,,ii  #aae? ,,congress  #a/ ,session    
,s4 #aaid  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,may #bb1 #bjag,mr4    
,casey 7= himself & ,mr4 ,grassley7     
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to provide = !     
cov]age ( m$ically necess>y food &      
vitam9s = dige/ive & inh]it$ metabolic  
disord]s "u ,f$]al heal? programs &     
private heal? insurance1 & = o!r        
purposes4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,m$ical ,nutrition ,equity 
,act ( #bjag4  #b4 ,f9d+s ,congress f9ds
 ! foll[+3  7#a7 ,specializ$ food is (t5
 m$ically necess>y = ! safe & effective 
managem5t ( _m dige/ive & inh]it$       
metabolic disord]s t impact dige/ion1   
absorption1 & metabolism ( nutri5ts4    
7#b7 ,al?\gh m$ically necess>y food is  
ess5tial = pati5ts1 x is (t5 exp5sive & 
n uni=mly reimburs$ by heal? insurance1 
leav+ _m families ) an insurm\ntable    
f9ancial burd54  7#c7 ,z a result1 _m   
pati5ts :o _c af=d m$ically necess>y    

food may exp]i5ce adv]se heal?          
consequ5ces f suboptimal disease        
managem5t1 includ+ hospitalization1     
intellectual impairm5t1 behavioral      
dysfunction1 inadequate gr[?1 nutri5t   
defici5cies1 & ev5 dea?4  #c4 ,cov]age (
 m$ically necess>y food & vitam9s =     
dige/ive & inh]it$ metabolic disord]s "u
 ,f$]al heal? programs & private heal?  
insurance  7a7 ,cov]age "u ! ,m$ic>e    
program  7#a7 ,m$ically necess>y food   
7,a7 ,9 g5]al ,section #ahfa7s77#b7 ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#aciex7s77#b77 is am5d$-- 7i7 9         
subp>agraph 7,,ff71 by /rik+ & at ! end2
  7ii7 9 subp>agraph 7,,gg71 by ins]t+ &
 at ! end2 &  7iii7 by add+ at ! end !  
foll[+ new subp>agraph3  7,,hh7 m$ically
 necess>y food 7z def9$ 9 subsection    
7jjj77 & ! m$ical equipm5t & supplies   
necess>y to adm9i/] su* food 7o!r ?an   
m$ical equipm5t & supplies describ$ 9   
subsection 7n772  4  7,b7 ,def9ition    
,section #ahfa ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #aciex7 is am5d$ by 

add+ at ! end ! foll[+ new subsection3  
7jjj7 ,m$ically ,necess>y ,food  7#a7   
,subject to p>agraph 7#b71 ! t]m        
m$ically necess>y food means food1      
includ+ a l[ prote9 modifi$ food product
 & an am9o acid prep>ation product1 t   
is--  7,a7 furni%$ pursuant to !        
prescription1 ord]1 or recomm5dation 7z 
applicable7 ( a physician or o!r heal?  
c>e pr(essional qualifi$ to make su*    
prescription1 ord]1 or recomm5dation1 = 
! diet>y managem5t ( a cov]$ disease or 
condition2  7,b7 a specially =mulat$ &  
process$ product 7z oppos$ to a         
naturally occurr+ food/uff us$ 9 its    
natural /ate7 = ! p>tial or exclusive   
fe$+ ( an individual by means ( oral    
intake or ent]al fe$+ by tube2  7,c7    
int5d$ = ! diet>y managem5t ( an        
individual :o1 because ( !rapeutic or   
*ronic m$ical ne$s1 has limit$ or       
impair$ capacity to +e/1 dige/1 absorb1 
or metabolize ord9>y food/uffs or c]ta9 
nutri5ts1 or :o has o!r special m$ically
 det]m9$ nutri5t requirem5ts1 ! diet>y  

managem5t ( :i* _c be a*iev$ by !       
modification ( ! normal diet alone2     
7,d7 int5d$ to be us$ "u m$ical         
sup]vision1 :i* may include 9 a home    
sett+2 &  7,e7 int5d$ only = an         
individual receiv+ active & ongo+ m$ical
 sup]vision :]e9 ! individual requires  
m$ical c>e on a recurr+ basis =1 among  
o!r ?+s1 in/ructions on ! use ( ! food4 
7#b7 ,= purposes ( p>agraph 7#a71 ! t]m 
m$ically necess>y food does n include ! 
foll[+3 7,a7 ,foods tak5 z "p ( an      
ov]all diet design$ to r$uce ! risk ( a 
disease or m$ical condition or z weight 
loss products1 ev5 if !y are recomm5d$  
by a physician or o!r heal? pr(essional4
  7,b7 ,foods m>ket$ z glut5-free = !   
managem5t ( celiac disease or non-celiac
 glut5 s5sitivity4  7,c7 ,foods m>ket$ =
 ! managem5t ( diabetes4  7,d7 ,o!r     
products det]m9$ appropriate by !       
,secret>y4  7#c7 ,9 ?is subsection1 !   
t]m cov]$ disease or condition means !  
foll[+ diseases or conditions3 7,a7     
,inh]it$ metabolic disord]s1 includ+ !  

