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Title II — Advancing Preventative Measures and Treatment of Obesity in Adults and Children in Underserved Communities

H.R. 4765 · 113th Congress · May 29, 2014 · Lineage

II Advancing Preventative Measures and Treatment of Obesity in Adults and Children in Underserved Communities

Sec. 201 Community health and wellness navigators pilot program: connecting America’s health professionals with our schools

(a)
In general— The Secretary of Health and Human Services shall award grants to 5 or more States for the establishment of a community navigator program, consisting of each such State making subgrants to 1 or more eligible entities for a local community navigator program described in subsection (b).
(b)
Program description— A local community navigator program described in this subsection shall consist of the following:
(1)
An eligible entity, in partnership with a local educational agency, a bureau-funded school, or a nonprofit health or education organization, will hire and train 2 or more community navigators.
(2)
The community navigators will facilitate a relationship between the eligible entity and the local educational agency, bureau-funded school, or nonprofit health or education organization in low-income communities to ensure increased access to medical care through educating parents and school administrators.
(3)
The community navigators will carry out educational activities for elementary school and secondary school students and their parents in low-income communities with the goal of—
(A)
increasing familial intake of nutritious meals;
(B)
increasing physical activity both in and out of the school setting; and
(C)
increasing access to medical care.
(4)
The community navigators will specifically recognize and address that there are subgroups that are shown to have particular barriers to physical activities, such as persons with disabilities.
(c)
Report— Not later than 2 years after the date of the enactment of this Act, the Secretary shall submit a report to the Congress on the effectiveness of the program under this section.
(d)
Definitions— In this section:
(1)
The term bureau-funded school has the meaning given such term in section 1146 of the Education Amendments of 1978 (25 U.S.C. 2026).
(2)
The terms elementary school, local educational agency, and secondary school have the meanings given to such terms in section 9101 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7801).
(3)
The term eligible entity includes a Federally qualified health center (as defined in section 1861(aa) of the Social Security Act (42 U.S.C. 1395x(aa))), a facility operated by the Indian Health Service (including a facility operated by an Indian tribe or tribal organization through a contract or compact with the Service under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.)), a free-standing children’s hospital that is described in subparagraph (L) or (M) of section 340B(a)(4) of the Public Health Service Act (42 U.S.C. 256b(a)(4)), a non-profit with demonstrated effectiveness in the area of health care and with a focus on serving low-income communities, a rural hospital, and a rural health clinic.
(4)
The term low-income communities includes—
(A)
communities with a high percentage of children eligible for free and reduced priced lunches under the Richard B. Russell National School Lunch Act (42 U.S.C. 1751 et seq.); and
(B)
any other communities determined by the Secretaries to be low-income for purposes of this section.
(5)
The term nonprofit health or education organization shall be defined by the Secretary.
(6)
The term Secretary means the Secretary of Health and Human Services.
(7)
The term State includes the District of Columbia and any commonwealth, territory, or possession of the United States, including the Commonwealth of Puerto Rico, the United States Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands.
(e)
Authorization of appropriations— To carry out this section, there are authorized to be appropriated such sums as may be necessary for fiscal years 2015 and 2016.

Sec. 202 Coverage of evidence-based preventive services under Medicaid and SCHIP

(a)
State Option To Provide Medical Assistance for Evidence-Based Preventive Services—
(1)
In general— Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended—
(A)
in subsection (a)—
(i)
in paragraph (28), by striking “and” at the end;
(ii)
by redesignating paragraph (29) as paragraph (30); and
(iii)
by inserting after paragraph (28) the following:

“(29) evidence-based preventive services described in subsection (ee); and”

(B)
by adding at the end the following:

“(ee) For purposes of subsection (a)(29), evidence-based preventive services described in this subsection are—

“(1) any preventive services which the Secretary has determined are reasonable and necessary for preventing obesity and comorbidities of obesity, including diet and exercise counseling, and healthy weight and obesity counseling; and

“(2) any other evidence-based, effective, clinical intervention for obese individuals designed to prevent comorbidities of obesity, including pharmacological or surgical services.”

(2)
Conforming amendment— Section 1902(a)(10)(C)(iv) of such Act (42 U.S.C. 1396(a)(10)(C)(iv)) is amended by inserting “, or (29)” after “(24)”.
(b)
State option To provide child health assistance for evidence-Based preventive services— Section 2110(a) of the Social Security Act (42 U.S.C. 1397jj(a)) is amended—
(1)
by redesignating paragraph (28) as paragraph (29); and
(2)
by inserting after paragraph (27) the following:

“(28) Evidence-based preventive services described in section 1905(ee).”

