ASPEN seeks an environment in which every patient receives safe, efficacious, and high-quality nutrition care. ASPEN’s advocates for high priority issues pertaining to clinical nutrition, including advocacy for nutrition related legislation, collaborating with coalitions and other like-minded organizations, and engaging with Congress, the Executive branch (NIH, regulatory agencies, CMS), public/private groups and others.
The objectives of the ASPEN Public Policy and Advocacy Program are to:
- Improve the quality and safety of all patients/consumers receiving nutrition support
- Advocate for fair reimbursement to ensure that beneficiaries of government funded health programs receive the highest quality nutrition support care
- Sponsor the concept of a fair marketplace that does not jeopardize the provision of safe and quality nutrition support
- Advocate for and support initiatives to better define, diagnose, and treat disease related malnutrition
Call to Action: Priority Issues
118th Congress (Current Congress)
Safe Step Act, S.652/H.R.2630
The purpose of this legislation is to improve step therapy protocols and ensure patients are able to safely and efficiently access the best treatment for them. The bill requires a group health plan to establish an exception to medication step-therapy protocol in specified cases. The bill also requires a group health plan to implement and make readily available a clear process for an individual to request an exception to the protocol, including required information and criteria for granting an exception. The bill further specifies timelines under which plans must respond to such requests. More information about the Safe Step Act can be found here.
117th Congress (Previous Congress)
*Note: ASPEN will continue to support these bills when they are re-introduced to the 118th Congress
Medical Nutrition Therapy (MNT), Bills S.1536/H.R.3108
This companion bill expands Medicare coverage of medical nutrition therapy (MNT) services. Currently, Medicare covers MNT only for individuals with diagnosed diabetes or kidney disease and post-kidney transplant and requires a physician referral. The bill extends coverage to individuals with other diseases and conditions, including malnutrition, prediabetes, obesity, eating disorders, cancer, and HIV/AIDS, hypertension, dyslipidemia, gastrointestinal diseases, cardiovascular disease, and other conditions causing unintended weight loss. This legislation also allows nurse practitioners, physician assistants, clinical nurse specialists, and psychologists to refer patients for MNT.
Patient Access to Medical Foods Act, H.R.56
This bill provides for coverage of medical foods under Medicare, Medicaid, the Children's Health Insurance Program, and TRICARE. The bill also requires private health insurance providers to cover medical foods. Generally, a medical food is a food prescribed by a physician for the dietary management of a disease or condition. The bill also expands this definition to include a food prescribed as a therapeutic option when a physician determines that traditional therapies are inappropriate for the patient. This bill is intended to amend the Orphan Drug Act to recognize Medical Foods and assign them a National Drug Code (NDC) to improve reimbursement.
Medical Nutrition Equity Act, S.2013/H.R.3783
The bill seeks to expand coverage under Medicare, Medicaid and other federal health care programs and private health insurance to include foods, vitamins, and individual amino acids that are medically necessary for the management of certain digestive and metabolic disorders and conditions. MNEA FactSheet
Preserving Patient Access to Home Infusion Act S.2652, H.R.5067
In August 2021, bipartisan legislation was introduced in the US Senate in the 117th Congress that will ensure Medicare patients maintain access to home infusion therapies that require the use of an infusion pump. The Preserving Patient Access to Home Infusion Act provides technical clarifications that removes the physical presence requirement from Medicare’s current home infusion therapy benefit, ensuring payment regardless of whether a health care professional is present in the patient’s home. The legislation also acknowledges the full scope of professional services delivered by home infusion clinicians, including essential pharmacist services. The act also permits nurse practitioners and physician assistants to establish and review a home infusion plan of care, in addition to a physician.
Other Priority Issues
Revised EN and PN Medicare Local Coverage Determinations (LCD)
New LCDs for EN and PN were updated in September 2021. Additional information can be found here: Enteral Nutrition; Parenteral Nutrition. A summary of the updates is provided by Bill Noyes, Sr. Vice President Reimbursement Policy at the National Home Infusion Association and Penny Allen, National Director, Nutrition Support Optum Infusion Pharmacy and Chair of the ASPEN Public Policy Committee in a webinar entitled “Update on Medicare’s Coverage Criteria for Parenteral and Enteral Nutrition.”