,,ii  #aaf? ,,congress  #b;d ,session   
,s4 #cfeg  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,may #g1 #bjbj,mr4     
,casey 7= himself & ,ms4 ,ern/7         
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,heal?1 ,education1 ,labor1 & ,p5sions  
,a ,,bill  ,to provide = ! cov]age (    
m$ically necess>y food & vitam9s &      
individual am9o acids = dige/ive &      
inh]it$ metabolic disord]s "u ,f$]al    
heal? programs & private heal?          
insurance1 & = o!r purposes4  #a4 ,%ort 
title ,?is ,act may be cit$ z ! ,m$ical 
,nutrition ,equity ,act ( #bjbj4  #b4   
,f9d+s ,congress f9ds ! foll[+3 7#a7    
,ea* ye>1 ?\s&s ( *ildr5 & adults 9 !   
,unit$ ,/ates are diagnos$ ) c]ta9      
dige/ive or inh]it$ metabolic disord]s t
 prev5t _! bodies f dige/+ or metaboliz+
 ! food !y ne$ to survive4 ,= !m1       
m$ically necess>y food1 :i* c (t5 be    
adm9i/]$ z an orally consum$ =mula1 is  
_! treatm5t4  7#b7 ,)\t m$ically        
necess>y food1 ^! pati5ts risk          

malnutrition1 surg]y1 & repeat$         
hospitalizations4 ,!y may suff]         
intellectual disability or ev5 dea?4    
,risks 9 p$iatric populations are       
p>ticul>ly pr(\nd & (t5 sev]e & also    
include inadequate gr[?1 abnormal       
developm5t1 cognitive impairm5t1 &      
behavioral disord]s4 ,specializ$        
m$ically necess>y food is /&>d-(-c>e    
!rapy = ^! pati5ts & is ess5tial to     
prev5t+ su* outcomes4  7#c7 ,:ile n e   
p]son diagnos$ ) ^! conditions ne$s to  
be treat$ ) m$ically necess>y food = a  
prolong$ p]iod1 x is critical t pati5ts 
& _! physicians be able to consid] !    
full range ( options & select ! treatm5t
 t w be mo/ effective = ea* pati5t4     
7#d7 ,insurance companies w typically   
cov] ph>maceuticals or biologics =      
treatm5t ( "s ( ^! conditions4 ,h[ev]1  
^! types ( treatm5ts may n be ! fir/-l9e
 !rapy a physician w\ld recomm5d1 d n "w
 = all pati5ts1 & c h undesirable risks1
 su* z canc] or suppression ( ! immune  
sy/em1 :i* c increase a pati5t's risk ( 

infection4  7#e7 ,ev5 :5 an insurance   
company does cov] m$ically necess>y     
food1 x (t5 comes ) ! /ipulation t !    
=mula be adm9i/]$ ?r\gh a fe$+ tube1 :i*
 requires exp5sive surg]y & c>ries      
additional risks = ! pati5t4  7#f7 ,te/+
 = select inborn errors ( metabolism is 
requir$ 9 all ,/ates1 & m ?an #g1jjj    
babies p] ye> are diagnos$ ) an inh]it$ 
metabolic disord]4 ,yet1 policies on    
m$ically necess>y food v>y significantly
 & d n always make x possible = families
 to get suffici5t nutrition = _! affect$
 *ildr54  #c4 ,cov]age ( m$ically       
necess>y food1 vitam9s1 & individual    
am9o acids = dige/ive & inh]it$         
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,,gg71 by /rik+ & at ! end2
  7ii7 9 subp>agraph 7,,hh71 by /rik+ ! 

