IDA Members Only Legislative Reports

IAND Members Only - Legislative Report

Legislative Priorities Update

Child Nutrition Reauthorization

Overview
This opportunity only comes once every five years so timing can be everything for change. We are all aware of the rise in childhood obesity and childhood hunger. This reauthorization offers ways to address both issues. ADA has been involved in crafting the language of the bills thanks to our members’ expertise.

The Child Nutrition Programs include the National School Lunch Program, School Breakfast Program, Child and Adult Care Food Program, Summer Food Service Program, and WIC programs. The programs serve over 30 million children, students and women every day. These programs create a safety net that ensures that children and adolescents at risk for poor nutritional intakes have access to a safe, adequate, and nutritious food supply and nutrition screening, assessment and intervention. It is important that continued funding be provided for these programs, which consistently have been shown to have a positive impact on child and adolescent health and well-being.

Our Recommendations
Child Nutrition Reauthorization provides an opportunity to elevate nutrition in the child nutrition and WIC programs. ADA calls for the next Child Nutrition Reauthorization needs to address five key areas.

Ensure the Dietary Guidelines are the foundation of federal food assistance and nutrition programs.
Provide adequate funding for program implementation.
Strengthen nutrition education and promotion.
Increase funding for Child Nutrition Program research.
Place trained professionals in roles where they make policies. Directors of the School Nutrition Program at the district level should be certified as Registered Dietitians, Dietetic Technicians, Registered, or School Nutrition Association School Nutrition Specialists.

We are supporting the bills below and amendments that will be offered that reduce childhood hunger,

Status
There are two major in each of the chambers (House and Senate) and the pressure is on Congress to pass the bills quickly before the current Act expires September 30, 2010. House Education and Labor Committee chair George Miller (D-CA) and Senate Agriculture Committee chair Blanche Lincoln (D-AR) sent a joint letter to President Obama on July 13, 2010, urging the President to support these efforts with strong push for passage.

S 3307-the Healthy, Hunger-Free Kids Act
The bill has passed unanimously out of the Senate by voice vote with ADA recommendations included.

H.R. 5504 - Improving Nutrition for America's Children Act
This bill has passed out of the Education and Labor Committee and is awaiting action by the full House. The sticking point is that the House has not identified how the bill will be paid for and all bills must be cost neutral.

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Older Americans Act

Overview
The Older Americans Act (OAA) was passed in 1965 to address inadequate community social services for older persons. One of the major emphases was on nutrition. Two programs were created, congregate dining and home delivered meals. Both provide important access to healthy food options for older adults. The OAA is considered to be the major vehicle for social and nutrition services to this group. It has a national network of 56 State agencies on aging, 629 area agencies on aging, nearly 20,000 service providers, 244 Tribal organizations, and 2 Native Hawaiian organizations representing 400 Tribes. This Act is authorized every five years and will be reviewed again in 2011.

Our Recommendations

Funding for Title 3C programs (Title 3C are the nutrition related programs) should remain intact and the current practice of transferring funds to Title 3B (Title 3B are the social service programs) programs should be eliminated. Currently, Title 3C programs are experiencing transfers of $38 million annually at the state level, leaving nutrition programs partially unfunded. This is critical to reduce hunger and food insecurity.
Registered dietitians should be employed at all levels of administration—from State Units on Aging, to Area Agencies on Aging to local service providers. Expertise in food, nutrition and health is vital for effective program implementation and operation given the advances in scientific evidence and best practices.
Define home delivered meal eligibility. Current rules state that persons age 60 or over who are frail, homebound by reason of illness or incapacitating disability, or otherwise isolated, shall be given priority in the delivery of services under this part. This definition should be expanded to include all un-paid caregivers for those currently eligible.
Nutrition screening should be conducted for all participants on a routine basis, with assessment and evidence-based counseling provided where appropriate.

Status
We will be working with key legislators when the bills are drafted. At this point, we are still are open to suggestions and ideas from members. We will begin establishing a working group within the Aging Network which includes the DPGs that focus on this group.

Food Safety

Overview
CDC estimates that 76 million Americans get sick, more than 300,000 are hospitalized, and 5,000 people die from foodborne illnesses each year. Recalls of fresh spinach, tomatoes, peppers lettuce and peanut butter led policy makers to overhaul current food safety laws.

To reduce these problems, Congress has introduced bills that will overhaul the Food and Drug Administration and put more safeguards in place for the food supply. As with any new bill, costs are an issue. It still needs to be decided how the $1.4 billion costs for these new initiatives will be covered. The House has already approved a food safety bill. Supporters are lobbying Senate Majority Leader Harry Reid to schedule a Senate vote next month.

