I 118th CONGRESS 2d Session H. R. 9631 IN THE HOUSE OF REPRESENTATIVES September 17, 2024 Ms. Lee of California introduced the following bill; which was referred to the Committee on Energy and Commerce , and in addition to the Committee on Agriculture , for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To provide for the establishment or expansion of Food as Medicine programs, and for other purposes.

1. Short title This Act may be cited as the National Food as Medicine Program Act of 2024 . 2. Food as Medicine Medicaid waiver grant program (a) In general The Secretary of Health and Human Services (in this section referred to as the Secretary ) shall establish a program under which the Secretary shall award grants to States to plan, implement, expand, or evaluate Food as Medicine programs. (b) Application A State seeking a grant under this section shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require. (c) Priority In awarding grants under this section, the Secretary shall give priority to States that have, as of the date of submission of the application for a grant under this section, a partnership with— (1) a network of health care providers that includes public, nonprofit, and community-based organizations or entities, and community health clinics, including Federally qualified health centers (as defined in section 1861 of the Social Security Act ( 42 U.S.C. 1395x )); or (2) public, nonprofit, socially disadvantaged, and community-based organizations or entities that provide locally-sourced (or regionally-sourced, if locally-sourced produce is not available) agricultural products (as defined in section 207 of the Agricultural Marketing Act of 1946 ( 7 U.S.C. 1626 )) grown, or working to transition to, a covered method of production. (d) Use of funds A State that receives a grant under this section shall use funds received through the grant to establish, implement, and expand Food as Medicine interventions to reduce nutrition-related chronic conditions, address food and nutrition insecurity, and improve health through providing locally-sourced (or regionally-sourced, if locally-sourced produce is not available) agricultural products grown, or working to transition to, a covered method of production. (e) Report to the Secretary Not less than 3 years after the date on which a State receives a grant under this section, such State shall provide to the Secretary a report that contains— (1) an evaluation of the impact of the Food as Medicine program established or expanded in such State, including relevant data collected under the Medicaid program under title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq. ); (2) the impact of the Food as Medicine program on, with respect to individuals participating in such program, the appropriate health, nutrition, and associated behavioral outcome baseline information for such individuals that is relevant to the stated goals and desired outcomes of the pilot project; (3) to the extent possible, the Food as Medicine Program’s impact on hospital admissions and readmissions, admissions into long-term care facilities, medication utilization, emergency room utilization rates, primary care, specialty care, primary care medical home engagement, patient experience, and health care team engagement; (4) other relevant findings, including recommendations on strengthening the administration of the program and resources needed to support and strengthen the Food as Medicine program. (f) Definitions In this section: (1) The term covered method of production means, with respect to an agricultural product, that the product is— (A) regeneratively produced; (B) organically produced; or (C) regeneratively and organically produced. (2) The term Food as Medicine program means a program under which a State pursuant to a waiver under section 1115 of the Social Security Act ( 42 U.S.C. 1315 ) provides to individuals eligible to receive medical assistance under such waiver medically supportive food and nutrition interventions. (3) The term food hub means a business or organization that actively manages the aggregation, distribution, and marketing of source-identified food products primarily from local and regional producers to strengthen their ability to satisfy wholesale, retail, and institutional demand. (4) (A) The term medically supportive food and nutrition interventions means interventions that provide culturally-appropriate, nutrient-rich whole food (including any fresh vegetables and fruit, legume, nut, seed, whole grain, low-mercury and high-omega-3 fatty acid seafood, or lean animal protein) prescribed by a health care professional for the prevention, reversal, or treatment of certain health conditions. (B) Such term includes the following interventions: (i) Meals that are— (I) tailored to a recipient’s health conditions by a registered dietitian nutritionist and adhere to standards informed by available dietary recommendations for specific health conditions or dietary therapies. based on evidence-based nutritional practice guidelines; and (II) consistent with the Dietary Guidelines for Americans established under section 301 of the National Nutrition Monitoring and Related Research Act of 1990 ( 7 U.S.C. 5341 ). (ii) Produce (vegetables and fruit) prescriptions, delivered or procured from in a grocery store, farm, farmers’ market, or food hub, that are consistent with the Dietary Guidelines for Americans established under section 301 of the National Nutrition Monitoring and Related Research Act of 1990 ( 7 U.S.C. 5341 ). (iii) Nutrition coaching or counseling, group medical visits, cooking education and tools, health coaching, and other behavioral supports based on a recipient’s medical conditions, when paired with the interventions described in subparagraphs (A) and (B). (5) The term organically produced means, with respect to an agricultural product, that the product is— (A) certified under the Organic Foods Production Act of 1990 ( 7 U.S.C. 6501 et seq. ) as organically produced; or (B) verified through a community-based, culturally-appropriate verification program under the Organic Foods Production Act of 1990 as organically produced. (6) The term regeneratively produced means, with respect to an agricultural product, that the product is produced— (A) using an integrated approach to farming and ranching rooted in the principles of soil health leading to improved target outcomes, including— (i) building soil health; (ii) restoring and maintaining water resources; (iii) protecting air quality; (iv) sequestering greenhouse gas emissions; (v) using