Sec. 203 Coverage of medical nutrition therapy under Medicaid and CHIP

(a)
State Option To Provide Medical Assistance for Medical Therapy Services—
(1)
In general— Section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)), as amended by section 202(a)(1), is amended—
(A)
in paragraph (29), by striking “and” at the end;
(B)
by redesignating paragraph (30) as paragraph (31); and
(C)
by inserting after paragraph (29) the following:

“(30) medical nutrition therapy services (as defined in section 1861(vv)(1)) for individuals with prediabetes or obesity or who are overweight (as defined by the Secretary); and”

(2)
Conforming amendment— Section 1902(a)(10)(C)(iv) of such Act (42 U.S.C. 1396(a)(10)(C)(iv)), as amended by section 202(a)(2), is amended by striking “or (29)” and inserting “(29), or (30)”.
(b)
State option To provide child health assistance for medical nutrition therapy services— Section 2110(a) of the Social Security Act (42 U.S.C. 1397jj(a)), as amended by section 202(b), is amended—
(1)
by redesignating paragraph (29) as paragraph (30); and
(2)
by inserting after paragraph (28) the following:

“(29) Medical nutrition therapy services (as defined in section 1861(vv)(1)) for individuals with prediabetes or obesity or who are overweight (as defined by the Secretary).”

Sec. 204 Clarification of EPSDT inclusion of prevention, screening, and treatment services for obesity and overweight; CHIP coverage

(a)
In general— Section 1905(r) of the Social Security Act (42 U.S.C. 1396d(r)) is amended—
(1)
in paragraph (1)(B)—
(A)
in clause (iv), by striking “and” at the end;
(B)
in clause (v), by striking the period at the end and inserting “, and”; and
(C)
by adding at the end the following:

“(vi) weight and BMI measurement and monitoring.”

(2)
in paragraph (5), by inserting “(including treatment services related to obesity and body weight, such as medical nutrition therapy services (as defined in section 1861(vv)(1)), physical therapy, exercise training, behavioral health counseling, and such other evidence-based services as recommended by the Secretary (taking into consideration the American Academy of Pediatrics Expert Committee Guidelines Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity and the National Center on Health, Physical Activity, and Disability’s Physical Activity Guidelines for Individuals with Disabilities)” after “screening services”.
(b)
CHIP—
(1)
Required coverage— Section 2103 of the Social Security Act (42 U.S.C. 1397cc) is amended—
(A)
in subsection (a), in the matter preceding paragraph (1), by striking “and (7)” and inserting “(7), and (8)”; and
(B)
in subsection (c)—
(i)
by redesignating paragraphs (7) and (8) as paragraphs (8) and (9), respectively; and
(ii)
by inserting after paragraph (6), the following:

“(7) Prevention, screening, and treatment services for overweight and obese—The child health assistance provided to a targeted low-income child shall include coverage of weight and BMI measurement and monitoring, as well as appropriate treatment services, including medical nutrition therapy services (as defined in section 1861(vv)(1)), physical therapy or exercise training, including steps needed to make such therapy and training inclusive for persons with disabilities, behavioral health counseling, and such other evidence-based services as recommended by the Secretary. For purposes of the previous sentence the Secretary shall take into consideration the American Academy of Pediatrics Expert Committee Guidelines Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity and the National Center on Health, Physical Activity, and Disability’s Physical Activity Guidelines for Individuals with Disabilities.”

(2)
Conforming amendment— Section 2102(a)(7)(B) of the Social Security Act (42 U.S.C. 1397bb(c)(2)) is amended by striking “section 2103(c)(5)” and inserting “paragraphs (5) and (7) of section 2103(c)”.

