S.Amdt. 3183

SA 3183. Mr. SANDERS submitted an amendment intended to be proposed
by him to the bill H.R. 2, to provide for the reform and continuation
of agricultural and other programs of the Department of Agriculture
through fiscal year 2023, and for other purposes; which was ordered to
lie on the table; as follows:

At the end of subtitle C of title IV, add the following:

SEC. 43__. MEDICALLY TAILORED MEALS PROGRAM.

(a) Definitions.--In this section:
(1) Eligible entity.--The term ``eligible entity'' means an
entity that is a partnership between a food organization and
a health organization.

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(2) Food organization.--The term ``food organization''
means--
(A) a medically tailored meals organization;
(B) an emergency feeding organization (as defined in
section 201A of the Emergency Food Assistance Act of 1983 (7
U.S.C. 7501));
(C) a senior center or other organization that provides
meals to older individuals;
(D) a farmer's market;
(E) a community-supported agriculture program;
(F) an agricultural cooperative;
(G) a local public benefit corporation; and
(H) a nonprofit organization focused on food insecurity or
improving local food systems, such as a food hub or a Meals
on Wheels program.
(3) Health organization.--The term ``health organization''
means--
(A) a Federally-qualified health center (as defined in
section 1905(l)(2)(B) of the Social Security Act (42 U.S.C.
1396d(l)(2)(B)));
(B) a hospital or clinic operated by the Department of
Veterans Affairs;
(C) a facility operated by the Indian Health Service or the
governing body of an Indian tribe (as defined in section 4 of
the Indian Self-Determination and Education Assistance Act
(25 U.S.C. 5304));
(D) a nonprofit hospital that is--
(i) a critical access hospital (as defined in section
1861(mm)(1) of the Social Security Act (42 U.S.C.
1395x(mm)(1)));
(ii) a disproportionate share hospital that receives
payments under section 1886(d)(5)(F) of the Social Security
Act (42 U.S.C. 1395ww(d)(5)(F)); or
(iii) a Medicare-dependent, small rural hospital (as
defined in section 1886(d)(5)(G)(iv) of the Social Security
Act (42 U.S.C. 1395ww(d)(5)(G)(iv))); and
(E) a sole community hospital (as defined in section
1886(d)(5)(D)(iii) of the Social Security Act (42 U.S.C.
1395ww(d)(5)(D)(iii))).
(4) Low-income household.--The term ``low-income
household'' means a household--
(A) in which 1 or more individuals are receiving--
(i) assistance under a State program funded under part A of
title IV of the Social Security Act (42 U.S.C. 601 et seq.);
(ii) supplemental security income payments under title XVI
of the Social Security Act (42 U.S.C. 1381 et seq.);
(iii) supplemental nutrition assistance program benefits
under the Food and Nutrition Act of 2008 (7 U.S.C. 2011 et
seq.);
(iv) assistance under the Medicaid program under title XIX
of the Social Security Act (42 U.S.C. 1396 et seq.);
(v) free or reduced price school meals under the Richard B.
Russell National School Lunch Act (42 U.S.C. 1751 et seq.) or
the Child Nutrition Act of 1966 (42 U.S.C. 1771 et seq.);
(vi) assistance under the low-income home energy assistance
program established under the Low-Income Home Energy
Assistance Act of 1981 (42 U.S.C. 8621 et seq.); or
(vii) payments under--

(I) section 1315, 1521, 1541, or 1542 of title 38, United
States Code; or
(II) section 306 of the Veterans' and Survivors' Pension
Improvement Act of 1978 (38 U.S.C. 1521 note; Public Law 95-
588); or

(B) that has an income that, as determined by the State in
which the household is located, does not exceed the greater
of--
(i) an amount equal to 200 percent of the poverty level for
that State; and
(ii) an amount equal to 80 percent of the median income for
that State.
(5) Medically tailored meals organization.--The term
``medically tailored meals organization'' means an entity
that has experience providing medically tailored meals and
individualized medical nutrition therapy or nutrition
counseling to meal recipients, as determined by the
Secretary.
(6) Medically tailored meals program.--The term ``medically
tailored meals program'' means a program under which meals
are designed by a registered dietitian or other nutrition
professional, as determined by the Secretary, to benefit a
low-income individual with a chronic condition.
(7) Wellness.--The term ``wellness'' means the 8 dimensions
of wellness described by the Secretary of Health and Human
Services for purposes of the Eight Dimensions of Wellness
program administered by the Substance Abuse and Mental Health
Services Administration.
(b) Establishment.--
(1) In general.--The Secretary, in coordination with other
applicable Federal agencies, shall establish a program under
which the Secretary shall award grants to eligible entities
to conduct pilot projects to demonstrate and evaluate the
impact of a medically tailored meals program on low-income
individuals with 1 or more chronic conditions that may be
improved by access to a healthy diet.
(2) Duration.--The Secretary shall carry out the program
under paragraph (1) for a 5-year period beginning on the date
that is 5 months after the date of enactment of this Act.
(3) Location.--The Secretary shall award grants under
paragraph (1) to eligible entities that are located in not
less than 10 States.
(c) Grants.--
(1) Application.--
(A) In general.--To be eligible to receive a grant under
subsection (b)(1), an eligible entity shall submit to the
Secretary an application at such time, in such manner, and
containing such information as the Secretary shall require,
including the information described in subparagraph (B).
(B) Contents.--An application submitted under subparagraph
(A) shall include--
(i) a description of the methods by which a medically
tailored meals program will target low-income individuals
with 1 or more chronic conditions that may be improved by
access to a healthy diet;
(ii) a plan for the screening and enrollment of the
individuals targeted under clause (i);
(iii) a plan for the evaluation of each individual that is
participating in the medically tailored meals program--

