Treat and Reduce Obesity Act of 2021
This bill expands Medicare coverage of intensive behavioral therapy for obesity. Specifically, the bill allows coverage for therapy that is provided by (1) a physician who is not a primary care physician; or (2) other health care providers (e.g., physician assistants and nurse practitioners) and approved counseling programs, if provided upon a referral from, and in coordination with, a physician or primary care practitioner. Currently, such therapy is covered only if provided by a primary care practitioner.
The bill also allows coverage under Medicare's prescription drug benefit of drugs used for the treatment of obesity or for weight loss management for individuals who are overweight.
[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 596 Introduced in Senate (IS)]
<DOC>
117th CONGRESS
1st Session
S. 596
To amend title XVIII of the Social Security Act to provide for the
coordination of programs to prevent and treat obesity, and for other
purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
March 4, 2021
Mr. Carper (for himself, Mr. Cassidy, Mrs. Capito, Mr. Coons, Mrs.
Blackburn, Ms. Klobuchar, Mrs. Hyde-Smith, Mrs. Shaheen, Ms. Sinema,
Ms. Ernst, Ms. Murkowski, Mr. Cramer, Mr. Tillis, and Mr. Heinrich)
introduced the following bill; which was read twice and referred to the
Committee on Finance
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to provide for the
coordination of programs to prevent and treat obesity, and for other
purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Treat and Reduce Obesity Act of
2021''.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) According to the Centers for Disease Control and
Prevention, about 41 percent of adults aged 60 and over had
obesity in the period of 2015 through 2016, representing more
than 27 million people.
(2) The National Institutes of Health has reported that
obesity and overweight are now the second leading cause of
death nationally, with an estimated 300,000 deaths a year
attributed to the epidemic.
(3) Obesity increases the risk for chronic diseases and
conditions, including high blood pressure, heart disease,
certain cancers, arthritis, mental illness, lipid disorders,
sleep apnea, and type 2 diabetes.
(4) More than half of Medicare beneficiaries are treated
for 5 or more chronic conditions per year. The rate of obesity
among Medicare beneficiaries doubled from 1987 to 2002 and
nearly doubled again by 2016, with Medicare spending on
individuals with obesity during that time rising
proportionately to reach $50 billion in 2014.
(5) Men and women with obesity at age 65 have decreased
life expectancy of 1.6 years for men and 1.4 years for women.
(6) The direct and indirect cost of obesity was more than
$427.8 billion in 2014 and is growing.
(7) On average, a Medicare beneficiary with obesity costs
$2,018 (in 2019 dollars) more than a healthy-weight
beneficiary.
(8) The prevalence of obesity among older individuals in
the United States is growing at a linear rate and, if nothing
changes, nearly one in two (47 percent) Medicare beneficiaries
aged 65 and over will have obesity in 2030, up from slightly
more than one in four (28 percent) in 2010.
SEC. 3. AUTHORITY TO EXPAND HEALTH CARE PROVIDERS QUALIFIED TO FURNISH
INTENSIVE BEHAVIORAL THERAPY.
Section 1861(ddd) of the Social Security Act (42 U.S.C. 1395x(ddd))
is amended by adding at the end the following new paragraph:
``(4)(A) Subject to subparagraph (B), the Secretary may, in
addition to qualified primary care physicians and other primary
care practitioners, cover intensive behavioral therapy for
obesity furnished by any of the following:
``(i) A physician (as defined in subsection (r)(1))
who is not a qualified primary care physician.
``(ii) Any other appropriate health care provider
(including a physician assistant, nurse practitioner,
or clinical nurse specialist (as those terms are
defined in subsection (aa)(5)), a clinical
psychologist, a registered dietitian or nutrition
professional (as defined in subsection (vv))).
``(iii) An evidence-based, community-based
lifestyle counseling program approved by the Secretary.
``(B) In the case of intensive behavioral therapy for
obesity furnished by a provider described in clause (ii) or
(iii) of subparagraph (A), the Secretary may only cover such
therapy if such therapy is furnished--
``(i) upon referral from, and in coordination with,
a physician or primary care practitioner operating in a
primary care setting or any other setting specified by
the Secretary; and
``(ii) in an office setting, a hospital outpatient
department, a community-based site that complies with
the Federal regulations concerning the privacy of
individually identifiable health information
promulgated under section 264(c) of the Health
Insurance Portability and Accountability Act of 1996,
or another setting specified by the Secretary.
``(C) In order to ensure a collaborative effort, the
coordination described in subparagraph (B)(i) shall include the
health care provider or lifestyle counseling program
communicating to the referring physician or primary care
practitioner any recommendations or treatment plans made
regarding the therapy.''.
SEC. 4. MEDICARE PART D COVERAGE OF OBESITY MEDICATION.
(a) In General.--Section 1860D-2(e)(2)(A) of the Social Security
Act (42 U.S.C. 1395w-102(e)(2)(A)) is amended, in the first sentence--
(1) by striking ``and other than'' and inserting ``other
than''; and
(2) by inserting after ``benzodiazepines),'' the following:
``and other than subparagraph (A) of such section if the drug
is used for the treatment of obesity (as defined in section
1861(yy)(2)(C)) or for weight loss management for an individual
who is overweight (as defined in section 1861(yy)(2)(F)(i)) and
has one or more related comorbidities,''.
(b) Effective Date.--The amendments made by subsection (a) shall
apply to plan years beginning on or after the date that is 2 years
after the date of the enactment of this Act.
SEC. 5. REPORT TO CONGRESS.
Not later than the date that is 1 year after the date of the
enactment of this Act, and every 2 years thereafter, the Secretary of
Health and Human Services shall submit a report to Congress describing
the steps the Secretary has taken to implement the provisions of, and
amendments made by, this Act. Such report shall also include
recommendations for better coordination and leveraging of programs
within the Department of Health and Human Services and other Federal
agencies that relate in any way to supporting appropriate research and
clinical care (such as any interactions between physicians and other
health care providers and their patients) to treat, reduce, and prevent
obesity in the adult population.
<all>
Introduced in Senate
Read twice and referred to the Committee on Finance.
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