Our Recommendations
A work group was established by ADA Leadership to provide guIANDnce on this issue. The Food Safety Work Group was charged with articulating the best structure and framework for federal food safety authority) including:

Making policy recommendations to the LPPC on food safety priorities related to threats to the safety of the food supply and consumer protections in food, food ingredients, and dietary supplements.
Clarifying ADA’s vision for the infrastructure of federal food safety authority, considering food safety in the broadest sense – including microbial contamination, food additives, and dietary supplements.
Clarifying ADA’s role in working with state and local partners who administer food safety programs.
Support Registered Dietitians and Dietetic Technicians, Registered, in their efforts to protect their constituencies against foodborne illness.

The Food Safety Work Group made the following general recommendations to ADA Leadership:

Food authority be science-based and consistently applied to all foods regulated by all agencies for both domestic and imported foods. We support the concept of a single food safety agency to protect the public’s health.
Food authority be collaborative across national, state and local agencies and between government and industry partners to foster more robust, consistent, accurate and timely communication and data sharing that leads to efficient and effective decision-making processes.
Food protection include statutory authority by government regulatory agencies for traceability and recall, supported by research, epidemiology, and inspection programs.
ADA must be a visible participant where food safely decisions are made, for example, in the Partnership for Food Safety Education, the Conference on Food Protection, the Council to Improve Foodborne Outbreak Response, in direct conference with federal and state agencies, and internationally in Codex Alimentarius discussions.

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Status

The House has passed their bill but the Senate bill has been stalled. Recently Senate reached bipartisan agreement on food safety. The stalled Senate food safety bill, FDA Food Safety Modernization Act, recently got new life as key lawmakers released a bipartisan, compromise agreement. This step should make it easier to bring the bill for a floor vote after summer recess. Senate Health, Education, Labor, and Pensions Committee Chairman Tom Harkin (IA), Ranking Member Mike Enzi (WY), bill authors Dick Durbin (IL) and Judd Gregg (NH,) and lead cosponsors Chris Dodd (CT) and Richard Burr (NC) were the major drivers of the agreement.

Some highlights of the bill include:

Gives FDA the authority to order and not just request a recall of tainted products.
Increases FDA inspections of processors.
Requires facilities to have plans to prevent bacterial contamination in manufacturing, processing, and packing food.
Requires importers to verify the safety of foreign food suppliers.
Provides training for facilities to help them comply with new safety regulations and “includes special accommodations for small businesses and farms.”
Authorizes a pilot project to test new methods for tracking foods in the event of a foodborne illness outbreak.

The compromise piece does not include language for bisphenolA (BPA) which has been a sticking point. Senator Feinstein of California is considering separate action for the issue which would ban baby bottles, sippy cups, baby food, and infant formula containers. It also does not address the regulatory burden this would place on small farmers, an issue as championed by Senator Tester of Montana and Senator Hagan of North Carolina.

Farm Bill

Overview
This legislation directs food production and supply. It also connects agriculture policy with health policy bridged by foods. The Farm Bill is up for reauthorization in 2012 and will shape our diets in the years ahead. The last farm bill, passed in 2008, included price supports for certain crops that made profitable to grow like corn and soybeans and the funding of major nutrition programs including SNAP (food stamps), and the WIC and seniors’ farmers’ market program.

Our recommendations
Our recommendations for the last Farm Bill were-

Support reforms to the Dietary Guidelines process that will make them more valuable and less confusing to consumers. ADA seeks less frequent issuance of these important findings – not every five years, as now required, but that the Dietary Guidelines be updated once a decade. The additional five years can be used for two important components of Dietary Guidelines work: to focus on better education and implementation strategies and to follow up with adequate time for conducting evidence-based research to be used in the development of future guidelines.
Recommend that food assistance/food stamps cover and create incentives for purchases consistent with the Dietary Guidelines for Americans.
Support many of the key tenets articulated by the anti-hunger community: increasing the minimum benefit and allotments, providing broader access, simplifying application and reporting criteria, matching state administrative reimbursements, providing greater funding for outreach and education, relying on the Electronic Benefit Transfer (EBT) technology, improving the environment for people to purchase food and obtaining fruits and vegetables, promoting after school and summer programs that offer safe recreational activities and urging that the public invest in ways to make real progress to eradicate hunger and food insecurity in the United States.

Status
We will be starting our work in this area in the next few months. Already coalitions and partnerships are forming.

Health Reform

Overview
On March 23, 2010, President Obama signed into law the Affordable Care Act. The law puts into place comprehensive health insurance reforms that will hold insurance companies more accountable and will lower health care costs, guarantee more health care choices, and enhance the quality of health care for all Americans.

Passage of the Act put the United States on the path to a new health care paradigm that has significant implications for the profession of dietetics. Under the new framework, health care will begin to shift away from the current fee-for-service payment model to one focused on preventive care and wellness, a patient-centered approach to treating multiple chronic diseases, and a reformed delivery system that includes more primary care providers, medical homes, and community-based health centers. These changes are vitally necessary to achieving the Act’s goals.

Status
ADA has been engaged in the health care reform debate from the beginning, and is stepping up its policymaking efforts during the next stage of health care reform: the process of implementing health care reform through state and federal rulemaking and state legislation. This implementation stage began almost immediately following passage of the Act and will likely continue for over a decade. This phase is in many ways the most important for ensuring RDs and DTRs play an integral role in the provision of health care pursuant to the Act.