Sec. 205 National Commission on Child Obesity

(a)
Establishment— There is established a commission to be known as the National Commission on Child Obesity (in this section referred to as the “Commission”).
(b)
Duties of commission— The Commission shall—
(1)
conduct a comprehensive study that examines and assesses the needs of children relating to the prevalence, prevention, and treatment of childhood overweight and obesity, including specific findings relating to—
(A)
best practices for the prevention and treatment of childhood overweight and obesity;
(B)
child physical health and mental health;
(C)
childcare in all settings;
(D)
child welfare;
(E)
elementary and secondary education;
(F)
food availability in neighborhoods;
(G)
access to health care;
(H)
health care utilization;
(I)
built environment;
(J)
parent physical health and education;
(K)
underserved communities, including tribal communities, health professional shortage areas designated under section 332 of the Public Health Service Act (42 U.S.C. 254e), medically underserved areas (as defined in section 799B of such Act (42 U.S.C. 295p), and areas in the Appalachian region (as defined in section 14102(a) of title 40, United States Code);
(L)
relevant activities in childhood overweight and obesity;
(M)
the availability of information on State and Federal supportive nutrition programs, such as the Summer Food Service Program, the Women, Infants, and Children Program, the State Children’s Health Insurance Program under title XXI of the Social Security Act, and the Supplemental Nutrition Assistance Program; and
(N)
children with disabilities;
(2)
identify, review, and evaluate existing laws, regulations, policies, programs, and public health initiatives relevant to best practices for the prevalence, prevention, and treatment of childhood overweight and obesity;
(3)
identify, review, and evaluate the lessons learned from past laws, regulations, policies, programs, and public health initiatives relevant to the prevalence, prevention, and treatment of childhood overweight and obesity;
(4)
advise on the need to revise laws, regulations, policies, and programs relative to addressing best practices for the prevalence, prevention, and treatment of childhood overweight and obesity at regular intervals as new knowledge is gained;
(5)
include in the interim report required by subsection (i)(1) recommendations on—
(A)
the appropriate Federal agency to establish the infrastructure for the creation of a comprehensive nationwide registry of patient data associated with children living with obesity;
(B)
the specific criteria needed for such registry to allow the field of pediatric clinicians access to patient-level, clinical data suitable for research and the development of best practices;
(C)
the appropriate funding level required for the establishment and implementation of such the registry described in subparagraph (A); and
(D)
how to capture large-scale data that are currently unavailable on adolescent and child patients who are currently obese; and
(6)
include in the final report required by subsection (i)(3) the Commission’s specific findings, conclusions, and recommendations to address the needs of children relating to the prevention and treatment of childhood overweight and obesity, including specific recommendations on—
(A)
the need for planning and establishing a national resource center for children and obesity; and
(B)
such coordination of resources and services, administrative actions, policies, regulations, and legislative changes as the Commission considers appropriate.
(c)
Composition—
(1)
Members— The Commission shall be composed of 15 members, of whom—
(A)
3 members, including at least one from each major national political party, shall be appointed by the President;
(B)
3 members shall be appointed by the majority leader of the Senate;
(C)
3 members shall be appointed by the minority leader of the Senate;
(D)
3 members shall be appointed by the Speaker of the House of Representatives; and
(E)
3 members shall be appointed by the minority leader of the House of Representatives.
(2)
Appointment— Members of the Commission shall be appointed not later than 6 months after the date of the enactment of this Act.
(3)
Chairperson, vice chairperson, and meetings—
(A)
In general— Not later than 30 days after the date on which all members of the Commission are appointed under paragraph (1), such members shall meet to elect a Chairperson and Vice Chairperson from among such members and shall determine a schedule of Commission meetings.
(B)
Initial meeting— The Commission shall meet and begin the operations of the Commission not later than 120 days after the appointment of members of the Commission.
(4)
Governmental appointees— An individual appointed to the Commission may not be an official or employee of the Federal Government.
(5)
Commission representation— The Commission shall include at least one—
(A)
representative from each of a nonprofit and for-profit entity with demonstrated expertise in addressing the needs of children relating to the prevalence, prevention, and treatment of childhood overweight and obesity;
(B)
State or local director of health; and
(C)
tribal health representative.
(6)
Qualifications— Members appointed under paragraph (1) may include—
(A)
individuals involved with providing services to children, including health and other social services;
(B)
individuals involved with administering health insurance coverage to children;
(C)
individuals with experience in public health initiatives relating to the prevention and treatment of childhood overweight and obesity, including coordination of resources and services among State and local governments, the Federal Government, and nongovernmental entities;
(D)
individuals with philanthropic experience focused on the needs of children relating to the prevalence, prevention, and treatment of childhood overweight and obesity;
(E)
individuals who have conducted academic research relating to the prevalence, prevention, and treatment of childhood overweight and obesity; and
(F)
individuals with significant experience in child health and policy.
(7)
Quorum and Vacancy—
(A)
Quorum— A majority of the members of the Commission shall constitute a quorum, but a lesser number of members may hold hearings.
(B)
