distinctive nutritional requirements, based on 
recognized scientific principles, are established 
by medical evaluation; and 
‘‘(B) includes nutritionally modified coun-
terparts of traditional foods and other forms of 
foods such as formulas, pills, capsules and bars, 
so long as consumed or administered enterally. 
‘‘(2) the term ‘enterally’ refers to consumption 
or administration through the gastrointestinal tract, 
whether orally or by tube. 
‘‘(b) COVERAGE.— 
‘‘(1) MEDICALLY NECESSARY FOOD AND FOOD 
MODIFIED TO BE LOW PROTEIN.—A group health 
plan, or a health insurance issuer that provides 
health insurance coverage in connection with a group 
health plan, shall provide coverage for medically nec-
essary food and food modified to be low protein that 
is formulated to be consumed or administered under 
the supervision of a qualified medical provider, for 
the treatment of conditions as recommended by the 
Advisory Committee on Heritable Disorders in 
Newborns and Children, and the medical equipment 
and supplies necessary to administer such food. 
‘‘(2) VITAMINS
AND
AMINO
ACIDS.—A group 
health plan, or a health insurance issuer that pro-
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vides health insurance coverage in connection with a 
group health plan, that provides prescription drug 
coverage, shall provide coverage for pharmacological 
doses of vitamins and amino acids used for the 
treatment of inborn errors of metabolism, for the 
treatment of conditions as recommended by the Ad-
visory 
Committee 
on 
Heritable 
Disorders 
in 
Newborns and Children and as prescribed by a 
qualified medical provider, to the same extent as 
other prescription drug coverage under such plan or 
coverage.’’. 
(3) AMENDMENTS TO THE INTERNAL REVENUE 
CODE.— 
(A) IN GENERAL.—Subchapter B of chap-
ter 100 of the Internal Revenue Code of 1986 
(relating to other group health plan require-
ments) is amended by inserting after section 
9813 the following new section: 
‘‘SEC. 9814. COVERAGE OF MEDICALLY NECESSARY FOOD 
AND FOOD MODIFIED TO BE LOW PROTEIN. 
‘‘(a) DEFINITIONS.—In this section— 
‘‘(1) the term ‘medically necessary food’— 
‘‘(A) means a food which is formulated to 
be consumed or administered enterally under 
the supervision of a qualified medical provider 
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and which is intended for the specific dietary 
management of a disease or condition for which 
distinctive nutritional requirements, based on 
recognized scientific principles, are established 
by medical evaluation; and 
‘‘(B) includes nutritionally modified coun-
terparts of traditional foods and other forms of 
foods such as formulas, pills, capsules and bars, 
so long as consumed or administered enterally. 
‘‘(2) the term ‘enterally’ refers to consumption 
or administration through the gastrointestinal tract, 
whether orally or by tube. 
‘‘(b) COVERAGE.— 
‘‘(1) MEDICALLY NECESSARY FOOD AND FOOD 
MODIFIED TO BE LOW PROTEIN.—A group health 
plan, or a health insurance issuer that provides 
health insurance coverage in connection with a group 
health plan, shall provide coverage for necessary 
medically necessary food and food modified to be low 
protein that is formulated to be consumed or admin-
istered under the supervision of a qualified medical 
provider, for the treatment of conditions as rec-
ommended by the Advisory Committee on Heritable 
Disorders in Newborns and Children, and the med-
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ical equipment and supplies necessary to administer 
such food. 
‘‘(2) VITAMINS
AND
AMINO
ACIDS.—A group 
health plan, or a health insurance issuer that pro-
vides health insurance coverage in connection with a 
group health plan, that provides prescription drug 
coverage, shall provide coverage for pharmacological 
doses of vitamins and amino acids used for the 
treatment of inborn errors of metabolism, for the 
treatment of conditions as recommended by the Ad-
visory 
Committee 
on 
Heritable 
Disorders 
in 
Newborns and Children and as prescribed by a 
qualified medical provider, to the same extent as 
other prescription drug coverage under such plan or 
coverage.’’. 
(B) 
CONFORMING
AMENDMENT.—The 
table of sections for subchapter B of chapter 
100 of such Code is amended by inserting after 
the item relating to section 9813 the following 
new item: 
‘‘Sec. 9814. Coverage of medically necessary food and food modified to be low 
protein.’’. 
(b) INDIVIDUAL MARKET.—Subpart 3 of part B of 
title XXVII of the Public Health Service Act (42 U.S.C. 
300gg–51 et seq.) is amended by adding at the end the 
following new section: 
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‘‘SEC. 2754. COVERAGE OF MEDICALLY NECESSARY FOOD 
AND FOOD MODIFIED TO BE LOW PROTEIN. 
‘‘The provisions of section 2708 shall apply to health 
insurance coverage offered by a health insurance issuer 
in the individual market in the same manner as they apply 
to health insurance coverage offered by a health insurance 
issuer in connection with a group health plan in the small 
or large group market.’’. 
SEC. 5. EFFECTIVE DATE; DETERMINATION OF MINIMUM 
YEARLY COVERAGE. 
(a) EFFECTIVE DATE.—The amendments made by 
sections 3 and 4 shall apply to plan years beginning after 
the date that is 180 days after the date of enactment of 
this Act. 
(b) DETERMINATION BY SECRETARY.— 
(1) IN GENERAL.—Prior to the date described 
under subsection (a), the Secretary of Health and 
Human Services (referred to in this Act as the ‘‘Sec-
retary’’) shall determine the minimum yearly cov-
erage for all health insurance plans pursuant to the 
amendments made by this Act. Such minimum year-
ly coverage shall apply to an individual during any 
period when the individual is covered under the plan 
and for as long as deemed medically necessary. The 
Secretary may establish age-specific minimum levels 
of coverage and periodically update these levels 
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based on a standard cost of living index, the actual 
cost of treatment, and other appropriate measures 
as determined by the Secretary. 
(2) NO
PREEMPTION.—The minimum yearly 
coverage determined by the Secretary under para-
graph (1) shall not preempt any State standards 
that require a higher minimum yearly coverage level 
for the same services and benefits. 
Æ 
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