S. 1640Senate111th Congress (2009-2011)In Committee

Take Back Your Health Act of 2009

A bill to amend title XVIII of the Social Security Act to provide coverage of intensive lifestyle treatment.

Sponsored by Ron WydenSen. Ron Wyden (D-OR)
Introduced August 6, 2009

Legislative Activity

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2 earlier actions
SenateIntro Referral Latest Action

Read twice and referred to the Committee on Finance.

August 6, 2009

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SenateIntro Referral

Introduced in Senate

August 6, 2009

SenateIntro Referral

Sponsor introductory remarks on measure. (CR S9043-9044)

August 6, 2009

SenateIntro Referral

Read twice and referred to the Committee on Finance.

August 6, 2009

Floor Debate

19 members

What members said about S. 1640 on the floor

2 Republicans16 Democrats1 Independent
Maria Cantwell
Sen. Maria CantwellD-WA · Aug 6, 2009

Mr. President, I am pleased to join with my colleague, Senator Grassley, and introduce an important piece of legislation that will modernize the tax incentive for domestic biodiesel production. The…

Michael F. Bennet
Sen. Michael F. BennetD-CO · Aug 6, 2009

Mr. President, I cannot tell you how much I appreciated your remarks--I was sitting in the chair--and those of Chairman Dodd as well. The hour is late. The idea that you would be here at that hour to…

Jeff Bingaman
Sen. Jeff BingamanD-NM · Aug 6, 2009

Mr. President, as the success of the Cash for Clunkers Program that we are working to extend today makes clear, there is substantial interest among consumers in upgrading the fuel efficiency of their…

Christopher J. Dodd
Sen. Christopher J. DoddD-CT · Aug 6, 2009

Mr. President, I rise to introduce the Livable Communities Act. Our communities are growing and changing. And the way we plan for their futures needs to evolve, as well. At stake is whether or not we…

Mark Udall
Sen. Mark UdallD-CO · Aug 6, 2009

Mr. President, today I am introducing along with my friend and colleague, Senator Bennet, the Ruedi Reservoir Water Allocation for Recovery of Endangered Fish Act. This bill will help address…

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Sheldon Whitehouse
Sen. Sheldon WhitehouseD-RI · Aug 6, 2009

I rise to speak in support of the Foreign Manufacturers Legal Accountability Act of 2009, which I am introducing today with the ranking member of the Judiciary Committee, Senator Sessions, and…

John D. Rockefeller IV
Sen. John D. Rockefeller IVD-WV · Aug 6, 2009

Mr. President, I rise today with the newest esteemed Member of this Chamber, Senator Al Franken, to introduce the Affordable Access to Prescription Medications Act of 2009. I think this is the first…

Ron Wyden
Sen. Ron WydenD-OR · Aug 6, 2009

Mr. President, businesses like airlines, trucking companies, and heating oil distributors buy and sell oil and futures contracts because they need to do so to run their day-to-day business and hedge…

Olympia J. Snowe
Sen. Olympia J. SnoweR-ME · Aug 6, 2009

Mr. President, I rise today to reintroduce legislation that will increase the trustworthiness of our Nation's mortgage security market by creating the Federal Board of Certification for mortgage…

Byron L. Dorgan
Sen. Byron L. DorganD-ND · Aug 6, 2009

Mr. President, today I introduced a bill entitled 7th Generation Promise: Indian Youth Suicide Prevention Act, to address the crisis of youth suicide in Indian Country. I introduce this legislation…

Patty Murray
Sen. Patty MurrayD-WA · Aug 6, 2009

Mr. President, for a child in a developing country, very simple tools, like safe injection technologies for vaccination, can mean the difference between life and death. But the fact is that many…

Russell D. Feingold
Sen. Russell D. FeingoldD-WI · Aug 6, 2009

Mr. President, today I am reintroducing legislation that seeks to answer a question more and more Americans are asking in light of our economic woes and our struggle toward energy independence: Why…

