119-hr4231

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4231 Introduced in House

    (IH) ]

<DOC>

119th CONGRESS
 1st Session
 H. R. 4231

 To amend title XVIII of the Social Security Act to provide for the 
 coordination of programs to prevent and treat obesity, and for other 
 purposes.

_______________________________________________________________________

 IN THE HOUSE OF REPRESENTATIVES

 June 27, 2025

 Mr. Kelly of Pennsylvania (for himself, Mr. Ruiz, Mrs. Miller-Meeks, 
 Ms. Moore of Wisconsin, Mr. Panetta, Mr. Fitzpatrick, Mr. Boyle of 
 Pennsylvania, Mr. Carey, Mr. Thanedar, Mr. Cohen, Ms. Norton, Ms. 
 Tlaib, and Mr. Schweikert) introduced the following bill; which was 
 referred to the Committee on Energy and Commerce, and in addition to 
 the Committee on Ways and Means, for a period to be subsequently 
 determined by the Speaker, in each case for consideration of such 
 provisions as fall within the jurisdiction of the committee concerned

_______________________________________________________________________

 A BILL

 To amend title XVIII of the Social Security Act to provide for the 
 coordination of programs to prevent and treat obesity, and for other 
 purposes.

 Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

 This Act may be cited as the ``Treat and Reduce Obesity Act of 
2025''.

SEC. 2. FINDINGS.

 Congress makes the following findings:

    (1) According to the Centers for Disease Control and 
 Prevention, about 41 percent of adults aged 60 and over had 
 obesity in the period of 2015 through 2016, representing more 
 than 27,000,000 people.

    (2) The National Institutes of Health has reported that 
 obesity and overweight are now the second leading cause of 
 death nationally, with an estimated 300,000 deaths a year 
 attributed to the epidemic.

    (3) Obesity increases the risk for chronic diseases and 
 conditions, including high blood pressure, heart disease, 
 certain cancers, arthritis, mental illness, lipid disorders, 
 sleep apnea, and type 2 diabetes.

    (4) More than half of Medicare beneficiaries are treated 
 for 5 or more chronic conditions per year. The rate of obesity 
 among Medicare beneficiaries doubled from 1987 to 2002 and 
 nearly doubled again by 2016, with Medicare spending on 
 individuals with obesity during that time rising 
 proportionately to reach $50,000,000,000 in 2014.

    (5) Men and women with obesity at age 65 have decreased 
 life expectancy of 1.6 years for men and 1.4 years for women.

    (6) The direct and indirect cost of obesity was more than 
 $427,800,000,000 in 2014 and is growing.

    (7) On average, a Medicare beneficiary with obesity costs 
 $2,018 (in 2019 dollars) more than a healthy-weight 
 beneficiary.

    (8) The prevalence of obesity among older individuals in 
 the United States is growing at a linear rate and, if nothing 
 changes, nearly 1 in 2 (47 percent) Medicare beneficiaries aged 
 65 and over will have obesity in 2030, up from slightly more 
 than 1 in 4 (28 percent) in 2010.

SEC. 3. AUTHORITY TO EXPAND HEALTH CARE PROVIDERS QUALIFIED TO FURNISH 
 INTENSIVE BEHAVIORAL THERAPY.

 

Section 1861
            (ddd) of the Social Security Act (42 U.S.C. 1395x
            (ddd) ) 
is amended by adding at the end the following new paragraph:
 ``

    (4)
        (A) Subject to subparagraph
        (B) , the Secretary may, in 
addition to qualified primary care physicians and other primary care 
practitioners, cover intensive behavioral therapy for obesity furnished 
by any of the following:
 ``
            (i) A physician (as defined in subsection

    (r)

    (1) ) 
 who is not a qualified primary care physician.
 ``
            (ii) Any other appropriate health care provider 
 (including a physician assistant, nurse practitioner, 
 or clinical nurse specialist (as those terms are 
 defined in subsection

    (aa)

    (5) ), a clinical 
 psychologist, a registered dietitian or nutrition 
 professional (as defined in subsection
            (vv) )).
 ``
            (iii) An evidence-based, community-based 
 lifestyle counseling program approved by the Secretary.
 ``
        (B) In the case of intensive behavioral therapy for 
 obesity furnished by a provider described in clause
            (ii) or
            (iii) of subparagraph
        (A) , the Secretary may only cover such 
 therapy if such therapy is furnished--
 ``
            (i) upon referral from, and in coordination with, 
 a physician or primary care practitioner operating in a 
 primary care setting or any other setting specified by 
 the Secretary; and
 ``
            (ii) in an office setting, a hospital outpatient 
 department, a community-based site that complies with 
 the Federal regulations concerning the privacy of 
 individually identifiable health information 
 promulgated under 

section 264
            (c) of the Health 
 Insurance Portability and Accountability Act of 1996, 
 or another setting specified by the Secretary.
 ``
            (C) In order to ensure a collaborative effort, the 
 coordination described in subparagraph
        (B)
            (i) shall include the 
 health care provider or lifestyle counseling program 
 communicating to the referring physician or primary care 
 practitioner any recommendations or treatment plans made 
 regarding the therapy.''.

SEC. 4. MEDICARE PART D COVERAGE OF OBESITY MEDICATION.

    (a) In General.--

Section 1860D-2

    (e)

    (2)
        (A) of the Social Security 
Act (42 U.S.C. 1395w-102

    (e)

    (2)
        (A) ) is amended, in the first sentence--

    (1) by striking ``and other than'' and inserting ``other 
 than''; and

    (2) by inserting after ``benzodiazepines),'' the following: 
 ``and other than subparagraph
        (A) of such section if the drug 
 is used for the treatment of obesity (as defined in 

section 1861

    (yy)

    (2)
            (C) ) or for weight loss management for an individual 
 who is overweight (as defined in 

section 1861

    (yy)

    (2)
        (F)
            (i) ) and 
 has 1 or more related comorbidities,''.

    (b) Effective Date.--The amendments made by subsection

    (a) shall 
apply to plan years beginning on or after the date that is 2 years 
after the date of the enactment of this Act.

SEC. 5. REPORT TO CONGRESS.

 Not later than the date that is 1 year after the date of the 
enactment of this Act, and every 2 years thereafter, the Secretary of 
Health and Human Services shall submit a report to Congress describing 
the steps the Secretary has taken to implement the provisions of, and 
amendments made by, this Act. Such report shall also include 
recommendations for better coordination and leveraging of programs 
within the Department of Health and Human Services and other Federal 
agencies that relate in any way to supporting appropriate research and 
clinical care (such as any interactions between physicians and other 
health care providers and their patients) to treat, reduce, and prevent 
obesity in the adult population.
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