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 fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committee on Ways and Means, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
A BILL 
To amend title XVIII of the Social Security Act to provide 
coverage of medical nutrition therapy services for individ-
uals with eating disorders 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 ‘‘Nutrition Counseling 
Aiding Recovery for Eating Disorders Act of 2019’’ or the 
‘‘Nutrition CARE Act of 2019’’. 
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SEC. 2. FINDINGS. 
Congress finds the following: 
(1) Eating disorders, including the specific dis-
orders of anorexia nervosa, bulimia nervosa, binge 
eating disorder, avoidant/restrictive food intake dis-
order, and other specified feeding or eating dis-
orders, are severe biologically based mental illnesses 
caused by a complex interaction of genetic, biologi-
cal, social, behavioral, and psychological factors. 
(2) Over 30,000,000 individuals in the United 
States of all ages, races, sizes, sexual orientations, 
ethnicities, and socioeconomic statuses, are affected 
by eating disorders during their lifetimes. 
(3) Eating disorders have one of the highest 
mortality rates of all mental illnesses, as eating dis-
orders can become fatal due to heart failure, kidney 
failure, stroke, hypoglycemia, and gastric rupture. 
Additionally, longitudinal studies have found that 
the suicide risk for those with an eating disorder is 
23 times the expected risk. 
(4) Eating disorders can be successfully treated 
with interventions at the appropriate durations and 
levels of care, yet only one-third of persons with eat-
ing disorders receive any medical, psychiatric, or 
therapeutic care. Best practice treatment of eating 
disorders includes patients, their families, and a 
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comprehensive team of professionals such as social 
workers, mental health counselors, primary care 
practitioners, psychiatrists, psychologists, dietitians, 
art therapists, and other specialty providers. 
(5) Studies examining the prevalence of eating 
disorders and insulin restriction among people with 
diabetes show that up to 35 percent of women with 
diabetes restrict insulin in order to lose weight at 
some point in their life. 
(6) Research shows that disordered eating 
among older adults consistently find that rates of 
disordered eating among the elderly are similar to 
those of younger persons. 
(7) Weight loss in the elderly may signal an 
undiagnosed medical illness or may be the result of 
a known medical condition and/or its pharmacologic 
treatment. 
(8) Eating disorders in the elderly are associ-
ated with significant morbidity and mortality, and a 
wide range of health issues arise secondary to eating 
disorders, including cardiac, metabolic, gastric, and 
bone conditions; diagnosis and proper treatment of 
this population are essential. 
(9) Eating disorders in the elderly are particu-
larly serious because chronic disorders or diseases 
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may already compromise a patient’s health. Inad-
equate nutrition can result in memory deficits, cog-
nitive decline, decubitus ulcers, impaired healing of 
sores, wounds, or infections, and dizziness, dis-
orientation, and falls. 
(10) Studies find that individuals with chronic 
illnesses and/or disabilities are four times more likely 
to have anorexia nervosa or bulimia nervosa com-
pared to the general population. 
SEC. 3. PROVIDING COVERAGE OF MEDICAL NUTRITION 
THERAPY SERVICES FOR INDIVIDUALS WITH 
EATING DISORDERS UNDER THE MEDICARE 
PROGRAM. 
Section 1861 of the Social Security Act (42 U.S.C. 
1395x) is amended— 
(1) in subsection (s)(2)(V)— 
(A) by redesignating clauses (i) through 
(iii) as subclauses (I) through (III), respec-
tively, and adjusting the margins accordingly; 
(B) in subclause (III), as so redesignated, 
by striking the semicolon at the end and insert-
ing ‘‘; and’’; 
(C) by striking ‘‘beneficiary with diabetes’’ 
and inserting the following: ‘‘beneficiary— 
‘‘(i) with diabetes’’; and 
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(D) by adding at the end the following new 
clause: 
‘‘(ii) beginning January 1, 2020, with an 
eating disorder (as defined by the Secretary in 
accordance with most recent edition of the Di-
agnostic and Statistical Manual of Mental Dis-
orders published by the American Psychiatric 
Association);’’; and 
(2) in subsection (vv)— 
(A) in paragraph (1)— 
(i) by inserting ‘‘(including manage-
ment of an eating disorder (as defined for 
purposes 
of 
subsection 
(s)(2)(V)(ii)))’’ 
after ‘‘disease management’’; and 
(ii) by inserting ‘‘or psychologist (or 
other mental health professional to the ex-
tent authorized under State law) and, in 
the case of such services furnished to an 
individual for the purpose of management 
of such an eating disorder, at the times 
specified in paragraph (4)’’ before the pe-
riod at the end; and 
(B) by adding at the end the following new 
paragraph: 
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‘‘(4)(A) For purposes of paragraph (1), the times 
specified in this paragraph are, with respect to medical 
nutrition therapy services furnished to an individual for 
purposes of management of an eating disorder, the fol-
lowing: 
‘‘(i) 13 hours (including a 1 hour initial assess-
ment and 12 hours of reassessment and interven-
tion) during the 1-year period beginning on the date 
such individual is first furnished such services. 
‘‘(ii) Subject to subparagraph (B), 4 hours dur-
ing each subsequent 1-year period. 
‘‘(B) In the case that the physician or psychologist 
(or other mental health professional to the extent author-
ized under State law) treating such individual determines 
that there has been a change with respect to the diagnosis, 
medical condition, or treatment regimen relating to the 
eating disorder of such individual that requires the fur-
nishing of medical nutrition therapy services beyond the 
times specified in subparagraph (A)(ii), the Secretary may 
provide for an additional number of hours to be available 
to such individual with respect to a period described in 
such subparagraph. 
‘‘(C) The Secretary may apply such other reasonable 
limitations with respect to the furnishing of medical nutri-
tion therapy services for purposes of management of an 
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eating disorder during a period described in subparagraph 
(A)(ii) as the Secretary determines appropriate.’’. 
Æ 
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