foll[+3  7i7 ,disord]s classifi$ z      
metabolic disord]s on ! ,recomm5d$      
,uni=m ,scre5+ ,panel ,core ,conditions 
li/ ( ! ,secret>y ( ,heal? & ,human     
,s]vices' ,advisory ,committee on       
,h]itable ,disord]s 9 ,newborns &       
,*ildr54  7ii7 ,n-acetyl glutamate      
syn?ase defici5cy4  7iii7 ,orni?9e      
transc>bamlyase defici5cy4  7iv7        
,c>bamoyl phosphate syn!/ase defici5cy4 
7v7 ,inh]it$ disord]s ( mito*ondrial    
function+4  7,b7 ,m$ical & surgical     
conditions ( malabsorption1 includ+ !   
foll[+3 7i7 ,impair$ absorption (       
nutri5ts caus$ by disord]s affect+ !    
absorptive surface1 functional l5g?1 &  
motility ( ! ga/ro9te/9al tract1 includ+
 %ort b[el syndrome & *ronic inte/9al   
pseudo-ob/ruction4  7ii7 ,malabsorption 
due to liv] or pancreatic disease4  7,c7
 ,immunoglobul9 ,e & non-,immunoglobul9 
,e-m$iat$ all]gies to food prote9s1     
includ+ ! foll[+3  7i7 ,immunoglobul9 ,e
 & non-,immunoglobul9 ,e-m$iat$ all]gies
 to food prote9s4  7ii7 ,food           

prote9-induc$ ent]ocolitis syndrome4    
7iii7 ,eos9ophilic disord]s1 includ+    
eos9ophilic esophagitis1 eos9ophilic    
gastroent]itis1 eos9ophilic colitis1 &  
po/-transplant eos9ophilic disord]s4    
7,d7 ,inflammatory or immune m$iat$     
conditions ( ! alim5t>y tract1 includ+ !
 foll[+3 7i7 ,inflammatory b[el disease1
 includ+ ,crohn's disease1 ulc]ative    
colitis1 & indet]m9ate colitis4  7ii7   
,ga/roesophageal reflux disease t is    
nonresponsive to /&>d m$ical !rapies4   
7,e7 ,any o!r disease or condition      
det]m9$ appropriate by ! ,secret>y4     
7#d7 ,9 ?is subsection1 ! t]m l[ prote9 
modifi$ food product means a product    
=mulat$ to h less ?an "o gram ( prote9  
p] s]v+4  4  7,c7 ,paym5t ,section      
#ahcc7;a77#a7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #aciel7a77#a77 is       
am5d$--  7i7 by /rik+ & be=e 7,,bb72 &  
7ii7 by ins]t+ be=e ! semicolon at ! end
 ! foll[+3 1 & 7,,cc7 ) respect to      
m$ically necess>y food 7z def9$ 9       
section #ahfa7;jjj771 ! am\nt paid %all 

be an am\nt equal to #hj p]c5t ( ! less]
 ( ! actual *>ge = ! s]vices or ! am\nt 
det]m9$ "u a fee s*$ule e/abli%$ by !   
,secret>y = purposes ( ?is subp>agraph44
  7,d7 ,effective date ,! am5dm5ts made 
by ?is subsection %all apply to items & 
s]vices furni%$ on or aft] ! date t is  
#a ye> aft] ! date ( ! enactm5t ( ?is   
,act4  7#b7 ,inclusion ( m$ically       
necess>y vitam9s z a cov]$ "p ,d drug   
7,a7 ,9 g5]al ,section                  
#ahfj;,d-#b7;e77#a7 ( ! ,social         
,security ,act 7#db ,u4,s4,c4           
#aciew-#ajb7;e77#a77 is am5d$-- 7i7 9   
subp>agraph 7,a71 by /rik+ or at ! end2 
7ii7 9 subp>agraph 7,b71 by /rik+ !     
comma at ! end & ins]t+ 2 or2 &  7iii7  
by ins]t+ aft] subp>agraph 7,b7 ! foll[+
 new subp>agraph3  7,c7 m$ically        
necess>y vitam9s us$ = ! managem5t ( a  
cov]$ disease or condition 7z def9$ 9   
section #ahfa7;jjj77#c77 pursuant to !  
prescription1 ord]1 or recomm5dation 7z 
applicable7 ( a physician or o!r heal?  
c>e pr(essional qualifi$ to make su*    