Bernard Sanders
Sen. Bernard SandersI-VT · Aug 6, 2009

Mr. President, today I am pleased to introduce the Thermal Energy Efficiency Act, which I believe can play an important role in moving our Nation toward green job creation and greenhouse gas…

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Barbara Boxer
Sen. Barbara BoxerD-CA · Aug 6, 2009

Mr. President, I rise to discuss the Gold Hill-Wakamatsu Preservation Act. This legislation would authorize the Bureau of Land Management to acquire and manage the Gold Hill Ranch near Coloma,…

Tom Harkin
Sen. Tom HarkinD-IA · Aug 6, 2009

Mr. President, our national energy situation continues to deteriorate. Volatile petroleum and gasoline prices threaten our economy, and our oil imports are responsible for an incredibly large wealth…

Ron Wyden
Sen. Ron WydenD-OR · Aug 6, 2009

Mr. President, I rise today to introduce the Take Back Your Health Act of 2009. I want to thank my friends Senator Cornyn and Senator Harkin for joining as original cosponsors of this bill. This bill…

Patrick J. Leahy
Sen. Patrick J. LeahyD-VT · Aug 6, 2009

Mr. President, today, I am pleased to introduce the Reserve Officers Association Modernization Act of 2009. I want to thank Senators Chambliss and Pryor for joining me to introduce this legislation.…

Edward M. Kennedy
Sen. Edward M. KennedyD-MA · Aug 6, 2009

Mr. President, this morning, 660,000 police officers and 300,000 firefighters across the country will get up and go to work to protect our homes, our families, and our communities. They will go into…

Jeff Sessions
Sen. Jeff SessionsR-AL · Aug 6, 2009

Mr. President, Senator Whitehouse's legislation would help American consumers bring civil claims against foreign manufacturers who produce faulty goods and send them into the U.S. market. Currently,…

Jeff Merkley
Sen. Jeff MerkleyD-OR · Aug 6, 2009

Mr. President, in recent years, consumer credit has gone from providing convenience and short-term financing to a game of tricks and traps that strips families of hard earned resources and locks the…

Bill Text

Latest available legislative text

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Introduced in SenateIssued August 6, 2009

II

111th CONGRESS

1st Session

S. 1640

IN THE SENATE OF THE UNITED STATES

August 6, 2009

Mr. Wyden (for himself, Mr. Cornyn, and Mr. Harkin) 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 coverage of intensive lifestyle treatment.

1.

Short title

This Act may be cited as the Take Back Your Health Act of 2009.

2.

Coverage of intensive lifestyle treatment

(a)

Intensive lifestyle treatment program

(1)

In general

Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended—

(A)

in subsection (s)(2)—

(i)

in subparagraph (DD) by striking and at the end;

(ii)

in subparagraph (EE) by inserting and at the end; and

(iii)

by adding at the end the following new subparagraph:

(FF)

items and services furnished under an intensive lifestyle treatment program (as defined in paragraph (hhh)(1)) to eligible beneficiaries (as defined in paragraph (hhh)(4));

; and

(B)

by adding at the end the following new subsection:

(hhh)

Intensive lifestyle treatment program

(1)

The term intensive lifestyle treatment program means a physician-supervised program (as defined in paragraph (2)) that furnishes the items and services described in paragraph (3) intended to beneficially affect the progression of chronic diseases to eligible beneficiaries (as defined in paragraph (4)).

