,i  #aacth ,,congress  #ast ,session    
,h4 ,r4 #cffe  ,,in ,,the ,,house ,,of  
,,representatives  ,december #e1        
#bjac,mr4 ,delaney 7for himself1 ,mr4   
,goodlatte1 ,mr4 ,polis1 ,mr4 ,johnson  
of ,georgia1 and ,ms4 ,moore7 introduced
 the following bill2 which was referred 
to the ,committee on ,energy and        
,commerce1 and in addition to the       
,committees on ,ways and ,means1 ,armed 
,services1 and ,oversight and           
,government ,reform1 for a period to be 
subsequently determined by the ,speaker1
 in each case for consideration of such 
provisions as fall within the           
jurisdiction of the committee concerned 
,a ,,bill  ,to provide for the coverage 
of medically necessary food under       
,federal health programs1 and for other 
purposes4  #a4 ,short title ,this ,act  
may be cited as the ,medical ,foods     
,equity ,act of #bjac4  #b4 ,findings   
,congress finds the following3 7#a7     
,newborns are screened for inborn errors
 of metabolism1 but treatment for such  

conditions is not uniformly covered by  
insurance4  7#b7 ,each year             
approximately #b1eej children in the    
,united ,states are diagnosed with an   
inborn error of metabolism disorder1    
requiring foods modified to be void of  
the nutrient or nutrients the child's   
body is incapable of processing1 or     
requiring supplementation with vitamins 
or amino acids4  7#c7 ,more than #ce    
,states have passed laws to at least    
partially address the inequity in       
coverage for medically necessary foods1 
critical treatment for such disorders4  
7#d7 ,the cost associated with providing
 medically necessary foods presents a   
large financial burden for many         
families4  7#e7 ,there is no current    
cure for inborn errors of metabolism    
disorders and treatment is necessary    
during the entire lifespan of the       
individual4  #c4 ,coverage in certain   
,federal health programs of medically   
necessary food and food modified to be  
low protein  7a7 ,coverage under the    

,medicare program  7#a7 ,coverage of    
medically necessary food under the      
original medicare fee-for-service       
program  7,a7 ,in general ,section      
#ahfa7s77#b7 of the ,social ,security   
,act 7#db ,u4,s4,c4 #aciex7s77#b77 is   
amended-- 7i7 in subparagraph 7,,ee71 by
 striking and at the end2  7ii7 in      
subparagraph 7,,ff71 by inserting and at
 the end2 and  7iii7 by adding at the   
end the following new subparagraph3     
7,,gg7 medically necessary food 7as     
defined in subsection 7iii77 and food   
modified to be low protein that is      
formulated to be consumed or            
administered under the supervision of a 
qualified medical provider1 for the     
treatment of conditions as recommended  
by the ,advisory ,committee on          
,heritable ,disorders in ,newborns and  
,children1 and the medical equipment and
 supplies necessary to administer such  
food2  4  7,b7 ,definition ,section     
#ahfa of the ,social ,security ,act 7#db
 ,u4,s4,c4 #aciex7 is amended by adding 

at the end the following new subsection3
  7iii7 7#a7 ,the term medically        
necessary food-- 7,a7 means a food which
 is formulated to be consumed or        
administered enterally under the        
supervision of a physician and which is 
intended for the specific dietary       
management of a disease or condition for
 which distinctive nutritional          
requirements1 based on recognized       
scientific principles1 are established  
by medical evaluation2 and  7,b7        
includes nutritionally modified         
counterparts of traditional foods and   
other forms of foods such as formulas1  
pills1 capsules1 and bars1 so long as   
consumed or administered enterally4     
7#b7 ,for purposes of paragraph 7#a71   
the term enterally refers to consumption
 or administration through the          
gastrointestinal tract1 whether orally  
or by tube4  4  7,c7 ,payment ,section  
#ahcc7;a77#a7 of the ,social ,security  
,act 7#db ,u4,s4,c4 #aciel7a77#a77 is   
amended-- 7i7 by striking and before    

