This bill amends Title XVIII of the Social Security Act to bring medical nutrition therapy (MNT) for eating disorders into the set of conditions eligible for Medicare outpatient nutrition services. The change directs Medicare to treat eating disorders as a covered clinical indication for nutrition counseling and associated MNT beginning in 2026.
The measure matters because it targets a longstanding coverage gap: while Medicare covers some mental health and medical care, it currently omits outpatient MNT tied specifically to eating disorder treatment. By establishing coverage and basic delivery rules, the bill aims to improve access to a component of multidisciplinary eating-disorder care that clinicians and families identify as essential to recovery.
At a Glance
What It Does
Amends section 1861 of the Social Security Act to add eating disorders to the list of diagnoses eligible for medical nutrition therapy and to expand the existing Medicare MNT rules to address management of eating disorders.
Who It Affects
Medicare Part B beneficiaries with clinically defined eating disorders, registered dietitians and other ‘nutrition professionals,’ physicians and mental-health clinicians who make referrals, and Medicare program administrators responsible for coding and payment policy.
Why It Matters
This creates a narrow but consequential route for reimbursement of evidence-based nutrition care within the Medicare framework, potentially changing clinical pathways, billing flows, and resource needs for treating older adults and other Medicare enrollees with eating disorders.
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What This Bill Actually Does
The bill changes two provisions of the Medicare statute. First, it inserts a specific reference to eating disorders — using the Diagnostic and Statistical Manual (DSM) definition as the reference point — into the statutory list of diagnoses for which medical nutrition therapy is recognized.
Second, it amends the existing MNT benefit rules to spell out who may furnish services, who can refer patients, and minimum time thresholds for counseling related to eating-disorder management.
Operationally, the statute narrows delivery to services given by a registered dietitian or other defined nutrition professional and requires a referral before Medicare payment. That referral can come from a physician or from a psychologist or other mental-health professional to the extent state law permits.
Those two gatekeeping elements (specified provider types and referral origin) will determine which clinicians can bill Medicare for these services and how patients enter the nutrition-care pathway.The bill builds in service-intensity rules: it requires a 1-hour initial assessment plus 12 additional hours for reassessment and intervention during the first year (13 hours total), and it sets a 4-hour-per-year floor for subsequent years, while authorizing the Secretary of Health and Human Services to place ‘‘other reasonable limitations’’ on later-year coverage. The combination of a defined minimum for year one and a capped-but-discretionary later-year allowance is designed to standardize early treatment while leaving room for CMS to limit ongoing utilization.Because the change is statutory, CMS will need to issue implementation guidance: taxonomy for billing and coding, definitions for ‘‘nutrition professional,’’ documentation rules that satisfy Medicare audit standards, and guidance on how the Secretary will apply the discretionary limits in later years.
Medicare Advantage plans, which generally follow Medicare-covered benefits, will also need to align their coverage policies with the revised Title XVIII language.
The Five Things You Need to Know
The bill adds an explicit eating-disorder diagnosis (to be defined by the Secretary consistent with the DSM) to Medicare’s list of conditions eligible for medical nutrition therapy.
Coverage for MNT tied to eating-disorder management becomes effective January 1, 2026.
Medicare payment is limited to services furnished by a registered dietitian or a defined nutrition professional and requires a referral from a physician or a psychologist/other state-authorized mental-health professional.
The statute mandates at least 13 hours of MNT in the first year (a 1-hour initial assessment plus 12 hours of reassessment and intervention) and at least 4 hours in each subsequent year, subject to Secretary-set limitations.
The Secretary of HHS may impose additional reasonable limitations on subsequent-year furnishing of MNT for eating disorders, leaving room for regulatory constraints on frequency, documentation, or payment.
Section-by-Section Breakdown
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Short title
States the act’s names: the Nutrition CARE Act of 2025 and the Nutrition Counseling Aiding Recovery for Eating Disorders Act of 2025. This is a labeling provision with no operational effect but frames the legislative intent toward nutrition-focused recovery services.
