SAFE Limos Act

Mr. President, I rise today to introduce the Medical Nutrition Therapy Act of 2021, along with my colleague from Michigan, Senator Peters. Our bill would 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 have seen 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. The Medical Nutrition Therapy Act would make two important changes to support patients, improve health outcomes, and reduce unnecessary health care 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, HIV/AIDS, gastrointestinal diseases including celiac disease, and cardiovascular disease. 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 health care team. It is evidenced- based and proven to positively affect weight, blood pressure, blood lipids, and blood sugar control. Nutritional counseling by RDNs is 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. Follow-up visits help reinforce important behavior and lifestyle changes and increase compliance.

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, Maine, has seen many patients denied access to medically necessary MNT. One of her patients 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. That same week, this patient turned 65 and transitioned onto Medicare. You can imagine his surprise upon arriving for his appointment and learning that MNT would not be covered. Fortunately for that patient, the outpatient facility changed its process to prevent similar situations, but this example demonstrates how the current restrictions can be detrimental for older adults at a critical juncture in their journey to better health.

Another unfortunate example from Maine was a patient with a new Celiac Disease diagnosis complicated by severe weight loss. His private insurance covered MNT as Celiac Disease is a controllable disease with proper nutrition. But when transitioning from private insurance to Medicare, this patient, too, lost his access to MNT. This truly is a lost opportunity since we know early treatment with MNT can prevent future and more serious health complications and chronic conditions in older adults. 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 have suffered more than any other population in terms of experiencing the worst health outcomes, including death. According to Centers for Medicare & Medicaid Services (CMS) data, among those hospitalized with COVID-19, 84 percent of patients had hypertension, 68 percent had hyperlipidemia, 51 percent had diabetes, and 35 percent of patients were obese. Tragically, many of these patients were never able to leave the hospital because they passed away. In addition to the human cost, there is a financial one: the impact on the Medicare program.

This should not come as a surprise since the health and 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 that 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 Dietitian 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 2021 is supported by nearly 50 national organizations, including the Academy of Nutrition and Dietetics, the American Diabetes Association, the Endocrine Society, the American Cancer Society Cancer Action Network, and UsAgainstAlzheimer's.

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

Thank you, Mr. President.

Mr. President, today I am introducing the Jobs and Childcare for Military Families Act, with my colleagues Senators Boozman and Tillis. By incentivizing private businesses to hire military spouses and allowing military families to use pre-tax dollars to pay for childcare, we can alleviate some of the unique hardships military families face and put them on firmer financial footing. This effort has only become more critical as the nation recovers from the coronavirus pandemic that has increased the number of unemployed and emphasized some longstanding issues in securing childcare for young families.

The families of America's servicemembers make sacrifices that are not as recognized in the public eye. Military spouses face routine moves every few years that require packing up a stable home in order to move to a new area and start over. This is compounded by the complex system of state licensing and certification requirements, which can limit these spouses from taking jobs that utilize their expertise and experience. Because of this, military spouses have unemployment rates substantially higher than the national average, and are often underemployed when they do have jobs. Adding to the financial struggle that frequent periods of unemployment and underemployment cause, the rising cost of childcare puts a substantial burden on many military families.

The Jobs and Childcare for Military Families Act would help these families in two ways. First, the bill makes military spouses an eligible population for the Work Opportunity Tax Credit. This tax credit has been proven effective in improving the employment prospects for other groups, and extending it to military spouses would help them find employment easier after moving a new area. Second, the bill instructs the administration to implement dependent care flexible spending accounts for all servicemembers. These accounts which are widely available in the private sector would allow military families to contribute pre-tax dollars to accounts

that they can then use to pay for childcare services, helping ease the financial burden of childcare.

I hope my colleagues will support this bill to help families who have made an incredible sacrifice for our nation.

Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.