p]iod & ins]t+ &2 &  7iii7 by add+ at ! 
end ! foll[+ new subp>agraph3  7,,ii7   
m$ically necess>y food 7z def9$ 9       
subsection 7kkk77 & ! 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  7kkk7 ,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        
product1 an am9o acid prep>ation        
product1 a modifi$ fat prep>ation       
product1 or a nutritional =mula 7includ+
 su* a =mula t does n require a         
prescription71 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 7,a7 ,9 ?is subsection1 ! t]m l[   
prote9 modifi$ food product means a type
 ( m$ical food t is modifi$ to be l[ 9  
prote9 & =mulat$ = oral consumption =   
individuals ) inborn errors ( prote9    
metabolism4  7,b7 ,su* t]m does n       
include foods t are naturally l[ 9      
prote91 su* z "s fruits or vegetables4  
4  7,c7 ,paym5t ,section #ahcc7;a77#a7 (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #aciel7a77#a77 is am5d$-- 7i7 by /rik+ 
& be=e 7,,dd72 &  7ii7 by ins]t+ be=e ! 
semicolon at ! end ! foll[+3 & 7,,ee7 ) 
respect to m$ically necess>y food 7z    
def9$ 9 section #ahfa7kkk771 ! 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$ically necess>y vitam9s & individual  
am9o acids z a cov]$ "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 & individual am9o acids
 us$ = ! managem5t ( a cov]$ disease or 
condition 7z def9$ 9 section            
#ahfa7kkk77#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$-- 7,a7 9 p>agraph  
7#bi7-- 7i7 by adju/+ ! left m>g9 s z to
 align ) ! left m>g9 ( p>agraph 7#bh72 &
  7ii7 by /rik+ & at ! end2  7,b7 by    
r$esignat+ p>agraph 7#cj7 z p>agraph    
7#cb72 &  7,c7 by ins]t+ aft] p>agraph  
7#bi7 ! foll[+ new p>agraphs3  7#cj7    
m$ically necess>y food 7z def9$ 9       
section #ahfa7kkk77 & ! m$ical equipm5t 
& supplies necess>y to adm9i/] su* food2
  7#ca7 m$ically necess>y vitam9s &     
individual am9o acids us$ = ! managem5t 
( a cov]$ disease or condition 7z def9$ 
9 section #ahfa7kkk77#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#bi7 & ins]t+ 7#bi71 7#cj71 & 7#ca74   
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$ically necess>y     
vitam9s & individual am9o acids describ$
 9 section #aije7;a77#ca7 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#aa7 ,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 #ahfa7kkk77 & !     
m$ical equipm5t & supplies necess>y to  
adm9i/] su* food4  7#ab7 ,c]ta9 vitam9s 
& individual am9o acids ,! *ild heal?   
assi/ance provid$ to a t>get$ l[-income 
*ild "u ! plan %all include cov]age (   
m$ically necess>y vitam9s & individual  
am9o acids us$ = ! managem5t ( a cov]$  
disease or condition 7z def9$ 9 section 

#ahfa7kkk77#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#h7 & ins]t+ 7#h71 7#aa71 & 7#ab74    
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 (       
def9ition ( m$ically necess>y food &    
cov]$ disease or condition "u ! ,,tric>e
 program  7#a7 ,9 g5]al ,section        
#ajgg7;h7 ( title #aj1 ,unit$ ,/ates    
,code1 is am5d$-- 7,a7 9 p>agraph       
7#b77;,a71 9 ! matt] prec$+ clause 7i71 
by /rik+ or an am9o acid prep>ation     
product & ins]t+ 1 an am9o acid         
prep>ation product1 a modifi$ fat       
prep>ation product1 or a nutritional    
=mula 7includ+ su* a =mula t does n     
require a prescription72 &  7,b7 9      

p>agraph 7#c7-- 7i7 9 subp>agraph 7,d71 
by /rik+ & at ! end2  7ii7 by r$esignat+
 subp>agraph 7,e7 z subp>agraph 7,f72 & 
7iii7 by ins]t+ aft] subp>agraph 7,d7 ! 
foll[+3  7,e7 ,immunoglobul9 ,e or      
non-,immunoglobul9 ,e m$iat$ all]gies to
 food prote9s2 &  4  7#b7 ,effective    
date ,! am5dm5ts made by p>agraph 7#a7  
%all apply to heal? c>e provid$ "u *apt]
 #ee ( title #aj1 ,unit$ ,/ates ,code1  
on or aft] ! date t is "o ye> aft] !    
date ( ! enactm5t ( ?is ,act4  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 #ahfa7kkk7 ( !       
,social ,security ,act7 & ! m$ical      
equipm5t & supplies necess>y to adm9i/] 
su* food2 &  7#b7 m$ically necess>y     
vitam9s & individual am9o acids 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  #bgbi;,a4 ,cov]age ( m$ically  
necess>y food1 vitam9s1 & individual    
am9o acids ,a heal? insurance issu] (f]+
 gr\p or individual heal? insurance     
cov]age %all provide cov]age =-- 7#a7   
m$ically necess>y food 7z def9$ 9       
section #ahfa7kkk7 ( ! ,social ,security
 ,act7 & ! m$ical equipm5t & supplies   
necess>y to adm9i/] su* food2 &  7#b7   
m$ically necess>y vitam9s & individual  
am9o acids 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    
7g7 ,nonpreemption ( ,/ate laws t       
provide great] cov]age ,no?+ 9 !        
provisions (1 or ! am5dm5ts made by1 ?is
 section %all preempt a ,/ate law t     
requires cov]age ( m$ically necess>y    
food & vitam9s & individual am9o acids =
 dige/ive & inh]it$ metabolic disord]s t
 exce$s ! requirem5ts = cov]age "u su*  
provisions & am5dm5ts4  7h7 ,m$ically   
necess>y nutrition cov]age includes     
comb9ations & supplies ,no?+ 9 !        
provisions (1 or ! am5dm5ts made by1 ?is
 section %all limit cov]age ( a m$ically
 necess>y food 7z def9$ 9 subsection    
7kkk7 ( section #ahfa ( ! ,social       
,security ,act1 z add$ by subsection    
7a77 or ! m$ical equipm5t & supplies    
necess>y to adm9i/] su* food :5         
prescrib$1 ord]$1 or recomm5d$ 9        
comb9ation ) ano!r m$ically necess>y    
food 7z s def9$7 or o!r necess>y m$ical 
equipm5t & supplies4