Text: H.R.3711 — 116th Congress (2019-2020)All Information (Except Text)

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Introduced in House (07/11/2019)

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3711 Introduced in House (IH)]


  1st Session
                                H. R. 3711

To amend title XVIII of the Social Security Act to provide coverage of 
    medical nutrition therapy services for individuals with eating 
                 disorders under the Medicare program.



                             July 11, 2019

 Ms. Judy Chu of California (for herself, Mr. Cardenas, Ms. Clarke of 
 New York, Mr. Fitzpatrick, Mrs. Lee of Nevada, Mr. Raskin, Mr. Rouda, 
    Mr. Tonko, Ms. Castor of Florida, and Mr. Young) introduced the 
   following bill; which was referred to the Committee on Energy and 
  Commerce, and in addition to the Committee on Ways and Means, 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 amend title XVIII of the Social Security Act to provide coverage of 
    medical nutrition therapy services for individuals with eating 
                 disorders under the Medicare program.

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


    This Act may be cited as the ``Nutrition Counseling Aiding Recovery 
for Eating Disorders Act of 2019'' or the ``Nutrition CARE Act of 


    Congress finds the following:
            (1) Eating disorders, including the specific disorders of 
        anorexia nervosa, bulimia nervosa, binge eating disorder, 
        avoidant/restrictive food intake disorder, and other specified 
        feeding or eating disorders, are severe biologically based 
        mental illnesses caused by a complex interaction of genetic, 
        biological, social, behavioral, and psychological factors.
            (2) Over 30,000,000 individuals in the United States of all 
        ages, races, sizes, sexual orientations, ethnicities, and 
        socioeconomic statuses, are affected by eating disorders during 
        their lifetimes.
            (3) Eating disorders have one of the highest mortality 
        rates of all mental illnesses, as eating disorders can become 
        fatal due to heart failure, kidney failure, stroke, 
        hypoglycemia, and gastric rupture. Additionally, longitudinal 
        studies have found that the suicide risk for those with an 
        eating disorder is 23 times the expected risk.
            (4) Eating disorders can be successfully treated with 
        interventions at the appropriate durations and levels of care, 
        yet only one-third of persons with eating disorders receive any 
        medical, psychiatric, or therapeutic care. Best practice 
        treatment of eating disorders includes patients, their 
        families, and a comprehensive team of professionals such as 
        social workers, mental health counselors, primary care 
        practitioners, psychiatrists, psychologists, dietitians, art 
        therapists, and other specialty providers.
            (5) Studies examining the prevalence of eating disorders 
        and insulin restriction among people with diabetes show that up 
        to 35 percent of women with diabetes restrict insulin in order 
        to lose weight at some point in their life.
            (6) Research shows that disordered eating among older 
        adults consistently find that rates of disordered eating among 
        the elderly are similar to those of younger persons.
            (7) Weight loss in the elderly may signal an undiagnosed 
        medical illness or may be the result of a known medical 
        condition and/or its pharmacologic treatment.
            (8) Eating disorders in the elderly are associated with 
        significant morbidity and mortality, and a wide range of health 
        issues arise secondary to eating disorders, including cardiac, 
        metabolic, gastric, and bone conditions; diagnosis and proper 
        treatment of this population are essential.
            (9) Eating disorders in the elderly are particularly 
        serious because chronic disorders or diseases may already 
        compromise a patient's health. Inadequate nutrition can result 
        in memory deficits, cognitive decline, decubitus ulcers, 
        impaired healing of sores, wounds, or infections, and 
        dizziness, disorientation, and falls.
            (10) Studies find that individuals with chronic illnesses 
        and/or disabilities are four times more likely to have anorexia 
        nervosa or bulimia nervosa compared to the general population.


    Section 1861 of the Social Security Act (42 U.S.C. 1395x) is 
            (1) in subsection (s)(2)(V)--
                    (A) by redesignating clauses (i) through (iii) as 
                subclauses (I) through (III), respectively, and 
                adjusting the margins accordingly;
                    (B) in subclause (III), as so redesignated, by 
                striking the semicolon at the end and inserting ``; 
                    (C) by striking ``beneficiary with diabetes'' and 
                inserting the following: ``beneficiary--
                    ``(i) with diabetes''; and
                    (D) by adding at the end the following new clause:
                    ``(ii) beginning January 1, 2020, with an eating 
                disorder (as defined by the Secretary in accordance 
                with most recent edition of the Diagnostic and 
                Statistical Manual of Mental Disorders published by the 
                American Psychiatric Association);''; and
            (2) in subsection (vv)--
                    (A) in paragraph (1)--
                            (i) by inserting ``(including management of 
                        an eating disorder (as defined for purposes of 
                        subsection (s)(2)(V)(ii)))'' after ``disease 
                        management''; and
                            (ii) by inserting ``or psychologist (or 
                        other mental health professional to the extent 
                        authorized under State law) and, in the case of 
                        such services furnished to an individual for 
                        the purpose of management of such an eating 
                        disorder, at the times specified in paragraph 
                        (4)'' before the period at the end; and
                    (B) by adding at the end the following new 
    ``(4)(A) For purposes of paragraph (1), the times specified in this 
paragraph are, with respect to medical nutrition therapy services 
furnished to an individual for purposes of management of an eating 
disorder, the following:
            ``(i) 13 hours (including a 1 hour initial assessment and 
        12 hours of reassessment and intervention) during the 1-year 
        period beginning on the date such individual is first furnished 
        such services.
            ``(ii) Subject to subparagraph (B), 4 hours during each 
        subsequent 1-year period.
    ``(B) In the case that the physician or psychologist (or other 
mental health professional to the extent authorized under State law) 
treating such individual determines that there has been a change with 
respect to the diagnosis, medical condition, or treatment regimen 
relating to the eating disorder of such individual that requires the 
furnishing of medical nutrition therapy services beyond the times 
specified in subparagraph (A)(ii), the Secretary may provide for an 
additional number of hours to be available to such individual with 
respect to a period described in such subparagraph.
    ``(C) The Secretary may apply such other reasonable limitations 
with respect to the furnishing of medical nutrition therapy services 
for purposes of management of an eating disorder during a period 
described in subparagraph (A)(ii) as the Secretary determines 

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