(I)(aa) at the time of entrance into the program, after 3
months of participation in the program, and after 6 months of
participation in the program; or
(bb) halfway through the duration of the program and at the
completion of the program; and
(II) that includes a plan to conduct an assessment of--

(aa) the health of the individual, including--
(AA) the effect on each identified chronic condition of the
individual and on the overall health of the individual;
(BB) the reliance of the individual on medication to
control each identified chronic condition of the individual;
and
(CC) the perception of the individual of the overall
personal health and wellness of that individual;
(bb) any reduction of individual and household food
insecurity;
(cc) any reduction in overall health care spending and
costs, including out-of-pocket costs, in-patient
hospitalization, emergency department visits, emergency
transport, and spending on medication;
(dd) any increased consumption of domestic fruits and
vegetables; and
(ee) any other clinically significant factor, as determined
by the Secretary, in coordination with the Secretary of
Health and Human Services.
(iv) a description of a plan to include educational
opportunities relating to nutrition for individuals
participating in a medically tailored meals program;
(v) a description of the partnership that constitutes the
eligible entity and the role of each partner in carrying out
a medically tailored meals program;
(vi) documentation of any necessary partnership agreements
or memoranda of understanding with a State Medicaid agency or
other appropriate entity to evaluate the effectiveness of a
medically tailored meals program in reducing health care use
and associated costs; and
(vii) a description of the methodology for the collection
and aggregation of data under subsection (d)(1) to analyze
the benefit of a medically tailored meals program on
individuals participating in that program.
(C) Submission deadline.--The Secretary shall not accept an
application under subparagraph (A) that is submitted less
than 1 year before the date on which the program terminates
under subsection (b)(2).
(2) Priority.--The Secretary shall give priority to an
eligible entity submitting an application under paragraph (1)
that--
(A) is a nonprofit organization that has demonstrable
experience, as determined by the Secretary, in--
(i) providing medically tailored meals to individuals;
(ii) reducing individual and household food insecurity; or
(iii) providing low-income individuals with access to
health care;
(B) is located in a State that has one of the 5 oldest
populations, as measured by median age;
(C) is located in a State that has an agreement with the
Federal Government that contains targets for health outcomes
and quality of care that include prioritization of chronic
conditions; or
(D) has demonstrated support for the development of local
or regional agriculture and food systems, as determined by
the Secretary.
(3) Grant duration.--A grant awarded under this section
shall be for a period of not less than 2 years.
(d) Pilot Projects.--
(1) In general.--An eligible entity conducting a pilot
project under a grant awarded under subsection (b)(1) shall
measure and evaluate the impact of the pilot project on the
factors described in items (aa) through (ee) of subsection
(c)(1)(B)(iii)(II).
(2) Individual participation.--An eligible entity
conducting a pilot project under a grant awarded under
subsection (b)(1) shall ensure that an individual
participating in the pilot project is enrolled and active in
the pilot project for not less than 1 year.
(e) Technical Assistance.--Of the funds under subsection
(g), the Secretary may use not more than $1,000,000 to
provide technical assistance to eligible entities awarded
grants under subsection (b)(1).
(f) Report.--Not later than 180 days after the termination
of the program under subsection (b)(2), the Secretary shall
submit to the Committee on Agriculture and the Committee on
Energy and Commerce of the House of Representatives and the
Committee on Agriculture, Nutrition, and Forestry and the
Committee on Health, Education, Labor, and Pensions of the
Senate a report that contains the recommendations of the
Secretary, in consultation with the Secretary of Human
Services--

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(1) on the advisability and feasibility of the continuation
or expansion of that program; and
(2) that are based on the impact of the program on the
factors described in items (aa) through (ee) of subsection
(c)(1)(B)(iii)(II).
(g) Authorization of Appropriations.--There is authorized
to be appropriated to carry out this section $20,000,000 for
each of fiscal years 2019 through 2023.
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