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 Cali-
fornia, 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. GIB-
BONS, 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-
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 reg-
istered dietitians and nutrition professionals.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; FINDINGS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Medicare Medical Nutrition Therapy Act of 1999’’.
(b) FINDINGS.—Congress finds as follows:
(1) Medical nutrition therapy is a medically
necessary and cost-effective way of treating and con-
trolling many diseases and medical conditions affect-
ing the elderly, including HIV/AIDS, cancer, kidney
disease, diabetes, heart disease, pressure ulcers, se-
vere burns, and surgical wounds.
(2) Medical nutrition therapy saves health care
costs by speeding recovery and reducing the inci-
dence of complications, resulting in fewer hos-
pitalizations, shorter hospital stays, and reduced
drug, surgery, and treatment needs.
(3) A study conducted by The Lewin Group
shows that, after the third year of coverage, savings
would be greater than costs for coverage of medical
nutrition therapy for all medicare beneficiaries, with
savings projected to grow steadily in following years.
(4) The Agency for Health Care Policy and Re-
search has indicated in its practice guidelines that
nutrition is key to both the prevention and the treat-
ment of pressure ulcers (also called bed sores) which
annually cost the health care system an estimated
$1.3 billion for treatment.
(5) Almost 17 million patients each year are
treated for illnesses or injuries that stem from or
place them at risk of malnutrition.
(6) Because medical nutrition therapy is not
covered under part B of the medicare program and
because more and more health care is delivered on
an outpatient basis, many patients are denied access
to the effective, low-tech treatment they need, result-
ing in an increased incidence of complications and a
need for higher cost treatments.
SEC. 2. MEDICARE COVERAGE OF MEDICAL NUTRITION
THERAPY SERVICES.
(a) COVERAGE.—Section 1861(s)(2) of the Social Se-
curity Act (42 U.S.C. 1395x(s)(2)) is amended—
(1) by striking ‘‘and’’ at the end of subpara-
graph (S);
(2) by striking the period at the end of sub-
paragraph (T) and inserting ‘‘; and’’; and
(3) by adding at the end the following new sub-
paragraph:
‘‘(U) medical nutrition therapy services (as de-
fined in subsection (uu)(1));’’.
(b) SERVICES DESCRIBED.—Section 1861 of such
Act (42 U.S.C. 1395x) is amended by adding at the end
the following new subsection:
‘‘Medical Nutrition Therapy Services; Registered
Dietitian or Nutrition Professional
‘‘(uu)(1) The term ‘medical nutrition therapy serv-
ices’ means nutritional diagnostic, therapy, and counseling
services for the purpose of disease management which are
furnished by a registered dietitian or nutrition profes-
sional (as defined in paragraph (2)) pursuant to a referral
by a physician (as defined in subsection (r)(1)).
‘‘(2) Subject to paragraph (3), the term ‘registered
dietitian or nutrition professional’ means an individual
who—
‘‘(A) holds a baccalaureate or higher degree
granted by a regionally accredited college or univer-
sity in the United States (or an equivalent foreign
degree) with completion of the academic require-
ments of a program in nutrition or dietetics, as ac-
credited by an appropriate national accreditation or-
ganization recognized by the Secretary for this pur-
pose;
‘‘(B) has completed at least 900 hours of super-
vised dietetics practice under the supervision of a
registered dietitian or nutrition professional; and
‘‘(C)(i) is licensed or certified as a dietitian or
nutrition professional by the State in which the serv-
ices are performed, or
‘‘(ii) in the case of an individual in a State
which does not provide for such licensure or certifi-
cation, meets such other criteria as the Secretary es-
tablishes.
‘‘(3) Subparagraphs (A) and (B) of paragraph (2)
shall not apply in the case of an individual who as of the
date of the enactment of this subsection is licensed or cer-
tified as a dietitian or nutrition professional by the State
in which medical nutrition therapy services are per-
formed.’’.
(c) PAYMENT.—Section 1833(a)(1) of such Act (42
U.S.C. 1395l(a)(1)) is amended—
(1) by striking ‘‘and’’ before ‘‘(S)’’, and
(2) by inserting before the semicolon at the end
the following: ‘‘, and (T) with respect to medical nu-
trition therapy services (as defined in section
1861(uu)), the amount paid shall be 80 percent of
the lesser of the actual charge for the services or the
amount determined under the fee schedule estab-
lished under section 1848(b) for the same services if
furnished by a physician’’.
(d) EFFECTIVE DATE.—The amendments made by
this section apply to services furnished on or after Janu-
ary 1, 2000.
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