I 
116TH CONGRESS 
2D SESSION 
H. R. 8658 
To establish a Federal strategy for preventing, diagnosing, and treating 
nonalcoholic steatohepatitis, commonly referred to as ‘‘NASH’’. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 23, 2020 
Mr. CRENSHAW (for himself and Mr. RUIZ) introduced the following bill; 
which was referred to the Committee on Energy and Commerce 
A BILL 
To establish a Federal strategy for preventing, diagnosing, 
and treating nonalcoholic steatohepatitis, commonly re-
ferred to as ‘‘NASH’’. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Nonalcoholic Steatohepatitis Care Act of 2020’’ or the 
‘‘NASH Care Act of 2020’’. 
(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. National prevention program for diabetes, nonalcoholic fatty liver dis-
ease, and metabolic syndrome. 
VerDate Sep 11 2014 
21:52 Nov 13, 2020
Jkt 019200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6211
E:\BILLS\H8658.IH
H8658
jbell on DSKJLSW7X2PROD with BILLS
Sec. 3. Grants for community-based patient education and provider training 
and outreach. 
Sec. 4. National Academies of Sciences study on education and policy needs for 
nonalcoholic steatohepatitis and nonalcoholic fatty liver disease. 
Sec. 5. National surveillance program for nonalcoholic fatty liver disease and 
nonalcoholic steatohepatitis. 
Sec. 6. Recommendations for the prevention, screening, diagnosis, and treat-
ment of interrelated conditions developed by multidisciplinary 
task force. 
Sec. 7. Renaming of NIH institute to reflect liver diseases and creation of divi-
sion of liver diseases. 
SEC. 2. NATIONAL PREVENTION PROGRAM FOR DIABETES, 
NONALCOHOLIC FATTY LIVER DISEASE, AND 
METABOLIC SYNDROME. 
Section 399V–3 of the Public Health Service Act 
(280g–14) is amended— 
(1) in subsection (a)— 
(A) by inserting ‘‘or continue’’ after ‘‘es-
tablish’’; 
(B) by striking ‘‘national diabetes’’; 
(C) by inserting ‘‘, nonalcoholic fatty liver 
disease, and metabolic syndrome’’ after ‘‘high 
risk for diabetes’’; and 
(D) by striking ‘‘burden of diabetes’’ and 
inserting ‘‘such conditions’’; 
(2) in subsection (b)— 
(A) by striking paragraph (1) 
(B) 
by 
redesignating 
paragraphs 
(2) 
through (4) as paragraphs (3) through (5); and 
(C) by inserting before paragraph (3) (as 
so redesignated) the following; 
VerDate Sep 11 2014 
21:52 Nov 13, 2020
Jkt 019200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H8658.IH
H8658
jbell on DSKJLSW7X2PROD with BILLS
‘‘(1) competitive grants to eligible entities for 
the purposes of identifying, developing, or dissemi-
nating best practices on the prevention, detection, 
and treatment of diabetes, nonalcoholic fatty liver 
disease, and metabolic syndrome; 
‘‘(2) competitive grants for eligible entities for 
the development of community-based prevention pro-
gram model sites;’’; 
(3) by redesignating subsection (d) as sub-
section (e); 
(4) by inserting after subsection (c) the fol-
lowing: 
‘‘(d) PREFERENCE.—In awarding grants under sub-
section (b), the Secretary may give preference to eligible 
entities that— 
‘‘(1) provide lifestyle interventions, including 
nutrition and exercise consultation; and 
‘‘(2) serve racial and ethnic minority commu-
nities with high rates of diabetes, nonalcoholic fatty 
liver disease, and metabolic syndrome.’’ ; and 
(5) in subsection (e) (as redesignated by para-
graph (3)), by striking ‘‘such sums as may be nec-
essary for each of fiscal years 2010 through 2014’’ 
and inserting ‘‘$27,300,000 for each of fiscal years 
2021 through 2025’’. 