State affiliates are currently being trained on the how to successfully effect implementation in their states by ADA PIA staff. A summary of opportunities follows.

Provision	Senate H.R. 3590 - Patient Protection & Affordable Care Act *with amendments from* House H.R. 4872 - Reconciliation Act of 2010
Health Aging. Preventive Services for adults 55-64	The Acts establish a grant program for state and local health departments and Indian tribes for: public health interventions, community preventive screenings, and referral and treatment for chronic diseases for individuals between 55 and 64 years old. Intervention activities include improving nutrition and increasing physical activity.
Workforce	The Acts call for an analysis of the current health care workforce (including registered dietitians) to determine gaps in delivery of care in underserved communities. Effective dates vary based on program.
Wellness/Prevention for Employees	The Acts allow the Department of Health and Human Services and the Department of Labor to set discounts up to 50 percent of insurance premiums if the wellness program is determined beneficial for the employee. Effective January 1, 2011.
School-Based Health Clinics	The Acts establish grants to launch school-based clinics. Optional services include nutrition counseling, but providers are not specifically listed. Authorized to be appropriated $50,000,000 for fiscal year 2010.
Prevention Task Forces, etc.	The Acts establish a Preventive Services Task Force and a Community Preventive Services Task Force. Effective upon passage into law. The Acts establish a Prevention and Public Health Investment Fund – funding is set at $2.4 billion for 2010 and increases up to $4.6 billion by 2019.
Medicare Preventive Services	The Acts adjust current law to allow the Centers for Medicare and Medicaid Services (CMS) to determine whether and how to expand existing and establish new preventive services. MNT beyond renal and diabetes is specifically included in the list of services that CMS may potentially expand. The Acts eliminate cost-sharing (co-payments and deductibles) for preventive services, making preventive care free for Medicare recipients. Effective January 1, 2011. The Acts provide for an annual wellness visit that includes personalized prevention plan services with a health care assessment. Along with physicians and nurses, registered dietitians are listed as screening and counseling providers, and CMS must establish appropriate reimbursement policies and rules for referral. Specifically, CMS must determine when a referral is warranted and how many counseling sessions a patient can receive. CMS has 18 months from the March 23, 2010, enactment date to finalize regulations.
Medicaid	The Acts establish a five-year grant program to encourage Medicaid beneficiaries to adopt more healthy lifestyles, specifically related to weight reduction, cholesterol reduction, prevention of the onset of diabetes, and diabetes self-managements. CMS will set the parameters for awarding grants. The Acts include coverage for those preventive services recommended by the United States Preventive Services Task Force (USPSTF). Because USPSTF currently recommends “intensive nutrition behavioral counseling” for adults with hyperlipidemia and “other diet-related chronic diseases,” CMS must determine (1) what constitutes “diet-related chronic diseases” for purposes of coverage and (2) who may provide the intensive counseling. USPSTF recommends referral to an RD after physician treatment. Effective January 1, 2011 Cost-sharing (co-payments and deductibles) for these preventive services are also eliminated. Effective January 1, 2011.
Home Health	The statute provides for a demonstration program for direct, home-based patient care. CMS will set the parameters, and although RDs are listed as possible providers, this is merely a recommendation, not a requirement. Because the pilot program may later be broadly adopted with potentially significant impact for the profession, ADA can assist those working in home health who want to show the benefits of having an RD provide nutrition services. Those interested should follow carefully the rules for the program and application procedures when they are proposed in the coming months for more details and to determine their eligibility for the program. Effective January 1, 2012.
Medical Homes	MEDICAID: The Acts allow for medical home waivers for state-coordinated programs focusing on (1) diabetes treatment and prevention and (2) treating cardiovascular disease and those considered overweight. Nutritionists are listed among providers, thus allowing for the inclusion of registered dietitians, although Congress did not identify them specifically. Instead, given their different licensing requirements and scope of practice, Congress deferred to individual states to decide whether RDs or others should be permitted to provide these services. Effective January 1, 2011. COMMUNITY SETTING: The Acts establish the medical home in public health programs and recommend the dietitian be included as a qualified provider and part of the medical home team, but CMS is given the authority to make the final determination.
Nutrition Labeling of Menu items at Chain Restaurants	The Acts require chain restaurants with at least 20 outlets to post calories on menus, menu boards (including drive-thru), and food display tags, with additional information (fat, saturated fat, carbohydrates, sodium, protein and fiber) available in writing upon consumer request. The Acts require national uniformity so that there is consistency in information provided, and states and localities will not be able to require that chains provide additional nutrient information on menus. Calorie labeling must also be affixed to vending machines. FDA is to issue proposed one year after enactment.
Child Obesity Demonstration project	The Acts fully fund $25 million (until 2014) for a demonstration project aimed at reducing childhood obesity in community-based settings and schools through educational, counseling, and training activities. Effective immediately.

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