Vacancy— Any vacancy in the Commission shall not affect its powers and shall be filled in the same manner in which the original appointment was made.
(d)
Powers of commission—
(1)
Hearings— The Commission may hold such hearings, meet and act at such times and places, and receive such evidence as may be necessary to carry out the functions of the Commission.
(2)
Information from Federal agencies—
(A)
In general— The Commission may access, to the extent authorized by law, from any executive department, bureau, agency, board, commission, office, independent establishment, or instrumentality of the Federal Government such information, suggestions, estimates, and statistics as the Commission considers necessary to carry out this section.
(B)
Provision of information— On written request of the Chairperson of the Commission, each department, bureau, agency, board, commission, office, independent establishment, or instrumentality of the Federal Government shall, to the extent authorized by law, provide the requested information to the Commission.
(C)
Receipt, handling, storage, and dissemination— Information shall only be received, handled, stored, and disseminated by members of the Commission and its staff consistent with all applicable statutes, regulations, and Executive orders.
(3)
Assistance from Federal agencies—
(A)
General services administration— On request of the Chairperson of the Commission, the Administrator of General Services shall provide to the Commission, on a reimbursable basis, administrative support and other assistance necessary for the Commission to carry out its duties.
(B)
Other departments and agencies— In addition to assistance under subparagraph (A), departments and agencies of the United States may provide to the Commission such assistance as they determine advisable and as authorized by law.
(4)
Contracting— The Commission may enter into financially reasonable contracts to enable the Commission to discharge its duties under this section.
(5)
Postal services— The Commission may use the United States mails in the same manner and under the same conditions as a department or agency of the United States.
(e)
Staff of commission—
(1)
In general— The Chairperson of the Commission, in consultation with the Vice Chairperson, in accordance with rules agreed upon by the Commission, may appoint and fix the compensation of a staff director, policy director, and administrative assistant (and other staff if agreed upon by a majority of Commission members) to enable the Commission to carry out its functions, in accordance with the provisions of title 5, United States Code, except that no rate of pay fixed under this paragraph may exceed the equivalent of that payable for a position at level V of the Executive Schedule under section 5316 of title 5, United States Code.
(2)
Staff of Federal agencies— Upon request of the Chairperson of the Commission, the head of any executive department, bureau, agency, board, commission, office, independent establishment, or instrumentality of the Federal Government may detail, without reimbursement, any of its personnel to the Commission to assist it in carrying out its duties under this section. Any detail of an employee shall be without interruption or loss of civil service status or privilege.
(3)
Consultant services— The Commission is authorized to procure (pursuant to a majority vote of the Commission members) the services of experts and consultants in accordance with section 3109 of title 5, United States Code, but at rates not to exceed the daily equivalent of the annual rate of basic pay for level IV of the Executive Schedule under section 5315 of title 5, United States Code.
(f)
Travel expenses— Each member of the Commission shall serve without compensation, but shall receive travel expenses, including per diem in lieu of subsistence, in accordance with applicable provisions in the same manner as persons employed intermittently in the Government service are allowed expenses under section 5703 of title 5, United States Code.
(g)
Applicability of FACA— The Federal Advisory Committee Act, including any provisions applicable to staff, is deemed to apply to the Commission.
(h)
Reports of commission; termination—
(1)
Interim report— The Commission shall, not later than 1 year after the date of its first meeting, submit to the President and the Congress an interim report containing specific findings, conclusions, and recommendations required under this section and agreed to by a majority of Commission members.
(2)
Other reports and information—
(A)
Reports— The Commission may issue additional reports as the Commission determines necessary.
(B)
Information— The Commission may hold public hearings to collect information and shall make such information available for use by the public.
(3)
Final report— The Commission shall, not later than 2 years after the date of its first meeting, submit to the President and Congress a final report containing specific findings, conclusions, and recommendations required under this section and agreed to by a majority of Commission members.
(4)
Termination—
(A)
In general— Unless reauthorized by statute, the Commission, and all the authorities of this section, shall terminate 180 days after the date on which the final report is submitted under paragraph (3).
(B)
Records— Not later than the date of termination of the Commission under subparagraph (A), all records and papers of the Commission shall be delivered to the Archivist of the United States for deposit in the National Archives.
(i)
Definitions— In this section:
(1)
Obesity— The term obesity with respect to children means having a body mass index (BMI) greater than or equal to the 95th percentile for age and sex according to the Centers for Disease Control and Prevention.
(2)
Child; children— The terms child and children mean an individual or individuals, respectively, who have not attained 18 years of age.
(j)
Authorization of appropriations— There is authorized to be appropriated to carry out this section, $1,500,000 for each of fiscal years 2015 and 2016.

Sec. 206 GAO report

Not later than 2 years after the first appropriation of Federal funds to carry out this Act, the Comptroller General of the United States shall submit to Congress a report on the effectiveness of the activities carried out under this Act in reducing child obesity, which shall include an analysis of the costs and the benefits of such activities.