Bill > HR5684

This bill aims to provide comprehensive coverage for medical foods, vitamins, and amino acids for individuals with digestive and inherited metabolic disorders across several federal health programs, including Medicare, Medicaid, Children's Health Insurance Program (CHIP), and Federal Employee Health Benefits Program (FEHBP). The legislation defines "medically necessary food" as specially formulated nutritional products prescribed by healthcare professionals for patients with specific medical conditions that impair their ability to digest or metabolize nutrients normally. The bill covers a wide range of conditions, including inherited metabolic disorders, malabsorption conditions, food protein allergies, inflammatory digestive conditions, and other specified medical issues. It mandates that these federal health programs cover 80% of the cost of such medically necessary foods and related medical equipment, ensuring that patients with these conditions can access critical nutritional treatments without facing prohibitive expenses. The bill was partially inspired by the 2022 formula shortage, which highlighted the essential nature of specialty formulas for patients with metabolic and digestive disorders, and aims to prevent potential medical complications that can arise when patients cannot access their required nutritional treatments. Additionally, the legislation includes a congressional recommendation that private health insurance plans should similarly cover these medically necessary foods, though this is not a legally binding requirement.

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https://www.congress.gov/bill/119th-congress/house-bill/5684/all-info