I 
115TH CONGRESS 
1ST SESSION H. R. 2587 
To provide for the coverage of medically necessary food and vitamins for 
digestive and inherited metabolic disorders under Federal health pro-
grams and private health insurance, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 22, 2017 
Mr. DELANEY (for himself, Ms. HERRERA BEUTLER, Mr. CAPUANO, and Mr. 
LYNCH) introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce, and in addition to the Committees on 
Ways and Means, Armed Services, and Oversight and Government Re-
form, for a period to be subsequently determined by the Speaker, in each 
case for consideration of such provisions as fall within the jurisdiction of 
the committee concerned 
A BILL 
To provide for the coverage of medically necessary food and 
vitamins for digestive and inherited metabolic disorders 
under Federal health programs and private health insur-
ance, and for other purposes. 
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 Eq-
uity Act of 2017’’. 
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SEC. 2. FINDINGS. 
Congress finds the following: 
(1) Specialized food is often medically necessary 
for the safe and effective management of many di-
gestive and inherited metabolic disorders that impact 
digestion, absorption, and metabolism of nutrients. 
(2) Although medically necessary food is essen-
tial for patients, it is often expensive and not uni-
formly reimbursed by health insurance, leaving many 
families with an insurmountable financial burden. 
(3) As a result, many patients who cannot af-
ford medically necessary food may experience ad-
verse health consequences from suboptimal disease 
management, including hospitalization, intellectual 
impairment, 
behavioral 
dysfunction, 
inadequate 
growth, nutrient deficiencies, and even death. 
SEC. 3. COVERAGE OF MEDICALLY NECESSARY FOOD AND 
VITAMINS FOR DIGESTIVE AND INHERITED 
METABOLIC DISORDERS UNDER FEDERAL 
HEALTH PROGRAMS AND PRIVATE HEALTH 
INSURANCE. 
(a) COVERAGE UNDER THE MEDICARE PROGRAM.— 
(1) MEDICALLY NECESSARY FOOD.— 
(A) IN GENERAL.—Section 1861(s)(2) of 
the Social Security Act (42 U.S.C. 1395x(s)(2)) 
is amended— 
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(i) in subparagraph (FF), by striking 
‘‘and’’ at the end; 
(ii) in subparagraph (GG), by insert-
ing ‘‘and’’ at the end; and 
(iii) by adding at the end the fol-
lowing new subparagraph: 
‘‘(HH) medically necessary food (as defined in 
subsection (jjj)) and the medical equipment and sup-
plies necessary to administer such food (other than 
medical equipment and supplies described in sub-
section (n));’’. 
(B) DEFINITION.—Section 1861 of the So-
cial Security Act (42 U.S.C. 1395x) is amended 
by adding at the end the following new sub-
section: 
‘‘Medically Necessary Food 
‘‘(jjj)(1) Subject to paragraph (2), the term ‘medi-
cally necessary food’ means food, including a low protein 
modified food product and an amino acid preparation 
product, that is— 
‘‘(A) furnished pursuant to the prescription, 
order, or recommendation (as applicable) of a physi-
cian or other health care professional qualified to 
make such prescription, order, or recommendation, 
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for the dietary management of a covered disease or 
condition; 
‘‘(B) a specially formulated and processed prod-
uct (as opposed to a naturally occurring foodstuff 
used in its natural state) for the partial or exclusive 
feeding of an individual by means of oral intake or 
enteral feeding by tube; 
‘‘(C) intended for the dietary management of 
an individual who, because of therapeutic or chronic 
medical needs, has limited or impaired capacity to 
ingest, digest, absorb, or metabolize ordinary food-
stuffs or certain nutrients, or who has other special 
medically determined nutrient requirements, the die-
tary management of which cannot be achieved by the 
modification of the normal diet alone; 
‘‘(D) intended to be used under medical super-
vision, which may include in a home setting; and 
‘‘(E) intended only for an individual receiving 
active and ongoing medical supervision wherein the 
individual requires medical care on a recurring basis 
for, among other things, instructions on the use of 
the food. 
‘‘(2) For purposes of paragraph (1), the term ‘medi-
cally necessary food’ does not include the following: 
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‘‘(A) Foods taken as part of an overall diet de-
signed to reduce the risk of a disease or medical con-
dition or as weight loss products, even if they are 
recommended by a physician or other health profes-
sional. 
‘‘(B) Foods marketed as gluten-free for the 
management of celiac disease or non-celiac gluten 
sensitivity. 
‘‘(C) Foods marketed for the management of 
diabetes. 
‘‘(D) Other products determined appropriate by 
the Secretary. 
‘‘(3) In this subsection, the term ‘covered disease or 
condition’ means the following diseases or conditions: 
‘‘(A) Inherited metabolic disorders, including 
the following: 
‘‘(i) Disorders classified as metabolic dis-
orders on the Recommended Uniform Screening 
Panel Core Conditions list of the Secretary of 
Health and Human Services’ Advisory Com-
mittee on Heritable Disorders in Newborns and 
Children. 
‘‘(ii) N-acetyl glutamate synthase defi-
ciency. 
