,,ii #aaeth ,,congress #ast ,session ,s4 #aaid ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,may #bb1 #bjag,mr4 ,casey 7for himself and ,mr4 ,grassley7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to provide for the coverage of medically necessary food and vitamins for digestive and inherited metabolic disorders under ,federal health programs and private health insurance1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,medical ,nutrition ,equity ,act of #bjag4 #b4 ,findings ,congress finds the following3 7#a7 ,specialized food is often medically necessary for the safe and effective management of many digestive and inherited metabolic disorders that impact digestion1 absorption1 and metabolism of nutrients4 7#b7 ,although medically necessary food is essential for patients1 it is often expensive and not uniformly reimbursed by health insurance1 leaving many families with an insurmountable financial burden4 7#c7 ,as a result1 many patients who cannot afford medically necessary food may experience adverse health consequences from suboptimal disease management1 including hospitalization1 intellectual impairment1 behavioral dysfunction1 inadequate growth1 nutrient deficiencies1 and even death4 #c4 ,coverage of medically necessary food and vitamins for digestive and inherited metabolic disorders under ,federal health programs and private health insurance 7a7 ,coverage under the ,medicare program 7#a7 ,medically necessary food 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,,ff71 by striking and at the end2 7ii7 in subparagraph 7,,gg71 by inserting and at the end2 and 7iii7 by adding at the end the following new subparagraph3 7,,hh7 medically necessary food 7as defined in subsection 7jjj77 and the medical equipment and supplies necessary to administer such food 7other than medical equipment and supplies described in subsection 7n772 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 7jjj7 ,medically ,necessary ,food 7#a7 ,subject to paragraph 7#b71 the term medically necessary food means food1 including a low protein modified food product and an amino acid preparation product1 that is-- 7,a7 furnished pursuant to the prescription1 order1 or recommendation 7as applicable7 of a physician or other health care professional qualified to make such prescription1 order1 or recommendation1 for the dietary management of a covered disease or condition2 7,b7 a specially formulated and processed product 7as opposed to a naturally occurring foodstuff used in its natural state7 for the partial or exclusive feeding of an individual by means of oral intake or enteral feeding by tube2 7,c7 intended for the dietary management of an individual who1 because of therapeutic or chronic medical needs1 has limited or impaired capacity to ingest1 digest1 absorb1 or metabolize ordinary foodstuffs or certain nutrients1 or who has other special medically determined nutrient requirements1 the dietary management of which cannot be achieved by the modification of the normal diet alone2 7,d7 intended to be used under medical supervision1 which may include in a home setting2 and 7,e7 intended only for an individual receiving active and ongoing medical supervision wherein the individual requires medical care on a recurring basis for1 among other things1 instructions on the use of the food4 7#b7 ,for purposes of paragraph 7#a71 the term medically necessary food does not include the following3 7,a7 ,foods taken as part of an overall diet designed to reduce the risk of a disease or medical condition or as weight loss products1 even if they are recommended by a physician or other health professional4 7,b7 ,foods marketed as gluten-free for the management of celiac disease or non-celiac gluten sensitivity4 7,c7 ,foods marketed for the management of diabetes4 7,d7 ,other products determined appropriate by the ,secretary4 7#c7 ,in this subsection1 the term covered disease or condition means the following diseases or conditions3 7,a7 ,inherited metabolic disorders1 including the following3 7i7 ,disorders classified as metabolic disorders on the ,recommended ,uniform ,screening ,panel ,core ,conditions list of the ,secretary of ,health and ,human ,services' ,advisory ,committee on ,heritable ,disorders in ,newborns and ,children4 7ii7 ,n-acetyl glutamate synthase deficiency4 7iii7 ,ornithine transcarbamlyase deficiency4 7iv7 ,carbamoyl phosphate synthestase deficiency4 7v7 ,inherited disorders of mitochondrial functioning4 7,b7 ,medical and surgical conditions of malabsorption1 including the following3 7i7 ,impaired absorption of nutrients caused by disorders affecting the absorptive surface1 functional length1 and motility of the gastrointestinal tract1 including short bowel syndrome and chronic intestinal pseudo-obstruction4 7ii7 ,malabsorption due to liver or pancreatic disease4 7,c7 ,immunoglobulin ,e and non-,immunoglobulin ,e-mediated allergies to food proteins1 including the following3 7i7 ,immunoglobulin ,e and non-,immunoglobulin ,e-mediated allergies to food proteins4 7ii7 ,food protein-induced enterocolitis syndrome4 7iii7 ,eosinophilic disorders1 including eosinophilic esophagitis1 eosinophilic gastroenteritis1 eosinophilic colitis1 and post-transplant eosinophilic disorders4 7,d7 ,inflammatory or immune mediated conditions of the alimentary tract1 including the following3 7i7 ,inflammatory bowel disease1 including ,crohn's disease1 ulcerative colitis1 and indeterminate colitis4 7ii7 ,gastroesophageal reflux disease that is nonresponsive to standard medical therapies4 7,e7 ,any other disease or condition determined appropriate by the ,secretary4 7#d7 ,in this subsection1 the term low protein modified food product means a product formulated to have less than one gram of protein per serving4 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,,bb72 