prescription1 ord]1 or recomm5dation1  4
  7,b7 ,effective date ,! am5dm5ts made 
by subp>agraph 7,a7 %all apply to plan  
ye>s beg9n+ on or aft] ! date t is #a   
ye> aft] ! date ( ! enactm5t ( ?is ,act4
  7b7 ,cov]age "u ! ,m$icaid program    
7#a7 ,9 g5]al ,section #aije7;a7 ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#acif;d7a77 is am5d$-- 7,a7 9 p>agraph  
7#bh71 by /rik+ & at ! end2  7,b7 by    
r$esignat+ p>agraph 7#bi7 z p>agraph    
7#ca72 &  7,c7 by ins]t+ aft] p>agraph  
7#bh7 ! foll[+ new p>agraphs3  7#bi7    
m$ically necess>y food 7z def9$ 9       
section #ahfa7;jjj77 & ! m$ical equipm5t
 & supplies necess>y to adm9i/] su*     
food2  7#cj7 m$ically necess>y vitam9s  
us$ = ! managem5t ( a cov]$ disease or  
condition 7z def9$ 9 section            
#ahfa7;jjj77#c77 pursuant to !          
prescription1 ord]1 or recomm5dation 7z 
applicable7 ( a physician or o!r heal?  
c>e pr(essional qualifi$ to make su*    
prescription1 ord]1 or recomm5dation2 & 
4  7#b7 ,con=m+ am5dm5ts  7,a7 ,m&atory 

b5efits ,section #aijb7;a77#aj77;,a7 ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#acif;a7a77#aj77;,a77 is am5d$1 9 !     
matt] prec$+ clause 7i71 by /rik+ &     
7#bh7 & ins]t+ 7#bh71 7#bi71 & 7#cj74   
7,b7 ,exception to cov]age re/riction   
,section #aibg7;d77#b77;,e7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#acifr-#h7;d77#b77;,e77 is am5d$ by     
ins]t+ & except = m$ically necess>y     
vitam9s describ$ 9 section              
#aije7;a77#cj7 be=e ! p]iod at ! end4   
7#c7 ,effective date  7,a7 ,9 g5]al     
,subject to subp>agraph 7,b71 ! am5dm5ts
 made by ?is subsection %all take effect
 on ! date t is #a ye> aft] ! date ( !  
enactm5t ( ?is ,act4  7,b7 ,exception to
 effective date if ,/ate legislation    
requir$ ,9 ! case ( a ,/ate plan =      
m$ical assi/ance "u title ,,xix ( !     
,social ,security ,act :i* ! ,secret>y (
 ,heal? & ,human ,s]vices det]m9es      
requires ,/ate legislation 7o!r ?an     
legislation appropriat+ funds7 9 ord] = 
! plan to meet ! additional requirem5ts 

impos$ by ! am5dm5ts made by ?is        
subsection1 ! ,/ate plan %all n be      
reg>d$ z fail+ to comply ) ! requirem5ts
 ( su* title solely on ! basis ( its    
failure to meet ?is additional          
requirem5t be=e ! fir/ day ( ! fir/     
cal5d> qu>t] beg9n+ aft] ! close ( !    
fir/ regul> session ( ! ,/ate           
legislature t beg9s aft] ! date ( !     
enactm5t ( ?is ,act4 ,= purposes ( !    
previ\s s5t5ce1 9 ! case ( a ,/ate t has
 a #b-ye> legislative session1 ea* ye> (
 su* session %all be deem$ to be a      
sep>ate regul> session ( ! ,/ate        
legislature4  7c7 ,cov]age "u ,,*ip     
7#a7 ,9 g5]al ,section #bajc7;c7 ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#acig;cc7c77 is am5d$ by add+ at ! end !
 foll[+3  7#i7 ,m$ically necess>y food  
,! *ild heal? assi/ance provid$ to a    
t>get$ l[-income *ild "u ! plan %all    
include cov]age ( m$ically necess>y food
 7z def9$ 9 section #ahfa7;jjj77 & !    
m$ical equipm5t & supplies necess>y to  
adm9i/] su* food4  7#aj7 ,c]ta9 vitam9s 