VerDate Sep 11 2014 
21:52 Nov 13, 2020
Jkt 019200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H8658.IH
H8658
jbell on DSKJLSW7X2PROD with BILLS
SEC. 3. GRANTS FOR COMMUNITY-BASED PATIENT EDU-
CATION AND PROVIDER TRAINING AND OUT-
REACH. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services, acting through the Director of the Cen-
ters for Disease Control and Prevention, shall establish 
a grant program under which the Secretary may award 
grants to eligible entities to provide education in the pre-
vention of nonalcoholic steatohepatitis (referred to in this 
Act as ‘‘NASH’’), which shall be know as the National 
NASH Prevention and Education Program (referred to in 
this section as ‘‘the Program’’). To the extent practicable, 
the Secretary shall align such program with the eligibility 
criteria to receive grants under the National Diabetes Pre-
vention Program of the Centers for Disease Control and 
Prevention. 
(b) ELIGIBLE ENTITIES.—An entity is eligible to re-
ceived a grant under the Program if such entity— 
(1)(A) provides lifestyle interventions such as 
promotion of liver health interventions or nutrition 
and exercise consultation; or 
(B) serves racial and ethnic minority commu-
nities with high rates of nonalcoholic fatty liver dis-
ease (as determined by Secretary); and 
(2) is a community-based, nonprofit organiza-
tion located in any state or is an experienced organi-
VerDate Sep 11 2014 
21:52 Nov 13, 2020
Jkt 019200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H8658.IH
H8658
jbell on DSKJLSW7X2PROD with BILLS
zation in developing liver health education and 
awareness programs. 
(c) APPLICATION.—An eligible entity seeking a grant 
under this section shall submit an application to the Sec-
retary at such time, in such manner, and containing such 
information as the Secretary may require. 
(d) TERM.—The term of a grant awarded under this 
section shall not exceed 5 years. 
(e) CURRICULUM DEVELOPMENT.— 
(1) IN GENERAL.—The Secretary shall develop, 
taking into consideration the best practices devel-
oped by grantees under section 399V–3(b)(1) of the 
Public Health Service Act, as amended by section 2 
of this Act, directly or through grants to eligible en-
tities, a curriculum to provide education in NASH 
prevention for use by recipients of grants under this 
section. 
(2) FOCUS AREAS.—The curriculum shall pro-
vide for consistency in— 
(A) application of screening and diagnostic 
recommendations; 
(B) collection of population data and qual-
ity measures; and 
VerDate Sep 11 2014 
21:52 Nov 13, 2020
Jkt 019200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H8658.IH
H8658
jbell on DSKJLSW7X2PROD with BILLS
(C) delivery of recommended evidence- 
based lifestyle interventions specific to nutrition 
and exercise. 
(f) POPULATIONS CONSIDERED.—In carrying out 
this section, the Secretary shall consider the needs of pedi-
atric and minority populations at risk for NASH. 
(g) COORDINATION WITH CONTINUING MEDICAL 
EDUCATION.—The task force established under section 6 
shall, to the extent practicable, coordinate the availability 
of training and outreach under this subsection with the 
opportunity for providers receiving training pursuant to 
this section to earn continuing medical education credits. 
(h) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2021 through 2025. 
SEC. 4. NATIONAL ACADEMIES OF SCIENCES STUDY ON 
EDUCATION AND POLICY NEEDS FOR NON-
ALCOHOLIC 
STEATOHEPATITIS 
AND 
NON-
ALCOHOLIC FATTY LIVER DISEASE. 
(a) IN GENERAL.—Not later than 180 days after the 
date of the enactment of this Act, the Secretary of Health 
and Human Services shall offer to enter into a contract 
with the National Academies of Sciences to conduct a 
VerDate Sep 11 2014 
21:52 Nov 13, 2020
Jkt 019200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H8658.IH
H8658
jbell on DSKJLSW7X2PROD with BILLS
study on nonalcoholic fatty liver disease and nonalcoholic 
steatohepatitis in the United States. 