7,z72 and  7ii7 by inserting before the 
semicolon at the end the following3 1   
and 7,,aa7 with respect to medically    
necessary food and pharmacological doses
 of vitamins and amino acids under      
section #ahfa7s77#b77;,,gg71 the amounts
 paid shall be #hj percent of the lesser
 of the actual charge for the services  
or #he percent of the amount determined 
under the fee schedule established under
 section #ahdh7;b7 for the same services
 if furnished by a physician4  7#b7     
,inclusion of pharmacological doses of  
vitamins and amino acids as a covered   
part ,d drug  7,a7 ,in general ,section 
#ahfj;,d-#b7;e77#a7 of the ,social      
,security ,act 7#db ,u4,s4,c4           
#aciew-#ajb7;e77#a77 is amended-- 7i7 in
 subparagraph 7,a71 by striking or at   
the end2  7ii7 in subparagraph 7,b71 by 
striking the comma at the end and       
inserting 2 or2 and  7iii7 by inserting 
after subparagraph 7,b7 the following   
new subparagraph3  7,c7 pharmacological 
doses of vitamins and amino acids used  

for the treatment of inborn errors of   
metabolism1 for the treatment of        
conditions as recommended by the        
,advisory ,committee on ,heritable      
,disorders in ,newborns and ,children   
and as prescribed by a qualified medical
 provider1  4  7,b7 ,effective date ,the
 amendments made by subparagraph 7,a7   
shall apply to plan years beginning on  
or after the date that is #f months     
after date of enactment of this ,act4   
7b7 ,coverage under the ,medicaid       
program  7#a7 ,in general ,section #aije
 of the ,social ,security ,act 7#db     
,u4,s4,c4 #acif;d7 is amended-- 7,a7 in 
subsection 7a7-- 7i7 in paragraph 7#ab71
 by inserting including pharmacological 
doses of vitamins and amino acids used  
for the treatment of inborn errors of   
metabolism1 for the treatment of        
conditions as recommended by the        
,advisory ,committee on ,heritable      
,disorders in ,newborns and ,children   
and as prescribed by a qualified medical
 provider1 after prescribed drugs12     

7ii7 in paragraph 7#bh71 by striking and
 at the end2  7iii7 by redesignating    
paragraph 7#bi7 as paragraph 7#cj72 and 
7iv7 by inserting after paragraph 7#bh7 
the following new paragraph3  7#bi7     
medically necessary food 7as defined in 
subsection 7ee77 and food modified to be
 low protein that is formulated to be   
consumed or administered under the      
supervision of a qualified medical      
provider1 for the treatment of          
conditions as recommended by the        
,advisory ,committee on ,heritable      
,disorders in ,newborns and ,children1  
and the medical equipment and supplies  
necessary to administer such food2 and  
2 and  7,b7 by adding at the end the    
following new subsection3  7ee7         
,medically necessary food defined  7#a7 
,in general ,for purposes of subsection 
7a77#bi71 the term medically necessary  
food-- 7,a7 means a food which is       
formulated to be consumed or            
administered enterally under the        
supervision of a physician and which is 

intended for the specific dietary       
management of a disease or condition for
 which distinctive nutritional          
requirements1 based on recognized       
scientific principles1 are established  
by medical evaluation2 and  7,b7        
includes nutritionally modified         
counterparts of traditional foods and   
other forms of foods such as formulas1  
pills1 capsules1 and bars1 so long as   
consumed or administered enterally4     
7#b7 ,enterally ,for purposes of        
paragraph 7#a71 the term enterally      
refers to consumption or administration 
through the gastrointestinal tract1     
whether orally or by tube4  4  7#b7     
,exception to rebate exclusion ,section 
#aibg7;d77#b77;,e7 of the ,social       
,security ,act 7#db ,u4,s4,c4           
#acifr-#h7;d77#b77;,e77 is amended by   
inserting 1 pharmacological doses of    
vitamins and amino acids used for the   
treatment of inborn errors of           
metabolism1 for the treatment of        
conditions as recommended by the        

