,,ii  #aafth ,,congress  #ast ,session  
,s4 #bijg  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,november #bj1 
#bjai,ms4 ,hassan 7for herself and ,ms4 
,murkowski7 introduced the following    
bill2 which was read twice and referred 
to the ,committee on ,finance  ,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 statues1 are affected by  
eating disorders during their lifetimes1
 with disordered eating in elderly      
persons showing similar prevalence rates
 as younger persons4  7#c7 ,eating      
disorders have one of the highest       
mortality rates of all mental illnesses 
and significant mortality and morbidity 
rates associated with elderly           
populations1 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 appropriate   
interventions1 yet only one-third of    

persons with eating disorders receive   
any 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 and other specialty         
providers  7#e7 ,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 or2
  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,v77ii7777 after     
disease management2  7ii7 by striking   
which are furnished by and all that     
follows through the period and inserting
 8which are furnished--  7,a7 by a      
registered dietitian or nutrition       
professional 7as defined in paragraph   
7#b772  7,b7 pursuant to a referral by--

  7i7 a physician 7as defined in        
subsection 7r77#a77 a physician 7as     
defined in subsection 7r77#a772 or  7ii7
 a psychologist 7or other mental health 
professional to the extent authorized   
under ,state law72 and  7,c7 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#d74  2   
and  7,b7 by adding at the end the      
following new paragraph3  7#d7 7,a7 ,for
 purposes of paragraph 7#a77;,c71 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 at least 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   
,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