(2)

A program described in this paragraph is a program under which—

(A)

items and services under the program are delivered—

(i)

in a physician's office or clinic;

(ii)

in a hospital on an outpatient basis; or

(iii)

in other settings determined appropriate by the Secretary;

(B)

a physician (as defined in section 1861(r)(1)) is immediately available and accessible for medical consultation and medical emergencies at all times items and services are being furnished under the program, except that, in the case of items and services furnished under such a program in a hospital, such availability shall be presumed;

(C)

individualized treatment is furnished under a written plan established and designed by a physician (as so defined) in advance of the start of the program and reviewed and signed by a physician every 60 days that describes—

(i)

the individual's diagnosis;

(ii)

the type, amount, frequency, and duration of the items and services furnished under the plan; and

(iii)

the goals set for the individual under the plan;

(D)

items and services may be provided in a series of 72 one-hour sessions (as defined in section 1848(b)(6)), up to 6 sessions per day, over a period of 18 weeks, and may include group sessions with up to 15 other eligible beneficiaries; and

(E)

items and services may be provided—

(i)

by an intensive lifestyle team;

(ii)

under the direction of a physician (as so defined); and

(iii)

if determined appropriate by the Secretary, in the case of such items and services provided in underserved areas, by a physician assistant, nurse practitioner, or clinical nurse specialist as provided under State law.

(3)

The items and services described in this paragraph are—

(A)

exercise;

(B)

risk factor modification, including education, counseling, and behavioral intervention (to the extent such education, counseling, and behavioral intervention is closely related to the individual's care and treatment and is tailored to the individual's needs);

(C)

psychosocial assessment;

(D)

provider consultation;

(E)

care coordination;

(F)

medication management;

(G)

medical nutritional therapy;

(H)

tobacco cessation;

(I)

outcomes assessment; and

(J)

such other items and services as the Secretary determines appropriate, but only if such items and services are—

(i)

reasonable and necessary for the diagnosis or active treatment of the individual's condition;

(ii)

reasonably expected to improve or maintain the individual's condition and functional level; and

(iii)

furnished under such guidelines relating to the frequency and duration of such items and services as the Secretary shall establish, taking into account accepted norms of medical practice and the reasonable expectation of improvement of the individual.

(4)

The term eligible beneficiary means an individual who is entitled to, or enrolled for, benefits under part A and enrolled under this part and who has been diagnosed with 1 or more of the following conditions:

(A)

Coronary heart disease.

(B)

Type 2 diabetes.

(C)

Metabolic syndrome.

(D)

Prostate cancer.

(E)

Breast cancer.

.

(2)

Payment for intensive lifestyle treatment programs

(A)

Inclusion in physicians' services

Section 1848(j)(3) of the Social Security Act (42 U.S.C. 1395w–4(j)(3)) is amended by inserting (2)(FF), after (2)(EE)..

(B)

Conforming amendment

Section 1848(b) of the Social Security Act (42 U.S.C. 1395w–4(b)) is amended by adding at the end the following new paragraph:

(6)

Treatment of intensive lifestyle treatment program

(A)

In general

In the case of an intensive lifestyle treatment program described in section 1861(hhh)(2), the Secretary shall establish an aggregate payment for items and services furnished under such program (as described in section 1861(hhh)(3)) not to exceed the cost to the program under this title for a hospitalization for a similarly situated eligible beneficiary, subject to the limitation under subparagraph (C).

(B)

Payment schedule

The Secretary shall—

(i)

make a payment to such a program in an amount that is equal to 50 percent of the amount established under subparagraph (A) upon completion of the initial consultation under the program; and

(ii)

subject to the limitation described in subparagraph (C), make a second payment to a program for the balance of the amount defined in subparagraph (A) upon completion of treatment under the program.

(C)

Limitation

(i)

In general

Notwithstanding the provisions of subparagraph (B), an intensive lifestyle treatment program shall not receive the payment described in subparagraph (B)(ii) unless it documents, upon the completion of the program by an eligible beneficiary, that services provided to such beneficiary under the program are beneficially affecting the progression of chronic disease or diseases in the beneficiary, as measured under clause (ii) with respect to 2 or more of the following measures:

(I)

Measures described in subclauses (I) through (V) of section 1861(eee)(4)(A)(ii).

(II)

High density lipoprotein.

(III)

Hemoglobin A1C.

(IV)

C-reactive protein.

(V)

Waist size.

(VI)

Elimination of cotinine level as evidence that the eligible beneficiary no longer uses tobacco.