(b) FOCUS AREAS.—The study conducted pursuant 
to subsection (a) shall focus on education and policy needs 
involving nonalcoholic fatty liver disease and nonalcoholic 
steatohepatitis, including— 
(1) opportunities to strengthen prevention of 
nonalcoholic fatty liver disease and nonalcoholic 
steatohepatitis, including through enhanced delivery 
of nutrition services; 
(2) barriers to diagnosis and treatment of non-
alcoholic 
fatty 
liver 
disease 
and 
nonalcoholic 
steatohepatitis, including opportunities to strengthen 
coverage under the Medicare program under title 
XVIII of the Social Security Act (42 U.S.C. 1395 et 
seq.), the Medicaid program under title XIX of such 
Act (42 U.S.C. 1396 et seq.), group health plans (as 
defined in section 2791 of the Public Health Service 
Act (42 U.S.C. 300gg–91)), and group or individual 
health insurance coverage (as such terms are defined 
in such section 2791); 
(3) recommendations for enhancing provider 
education on nonalcoholic fatty liver disease and 
nonalcoholic steatohepatitis; and 
VerDate Sep 11 2014 
21:52 Nov 13, 2020
Jkt 019200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H8658.IH
H8658
jbell on DSKJLSW7X2PROD with BILLS
(4) recommendations for enhancing patient 
awareness of nonalcoholic fatty liver disease and 
nonalcoholic steatohepatitis, including early identi-
fication of risk factors and linkage to appropriate 
care. 
(c) REPORT.—The agreement entered into under sub-
section (a) shall require the National Academies of 
Sciences to, not later than January 1, 2022, submit a re-
port on the findings of the study to the Secretary and the 
Chairman and Ranking Member of each of the following 
committees: 
(1) The Committee on Energy and Commerce 
of the House of Representatives. 
(2) The Committee on Ways and Means of the 
House of Representatives. 
(3) The Committee on Finance of the Senate. 
(4) The Committee on Health, Education, 
Labor, and Pensions of the Senate. 
(d) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
$1,000,000 for each of fiscal years 2021 and 2022. 
VerDate Sep 11 2014 
21:52 Nov 13, 2020
Jkt 019200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H8658.IH
H8658
jbell on DSKJLSW7X2PROD with BILLS
SEC. 5. NATIONAL SURVEILLANCE PROGRAM FOR NON-
ALCOHOLIC FATTY LIVER DISEASE AND NON-
ALCOHOLIC STEATOHEPATITIS. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services, acting through the Director of the Cen-
ters for Disease Control and Prevention, shall establish 
a program to provide for surveillance on the prevalence 
of nonalcoholic fatty liver disease and nonalcoholic 
steatohepatitis in the United States. 
(b) PROGRAM ACTIVITIES.— 
(1) SURVEILLANCE ACTIVITIES.—The program 
established under subsection (a) shall include, at a 
minimum, each of the following surveillance activi-
ties: 
(A) Conducting local surveillance activities 
to collect data on the prevalence and severity of 
nonalcoholic fatty level disease and nonalcoholic 
steatohepatitis. 
(B) Compiling and annually publishing 
data on the number of individuals with non-
alcoholic fatty level disease and nonalcoholic 
steatohepatitis nationally as well as in each 
state. 
(C) To the extent practicable, providing 
data on the general population at risk of devel-
oping the conditions. 
VerDate Sep 11 2014 
21:52 Nov 13, 2020
Jkt 019200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H8658.IH
H8658
jbell on DSKJLSW7X2PROD with BILLS
(2) TECHNICAL ASSISTANCE ON VITAL STATIS-
TICS.—In carrying out the program under sub-
section (a), the Secretary of Health and Human 
Services, acting through the Director of the Centers 
for Disease Control and Prevention, shall issue guid-
ance that provides technical assistance to health care 
providers and State and local health departments on 
best practices to ensure appropriate collection of 
vital statistics for purposes of birth and death cer-
tificates, including vital statistics on populations 
with nonalcoholic fatty level disease and nonalcoholic 
steatohepatitis. 
(c) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated— 
(1) to carry out surveillance activities described 
in subsection (b)(1), $10,000,000 for each of fiscal 
years 2021 and 2022; 
(2) to carry out technical assistance activities 
described in subsection (b)(3), $10,000,000 for each 
of fiscal years 2021 and 2022; and 
(3) to carry out the activities described in sub-
section (b)(2), $5,000,000 for each of fiscal years 
2021 through 2025. 
VerDate Sep 11 2014 
21:52 Nov 13, 2020
Jkt 019200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H8658.IH
H8658
jbell on DSKJLSW7X2PROD with BILLS
SEC. 
6. 
RECOMMENDATIONS 
FOR 
THE 
PREVENTION, 
SCREENING, DIAGNOSIS, AND TREATMENT OF 
INTERRELATED CONDITIONS DEVELOPED BY 
MULTIDISCIPLINARY TASK FORCE. 