Findings
Sets out Congress’s factual predicates: prevalence estimates, mortality and comorbidity concerns, gaps in current Medicare coverage (noting outpatient MNT is not covered for eating disorders), and the economic burden. Those findings are useful for administrative interpretation and for justifying the statute’s targeted coverage expansion, but they impose no regulatory rules themselves.
Adds eating disorders to the list of MNT-eligible diagnoses
Amends the statutory clause that ties MNT coverage to specific conditions by inserting a new subclause for beneficiaries with an eating disorder, with the Secretary directed to define that term consistent with the DSM. This is the core legal change that triggers programmatic coverage; implementation will require CMS to translate the DSM-based definition into ICD coding guidance and to decide how comorbid or subthreshold cases are treated.
Provider, referral, and minimum-hour rules for eating-disorder MNT
Changes the existing MNT paragraph to: (1) explicitly include eating-disorder management within the scope of disease-management MNT; (2) require that services be furnished by registered dietitians or defined nutrition professionals; (3) require referrals from physicians or mental-health professionals authorized under state law; and (4) set minimum hours (13 in year one, 4 in subsequent years) while giving the Secretary authority to set other reasonable limits. Practically, this provision defines billing eligibility, referral pathways, and a baseline intensity of covered care — all levers that will shape access, utilization, and audit standards.
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Who Benefits
- Medicare beneficiaries with clinically diagnosed eating disorders — they gain a statutory pathway to receive reimbursable medical nutrition therapy that many clinicians consider essential to recovery.
- Registered dietitians and designated nutrition professionals — the bill creates a clearer reimbursement route for delivering MNT tied to eating-disorder care, potentially expanding a billable service line for those providers.
- Mental-health clinicians and physicians treating eating disorders — having MNT as a covered, referable service supports integrated care plans and may improve coordination across medical, psychiatric, and nutritional domains.
Who Bears the Cost
- Medicare (Part B) and the federal government — adding a new covered service will increase program spending, at least in the short term, and may raise long-term costs if utilization grows beyond projections.
- CMS and federal regulators — they must issue coding, billing, and medical-necessity guidance, and carry the administrative burden of implementing the new benefit and overseeing compliance and audits.
- Medicare Advantage plans and plan sponsors — though not named, MA plans typically mirror fee-for-service covered benefits and will face actuarial and utilization consequences, plus the need to update provider networks and prior-authorization rules.
Key Issues
The Core Tension
The central dilemma is between improving access to an evidence-based component of eating-disorder care and controlling program integrity and costs: the statute expands an entitlement to nutrition therapy, but practical access will depend on provider capacity, the Secretary’s limits, and CMS’s administrative choices — so the policy solves the coverage gap on paper while creating new bottlenecks in practice.
The statute establishes coverage in relatively narrow terms: it recognizes eating disorders for MNT, specifies provider types and referral sources, and sets minimum hour thresholds, but it leaves substantial implementation detail to the Secretary. That residual delegation creates two practical risks.
First, CMS rulemaking and guidance will determine how expansive the benefit actually is — e.g., what counts as a ‘‘nutrition professional,’’ whether telehealth-delivered MNT fits, how to code complex comorbid cases, and how strictly to apply documentation standards for medical necessity and audits. Second, the Secretary’s authority to impose ‘‘other reasonable limitations’’ on subsequent-year coverage is open-ended and could be used to constrain utilization (frequency, duration, or intensity) in ways that blunt the statute’s clinical intent.
Access risk is the other major implementation pressure. The bill presumes an available workforce of registered dietitians or nutrition professionals with eating-disorder expertise; in reality, such specialists are unevenly distributed and not all RDNs have the training to treat eating disorders.
The referral requirement (physician or psychologist/mental-health professional) creates a clinical gate that may delay care in areas with scarce mental-health providers. Finally, linking the definition to the DSM gives clinical clarity but may limit coverage for subthreshold presentations or for alternative diagnostic frameworks, and it raises questions about crosswalks to billing codes (ICD) and the contemporaneous updates needed if the DSM changes.
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