Sec. 704. Coverage of medically necessary food and vitamins for digestive and inherited metabolic disorders under the TRICARE program
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Congress finds the following: Specialized food is often medically necessary for the safe and effective management of many digestive and inherited metabolic disorders that impact digestion, absorption, and metabolism of nutrients. Although medically necessary food is essential for patients, it is often expensive and not uniformly reimbursed by health insurance, leaving many families with an insurmountable financial burden. As a result, many patients who cannot afford medically necessary food may experience adverse health consequences from suboptimal disease management, including hospitalization, intellectual impairment, behavioral dysfunction, inadequate growth, nutrient deficiencies, and even death.
Section 1077 of title 10, United States Code, is amended— in subsection (a)— in paragraph (3), by inserting before the period at the end the following: , including medically necessary vitamins ; and by adding at the end the following new paragraph: Medically necessary food and the medical equipment and supplies necessary to administer such food (other than medical equipment and supplies described in section 1861(n) of the Social Security Act ( 42 U.S.C. 1395x(n) )). ; and by adding at the end the following new subsection:
For purposes of subsection (a)(3), the term medically necessary vitamins means vitamins used for the management of a covered disease or condition pursuant to the prescription, order, or recommendation (as applicable) of a specified, duly authorized provider, such as a physician (as defined in section 1861(r)(1) of the Social Security Act ( 42 U.S.C. 1395x(r)(1) )), or a nurse practitioner, a clinical nurse specialist, or a physician assistant (as those terms are defined in section 1861(aa)(5) of such Act).
For purposes of subsection (a)(18), the term medically necessary food — means food, including a low protein modified food product or an amino acid preparation product, that is— furnished pursuant to the prescription, order, or recommendation (as applicable) of a specified, duly authorized provider, such as a physician (as defined in section 1861(r)(1) of the Social Security Act ( 42 U.S.C. 1395x(r)(1) )), or a nurse practitioner, a clinical nurse specialist, or a physician assistant (as those terms are defined in section 1861(aa)(5) of such Act), for the dietary management of a covered disease or condition; a specially formulated and processed product (as opposed to a naturally occurring foodstuff used in its natural state) for the partial or exclusive feeding of an individual by means of oral intake or enteral feeding by tube; intended for the dietary management of an individual who, because of therapeutic or chronic medical needs, has limited or impaired capacity to ingest, digest, absorb, or metabolize ordinary foodstuffs or certain nutrients, or who has other special medically determined nutrient requirements, the dietary management of which cannot be achieved by the modification of the normal diet alone; intended to be used under medical supervision, which may include in a home setting; and intended only for an individual receiving active and ongoing medical supervision wherein the individual requires medical care on a recurring basis for, among other things, instructions on the use of the food; and does not include— food taken as part of an overall diet designed to reduce the risk of a disease or medical condition or as weight loss products, even if they are recommended by a physician or other health professional; food marketed as gluten-free for the management of celiac disease or non-celiac gluten sensitivity; food marketed for the management of diabetes; or such other products as the Secretary determines appropriate.
In this subsection: The term covered disease or condition means the following diseases or conditions: Inflammatory bowel disease, including Crohn’s disease, ulcerative colitis, and indeterminate colitis. Gastroesophageal reflux disease that is nonresponsive to standard medical therapies. Immunoglobulin E and non-Immunoglobulin E mediated allergies to food proteins. Food protein-induced enterocolitis syndrome. Eosinophilic disorders, including eosinophilic esophagitis, eosinophilic gastroenteritis, eosinophilic colitis, and post-transplant eosinophilic disorders.
Impaired absorption of nutrients caused by disorders affecting the absorptive surface, functional length, and motility of the gastrointestinal tract, including short bowel syndrome and chronic intestinal pseudo-obstruction. Malabsorption due to liver or pancreatic disease. Inherited metabolic disorders, including the following: Disorders classified as metabolic disorders on the Recommended Uniform Screening Panel Core Conditions list of the Secretary of Health and Human Services’ Advisory Committee on Heritable Disorders in Newborns and Children.
N-acetyl glutamate synthase deficiency. Ornithine transcarbamylase deficiency. Carbamoyl phosphate synthetase deficiency. Inherited disorders of mitochondrial functioning. Such other diseases or conditions as the Secretary determines appropriate. The term low protein modified food product means a product formulated to have less than one gram of protein per serving. . The amendments made by paragraph
(1)shall apply to health care provided under chapter 55 of such title on or after the date that is one year after the date of the enactment of this Act.
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Sec. 704
Coverage of medically necessary food and vitamins for digestive and inherited metabolic disorders under the TRICARE program
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