Many initiatives take involvement from ASPEN stakeholders. You can help by reaching out to legislators at the state and federal level and call or email them to share your opinion. Here are steps to take:

1. Federal Congress: Go to www.congress.gov to find out your Senate or House members.
2. Each of the lists provides their office phone numbers and email address.
3. State level: enter https://www.XX.gov/  with XX the abbreviation for your state - For example www.PA.gov is the official state of Pennsylvania website.
4. Use the letter template here to create your communication.

Call to Action: Priority Issues

• Medicare’s Changing Coverage Criteria for Parenteral and Enteral Nutrition. National Home Infusion Association (NHIA) and ASPEN recently held a Talk Infusion webinar on Medicare’s changing coverage criteria for parenteral and enteral nutrition. Watch recording. Available for ASPEN members only. Listen to a podcast recording. Access Parenteral and Enteral Nutrition FAQs.

• Malnutrition Awareness Week Senate Resolution: Sens. Chris Murphy (D-Conn.) and Chuck Grassley (R-Iowa) have introduced a resolution in the U.S. Senate to recognize Malnutrition Awareness Week^TM 2020. Update: The US Senate passed Senate Res. 716, Designating the week of October 5 through October 9, 2020, as “Malnutrition Awareness Week” on November 12, 2020.
  
  
• The Medical Nutrition Therapy Act of 2020 was introduced in the House by Representative Engel on May 22, 2020 (H.R.6971). This bill expands Medicare coverage of medical nutrition therapy services.  Currently, Medicare covers such services for individuals with diabetes or kidney disease under certain circumstances; such services must also be provided by a registered dietitian or nutrition professional pursuant to a physician referral. The bill extends coverage to individuals with other diseases and conditions, including obesity, eating disorders, cancer, malnutrition, and HIV/AIDS; such services may also be referred by a physician assistant, nurse practitioner, clinical nurse specialist, or (for eating disorders) a clinical psychologist. A companion Senate bill, to amend title XVIII of the Social Security Act to expand the availability of medical nutrition therapy services under the Medicare program (S.4504) was introduced on August 6, 2020 by Senator Collins. ASPEN supports House Bill 6797 and Senate Bill S 4504 and strongly encourage you to contact your Congressman and Senator to request their support of these bills.
  
  
• The Medical Nutrition Equity Act of 2019 was introduced by Representative McGovern and others on May 2, 2019 ( H.R.2501). This bill is intended to provide for the coverage in Federal Health Programs and private health insurances of medically necessary food and vitamins and individual amino acids prescribed or ordered by the physician or other qualified health professionals for digestive and inherited metabolic disorders. The medical food may be used for either partial or exclusive feeding of an individual by way of oral intake or enteral feeding tube. See attached bill for more details.

• H.R.1888 The Expansion of Nutrition's Role in Curricula and Healthcare (ENRICH) Act – to provide for a grants program to develop and enhance integrated nutrition and physical activity curriculum in medical schools.

• Drug Shortage Legislation
  U.S. Senator Susan Collins (R-ME) and Senator Tina Smith (D-MN) introduced S.2723 Mitigating Emergency Drug Shortages (MEDS Act), legislation that would help increase the supplies of vital drugs needed to treat or prevent a wide variety of diseases, illnesses, and conditions.  House Energy & Commerce Committee Chair Frank Pallone (D-NJ) and Rep. Brett Guthrie (R-KY) introduced legislation H.R.4866 National Centers of Excellence in Continuous Pharmaceutical Manufacturing Act of 2019, that aims to limit drug shortages and spur U.S. drug manufacturing by encouraging use of continuous manufacturing in the development and approval of drugs and biologics. The bill would give FDA $80 million to designate certain universities as National Centers of Excellence in Continuous Pharmaceutical Manufacturing, which would study and recommend improvements to continuous manufacturing.
  
  
• Step Therapy
  A focus of the Digestive Disease National Coalition (DDNC) this legislative year, a coalition to which ASPEN belongs, has been on STEP therapy. Also known as a ‘fail first’ protocol, STEP therapy protocols mandate patients try and fail medication preferred by the insurer before approving medications prescribed by their doctor. This interferes with the proper control of digestive disorders causing limitations in nutritional intake, malnutrition, and the potential need for either enteral or parenteral nutrition support. On November 30, 2019, DDNC coordinated a National Day of Advocacy to encourage federal legislators to support the Safe Step Act ( H.R. 2279/ S. 2546). A summary of the Day of Advocacy and information on how to contact your legislators to support the Act may be found at this link.
  
  
• Older Americans Act Reauthorization

  HR4334: Dignity in Aging Act of 2019 establishes, reauthorizes, and revises several programs administered by the Department of Health and Human Services and the Department of Labor relating to care for the elderly. Among other things, the bill reauthorizes through FY2024 and revises programs that support:

• caregivers of the elderly;
• informational services, such as pension counseling;
• nutritional services, such as meal delivery;
• disease prevention and health promotion services;
• community and workforce training regarding elder care; and
• abuse and neglect prevention services. The bill also establishes several entities and programs to further support elder care, including initiatives that aim to promote independent living and reduce social isolation for the elderly. This bill was passed in the House on October 28, 2019 and then sent to the Senate where it sits on the Legislative Calendar under General Orders. 

The bill also establishes several entities and programs to further support elder care, including initiatives that aim to promote independent living and reduce social isolation for the elderly. This bill was passed in the House on October 28, 2019 and then sent to the Senate where it sits on the Legislative Calendar under General Orders.  

• Cost-Shifting: Preserving the Patient-Provider Decision Making Relationship
  Many home parenteral and enteral nutrition patients are impacted by payor policies which shift the cost of medical therapies back to the patient. DDNC developed a White Paper to help guide advocacy efforts to improve access of essential medications to patients.  
  
  

ASPEN Advocacy and Public Policy Coalition Memberships

• Digestive Disease National Coalition
• Defeat Malnutrition.Today
• Healthcare Nutrition Council (HNC)
• Nutrition Action Alliance (part of American Society for Nutrition)
   

Enteral and Parenteral Nutrition Reimbursement Toolkit