,advisory ,committee on ,heritable      
,disorders in ,newborns and ,children   
and as prescribed by a qualified medical
 provider1 after prenatal vitamins4     
7#c7 ,conforming amendment ,section     
#aijb7;a77#aj77;,a7 of the ,social      
,security ,act 7#db ,u4,s4,c4           
#acif;a7a77#aj77;,a77 is amended1 in the
 matter preceding clause 7i71 by        
striking and 7#bh7 and inserting 7#bh71 
and 7#bi74  7#d7 ,exception to effective
 date if ,state legislation required ,in
 the case of a ,state plan for medical  
assistance under title ,,xix of the     
,social ,security ,act which the        
,secretary of ,health and ,human        
,services determines requires ,state    
legislation 7other than legislation     
appropriating funds7 in order for the   
plan to meet the additional requirement 
imposed by the amendments made by this  
subsection1 the ,state plan shall not be
 regarded as failing to comply with the 
requirements of such title solely on the
 basis of its failure to meet this      

additional requirement before the first 
day of the first calendar quarter       
beginning after the close of the first  
regular session of the ,state           
legislature that begins after the date  
of the enactment of this ,act4 ,for     
purposes of the previous sentence1 in   
the case of a ,state that has a #b-year 
legislative session1 each year of such  
session shall be deemed to be a separate
 regular session of the ,state          
legislature4  7c7 ,coverage under ,,chip
  7#a7 ,in general  7,a7 ,medically     
necessary food ,section #bajc7;c7 of the
 ,social ,security ,act 7#db ,u4,s4,c4  
#acig;cc7c77 is amended by adding at the
 end the following3  7#i7 ,medically    
necessary food  7,a7 ,in general ,the   
child health assistance provided to a   
targeted low-income child under the plan
 shall include coverage of medically    
necessary food and food modified to be  
low protein that is formulated to be    
consumed or administered under the      
supervision of a qualified medical      

provider1 for the treatment of          
conditions as recommended by the        
,advisory ,committee on ,heritable      
,disorders in ,newborns and ,children1  
and the medical equipment and supplies  
necessary to administer such food4  7,b7
 ,definitions ,in this paragraph-- 7i7  
the term medically necessary food-- 7,i7
 means a food which is formulated to be 
consumed or administered enterally under
 the supervision of a physician and     
which is intended for the specific      
dietary management of a disease or      
condition for which distinctive         
nutritional requirements1 based on      
recognized scientific principles1 are   
established by medical evaluation2 and  
7,,ii7 includes nutritionally modified  
counterparts of traditional foods and   
other forms of foods such as formulas1  
pills1 capsules1 and bars1 so long as   
consumed or administered enterally2 and 
7ii7 the term enterally refers to       
consumption or administration through   
the gastrointestinal tract1 whether     

orally or by tube4  4  7,b7 ,vitamins   
and amino acids ,section #baaj7;a77#f7  
of the ,social ,security ,act 7#db      
,u4,s4,c4 #acig;jj7a77#f77 is amended by
 striking and biologicals and the       
administration of such drugs and        
biologicals1 only if such drugs and     
biologicals and inserting 1             
pharmacological doses of vitamins and   
amino acids used for the treatment of   
inborn errors of metabolism1 for the    
treatment of conditions as recommended  
by the ,advisory ,committee on          
,heritable ,disorders in ,newborns and  
,children and as prescribed by a        
qualified medical provider1 and         
biologicals1 and the administration of  
such drugs1 vitamins and amino acids1   
and biologicals1 only if such drugs1    
vitamins and amino acids1 and           
biologicals4  7#b7 ,conforming amendment
 ,section #bajc7;a7 of the ,social      
,security ,act 7#db ,u4,s4,c4           
#acig;cc7a77 is amended1 in the matter  
preceding paragraph 7#a71 by striking 1 