and 7ii7 by inserting before the semicolon at the end the following3 1 and 7,,cc7 with respect to medically necessary food 7as defined in section #ahfa7;jjj771 the amount paid shall be an amount equal to #hj percent of the lesser of the actual charge for the services or the amount determined under a fee schedule established by the ,secretary for purposes of this subparagraph44 7,d7 ,effective date ,the amendments made by this subsection shall apply to items and services furnished on or after the date that is #a year after the date of the enactment of this ,act4 7#b7 ,inclusion of medically necessary vitamins 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 medically necessary vitamins used for the management of a covered disease or condition 7as defined in section #ahfa7;jjj77#c77 pursuant to the prescription1 order1 or recommendation 7as applicable7 of a physician or other health care professional qualified to make such prescription1 order1 or recommendation1 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 #a year after the date of the enactment of this ,act4 7b7 ,coverage under the ,medicaid program 7#a7 ,in general ,section #aije7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a77 is amended-- 7,a7 in paragraph 7#bh71 by striking and at the end2 7,b7 by redesignating paragraph 7#bi7 as paragraph 7#ca72 and 7,c7 by inserting after paragraph 7#bh7 the following new paragraphs3 7#bi7 medically necessary food 7as defined in section #ahfa7;jjj77 and the medical equipment and supplies necessary to administer such food2 7#cj7 medically necessary vitamins used for the management of a covered disease or condition 7as defined in section #ahfa7;jjj77#c77 pursuant to the prescription1 order1 or recommendation 7as applicable7 of a physician or other health care professional qualified to make such prescription1 order1 or recommendation2 and 4 7#b7 ,conforming amendments 7,a7 ,mandatory benefits ,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 7#bi71 and 7#cj74 7,b7 ,exception to coverage restriction ,section #aibg7;d77#b77;,e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#h7;d77#b77;,e77 is amended by inserting and except for medically necessary vitamins described in section #aije7;a77#cj7 before the period at the end4 7#c7 ,effective date 7,a7 ,in general ,subject to subparagraph 7,b71 the amendments made by this subsection shall take effect on the date that is #a year after the date of the enactment of this ,act4 7,b7 ,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 requirements 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 ,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 ,the child health assistance provided to a targeted low-income child under the plan shall include coverage of medically necessary food 7as defined in section #ahfa7;jjj77 and the medical equipment and supplies necessary to administer such food4 7#aj7 ,certain vitamins ,the child health assistance provided to a targeted low-income child under the plan shall include coverage of medically necessary vitamins used for the management of a covered disease or condition 7as defined in section #ahfa7;jjj77#c77 pursuant to the prescription1 order1 or recommendation 7as applicable7 of a physician or other health care professional qualified to make such prescription1 order1 or recommendation4 4 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 and 7#g7 and inserting 7#g71 7#i71 and 7#aj74 7#c7 ,effective date 7,a7 ,in general ,subject to subparagraph 7,b71 the amendments made by this subsection shall take effect on the date that is #a year after the date of the enactment of this ,act4 7,b7 ,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 requirements 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 ,modification of diseases and conditions covered under ,,tricare program ,section #ajgg7;h77#c7 of title #aj1 ,united ,states ,code1 is amended-- 7#a7 in subparagraph 7,d71 by striking and2 7#b7 by redesignating subparagraph 7,e7 as subparagraph 7,f72 and 7#c7 by inserting after subparagraph 7,d7 the following3 7,e7 ,immunoglobulin ,e or non-,immunoglobulin ,e mediated allergies to food proteins4 4 7e7 ,coverage under ,,fehbp 7#a7 ,in general ,section #hijb of title #e1 ,united ,states ,code1 is amended by adding at the end the following3 7p7 ,a contract for a plan under this chapter shall require the carrier to provide coverage for-- 7#a7 medically necessary food 7as defined in section #ahfa7;jjj7 of the ,social ,security ,act7 and the medical equipment and supplies necessary to administer such food2 and 7#b7 medically necessary vitamins in the same manner provided for under section #ahfj;,d-#b7;e77#a77;,c7 of the ,social ,security ,act4 4 7#b7 ,effective date ,the amendment made by paragraph 7#a7 shall apply with respect to contract years beginning on or after the date that is #a year after the date of enactment of this ,act4 7f7 ,coverage under private health insurance 7#a7 ,in general ,subpart ,,ii of part ,a of title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#aa et seq47 is amended by adding at the end the following3 #bgbi4 ,coverage of medically necessary food and vitamins ,a health insurance issuer offering group or individual health insurance coverage shall provide coverage for-- 7#a7 medically necessary food 7as defined in section #ahfa7;jjj7 of the ,social ,security ,act7 and the medical equipment and supplies necessary to administer such food2 and 7#b7 medically necessary vitamins in the same manner provided for under section #ahfj;,d-#b7;e77#a77;,c7 of the ,social ,security ,act4 4 7#b7 ,effective date ,the amendment made by paragraph 7#a7 shall apply to plan years beginning on or after the date that is #a year after the date of the enactment of this ,act4