(VII)

Prostate specific antigen or other prognostic biomarkers of prostate cancer.

(VIII)

Prognostic biomarkers of breast cancer.

(ii)

Measurement

The Secretary shall determine the beneficial progression of chronic disease or diseases under clause (i), using the level of 2 or more of the measures described in subclause (i) before receiving services under such program and such levels after completion of treatment under the program—

(I)

by normalization (as defined by the Secretary); and

(II)

in the case of—

(aa)

measures described in subclauses (I) through (V), (VII), and (VIII), by at least 10 percent reduction; or

(bb)

the measure described in subclause (VI), by elimination.

(iii)

Refund of payments or costs in certain circumstances

In the case of an eligible beneficiary who, within 1 year of receiving an initial consultation under the program, receives any other treatment covered under part A or this part for any condition that relates to the initial diagnosis resulting in eligibility for the intensive lifestyle treatment program, except for a physician office visit for the purpose of making adjustments to medication prescribed to the eligible beneficiary, such program shall refund to the Secretary the lesser of—

(I)

any payments made under paragraph (B) for services provided to the eligible beneficiary under the program; or

(II)

the cost of such other treatment covered under part A or this part such condition.

(D)

Coverage of sessions

(i)

In general

Items and services provided under the program in a series of 72 one-hour sessions (as defined in clause (ii)), up to 6 sessions per day, over a period of 18 weeks shall, subject to the limitation under subparagraph (C), be eligible for the aggregate payment established under subparagraph (A).

(ii)

Definition of session

Each of the services described in subparagraphs (A) through (J) of section 1861(hhh)(3), when furnished for 1 hour, is a separate session under an intensive lifestyle treatment program.

.

(b)

Copayments for intensive lifestyle treatment items and services

Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)) is amended—

(1)

by striking and before (W);

(2)

by inserting before the semicolon at the end the following: , and (X) with respect to items and services furnished under an intensive lifestyle treatment program (as defined in section 1861(hhh)(2)), the amount paid shall be 100 percent of the lesser of the actual charge for the services or the amount determined under section 1848(b)(6)(A).

(c)

Lifestyle rewards program

Title XVIII of the Social Security Act is amended by adding at the end the following new section:

1899.

Lifestyle Rewards Programs

(a)

Establishment

The Secretary shall establish a Lifestyle Rewards Program (in this section referred to as the program) for eligible beneficiaries (as defined in section 1861(s)(2)(hhh)(4)) who have successfully completed an intensive lifestyle treatment program (as defined in section 1861(hhh)(2)) and meet the requirements described in subsection (b).

(b)

Requirements

In order to receive an award under the program, an eligible beneficiary must—

(1)

demonstrate that the program has beneficially affected the progression of chronic disease or diseases in the beneficiary upon completion of the program, as measured under clause (ii) of section 1848(b)(6)(C) with respect to 2 or more of the measures described in clause (i) of such section; and

(2)

during the 1 year period beginning on the date of an initial consultation under the lifestyle treatment program, receive no other treatment under part A or this part for any condition that relates to the initial diagnosis resulting in eligibility for the intensive lifestyle treatment program, except for a physician office visit for the purpose of making adjustments to medication prescribed to the eligible beneficiary.

(c)

Form of reward

The Secretary shall make such award to eligible beneficiaries described in subsection (a) in such form and manner as the Secretary, by regulation, shall prescribe.

(d)

Amount of reward

The amount of such award for each such eligible beneficiary shall be $200.

.

(d)

Effective date

The amendments made by this section shall apply to items and services furnished on or after January 1, 2010.

3.

Sense of the Congress

It is the sense of the Congress that the services provided under a intensive lifestyle treatment program (as defined in section 1861(hhh)(2) of the Social Security Act, as added by section 2(a))—

(1)

would benefit individuals with chronic diseases who are not enrolled in the Medicare Program under title XVIII of the Social Security Act; and

(2)

should be covered by all public and private payers.