How HR 2587 changes current law

Compared against current U.S. Code AI-generated reading aid — verify against the official bill.

The bill adds coverage for medically necessary food and vitamins for digestive and inherited metabolic disorders under federal health programs and private health insurance.

• 42 U.S.C. 1395x(s)(2)

  (HH) medically necessary food (as defined in subsection (jjj)) and the medical equipment and supplies necessary to administer such food (other than medical equipment and supplies described in subsection (n));

  This change adds the coverage of medically necessary food under the Medicare program.

• 42 U.S.C. 1395x

  Medically Necessary Food (jjj)(1) Subject to paragraph (2), the term `medically necessary food' means food, including a low protein modified food product and an amino acid preparation product, that is... intended for the dietary management of an individual who... has limited or impaired capacity to ingest, digest, absorb, or metabolize ordinary foodstuffs or certain nutrients.

  This definition clarifies what constitutes medically necessary food for patients.

• 42 U.S.C. 1395l(a)(1)

  and (CC) with respect to medically necessary food (as defined in section 1861(jjj)), the amount paid shall be an amount equal to 80 percent of the lesser of the actual charge for the services or the amount determined under a fee schedule established by the Secretary for purposes of this subparagraph.

  This amendment establishes the payment structure for medically necessary food under Medicare, allowing for reimbursement for such expenses.

• 42 U.S.C. 1395w-102(e)(1)

  (C) medically necessary vitamins used for the management of a covered disease or condition (as defined in section 1861(jjj)(3)) pursuant to the prescription, order, or recommendation (as applicable) of a physician or other health care professional qualified to make such prescription, order, or recommendation.

  This allows for the coverage of medically necessary vitamins under Medicare Part D.

• 42 U.S.C. 1396d(a)

  (29) medically necessary food (as defined in section 1861(jjj)) and the medical equipment and supplies necessary to administer such food;

  This inclusion establishes medically necessary food as a mandatory Medicaid benefit.

• 42 U.S.C. 1396d(a)

  (30) medically necessary vitamins used for the management of a covered disease or condition (as defined in section 1861(jjj)(3)) pursuant to the prescription, order, or recommendation (as applicable) of a physician or other health care professional qualified to make such prescription, order, or recommendation;

  This addition ensures that Medicaid covers medically necessary vitamins.

• 42 U.S.C. 1396a(a)(10)(A)

  (28) → (28), (29), and (30)

  This change updates the list of mandatory benefits under Medicaid to include medically necessary food and vitamins.

• 42 U.S.C. 1396r-8(d)(2)(E)

  and except for medically necessary vitamins described in section 1905(a)(30)

  This specifies that there is an exception for medically necessary vitamins in the coverage restrictions.

• 42 U.S.C. 1397cc(c)

  Medically necessary food.--The child health assistance provided to a targeted low-income child under the plan shall include coverage of medically necessary food (as defined in section 1861(jjj)) and the medical equipment and supplies necessary to administer such food.

  This amendment ensures coverage for medically necessary food for low-income children under CHIP.

• 42 U.S.C. 1397cc(c)

  Certain vitamins.--The child health assistance provided to a targeted low-income child under the plan shall include coverage of medically necessary vitamins used for the management of a covered disease or condition (as defined in section 1861(jjj)(3))

  This ensures that medically necessary vitamins are also covered for children under CHIP.