,i  #aafth ,,congress  #ast ,session    
,h4 ,r4 #cgaa  ,,in ,,the ,,house ,,of  
,,representatives  ,july #aa1 #bjai,ms4 
,judy ,chu of ,california 7for herself1 
,mr4 ,crdenas1 ,ms4 ,clarke of ,new     
,york1 ,mr4 ,fitzpatrick1 ,mrs4 ,lee of 
,nevada1 ,mr4 ,raskin1 ,mr4 ,rouda1 ,mr4
 ,tonko1 ,ms4 ,castor of ,florida1 and  
,mr4 ,young7 introduced the following   
bill2 which was referred to the         
,committee on ,energy and ,commerce1 and
 in addition to the ,committee on ,ways 
and ,means1 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 amend title ,,xviii of   
the ,social ,security ,act to provide   
coverage of medical nutrition therapy   
services for individuals with eating    
disorders under the ,medicare program4  
#a4 ,short title ,this ,act may be cited
 as the ,nutrition ,counseling ,aiding  
,recovery for ,eating ,disorders ,act of

 #bjai or the ,nutrition ,,care ,act of 
#bjai4  #b4 ,findings ,congress finds   
the following3  7#a7 ,eating disorders1 
including the specific disorders of     
anorexia nervosa1 bulimia nervosa1 binge
 eating disorder1 avoidant_/restrictive 
food intake disorder1 and other         
specified feeding or eating disorders1  
are severe biologically based mental    
illnesses caused by a complex           
interaction of genetic1 biological1     
social1 behavioral1 and psychological   
factors4  7#b7 ,over #cj1jjj1jjj        
individuals in the ,united ,states of   
all ages1 races1 sizes1 sexual          
orientations1 ethnicities1 and          
socioeconomic statuses1 are affected by 
eating disorders during their lifetimes4
  7#c7 ,eating disorders have one of the
 highest mortality rates of all mental  
illnesses1 as eating disorders can      
become fatal due to heart failure1      
kidney failure1 stroke1 hypoglycemia1   
and gastric rupture4 ,additionally1     
longitudinal studies have found that the

 suicide risk for those with an eating  
disorder is #bc times the expected risk4
  7#d7 ,eating disorders can be         
successfully treated with interventions 
at the appropriate durations and levels 
of care1 yet only one-third of persons  
with eating disorders receive any       
medical1 psychiatric1 or therapeutic    
care4 ,best practice treatment of eating
 disorders includes patients1 their     
families1 and a comprehensive team of   
professionals such as social workers1   
mental health counselors1 primary care  
practitioners1 psychiatrists1           
psychologists1 dietitians1 art          
therapists1 and other specialty         
providers4  7#e7 ,studies examining the 
prevalence of eating disorders and      
insulin restriction among people with   
diabetes show that up to #ce percent of 
women with diabetes restrict insulin in 
order to lose weight at some point in   
their life4  7#f7 ,research shows that  
disordered eating among older adults    
consistently find that rates of         

disordered eating among the elderly are 
similar to those of younger persons4    
7#g7 ,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     
treatment4  7#h7 ,eating disorders in   
the elderly are associated with         
significant morbidity and mortality1 and
 a wide range of health issues arise    
secondary to eating disorders1 including
 cardiac1 metabolic1 gastric1 and bone  
conditions2 diagnosis and proper        
treatment of this population are        
essential4  7#i7 ,eating disorders in   
the elderly are particularly serious    
because chronic disorders or diseases   
may already compromise a patient's      
health4 ,inadequate nutrition can result
 in memory deficits1 cognitive decline1 
decubitus ulcers1 impaired healing of   
sores1 wounds1 or infections1 and       
dizziness1 disorientation1 and falls4   
7#aj7 ,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         
population4  #c4 ,providing coverage of 
medical nutrition therapy services for  
individuals with eating disorders under 
the ,medicare program ,section #ahfa of 
the ,social ,security ,act 7#db         
,u4,s4,c4 #aciex7 is amended-- 7#a7 in  
subsection 7s77#b77,v7--  7,a7 by       
redesignating clauses 7i7 through 7iii7 
as subclauses 7,i7 through 7,,iii71     
respectively1 and adjusting the margins 
accordingly2  7,b7 in subclause 7,,iii71
 as so redesignated1 by striking the    
semicolon at the end and inserting 2    
and2  7,c7 by striking beneficiary with 
diabetes and inserting the following3   
beneficiary-- 7i7 with diabetes  2 and  
7,d7 by adding at the end the following 
new clause3  7ii7 beginning ,january #a1
 #bjbj1 with an eating disorder 7as     
defined by the ,secretary in accordance 
with most recent edition of the         
,diagnostic and ,statistical ,manual of 

,mental ,disorders published by the     
,american ,psychiatric ,association72  2
 and  7#b7 in subsection 7vv7-- 7,a7 in 
paragraph 7#a7--  7i7 by inserting      
7including management of an eating      
disorder 7as defined for purposes of    
subsection 7s77#b77,v77ii777 after      
disease management2 and  7ii7 by        
inserting or psychologist 7or other     
mental health professional to the extent
 authorized under ,state law7 and1 in   
the case of such services furnished to  
an individual for the purpose of        
management of such an eating disorder1  
at the times specified in paragraph 7#d7
 before the period at the end2 and  7,b7
 by adding at the end the following new 
paragraph3  7#d7 7,a7 ,for purposes of  
paragraph 7#a71 the times specified in  
this paragraph are1 with respect to     
medical nutrition therapy services      
furnished to an individual for purposes 
of management of an eating disorder1 the
 following3  7i7 #ac hours 7including a 
#a hour initial assessment and #ab hours

 of reassessment and intervention7      
during the #a-year period beginning on  
the date such individual is first       
furnished such services4  7ii7 ,subject 
to subparagraph 7,b71 #d hours during   
each subsequent #a-year period4  7,b7   
,in the case that the physician or      
psychologist 7or other mental health    
professional to the extent authorized   
under ,state law7 treating such         
individual determines that there has    
been a change with respect to the       
diagnosis1 medical condition1 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         
7,a77ii71 the ,secretary may provide for
 an additional number of hours to be    
available to such individual with       
respect to a period described in such   
subparagraph4  7,c7 ,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 7,a77ii7 as the ,secretary 
determines appropriate4  4