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‘‘(iii) Ornithine transcarbamlyase defi-
ciency. 
‘‘(iv) Carbamoyl phosphate synthestase de-
ficiency. 
‘‘(v) Inherited disorders of mitochondrial 
functioning. 
‘‘(B) Medical and surgical conditions of mal-
absorption, including the following: 
‘‘(i) Impaired absorption of nutrients 
caused by disorders affecting the absorptive 
surface, functional length, and motility of the 
gastrointestinal tract, including short bowel 
syndrome and chronic intestinal pseudo-obstruc-
tion. 
‘‘(ii) Malabsorption due to liver or pan-
creatic disease. 
‘‘(C) Immunoglobulin E and non-Immunoglobu-
lin E-mediated allergies to food proteins, including 
the following: 
‘‘(i) Immunoglobulin E and non-Immuno-
globulin E-mediated allergies to food proteins. 
‘‘(ii) Food protein-induced enterocolitis 
syndrome. 
‘‘(iii) 
Eosinophilic 
disorders, 
including 
eosinophilic esophagitis, eosinophilic gastroen-
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teritis, eosinophilic colitis, and post-transplant 
eosinophilic disorders. 
‘‘(D) Inflammatory or immune mediated condi-
tions of the alimentary tract, including the following: 
‘‘(i) Inflammatory bowel disease, including 
Crohn’s disease, ulcerative colitis, and indeter-
minate colitis. 
‘‘(ii) Gastroesophageal reflux disease that 
is nonresponsive to standard medical therapies. 
‘‘(E) Any other disease or condition determined 
appropriate by the Secretary. 
‘‘(4) In this subsection, the term ‘ low protein modi-
fied food product’ means a product formulated to have less 
than one gram of protein per serving.’’. 
(C) PAYMENT.—Section 1833(a)(1) of the 
Social Security Act (42 U.S.C. 1395l(a)(1)) is 
amended— 
(i) by striking ‘‘and’’ before ‘‘(BB)’’; 
and 
(ii) by inserting before the semicolon 
at the end the following: ‘‘, and (CC) with 
respect to medically necessary food (as de-
fined in section 1861(jjj)), the amount 
paid shall be an amount equal to 80 per-
cent of the lesser of the actual charge for 
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the services or the amount determined 
under a fee schedule established by the 
Secretary for purposes of this subpara-
graph.’’. 
(D) EFFECTIVE DATE.—The amendments 
made by this subsection shall apply to items 
and services furnished on or after the date that 
is 1 year after the date of the enactment of this 
Act. 
(2) INCLUSION OF MEDICALLY NECESSARY VI-
TAMINS AS A COVERED PART D DRUG.— 
(A) IN GENERAL.—Section 1860D–2(e)(1) 
of the Social Security Act (42 U.S.C. 1395w– 
102(e)(1)) is amended— 
(i) in subparagraph (A), by striking 
‘‘or’’ at the end; 
(ii) in subparagraph (B), by striking 
the comma at the end and inserting ‘‘; or’’; 
and 
(iii) by inserting after subparagraph 
(B) the following new subparagraph: 
‘‘(C) medically necessary vitamins used for 
the management of a covered disease or condi-
tion (as defined in section 1861(jjj)(3)) pursu-
ant to the prescription, order, or recommenda-
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tion (as applicable) of a physician or other 
health care professional qualified to make such 
prescription, order, or recommendation,’’. 
(B) EFFECTIVE DATE.—The amendments 
made by subparagraph (A) shall apply to plan 
years beginning on or after the date that is 1 
year after the date of the enactment of this Act. 
(b) COVERAGE UNDER THE MEDICAID PROGRAM.— 
(1) IN GENERAL.—Section 1905(a) of the So-
cial Security Act (42 U.S.C. 1396d(a)) is amend-
ed— 
(A) in paragraph (28), by striking ‘‘and’’ 
at the end; 
(B) by redesignating paragraph (29) as 
paragraph (31); and 
(C) by inserting after paragraph (28) the 
following new paragraphs: 
‘‘(29) medically necessary food (as defined in 
section 1861(jjj)) and the medical equipment and 
supplies necessary to administer such food; 
‘‘(30) medically necessary vitamins used for the 
management of a covered disease or condition (as 
defined in section 1861(jjj)(3)) pursuant to the pre-
scription, order, or recommendation (as applicable) 
of a physician or other health care professional 
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qualified to make such prescription, order, or rec-
ommendation; and’’. 
(2) CONFORMING AMENDMENTS.— 
(A) 
MANDATORY
BENEFITS.—Section 
1902(a)(10)(A) of the Social Security Act (42 
U.S.C. 1396a(a)(10)(A)) is amended, in the 
matter preceding clause (i), by striking ‘‘and 
(28)’’ and inserting ‘‘(28), (29), and (30)’’. 
(B) EXCEPTION
TO
COVERAGE
RESTRIC-
TION.—Section 1927(d)(2)(E) of the Social Se-
curity Act (42 U.S.C. 1396r–8(d)(2)(E)) is 
amended by inserting ‘‘and except for medically 
necessary 
vitamins 
described 
in 
section 
1905(a)(30)’’ before the period at the end. 
