Title: Treat and Reduce Obesity Act of 2019
Policy area: Health

Summary:
Treat and Reduce Obesity Act of 2019
This bill expands Medicare coverage of intensive behavioral therapy for obesity. Specifically, the bill allows coverage for therapy that is provided by (1) a physician who is not a primary care physician; or (2) other health care providers (e.g., physician assistants and nurse practitioners) and approved counseling programs, if provided upon a referral from, and in coordination with, a physician or primary care practitioner. Currently, such therapy is covered only if provided by a primary care practitioner.
The bill also allows coverage under Medicare's prescription drug benefit of drugs used for the treatment of obesity or for weight loss management for individuals who are overweight.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 595 Introduced in Senate (IS)]

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116th CONGRESS
  1st Session
                                 S. 595

  To amend title XVIII of the Social Security Act to provide for the 
 coordination of programs to prevent and treat obesity, and for other 
                               purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           February 28, 2019

  Mr. Cassidy (for himself, Mr. Carper, Mrs. Capito, Mr. Coons, Mrs. 
 Blackburn, Mr. Heinrich, Ms. Murkowski, and Ms. Klobuchar) introduced 
the following bill; which was read twice and referred to the Committee 
                               on Finance

_______________________________________________________________________

                                 A BILL


 
  To amend title XVIII of the Social Security Act to provide for the 
 coordination of programs to prevent and treat obesity, and for other 
                               purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Treat and Reduce Obesity Act of 
2019''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) According to the Centers for Disease Control and 
        Prevention, about 41 percent of adults aged 60 and over had 
        obesity in the period of 2015 through 2016, representing more 
        than 27 million people.
            (2) The National Institutes of Health has reported that 
        obesity and overweight are now the second leading cause of 
        death nationally, with an estimated 300,000 deaths a year 
        attributed to the epidemic.
            (3) Obesity increases the risk for chronic diseases and 
        conditions, including high blood pressure, heart disease, 
        certain cancers, arthritis, mental illness, lipid disorders, 
        sleep apnea, and type 2 diabetes.
            (4) More than half of Medicare beneficiaries are treated 
        for 5 or more chronic conditions per year. The rate of obesity 
        among Medicare beneficiaries doubled from 1987 to 2002 and 
        nearly doubled again by 2016, with Medicare spending on 
        individuals with obesity during that time rising 
        proportionately to reach $50 billion in 2014.
            (5) Men and women with obesity at age 65 have decreased 
        life expectancy of 1.6 years for men and 1.4 years for women.
            (6) The direct and indirect cost of obesity was more than 
        $427.8 billion in 2014 and is growing.
            (7) On average, a Medicare beneficiary with obesity costs 
        $2,018 (in 2019 dollars) more than a healthy-weight 
        beneficiary.
            (8) The prevalence of obesity among older individuals in 
        the United States is growing at a linear rate and, if nothing 
        changes, nearly one in two (47 percent) Medicare beneficiaries 
        aged 65 and over will have obesity in 2030, up from slightly 
        more than one in four (28 percent) in 2010.

SEC. 3. AUTHORITY TO EXPAND HEALTH CARE PROVIDERS QUALIFIED TO FURNISH 
              INTENSIVE BEHAVIORAL THERAPY.

    Section 1861(ddd) of the Social Security Act (42 U.S.C. 1395x(ddd)) 
is amended by adding at the end the following new paragraph:
            ``(4)(A) Subject to subparagraph (B), the Secretary may, in 
        addition to qualified primary care physicians and other primary 
        care practitioners, cover intensive behavioral therapy for 
        obesity furnished by any of the following:
                    ``(i) A physician (as defined in subsection (r)(1)) 
                who is not a qualified primary care physician.
                    ``(ii) Any other appropriate health care provider 
                (including a physician assistant, nurse practitioner, 
                or clinical nurse specialist (as those terms are 
                defined in subsection (aa)(5)), a clinical 
                psychologist, a registered dietitian or nutrition 
                professional (as defined in subsection (vv))).
                    ``(iii) An evidence-based, community-based 
                lifestyle counseling program approved by the Secretary.
            ``(B) In the case of intensive behavioral therapy for 
        obesity furnished by a provider described in clause (ii) or 
        (iii) of subparagraph (A), the Secretary may only cover such 
        therapy if such therapy is furnished--
                    ``(i) upon referral from, and in coordination with, 
                a physician or primary care practitioner operating in a 
                primary care setting or any other setting specified by 
                the Secretary; and
                    ``(ii) in an office setting, a hospital outpatient 
                department, a community-based site that complies with 
                the Federal regulations concerning the privacy of 
                individually identifiable health information 
                promulgated under section 264(c) of the Health 
                Insurance Portability and Accountability Act of 1996, 
                or another setting specified by the Secretary.
            ``(C) In order to ensure a collaborative effort, the 
        coordination described in subparagraph (B)(i) shall include the 
        health care provider or lifestyle counseling program 
        communicating to the referring physician or primary care 
        practitioner any recommendations or treatment plans made 
        regarding the therapy.''.

SEC. 4. MEDICARE PART D COVERAGE OF OBESITY MEDICATION.

    (a) In General.--Section 1860D-2(e)(2)(A) of the Social Security 
Act (42 U.S.C. 1395w-102(e)(2)(A)) is amended, in the first sentence--
            (1) by striking ``and other than'' and inserting ``other 
        than''; and
            (2) by inserting after ``benzodiazepines),'' the following: 
        ``and other than subparagraph (A) of such section if the drug 
        is used for the treatment of obesity (as defined in section 
        1861(yy)(2)(C)) or for weight loss management for an individual 
        who is overweight (as defined in section 1861(yy)(2)(F)(i)) and 
        has one or more related comorbidities,''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to plan years beginning on or after the date that is 2 years 
after the date of the enactment of this Act.

SEC. 5. REPORT TO CONGRESS.

    Not later than the date that is 1 year after the date of the 
enactment of this Act, and every 2 years thereafter, the Secretary of 
Health and Human Services shall submit a report to Congress describing 
the steps the Secretary has taken to implement the provisions of, and 
amendments made by, this Act. Such report shall also include 
recommendations for better coordination and leveraging of programs 
within the Department of Health and Human Services and other Federal 
agencies that relate in any way to supporting appropriate research and 
clinical care (such as any interactions between physicians and other 
health care providers and their patients) to treat, reduce, and prevent 
obesity in the adult population.
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