,,ii  #aaf? ,,congress  #b;d ,session   
,s4 #dejd  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,augu/ #f1 #bjbj,ms4   
,coll9s 7= h]self & ,mr4 ,pet]s7        
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
exp& ! availability ( m$ical nutrition  
!rapy s]vices "u ! ,m$ic>e program4  #a4
 ,%ort title ,?is ,act may be cit$ z !  
,m$ical ,nutrition ,!rapy ,act ( #bjbj4 
#b4 ,exp&+ ! availability ( m$ical      
nutrition !rapy s]vices "u ! ,m$ic>e    
program  7a7 ,9 g5]al ,section #ahfa ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#aciex7 is am5d$-- 7#a7 9 subsection    
7s77#b77,v71 by /rik+ 9 ! case ( & all t
 foll[s ?r\gh organizations2 &  7#b7 9  
subsection 7vv7-- 7,a7 9 p>agraph 7#a7--
 7i7 by /rik+ disease managem5t & ins]t+
 ! prev5tion1 managem5t1 or treatm5t ( a
 disease or condition specifi$ 9        
p>agraph 7#d72  7ii7 by ins]t+ or by a  
physician assi/ant1 nurse practition]1  

or cl9ical nurse speciali/ 7z su* t]ms  
are def9$ 9 subsection 7aa77#e771 or1 9 
! case ( su* s]vices furni%$ to manage  
su* a disease or condition t is an eat+ 
disord]1 by a cl9ical psy*ologi/ 7z     
def9$ by ! ,secret>y7 be=e ! p]iod at ! 
end2 &  7iii7 by add+ at ! end ! foll[+ 
new s5t5ce3 ,su* t]m %all n include any 
su* s]vices furni%$ to an individual = !
 prev5tion1 managem5t1 or treatm5t ( a  
r5al disease if su* individual is       
receiv+ ma9t5ance dialysis = :i* paym5t 
is made "u section #ahha42 &  7,b7 by   
add+ at ! end ! foll[+ new p>agraph3    
7#d7 ,= purposes ( p>agraph 7#a71 !     
diseases & conditions specifi$ 9 ?is    
p>agraph are ! foll[+3 7,a7 ,diabetes & 
pr$iabetes4  7,b7 ,a r5al disease4  7,c7
 ,obesity 7z def9$ = purposes (         
subsection 7yy77#b77;,c7 or z o!rwise   
def9$ by ! ,secret>y74  7,d7            
,hyp]t5sion4  7,e7 ,dyslipidemia4  7,f7 
,malnutrition4  7,g7 ,eat+ disord]s4    
7,h7 ,canc]4  7,i7 ,celiac disease4     
7,j7 ,,hiv4  7,k7 ,,aids4  7,l7 ,any o!r

 disease or condition-- 7i7 specifi$ by 
! ,secret>y relat+ to un9t5tional weight
 loss2  7ii7 = :i* ! ,secret>y det]m9es 
! s]vices describ$ 9 p>agraph 7#a7 to be
 m$ically necess>y & appropriate = !    
prev5tion1 managem5t1 or treatm5t ( su* 
disease or condition1 consi/5t ) any    
applicable recomm5dations ( ! ,unit$    
,/ates ,prev5tive ,s]vices ,task ,=ce2  
or  7iii7 = :i* ! ,secret>y det]m9es !  
s]vices describ$ 9 p>agraph 7#a7 are    
m$ically necess>y1 consi/5t ) ei!r      
protocols e/abli%$ by regi/]$ dietitians
 or nutrition pr(essional organizations 
or ) accept$ cl9ical guidel9es id5tifi$ 
by ! ,secret>y4  4  7b7 ,exclusion      
modification ,section #ahfb7;a77#a7 is  
am5d$-- 7#a7 9 subp>agraph 7,o71 by     
/rik+ & at ! end2  7#b7 9 subp>agraph   
7,p71 by /rik+ ! semicolon at ! end &   
ins]t+ 1 &2 &  7#c7 by add+ at ! end !  
foll[+ new subp>agraph3  7,q7 9 ! case (
 m$ical nutrition !rapy s]vices 7z def9$
 9 section #ahfa7vv771 :i* are n furni%$
 = ! prev5tion1 managem5t1 or treatm5t (

 a disease or condition specifi$ 9      
p>agraph 7#d7 ( su* section2  4  7c7    
,effective date ,! am5dm5ts made by ?is 
section %all apply ) respect to items & 
s]vices furni%$ on or aft] ,janu>y #a1  
#bjba4