Weekly Public Policy Update

Academy Meets with White House to Push for Obesity Treatment and RDN Reimbursement
The Academy joined member groups of the Obesity Care Continuum, the Campaign to End Obesity, and our partners in the Medicare Part D Coalition at the White House for an intimate meeting with members of President Obama's Domestic Policy Council to discuss benefits of the Treat and Reduce Obesity Act (TROA).  TROA is legislation that would provide Medicare recipients and their healthcare providers with meaningful tools to treat and reduce obesity by (1) improving access to obesity screening and counseling services by RDNs and other qualified practitioners and (2) covering new FDA-approved prescription drugs for chronic weight management.

The purpose of the meeting was to inform White House staff about the tremendous bipartisan support of more than 120 members of the House and Senate urging CMS to implement the key aspects of the TROA through a regulatory solution. Obesity advocates highlighted how CMS has taken administrative actions in the past that serve as precedent for the agency to act on repealing the prohibition on Medicare Part D coverage of FDA-approved obesity drugs and the Academy detailed an available regulatory mechanism for expanding the list of eligible providers that could provide intensive behavioral therapy services.  The Academy shared detailed information about the cost benefits and clinical efficacy of RDN-provided behavioral counseling for obesity and encouraged the administration to work with CMS in the coming months in pursuing a solution.

We continue to work both legislatively and administratively to enable RDNs to provide and be reimbursed for medical nutrition therapy (MNT) for a broader class of disease states and conditions, thereby enhancing opportunities for members and improving the nation’s health.

Congress Passes Spending Bill
On December 9th, Congress came to an agreement on a $1.01 trillion package to keep most of the government open through September 2015. The bill referred to as, “CROmnibus”, includes 11 of the 12 appropriations bills and a Continuing Resolution (CR) for Homeland Security through February 27, 2015 in response to the President’s executive action on immigration.

Below is a summary of the domestic nutrition program funding levels and policy riders found in the agriculture appropriations compromise followed by links to the bill text and committee summaries.

FY15 Summary of Agriculture Appropriations Nutrition Programs

  *   Child Nutrition Programs in Schools – $21.3 billion in mandatory funding, including:
     *   $16 million to continue summer food demonstration projects, including summer EBT.
     *   Nutrition Standards for School Meals: Language is included allowing states some flexibility on the whole grain and sodium nutrition standards. First, it allows states to waive the whole grain requirement if schools demonstrate hardship (including financial hardship) in procuring whole grain products acceptable to students and compliant with the standards.  Second, it prohibits new lower sodium requirements from going into effect without additional research on sodium and its effects on children.
     *   $25 million for competitive grants for schools to purchase equipment needed to serve healthier meals, improve food safety, and help support the establishment, maintenance, or expansion of the school breakfast program. This is level funding from FY14.
  *   Women, Infants and Children (WIC) – $6.623 billion with $60 million for breastfeeding peer counselors, $14 million for infrastructure, $30 million for management information systems, and $25 million for WIC EBT systems and activities.
     *   Changes to the WIC Food Package: Bill language stated that no vegetable can be excluded until the next scientific review determines otherwise. If the scientific review process by the Institute of Medicine (IOM) results in excluding any vegetable, then an audit of the scientific research by the Comptroller General must occur. Stay tuned for more details as the IOM Review process, which began earlier this year, unfolds.

  *   Supplemental Nutrition Assistance Program (SNAP) – $81.8 billion in mandatory funding with a $3 billion reserve fund.
     *   Language is included to fund employment and training pilot projects as well as program integrity activities authorized by the 2014 Farm Bill.
  *   The Emergency Food Assistance Program (TEFAP) storage & distribution – $49.4 million
  *   TEFAP Commodities – $324 million (reflects farm bill increase)
  *   Community Supplemental Food Program (CSFP) – $211 million to provide monthly nutritious food packages to low-income seniors. It also includes $2.8 million to allow CSFP to expand to 7 new states.
 FY15 Summary of Labor, Health and Human Services Appropriations Nutrition Programs

  *   HIV/AIDS Prevention and Treatment- the bill includes $265 billion for the Ryan White HIV/AIDS program. It rejects the consolidation of Part C and Part D programs, as proposed by the Administration.
  *   Million Hearts-received $4 million in funding in the omnibus.
  *   Elder Justice-includes $4 million for a new Elder Justice Initiative within the Elder Rights Support program to develop partnerships across disciplines for the prevention, investigation and prosecution of abuse, including abuse against the elderly.
  *   Diabetes-the National Diabetes Prevention Program (NDPP) received $10 million.
  *   Senior Nutrition Programs- $815 million for Senior Nutrition programs, which is the same as the 2014 enacted level.
  *   Maternal and Child Health Services Block Grant- received a $3 million increase, from $634 million to $637 million through September 30, 2015.

For additional information, refer to the following:
House Republican Agriculture Appropriations Summary<http://appropriations.house.gov/uploadedfiles/ag_press_summary.pdf>
House Democrat Agriculture Appropriations Summary<http://democrats.appropriations.house.gov/sites/democrats.appropriations.house.gov/files/documents/Agriculture.pdf>
Senate Omnibus Summary<http://www.appropriations.senate.gov/sites/default/files/12_09_14%20fy15%20omnibus%20summary.pdf>
Text of the bill<http://rules.house.gov/bill/113/hr-83>

Feed the Future Legislation Passes in the House
The US government through the Agency for International Development (USAID) is working to address some of the immediate and underlying determinants of global malnutrition through the Feed the Future initiative. Academy champion, Congresswoman Betty McCollum (Minn.), has led bipartisan efforts to pass a bill that would solidify the funding for this crucial program.  This inclusive bill recognizes the need for adequate nutrition and helping build the local agriculture economy.

Now it is on to the Senate racing against the clock to end the session.

Academy Attends Launch of Global Nutrition Report
The Global Nutrition Report details the severe problem of malnutrition worldwide.
Global estimates suggest that 2-3 billion individuals suffer from one or more form of malnutrition related to under nutrition, overweight and obesity, and/or micronutrient deficiency. As evidence mounts to support the intergenerational transmission and economic burden of malnutrition, it is imperative that we scale up investments in nutrition now.

The cost of malnutrition is high. This is evident not only in the tragic human costs associated with increased morbidity and mortality but the significant economic cost. The data to support these associations is powerful and growing. Recent studies have found 45% of under-five mortality is attributable to malnutrition. Economically, countries are estimated to lose 11% of annual GNP secondary to malnutrition.

However, the median economic return on investing in nutrition is estimated to be $16 for each $1 invested. This benefit-cost ratio is even higher in some countries proving competitive with other government investments such as roads and overall health.

Judy

Judy Klavens-Giunta,RDN
Policy and Advocacy Leader
PHCN PG