(a) IN GENERAL.—Not later than 180 days after the 
date of the enactment of this Act, the Secretary of Health 
and Human Services shall establish a multidisciplinary 
task force, and appoint members to such task force, to 
develop recommendations for the prevention, screening, di-
agnosis, and treatment for several interrelated conditions, 
including, at a minimum— 
(1) nonalcoholic fatty liver disease; 
(2) nonalcoholic steatohepatitis; 
(3) obesity; 
(4) diabetes and other metabolic disorders; and 
(5) any other conditions determined appropriate 
by the Secretary. 
(b) MEMBERSHIP.—The task force established under 
subsection (a) shall be composed of not more than 12 
members to be appointed by the Secretary and shall in-
clude representatives of each of the following groups: 
(1) 
Physician 
specialists, 
including 
in 
hepatology, gastroenterology, endocrinology, cardi-
ology, and endocrinology. 
(2) Experts in public health and epidemiology. 
(3) Patient advocates. 
VerDate Sep 11 2014 
21:52 Nov 13, 2020
Jkt 019200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H8658.IH
H8658
jbell on DSKJLSW7X2PROD with BILLS
(4) Non-voting representatives of Federal agen-
cies, including the Food and Drug Administration, 
the National Institutes of Health, the Centers for 
Disease Control and Prevention, and the Office of 
the Assistant Secretary for Health of the Depart-
ment of Health and Human Services. 
(5) Non-voting representatives of manufactur-
ers of drugs, devices, or diagnostic tools approved by 
the Food and Drug Administration for the treat-
ment of any of the conditions specified in subsection 
(a). 
(c) DEVELOPMENT OF RECOMMENDATIONS.—In de-
veloping the recommendations under subsection (a), the 
task force established under such subsection shall con-
sider— 
(1) guidelines issued by the American Associa-
tion for the Study of Liver Diseases, published evi-
dence, recommendations of the United States Pre-
ventive Services Task Force, and other information 
it determines appropriate in developing such rec-
ommendations; and 
(2) whether a combined protocol addressing a 
range of conditions specified in such subsection is 
advised for populations affected by more than one 
VerDate Sep 11 2014 
21:52 Nov 13, 2020
Jkt 019200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H8658.IH
H8658
jbell on DSKJLSW7X2PROD with BILLS
condition for which such recommendations are being 
developed. 
(d) DEADLINE
FOR
COMPILING
RECOMMENDA-
TIONS.—The task force shall compile screening and diag-
nosis recommendations developed under subsection (a) not 
later than 18 months after the date on which the first 
meeting of the task force concludes. 
(e) PUBLIC HEALTH ACTION PLAN.— 
(1) IN GENERAL.—Not later than 1 year after 
the date of the enactment of this Act, the task force 
shall develop an action plan to combat nonalcoholic 
steatohepatitis (referred to in this section as ‘‘the 
Action Plan’’). 
(2) ISSUES
ADDRESSED.—The Action Plan 
shall identify key goals and implementation strate-
gies for— 
(A) assuring appropriate surveillance of 
the public health impact in the United States of 
nonalcoholic steatohepatitis; 
(B) increasing awareness among the gen-
eral public of the United States of risk factors; 
(C) enhancing clinical education on the 
prevention, diagnosis, and treatment of non-
alcoholic steatohepatitis among physicians and 
VerDate Sep 11 2014 
21:52 Nov 13, 2020
Jkt 019200
PO 00000
Frm 00013
Fmt 6652
Sfmt 6201
E:\BILLS\H8658.IH
H8658
jbell on DSKJLSW7X2PROD with BILLS
health care professionals within the United 
States; 
(D) supporting research on therapies and 
cures for nonalcoholic steatohepatitis; and 
(E) other areas determined appropriate by 
the Secretary. 
(3) EVALUATION AND REPORT.— 
(A) EVALUATION.—The Secretary shall, at 
least every 2 years, evaluate the implementation 
of the Action Plan under this section to provide 
any updates or modifications to such plan. 
(B) REPORT.—Not later than 18 months 
after the date on which the Action Plan devel-
oped under paragraph (1) is released, the Sec-
retary shall submit to Congress a report that 
discusses any updated recommendations for up-
dates 
or 
modifications 
considering 
initial 
progress made in advancing the action plan’s 
goals or barriers to attaining such goals. 
