of clause (i), as so redesignated; and 

22 (4) by adding at the end the following new 

23 clause: 

24 ‘‘(ii) who is not described in clause (i) but 

25 who has another disease, condition, or disorder 

26 for which the Secretary has made a national 


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•S 3584 IS

1 coverage determination (as defined in section 

2 1869(f)(1)(B)) for the coverage of such serv3 ices;’’. 

4 (b) COVERAGE OF SERVICES FURNISHED BY PHYSI5 CIANS.—Section 1861(vv)(1) of the Social Security Act 

6 (42 U.S.C. 1395x(vv)(1)) is amended by inserting ‘‘or 

7 which are furnished by a physician’’ before the period at 

8 the end. 

9 (c) NATIONAL COVERAGE DETERMINATION PROC10 ESS.—In making a national coverage determination de11 scribed in section 1861(s)(2)(V)(ii) of the Social Security 

12 Act, as added by subsection (a)(4), the Secretary of 

13 Health and Human Services, acting through the Adminis14 trator of the Centers for Medicare & Medicaid Services, 

15 shall— 

16 (1) consult with dietetic and nutrition profes17 sional organizations in determining appropriate pro18 tocols for coverage of medical nutrition therapy serv19 ices for individuals with different diseases, condi20 tions, and disorders; and 

21 (2) consider the degree to which medical nutri22 tion therapy interventions prevent or help prevent 

23 the onset or progression of more serious diseases, 

24 conditions, or disorders. 


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1 SEC. 404. CLARIFICATION OF EPSDT INCLUSION OF PRE2 VENTION, SCREENING, AND TREATMENT 

3 SERVICES FOR OBESITY AND OVERWEIGHT; 

4 SCHIP COVERAGE. 

5 (a) IN GENERAL.—Section 1905(r)(5) of the Social 

6 Security Act (42 U.S.C. 1396d(r)(5)) is amended by in7 serting ‘‘, including weight and BMI measurement and 

8 monitoring, as well as appropriate treatment services (in9 cluding but not limited to) medical nutrition therapy serv10 ices (as defined in section 1861(vv)(1)), physical therapy 

11 or exercise training, and behavioral health counseling, 

12 based on recommendations of the United States Council 

13 on Overweight-Obesity Prevention under section 399R of 

14 the Public Health Service Act and such other expert rec15 ommendations and studies as determined by the Sec16 retary’’ before the period. 

17 (b) SCHIP.— 

18 (1) REQUIRED COVERAGE.—Section 2103 (42 

19 U.S.C. 1397cc) is amended— 

20 (A) in subsection (a), in the matter before 

21 paragraph (1), by striking ‘‘subsection (c)(5)’’ 

22 and inserting ‘‘paragraphs (5) and (7) of sub23 section (c)’’; and 

24 (B) in subsection (c)— 

25 (i) by redesignating paragraph (5) as 

26 paragraph (7); and 


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•S 3584 IS

1 (ii) by inserting after paragraph (4), 

2 the following: 

3 ‘‘(5) PREVENTION, SCREENING, AND TREAT4 MENT SERVICES FOR OBESITY AND OVERWEIGHT.— 

5 The child health assistance provided to a targeted 

6 low-income child shall include coverage of weight 

7 and BMI measurement and monitoring, as well as 

8 appropriate treatment services (including but not 

9 limited to) medical nutrition therapy services (as de10 fined in section 1861(vv)(1)), physical therapy or ex11 ercise training, and behavioral health counseling, 

12 based on recommendations of the United States 

13 Council on Overweight-Obesity Prevention under 

14 section 399R of the Public Health Service Act and 

15 such other expert recommendations and studies as 

16 determined by the Secretary.’’. 

17 (2) CONFORMING AMENDMENT.—Section 

18 2102(a)(7)(B) (42 U.S.C. 1397bb(c)(2)) is amended 

19 by inserting ‘‘and services described in section 

20 2103(c)(5)’’ after ‘‘emergency services’’. 


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•S 3584 IS

1 SEC. 405. INCLUSION OF PREVENTIVE SERVICES IN QUAL2 ITY MATERNAL AND CHILD HEALTH SERV3 ICES. 

4 Section 501(b) of the Social Security Act (42 U.S.C. 

5 701(b)) is amended by adding at the end the following 

6 new paragraph: 

7 ‘‘(5) The term ‘quality maternal and child 

8 health services’ includes the following: 

9 ‘‘(A) Evidence-based preventive services 

10 described in section 1905(y). 

11 ‘‘(B) Medical nutrition counseling for indi12 viduals with pre-diabetes or obesity, or who are 

13 overweight (as defined by the Secretary). 

14 ‘‘(C) Weight and BMI measurement and 

15 monitoring, as well as appropriate treatment 

16 services (including but not limited to) medical 

17 nutrition therapy services (as defined in section 

18 1861(vv)(1)), physical therapy or exercise train19 ing, and behavioral health counseling, based on 

20 recommendations of the United States Council 

21 on Overweight-Obesity Prevention under section 

22 399R of the Public Health Service Act and 

23 such other expert recommendations and studies 

24 as determined by the Secretary.’’. 


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1 SEC. 406. EFFECTIVE DATE. 

2 (a) IN GENERAL.—Except as provided in subsection 

3 (b), the amendments made by this title take effect on Oc4 tober 1, 2009. 

5 (b) EXTENSION OF EFFECTIVE DATE FOR STATE

6 LAW AMENDMENT.—In the case of a State plan under 

7 title XIX or XXI of the Social Security Act (42 U.S.C. 

8 1396 et seq., 1397aa et seq.) which the Secretary of 

9 Health and Human Services determines requires State 

10 legislation in order for the plan to meet the additional re11 quirements imposed by the amendments made by this sec12 tion, the State plan shall not be regarded as failing to 

13 comply with the requirements of such title solely on the 

14 basis of its failure to meet these additional requirements 

15 before the first day of the first calendar quarter beginning 

16 after the close of the first regular session of the State leg17 islature that begins after the date of enactment of this 

18 Act. For purposes of the previous sentence, in the case 

19 of a State that has a 2-year legislative session, each year 

20 of the session is considered to be a separate regular ses21 sion of the State legislature. 

Æ 


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