sustainable and integrated pest management to eliminate reliance on pesticides; (vi) improving nutrient cycling to reduce use of external fertilizers; (vii) supporting Native-led stewardship practices (as described in Order No. 3403 entitled Joint Secretarial Order on Fulfilling the Trust Responsibility to Indian Tribes in the Stewardship of Federal Lands and Waters published jointly by the Secretary of Agriculture and the Secretary of the Interior on November 15, 2021); and (viii) fostering wildlife and animal welfare; and (B) in a manner that fosters community and social wellness, including— (i) improving human health in rural and urban communities; (ii) creating supportive livelihoods (worker conditions, safety) and durable solutions for a healthy food and agriculture workforce; (iii) creating economic vitality for farmers, ranchers, and a healthy food and agriculture workforce; and (iv) optimizing the above target outcomes to ensure that there is minimal negative impact on other target outcomes. (7) The term regeneratively-organically produced means, with respect to an agricultural product, that the product is produced— (A) using some organic methods, as described in the Organic Foods Production Act of 1990 ( 7 U.S.C. 6501 et seq. ); and (B) using some methods included in the integrated approach described in paragraph (5). (8) The term State each of the several States and each territory and possession of the United States. 3. Department of Agriculture Food as Medicine technical assistance program (a) In general The Secretary of Agriculture (referred to in this section as the Secretary ) shall enter into cooperative agreements with eligible entities to provide technical assistance and infrastructure support to producers to enable such producers to connect with local health care providers for purposes of providing nutritious food under a Food is Medicine program established or expanded pursuant to section 2. An eligible entity may work in collaboration with a Regional Food Business Center of the Department of Agriculture to provide such technical assistance under a cooperative agreement. (b) Application An eligible entity seeking to enter into a cooperative agreement under this section shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require. (c) Priority In selecting eligible entities with which to enter into cooperative agreements under this section, the Secretary shall give priority to applications containing proposals— (1) to provide technical assistance and infrastructure support to beginning farmers and ranchers (as defined in section 343(a) of the Consolidated Farm and Rural Development Act ( 7 U.S.C. 1991(a) )) and socially disadvantaged farmers and ranchers (as defined in section 355(e) of the Consolidated Farm and Rural Development Act ( 7 U.S.C. 2003(e) )); and (2) to provide technical assistance and infrastructure support to producers that produce agricultural products (as defined in section 207 of the Agricultural Marketing Act of 1946 ( 7 U.S.C. 1626 )) that are produced using a covered method of production (as defined in section 2) or verified through community-based, culturally appropriate verification programs. (d) Definitions In this section: (1) The term Food is Medicine program has the meaning given such term in section 2. (2) The term eligible entity means— (A) a land-grant college or university; (B) a food hub (as defined in section 2); or (C) a Regional Food Business Center supported by the Department of Agriculture. (3) The term land-grant college or university has the meaning given the term land-grant colleges and universities in section 1404 of the National Agricultural Research, Extension, and Teaching Policy Act of 1977 ( 7 U.S.C. 3103 ). 4. Report to Congress Not later than one year after the date on which the first grant is awarded under section 2, the Secretary of Health and Human Services, in consultation with the Secretary of Agriculture, shall submit to Congress a report that includes the information received from the States under section 2 and the Secretary’s recommendations with respect to best practices for carrying out a Food is Medicine program. 5. Food as Medicine Guidance (a) In general Not later than one year after the date of the enactment of this Act, the Secretary of Health and Human Services, in consultation with the officials and stakeholders described in subsection (c), shall develop and issue— (1) recommendations for States and counties to implement or expand a Food as Medicine program (as defined in section 2), clinical nutrition training for health care providers, and nutritional and behavioral support for patients to integrate food interventions into daily habits; and (2) guidance related to— (A) how a State may include food insecurity and or nutrition insecurity as conditions making an individual eligible to participate in Food as Medicine programs, in addition to eligible populations with chronic conditions; (B) eligible populations that address food insecurity, nutrition insecurity, and chronic conditions; (C) the duration and dosage of medically supportive food and nutrition intervention plans; (D) the value-based procurement of food through a managed care rate setting process that includes minimum percentages and tier-based incentives to increase the procurement of products grown using covered methods of production (as defined in section 2) by socially disadvantaged farmers and ranchers (as defined in section 2501 of the Food, Agriculture, Conservation, and Trade Act of 1990 ( 7 U.S.C. 2279 )); (E) determination of providers permitted to provide medically supportive food and nutrition interventions (as defined in section 2); and (F) continuing education for health care providers prescribing medically supportive food and nutrition interventions. (b) Public comment period The Secretary shall provide for 30-day public comment period with respect to any proposed guidance issued under this section. Such guidance shall not be finalized until the date that is 60 days after the close of such public comment period. (c) Officials and stakeholders described The officials and stakeholders described in this subsection include the following: (1) The heads of appropriate Federal agencies within the Department of Health and Human Services. (2) The Secretary of Agriculture. (3) Diverse stakeholders from community-based organizations, small- to medium-sized farms operated by socially disadvantaged farmers and ranchers, food hubs, health care providers, and Medicaid managed care organizations who have helped to implement Food as Medicine programs.