I 
117TH CONGRESS 
1ST SESSION H. R. 3108 
To amend title XVIII of the Social Security Act to expand the availability 
of medical nutrition therapy services under the Medicare program. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 11, 2021 
Ms. KELLY of Illinois (for herself and Mr. UPTON) 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 sub-
sequently 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 expand 
the availability of medical nutrition therapy services 
under the Medicare program. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Medical Nutrition 
Therapy Act of 2021’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
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(1) Over two-thirds of Medicare fee-for-service 
beneficiaries have two or more chronic conditions, 
many of which can be prevented, delayed, treated, or 
managed through nutrition. 
(2) Individuals from many racial and ethnic mi-
nority backgrounds are more likely to be diagnosed 
with chronic diseases such as diabetes, prediabetes, 
chronic kidney disease, end-stage renal disease, and 
obesity. 
(3) The Centers for Disease Control and Pre-
vention finds that individuals are at an increased 
risk of severe illness from COVID–19 if they have 
cancer, chronic kidney disease, diabetes, heart condi-
tions such as health failure or coronary artery dis-
ease, or obesity. 
(4) Coverage for medical nutrition therapy is 
only available to Medicare part B beneficiaries with 
diabetes or a renal disease, despite medical nutrition 
therapy being part of the standard of care, in clin-
ical guidelines, and medically necessary for many 
more chronic conditions. 
(5) Medical nutrition therapy has been shown 
to be a cost-effective component of treatment for 
obesity, diabetes, hypertension, dyslipidemia, HIV 
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infection, unintended weight loss in older adults and 
other chronic conditions. 
SEC. 3. EXPANDING THE AVAILABILITY OF MEDICAL NU-
TRITION THERAPY SERVICES UNDER THE 
MEDICARE PROGRAM. 
(a) IN GENERAL.—Section 1861 of the Social Secu-
rity Act (42 U.S.C. 1395x) is amended— 
(1) in subsection (s)(2)(V), by striking ‘‘in the 
case of’’ and all that follows through ‘‘organiza-
tions’’; and 
(2) in subsection (vv)— 
(A) in paragraph (1)— 
(i) by striking ‘‘disease management’’ 
and inserting ‘‘the prevention, manage-
ment, or treatment of a disease or condi-
tion specified in paragraph (4)’’; and 
(ii) by striking ‘‘by a physician’’ and 
all that follows through the period at the 
end and inserting the following: ‘‘by a— 
‘‘(A) physician (as defined in subsection 
(r)(1)); 
‘‘(B) physician assistant; 
‘‘(C) nurse practitioner; 
‘‘(D) clinical nurse specialist (as defined in 
subsection (aa)(5)(B)); or 
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‘‘(E) in the case of such services furnished 
to manage such a disease or condition that is 
an eating disorder, a clinical psychologist (as 
defined by the Secretary). 
Such term shall not include any services furnished 
to an individual for the prevention, management, or 
treatment of a renal disease if such individual is re-
ceiving maintenance dialysis for which payment is 
made under section 1881.’’; and 
(B) by adding at the end the following new 
paragraph: 
‘‘(4) For purposes of paragraph (1), the diseases and 
conditions specified in this paragraph are the following: 
‘‘(A) Diabetes and prediabetes. 
‘‘(B) A renal disease. 
‘‘(C) Obesity (as defined for purposes of sub-
section (yy)(2)(C) or as otherwise defined by the 
Secretary). 
‘‘(D) Hypertension. 
‘‘(E) Dyslipidemia. 
‘‘(F) Malnutrition. 
‘‘(G) Eating disorders. 
‘‘(H) Cancer. 
‘‘(I) Gastrointestinal diseases, including celiac 
disease. 
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‘‘(J) HIV. 
‘‘(K) AIDS. 
‘‘(L) Cardiovascular disease. 
‘‘(M) Any other disease or condition— 
‘‘(i) specified by the Secretary relating to 
unintentional weight loss; 
‘‘(ii) for which the Secretary determines 
the services described in paragraph (1) to be 
medically necessary and appropriate for the 
prevention, management, or treatment of such 
disease or condition, consistent with any appli-
cable recommendations of the United States 
Preventive Services Task Force; or 
‘‘(iii) for which the Secretary determines 
the services described in paragraph (1) are 
medically necessary, consistent with either pro-
tocols established by registered dietitians or nu-
trition professional organizations or with ac-
cepted clinical guidelines identified by the Sec-
retary.’’. 
(b) EXCLUSION MODIFICATION.—Section 1862(a)(1) 
is amended— 
(1) in subparagraph (O), by striking ‘‘and’’ at 
the end; 
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(2) in subparagraph (P), by striking the semi-
colon at the end and inserting ‘‘, and’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(Q) in the case of medical nutrition therapy 
services (as defined in section 1861(vv)), which are 
not furnished for the prevention, management, or 
treatment of a disease or condition specified in para-
graph (4) of such section;’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to items and services 
furnished on or after January 1, 2023. 
Æ 
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