II 113th CONGRESS 1st Session S. 1184 IN THE SENATE OF THE UNITED STATES June 19, 2013 Mr. Carper (for himself and Ms. Murkowski ) 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 include information on the coverage of intensive behavioral therapy for obesity in the Medicare and You Handbook and to provide for the coordination of programs to prevent and treat obesity, and for other purposes.

1. Short title This Act may be cited as the Treat and Reduce Obesity Act of 2013 . 2. Findings Congress makes the following findings: (1) According to the Centers for Disease Control and Prevention, about 35 percent of adults aged 65 and over were obese in the period of 2007 through 2010, representing over 8 million adults aged 65 through 74. (2) Obesity increases the risk for chronic diseases and conditions, including high blood pressure, heart disease, and type 2 diabetes. (3) More than half of Medicare beneficiaries are treated for 5 or more chronic conditions per year. The rate of obesity among Medicare patients doubled from 1987 to 2002, and spending on those individuals more than doubled. (4) Obese men and women at age 65 have decreased life expectancy of 1.6 years for men and 1.4 years for women. (5) The direct and indirect cost of obesity is more than $450 billion annually. (6) On average, an obese Medicare beneficiary costs $1,964 more than a normal-weight beneficiary. (7) The prevalence of obesity among older Americans is growing at a linear rate and, left unchanged, nearly half of the elderly population will be obese in 2030 according to a Congressional Research Report on obesity. 3. Inclusion of information on coverage of intensive behavioral therapy for obesity in the Medicare and You Handbook (a) In general Section 1804(a) of the Social Security Act (42 U.S.C. 1395b–2(a)) is amended— (1) in paragraph (2), by striking “and” at the end; (2) in paragraph (3), by striking the period at the end and inserting , and ; and (3) by inserting after paragraph (3) the following new paragraph: (4) information on the coverage of intensive behavioral therapy for obesity under this title, including information regarding primary care physicians and other providers of services and suppliers who are eligible to furnish such therapy. . (b) Effective date The amendments made by this section shall apply to notices distributed on or after the date of enactment of this Act. 4. Plan for coordination of HHS efforts; providing the Secretary of Health and Human Services with authority to coordinate programs to prevent and treat obesity and expand coverage options for obesity under Medicare Section 1861(ddd) of the Social Security Act ( 42 U.S.C. 1395x(ddd) ), as amended by section 3, is amended by adding at the end the following new paragraph: (5) (A) Not later than 1 year after the date of enactment of the Treat and Reduce Obesity Act of 2013 , the Secretary shall develop and implement a plan to coordinate the efforts of all offices and agencies of the Department of Health and Human Services (such as the Centers for Medicare & Medicaid Services, the Centers for Disease Control and Prevention, the National Institutes of Health, the Health Resources and Services Administration, and other offices and agencies) to treat, reduce, and prevent obesity and overweight in the adult population. Beginning 2 years after such date of enactment, the Secretary shall annually update such plan. (B) In developing and implementing the plan under subparagraph (A), the Secretary shall work with at least 5 representatives, selected by the Secretary, of expert organizations (such as public health associations, physician associations, key healthcare provider groups, planning and development organizations, education associations, advocacy groups, patient groups, relevant industries, State and local leadership, and other entities as determined appropriate by the Secretary). (C) The Secretary shall ensure that the plan under subparagraph (A) is coordinated with the National Prevention Strategy and does not duplicate the efforts of the National Prevention Council and the National Prevention Strategy. (D) The plan under subparagraph (A) shall include the following: (i) Strategies to comprehensively treat and reduce overweight and obesity. (ii) A description of— (I) the coordination of interagency cooperation under the plan; and (II) actions under the plan related to the treatment and reduction of overweight and obesity in the United States. (iii) Identification of best practices in States, communities, organizations, businesses, and other entities as appropriate, regarding treatment of overweight and obesity. (iv) A description of collaboration with States, communities, organizations, businesses, and other appropriate entities to evaluate the effectiveness of obesity and overweight interventions under the plan. (v) Research initiatives, including ongoing surveillance and monitoring using tools such as the National Health and Nutrition Examination Survey and the Behavioral Risk Factor Surveillance System and assurances for adequate and consistent funding to support data collection and analysis to inform policy under the plan. (vi) Recommendations for the coordination of budgets, grant and pilot programs, policies, and programs across Federal agencies to cohesively treat overweight and obesity. (E) Not later than 24 months after the date of enactment of the Treat and Reduce Obesity Act of 2013 , and on an annual basis thereafter, the Secretary shall submit to the President and to the relevant committees of Congress, a report that— (i) summarizes the plan under subparagraph (A) to coordinate interagency efforts surrounding the treatment, reduction, and prevention of obesity and overweight, including a detailed strategic plan with recommendations for each office and agency involved; (ii) in the case of the second report submitted under this subparagraph (and each subsequent report), evaluates the effectiveness of those coordinated interventions and conducts interim assessments and reporting of health outcomes, achievement of milestones, and implementation of strategic plan goals; and (iii) makes recommendations for updating the plan for the following year based on data and findings from the previous year. . 5. 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) ), as amended by sections 3 and 4, is amended by adding at the end the following new paragraph: (6) (A) The Secretary may, in addition to qualified primary care physicians and other primary care practitioners, cover intensive behavioral therapy for obesity— (i) furnished by a physician (as defined in subsection (r)(1)) who is not a qualified primary care physician; (ii) furnished— (I) by 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, and a registered dietitian or nutrition professional (as defined in subsection (vv)); (II) 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 (III) in an office setting, a hospital outpatient department, or another setting specified by the Secretary; or (iii) furnished by an evidence-based, community-based lifestyle counseling program certified by the Secretary. (B) In order to ensure a collaborative effort, the coordination described in subparagraph (A)(ii)(II) may include the health care provider communicating to the physician or primary care practitioner making the referral any recommendations or treatment plans made regarding the therapy. . 6. 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 by inserting after restricted under section 1927(d)(2), the following, other than subparagraph (A) of such section if the drug is used for the treatment of obesity (as defined for purposes of section 1861(yy)(2)(C)) or for being overweight (as defined for purposes of section 1861(yy)(2)(F)(i)) and if the individual has one or more comorbidities, . (b) Effective date The amendment made by subsection (a) shall apply to plan years beginning on or after the date that is 2 years after the date of enactment of this Act.