a disease or condition for which distinctive nu-
tritional requirements, based on recognized sci-
entific 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; and 
‘‘(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. 
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‘‘(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 contents in section 1 of such Act is 
amended by inserting after the item relating to 
section 714 the following new items: 
‘‘Sec. 715. Additional market reforms. 
‘‘Sec. 716. Coverage of medically necessary food and food modified to be low 
protein.’’. 
(2) AMENDMENTS
TO
THE
PUBLIC
HEALTH 
SERVICE ACT.—Subpart 2 of part A of title XXVII 
of the Public Health Service Act (42 U.S.C. 300gg– 
4 et seq.) is amended by adding at the end the fol-
lowing new section: 
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‘‘SEC. 2729. 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 physician and which is in-
tended for the specific dietary management of 
a disease or condition for which distinctive nu-
tritional requirements, based on recognized sci-
entific 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; and 
‘‘(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-
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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-
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-
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emcdonald on DSK2BSOYB1PROD with BILLS
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 physician and which is in-
tended for the specific dietary management of 
a disease or condition for which distinctive nu-
tritional requirements, based on recognized sci-
entific 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; and 
‘‘(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 
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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 
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 
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that require a higher minimum yearly coverage level 
for the same services and benefits. 
Æ 
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