(3) EFFECTIVE DATE.— 
(A) IN
GENERAL.—Subject to subpara-
graph (B), the amendments made by this sub-
section shall take effect on the date that is 1 
year after the date of the enactment of this Act. 
(B) EXCEPTION TO EFFECTIVE DATE IF 
STATE LEGISLATION REQUIRED.—In the case of 
a State plan for medical assistance under title 
XIX of the Social Security Act which the Sec-
retary of Health and Human Services deter-
mines requires State legislation (other than leg-
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islation appropriating funds) in order for the 
plan to meet the additional requirements im-
posed by the amendments made by this sub-
section, the State plan shall not be regarded as 
failing to comply with the requirements of such 
title solely on the basis of its failure to meet 
this additional requirement before the first day 
of the first calendar quarter beginning after the 
close of the first regular session of the State 
legislature that begins after the date of the en-
actment of this Act. For purposes of the pre-
vious sentence, in the case of a State that has 
a 2-year legislative session, each year of such 
session shall be deemed to be a separate regular 
session of the State legislature. 
(c) COVERAGE UNDER CHIP.— 
(1) IN GENERAL.—Section 2103(c) of the So-
cial Security Act (42 U.S.C. 1397cc(c)) is amended 
by adding at the end the following: 
‘‘(9) MEDICALLY NECESSARY FOOD.—The child 
health assistance provided to a targeted low-income 
child under the plan shall include coverage of medi-
cally necessary food (as defined in section 1861(jjj)) 
and the medical equipment and supplies necessary to 
administer such food. 
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‘‘(10) CERTAIN
VITAMINS.—The child health 
assistance provided to a targeted low-income child 
under the plan shall include coverage of medically 
necessary vitamins used for the management of a 
covered disease or condition (as defined in section 
1861(jjj)(3)) pursuant to the prescription, order, or 
recommendation (as applicable) of a physician or 
other health care professional qualified to make such 
prescription, order, or recommendation.’’. 
(2) 
CONFORMING
AMENDMENT.—Section 
2103(a) of the Social Security Act (42 U.S.C. 
1397cc(a)) is amended, in the matter preceding 
paragraph (1), by striking ‘‘and (7)’’ and inserting 
‘‘(7), (9), and (10)’’. 
(3) EFFECTIVE DATE.— 
(A) IN
GENERAL.—Subject to subpara-
graph (B), the amendments made by this sub-
section shall take effect on the date that is 1 
year after the date of the enactment of this Act. 
(B) EXCEPTION TO EFFECTIVE DATE IF 
STATE LEGISLATION REQUIRED.—In the case of 
a State child health plan for child health assist-
ance under title XXI of the Social Security Act 
which the Secretary of Health and Human 
Services determines requires State legislation 
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(other than legislation appropriating funds) in 
order for the plan to meet the additional re-
quirements imposed by the amendments made 
by this subsection, the State child health plan 
shall not be regarded as failing to comply with 
the requirements of such title solely on the 
basis of its failure to meet this additional re-
quirement before the first day of the first cal-
endar quarter beginning after the close of the 
first regular session of the State legislature that 
begins after the date of the enactment of this 
Act. For purposes of the previous sentence, in 
the case of a State that has a 2-year legislative 
session, each year of such session shall be 
deemed to be a separate regular session of the 
State legislature. 
(d) MODIFICATION OF DISEASES AND CONDITIONS 
COVERED
UNDER
TRICARE 
PROGRAM.—Section 
1077(h)(3) of title 10, United States Code, is amended— 
(1) in subparagraph (D), by striking ‘‘and’’; 
(2) by redesignating subparagraph (E) as sub-
paragraph (F); and 
(3) by inserting after subparagraph (D) the fol-
lowing: 
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‘‘(E) Immunoglobulin E or non-Immunoglobulin 
E mediated allergies to food proteins.’’. 
(e) COVERAGE UNDER FEHBP.— 
(1) IN
GENERAL.—Section 8902 of title 5, 
United States Code, is amended by adding at the 
end the following: 
‘‘(p) A contract for a plan under this chapter shall 
require the carrier to provide coverage for— 
‘‘(1) medically necessary food (as defined in 
section 1861(jjj) of the Social Security Act) and the 
medical equipment and supplies necessary to admin-
ister such food; and 
‘‘(2) medically necessary vitamins in the same 
manner 
provided 
for 
under 
section 
1860D– 
2(e)(1)(C) of the Social Security Act.’’. 
(2) EFFECTIVE DATE.—The amendment made 
by paragraph (1) shall apply with respect to contract 
years beginning on or after the date that is 1 year 
after the date of enactment of this Act. 
(f) COVERAGE UNDER PRIVATE HEALTH INSUR-
ANCE.— 
(1) IN GENERAL.—Subpart II of part A of title 
XXVII of the Public Health Service Act (42 U.S.C. 
300gg–11 et seq.) is amended by adding at the end 
the following: 
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