,! *ild heal? assi/ance provid$ to a    
t>get$ l[-income *ild "u ! plan %all    
include cov]age ( m$ically necess>y     
vitam9s us$ = ! managem5t ( a cov]$     
disease or condition 7z def9$ 9 section 
#ahfa7;jjj77#c77 pursuant to !          
prescription1 ord]1 or recomm5dation 7z 
applicable7 ( a physician or o!r heal?  
c>e pr(essional qualifi$ to make su*    
prescription1 ord]1 or recomm5dation4  4
  7#b7 ,con=m+ am5dm5t ,section         
#bajc7;a7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acig;cc7a77 is am5d$1 9 
! matt] prec$+ p>agraph 7#a71 by /rik+ &
 7#g7 & ins]t+ 7#g71 7#i71 & 7#aj74     
7#c7 ,effective date  7,a7 ,9 g5]al     
,subject to subp>agraph 7,b71 ! am5dm5ts
 made by ?is subsection %all take effect
 on ! date t is #a ye> aft] ! date ( !  
enactm5t ( ?is ,act4  7,b7 ,exception to
 effective date if ,/ate legislation    
requir$ ,9 ! case ( a ,/ate *ild heal?  
plan = *ild heal? assi/ance "u title    
,,xxi ( ! ,social ,security ,act :i* !  
,secret>y ( ,heal? & ,human ,s]vices    

det]m9es requires ,/ate legislation 7o!r
 ?an legislation appropriat+ funds7 9   
ord] = ! plan to meet ! additional      
requirem5ts impos$ by ! am5dm5ts made by
 ?is subsection1 ! ,/ate *ild heal? plan
 %all n be reg>d$ z fail+ to comply ) ! 
requirem5ts ( su* title solely on !     
basis ( its failure to meet ?is         
additional requirem5t be=e ! fir/ day ( 
! fir/ cal5d> qu>t] beg9n+ aft] ! close 
( ! fir/ regul> session ( ! ,/ate       
legislature t beg9s aft] ! date ( !     
enactm5t ( ?is ,act4 ,= purposes ( !    
previ\s s5t5ce1 9 ! case ( a ,/ate t has
 a #b-ye> legislative session1 ea* ye> (
 su* session %all be deem$ to be a      
sep>ate regul> session ( ! ,/ate        
legislature4  7d7 ,modification (       
diseases & conditions cov]$ "u ,,tric>e 
program ,section #ajgg7;h77#c7 ( title  
#aj1 ,unit$ ,/ates ,code1 is am5d$--    
7#a7 9 subp>agraph 7,d71 by /rik+ &2    
7#b7 by r$esignat+ subp>agraph 7,e7 z   
subp>agraph 7,f72 &  7#c7 by ins]t+ aft]
 subp>agraph 7,d7 ! foll[+3  7,e7       

,immunoglobul9 ,e or non-,immunoglobul9 
,e m$iat$ all]gies to food prote9s4  4  
7e7 ,cov]age "u ,,fehbp  7#a7 ,9 g5]al  
,section #hijb ( title #e1 ,unit$ ,/ates
 ,code1 is am5d$ by add+ at ! end !     
foll[+3  7p7 ,a contract = a plan "u ?is
 *apt] %all require ! c>ri] to provide  
cov]age =-- 7#a7 m$ically necess>y food 
7z def9$ 9 section #ahfa7;jjj7 ( !      
,social ,security ,act7 & ! m$ical      
equipm5t & supplies necess>y to adm9i/] 
su* food2 &  7#b7 m$ically necess>y     
vitam9s 9 ! same mann] provid$ = "u     
section #ahfj;,d-#b7;e77#a77;,c7 ( !    
,social ,security ,act4  4  7#b7        
,effective date ,! am5dm5t made by      
p>agraph 7#a7 %all apply ) respect to   
contract ye>s beg9n+ on or aft] ! date t
 is #a ye> aft] ! date ( enactm5t ( ?is 
,act4  7f7 ,cov]age "u private heal?    
insurance  7#a7 ,9 g5]al ,subp>t ,,ii ( 
"p ,a ( title ,,xxvii ( ! ,public ,heal?
 ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#aa
 et seq47 is am5d$ by add+ at ! end !   
foll[+3  #bgbi4 ,cov]age ( m$ically     

necess>y food & vitam9s ,a heal?        
insurance issu] (f]+ gr\p or individual 
heal? insurance cov]age %all provide    
cov]age =--  7#a7 m$ically necess>y food
 7z def9$ 9 section #ahfa7;jjj7 ( !     
,social ,security ,act7 & ! m$ical      
equipm5t & supplies necess>y to adm9i/] 
su* food2 &  7#b7 m$ically necess>y     
vitam9s 9 ! same mann] provid$ = "u     
section #ahfj;,d-#b7;e77#a77;,c7 ( !    
,social ,security ,act4  4  7#b7        
,effective date ,! am5dm5t made by      
p>agraph 7#a7 %all apply to plan ye>s   
beg9n+ on or aft] ! date t is #a ye>    
aft] ! date ( ! enactm5t ( ?is ,act4