II 118th CONGRESS 1st Session S. 3297 IN THE SENATE OF THE UNITED STATES November 14 (legislative day, November 13), 2023 Ms. Collins (for herself and Mr. Peters ) 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 expand the availability of medical nutrition therapy services under the Medicare program.

1. Short title This Act may be cited as the Medical Nutrition Therapy Act of 2023 . 2. Findings Congress finds the following: (1) Over two-thirds of Medicare fee-for-service beneficiaries have 2 or more chronic conditions, many of which can be prevented, delayed, treated, or managed through nutrition. (2) Individuals from many racial and ethnic minority backgrounds are more likely to be diagnosed with chronic diseases such as diabetes, prediabetes, chronic kidney disease, end-stage renal disease, and obesity. (3) Coverage for medical nutrition therapy is only available to Medicare Part B beneficiaries with diabetes or a renal disease, despite medical nutrition therapy being part of the standard of care, in clinical guidelines, and medically necessary for many more chronic conditions. (4) Medical nutrition therapy has been shown to be a cost-effective component of treatment for obesity, diabetes, hypertension, dyslipidemia, HIV infection, unintended weight loss in older adults, and other chronic conditions. 3. Expanding the availability of medical nutrition therapy services under the Medicare program (a) In general Section 1861 of the Social Security Act ( 42 U.S.C. 1395x ) is amended— (1) in subsection (s)(2)(V), by striking in the case of and all that follows through organizations ; and (2) in subsection (vv)— (A) in paragraph (1)— (i) by striking disease management and inserting the prevention, management, or treatment of a disease or condition specified in paragraph (4) ; and (ii) by striking by a physician and all that follows through the period at the end and inserting the following: by— (A) a physician (as defined in subsection (r)(1)); (B) a physician assistant (as defined in subsection (aa)(5)(A)); (C) a nurse practitioner (as defined in subsection (aa)(5)(A)); (D) a clinical nurse specialist (as defined in subsection (aa)(5)(B)); or (E) in the case of such services furnished to manage such a disease or condition that is an eating disorder, a clinical psychologist (as defined by the Secretary). ; and (iii) by adding at the end the following new sentence: Such term shall not include any such services furnished to an individual for the prevention, management, or treatment of a renal disease if such individual is receiving maintenance dialysis for which payment is made under section 1881. ; and (B) by adding at the end the following new paragraph: (4) For purposes of paragraph (1), the diseases and conditions specified in this paragraph are the following: (A) Diabetes. (B) Prediabetes. (C) A renal disease. (D) Obesity (as defined for purposes of subsection (yy)(2)(C) or as otherwise defined by the Secretary). (E) Hypertension. (F) Dyslipidemia. (G) Malnutrition. (H) Eating disorders. (I) Cancer. (J) Gastrointestinal diseases, including Celiac disease. (K) HIV. (L) AIDS. (M) Cardiovascular disease. (N) Any other disease or condition— (i) specified by the Secretary relating to unintentional weight loss; (ii) for which the Secretary determines the services described in paragraph (1) to be medically necessary and appropriate for the prevention, management, or treatment of such disease or condition, consistent with any applicable recommendations of the United States Preventive Services Task Force; or (iii) for which the Secretary determines the services described in paragraph (1) are medically necessary, consistent either with protocols established by registered dietitian or nutrition professional organizations or with accepted clinical guidelines identified by the Secretary. . (b) Exclusion modification Section 1862(a)(1) is amended— (1) in subparagraph (O), by striking and at the end; (2) in subparagraph (P), by striking the semicolon at the end and inserting , and ; and (3) by adding at the end the following new subparagraph: (Q) in the case of medical nutrition therapy services (as defined in section 1861(vv)), which are not furnished for the prevention, management, or treatment of a disease or condition specified in paragraph (4) of such section; . (c) Effective date The amendments made by this section shall apply with respect to items and services furnished in years beginning on or after the date that is 2 years after the date of the enactment of this Act.