,,ii  #aai? ,,congress  #b;d ,session   
,s4 #cicd  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,febru>y #bf1 #bjbf,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$ical ,nutrition ,!rapy ,act ( #bjbf4 
#b4 ,f9d+s ,congress f9ds ! foll[+3 7#a7
 ,ov] two-?irds ( ,m$ic>e fee-=-s]vice  
b5efici>ies h #b or m *ronic conditions1
 _m ( :i* c be prev5t$1 delay$1 treat$1 
or manag$ ?r\gh nutrition4  7#b7        
,individuals f _m racial & e?nic m9ority
 backgr\nds are m likely to be diagnos$ 
) *ronic diseases su* z diabetes1       
pr$iabetes1 *ronic kidney disease1      
end-/age r5al disease1 & obesity4  7#c7 
,cov]age = m$ical nutrition !rapy is    
only available to ,m$ic>e ,"p ,b        
b5efici>ies ) diabetes or a r5al        

disease1 despite m$ical nutrition !rapy 
be+ "p ( ! /&>d ( c>e1 9 cl9ical        
guidel9es1 & m$ically necess>y = _m m   
*ronic conditions4  7#d7 ,m$ical        
nutrition !rapy has be5 %[n to be a     
co/-effective compon5t ( treatm5t =     
obesity1 diabetes1 hyp]t5sion1          
dyslipidemia1 ,,hiv infection1 un9t5d$  
weight loss 9 old] adults1 & o!r *ronic 
conditions4  #c4 ,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 /rik+ by a physician &  
all t foll[s ?r\gh ! p]iod at ! end &   
ins]t+ ! foll[+3 by-- 7,a7 a physician  
7z def9$ 9 subsection 7r77#a772  7,b7 a 

physician assi/ant 7z def9$ 9 subsection
 7aa77#e772  7,c7 a nurse practition] 7z
 def9$ 9 subsection 7aa77#e772  7,d7 a  
cl9ical nurse speciali/ 7z def9$ 9      
subsection 7aa77#e77;,b772 or  7,e7 9 ! 
case ( su* s]vices furni%$ to manage su*
 a disease or condition t is an eat+    
disord]1 a cl9ical psy*ologi/ 7z def9$  
by ! ,secret>y74  2 &  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        
,diabetes4  7,b7 ,pr$iabetes4  7,c7 ,a  
r5al disease4  7,d7 ,obesity 7z def9$ = 
purposes ( subsection 7yy77#b77;,c7 or z
 o!rwise def9$ by ! ,secret>y74  7,e7   
,hyp]t5sion4  7,f7 ,dyslipidemia4  7,g7 
,malnutrition4  7,h7 ,eat+ disord]s4    

7,i7 ,canc]4  7,j7 ,ga/ro9te/9al        
diseases1 includ+ ,celiac disease4  7,k7
 ,,hiv4  7,l7 ,,aids4  7,m7             
,c>diovascul> disease4  7,n7 ,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/]$ dietitian 
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%$ 9 ye>s beg9n+ on or aft]
 ! date t is #b ye>s aft] ! date ( !    
enactm5t ( ?is ,act4