Statements on Introduced Bills and Joint Resolutions

Floor Speech

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Ms. COLLINS. Mr. President, I rise today to join my colleague from Michigan, Senator Peters, in introducing legislation to expand Medicare beneficiaries' access to Medical Nutrition Therapy, or MNT, which is a cost-effective component of treatment for obesity, diabetes, hypertension, dyslipidemia, and other chronic conditions. At a time when we are seeing many diet-related chronic conditions contribute to poor COVID-19 outcomes, increasing access to MNT should be part of the strategy to improve disease management and prevention for America's seniors. Our legislation, the Medical Nutrition Therapy Act of 2020, would make two important changes to support patients, improve health outcomes, and reduce unnecessary healthcare costs.

First, it would expand Medicare Part B coverage of outpatient medical nutrition therapy services to a number of currently uncovered diseases or conditions--including prediabetes, obesity, high blood pressure, high cholesterol, malnutrition, eating disorders, cancer, celiac disease, and HIV/AIDS. Currently, Medicare Part B only covers outpatient MNT for diabetes, renal disease, and post-kidney transplant. Second, the bill would allow more types of providers--including nurse practitioners, physician assistants, clinical nurse specialists, and psychologists--to refer patients to MNT. This is especially critical for a rural State like Maine, where a NP or PA may be one's trusted primary care provider.

MNT counseling is provided by registered dietitian nutritionists, RDNs, as part of a collaborative healthcare team. It is evidenced-based and proven to positively impact weight, blood pressure, blood lipids, and blood sugar control, and nutritional counseling by RDNs is even recommended by the National Lipid Association to promote long-term adherence to an individualized, heart-healthy diet. Through MNT, individuals benefit from in-depth individualized nutrition assessments and trusted followup visits for the repeated reinforcement necessary to aid with behavior and lifestyle changes.

Seniors deserve improved access to this cost-effective medical treatment, but many older adults are missing out under the current Medicare policy. Marcy Kyle, a RDN from Rockport, ME, shared numerous stories of patients being denied access to medically necessary MNT that illustrate why this legislation is needed. In one story, a patient with prediabetes was referred by his primary care physician for MNT at age 64. At that time, his private insurance covered the service and he booked the first available appointment the following week. But this patient turned 65 that week and transitioned onto Medicare. You can imagine his surprise upon arriving for his appointment that MNT would not be covered. While the outpatient facility changed its process after this case in order to prevent similar situations, it demonstrates how the current restrictions are detrimental for older adults at a critical juncture in their health journey.

Another example from Maine was a patient with a new diagnosis of celiac disease complicated by severe weight loss. His private insurance covered MNT as celiac disease is a very controllable disease with proper nutrition. But when transitioning from private insurance to Medicare, this patient lost his opportunity for MNT. We know that early treatment with MNT can prevent future and more serious health complications and chronic conditions in older adults, and conditions such as prediabetes and celiac disease should be covered.

The health and financial crisis brought on by the COVID-19 pandemic makes access to MNT even more important. Seniors with diet-related conditions are suffering more than any other population in terms of the worst health outcomes, including death. Data from the Centers for Medicare & Medicaid Services, CMS, in June confirmed elevated risk for seniors with underlying health conditions. Among those hospitalized with COVID-19, 79 percent of patients had hypertension, 60 percent had hyperlipidemia, 50 percent of patients either presented with chronic kidney disease or diabetes. Tragically, of those hospitalized, 28 percent were never able to leave the hospital because they passed away.

In addition to the significant health impacts, the economic impact of chronic diseases is staggering. According to the U.S. Centers for Disease Control and Prevention, 90 percent of the $3.5 trillion the United States spends annually on health care goes to the treatment of people with chronic diseases and mental health conditions. Preventing chronic diseases, or managing symptoms when prevention is not possible, is one way to reduce these costs. This is particularly important for the Medicare Program as more than two-thirds of seniors on Medicare live with multiple chronic conditions. As one registered dietition nutritionist in Maine told me, ``We all know a dollar spent on prevention saves many health care dollars in the long run and is the right thing to do for our seniors at a time when they have limited budgets.''

The Medical Nutrition Therapy Act of 2020 is supported by more than 30 national organizations, including the Academy of Nutrition and Dietetics, the American Diabetes Association, the Endocrine Society, the American Cancer Society Cancer Action Network, and the National Kidney Foundation.

I urge my colleagues to support this important legislation to improve access to cost-effective medical treatment for Medicare patients with chronic diseases.

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