and 7#g7 and inserting 1 7#g71 and 7#i74
  7#c7 ,exception to effective date if  
,state legislation required ,in the case
 of a ,state child health plan for child
 health assistance under title ,,xxi of 
the ,social ,security ,act which the    
,secretary of ,health and ,human        
,services determines requires ,state    
legislation 7other than legislation     
appropriating funds7 in order for the   
plan to meet the additional requirement 
imposed by the amendments made by this  
subsection1 the ,state child health plan
 shall not be regarded as failing to    
comply with the requirements of such    
title solely on the basis of its failure
 to meet this additional requirement    
before the first day of the first       
calendar quarter beginning after the    
close of the first regular session of   
the ,state legislature that begins after
 the date of the enactment of this ,act4
 ,for purposes of the previous sentence1
 in the case of a ,state that has a     
#b-year legislative session1 each year  

of such session shall be deemed to be a 
separate regular session of the ,state  
legislature4  7d7 ,availability of      
medically necessary food1 food modified 
,to be low protein1 and related items   
under the ,,tricare program ,section    
#ajgg of title #aj1 ,united ,states     
,code1 is amended-- 7#a7 in subsection  
7a77#h71 by striking including and all  
that follows and inserting 8including   
the following3  7,a7 ,well-baby care    
that includes one screening of an infant
 for the level of lead in the blood of  
the infant4  7,b7 ,in accordance with   
subsection 7g71 medically necessary food
 7as defined in section #ahfa7;iii7 of  
the ,social ,security ,act7 and food    
modified to be low protein that is      
formulated to be consumed or            
administered under the supervision of a 
qualified medical provider1 for the     
treatment of conditions as recommended  
by the ,advisory ,committee on          
,heritable ,disorders in ,newborns and  
,children1 and the medical equipment and

 supplies necessary to administer such  
food4  7,c7 ,in accordance with         
subsection 7g71 pharmacological doses of
 vitamins and amino acids used for the  
treatment of inborn errors of metabolism
 and other conditions as recommended by 
the ,advisory ,committee on ,heritable  
,disorders in ,newborns and ,children   
and as prescribed by a qualified medical
 provider4  2 and  7#b7 by adding at the
 end the following new subsection3  7g7 
,treatments described in subparagraphs  
7,b7 and 7,c7 of subsection 7a77#h7 may 
be provided under this section to a     
patient regardless of the age of the    
patient4  4  7e7 ,coverage under ,,fehbp
  7#a7 ,in general ,section #hijd of    
title #e1 ,united ,states ,code1 is     
amended by adding at the end the        
following new subsection3  7c7 7#a7 ,any
 health benefits plan offered under this
 chapter shall1 in accordance with      
paragraph 7#b71 include benefits for--  
7,a7 medically necessary food 7as       
defined in section #ahfa7;iii7 of the   

,social ,security ,act7 and food        
modified to be low protein that is      
formulated to be consumed or            
administered under the supervision of a 
qualified medical provider1 for the     
treatment of conditions as recommended  
by the ,advisory ,committee on          
,heritable ,disorders in ,newborns and  
,children1 and the medical equipment and
 supplies necessary to administer such  
food2 and  7,b7 pharmacological doses of
 vitamins and amino acids used for the  
treatment of inborn errors of           
metabolism1 for the treatment of        
conditions as recommended by the        
,advisory ,committee on ,heritable      
,disorders in ,newborns and ,children   
and as prescribed by a qualified medical
 provider4  7#b7 ,benefits for          
treatments described in subparagraphs   
7,a7 and 7,b7 of paragraph 7#a7 shall be
 provided under such a health benefits  
plan to an individual regardless of the 
age of the individual4  4  7#b7         
,effective date ,the amendment made by  

paragraph 7#a7 shall apply to contract  
years beginning after the date that is  
#i months after the date of enactment of
 this ,act4  #d4 ,effective date        
,subject to subsections 7b77#d7 and     
7c77#c7 of section 7#c71 the amendments 
made by section #c 7other than          
subsection 7e7 of such section7 shall   
apply to plan years and contract years  
beginning after the date that is #f     
months after the date of enactment of   
this ,act4