(f) REPORT REGARDING LIVER CANCER.—Not later 
than 1 year after the date on which the first meeting of 
the working group is held, the working group shall trans-
mit to the Director of the NIH a report providing rec-
ommendations with respect to preventive and diagnostic 
measures that could, in consideration of the relationship 
VerDate Sep 11 2014 
21:52 Nov 13, 2020
Jkt 019200
PO 00000
Frm 00014
Fmt 6652
Sfmt 6201
E:\BILLS\H8658.IH
H8658
jbell on DSKJLSW7X2PROD with BILLS
between the prevalence of liver cancer and the prevalence 
of certain liver diseases, help reduce liver cancer rates and 
make liver cancer more treatable when detected. 
SEC. 7. RENAMING OF NIH INSTITUTE TO REFLECT LIVER 
DISEASES AND CREATION OF DIVISION OF 
LIVER DISEASES. 
(a) INSTITUTE RENAMED.—Effective on January 1, 
2021, title IV of the Public Health Service Act is amended 
by striking ‘‘National Institute for Diabetes and Digestive 
and Kidney Diseases’’ each place it appears in section 
401(b) (42 U.S.C. 281(b)), in section 409A(a) (42 U.S.C. 
284a(a)), in the heading of subpart 3 of part C, in section 
426 (42 U.S.C. 285c), and section 430 (42 U.S.C. 285c– 
4) and inserting ‘‘The National Institute of Diabetes and 
Digestive, Kidney, and Liver Diseases’’. 
(b) CONFORMING CHANGES.—Effective on January 
1, 2021, any reference to the National Institute for Diabe-
tes and Digestive and Kidney Diseases in any law, regula-
tion, document, record, or other paper of the United 
States shall be deemed to be a reference to the National 
Institute of Diabetes and Digestive, Kidney, and Liver 
Diseases. 
(c) ESTABLISHMENT OF DIVISION FOR LIVER DIS-
EASES.— 
VerDate Sep 11 2014 
21:52 Nov 13, 2020
Jkt 019200
PO 00000
Frm 00015
Fmt 6652
Sfmt 6201
E:\BILLS\H8658.IH
H8658
jbell on DSKJLSW7X2PROD with BILLS
(1) IN GENERAL.—Section 428 of the Public 
Health Service Act (42 U.S.C. 285c–2) is amend-
ed— 
(A) in subsection (a)(1)— 
(i) in the matter preceding subpara-
graph (A), by inserting ‘‘a Division Direc-
tor for Liver Diseases,’’ after ‘‘and Nutri-
tion,’’; and 
(ii) in subparagraph (A), by inserting 
‘‘liver diseases,’’ after ‘‘and nutrition,’’; 
and 
(B) in subsection (b)— 
(i) in the matter preceding paragraph 
(1), by inserting ‘‘the Division Director for 
Liver Diseases,’’ after ‘‘and Nutrition,’’; 
and 
(ii) in paragraph (1), by inserting 
‘‘liver diseases,’’ after ‘‘and nutritional dis-
orders,’’. 
(2) TRANSFER
OF
AUTHORITY.—Effective on 
January 1, 2021, the Secretary of Health and 
Human Services, acting through the Director of the 
National Institutes of Health, shall transfer to the 
Division Director of Liver Diseases of the National 
Institute of Diabetes and Digestive, Kidney, and 
VerDate Sep 11 2014 
21:52 Nov 13, 2020
Jkt 019200
PO 00000
Frm 00016
Fmt 6652
Sfmt 6201
E:\BILLS\H8658.IH
H8658
jbell on DSKJLSW7X2PROD with BILLS
Liver Diseases, the authorities (including all budget 
authorities, available appropriations, and personnel), 
duties, obligations, and related legal and administra-
tive functions prescribed by law or otherwise pre-
viously granted to the Liver Disease Research 
Branch within the Division of Digestive Diseases 
and Nutrition of the National Institute for Diabetes 
and Digestive and Kidney Diseases. 
Æ 
VerDate Sep 11 2014 
21:52 Nov 13, 2020
Jkt 019200
PO 00000
Frm 00017
Fmt 6652
Sfmt 6301
E:\BILLS\H8658.IH
H8658
jbell on DSKJLSW7X2PROD with BILLS