ENROLLED ORIGINAL
AN ACT
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IN THE COUNCIL OF THE DISTRICT OF COLUMBIA
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To require health insurers in the District to provide coverage for medically necessary foods.
BE IT ENACTED BY THE COUNCIL OF THE DISTRICT OF COLUMBIA, That this
act be cited as the Medically Necessary Foods Coverage Act of 2022.
Sec. 2. Medically necessary foods.
(a) A health benefits plan issued, renewed, extended, or modified in the District by a
health insurer after December 31, 2022, shall provide coverage for the cost of medically
necessary food ordered as necessary by a provider for the following diseases or conditions:
(1) Inflammatory bowel disease, including Crohns disease, ulcerative colitis, and
indeterminate colitis;
(2) Gastroesophageal reflux disease that is nonresponsive to standard medical
therapies;
(3) Immunoglobulin E- and non-Immunoglobulin E-mediated allergies to food
proteins;
(4) Food protein-induced enterocolitis syndrome;
(5) Eosinophilic disorders, including eosinophilic esophagitis, eosinophilic
gastroenteritis, eosinophilic colitis, and post-transplant eosinophilic disorders;
(6) Impaired absorption of nutrients caused by disorders affecting the absorptive
surface, functional length, and motility of the gastrointestinal tract, including short bowel
syndrome and chronic intestinal pseudo-obstruction;
(7) Malabsorption due to liver or pancreatic disease;
(8) Inherited metabolic disorders; and
(9) Any other diseases or conditions as determined by the Mayor through
rulemaking.
(b) The coverage provided under this section shall not be more restrictive than or separate
from coverage provided for any other illness, condition, or disorder for purposes of determining
deductibles, benefit year or lifetime durational limits, benefit year or lifetime dollar limits,
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ENROLLED ORIGINAL
lifetime episodes or treatment limits, copayment and coinsurance factors, and benefit year
maximum for deductibles and copayments and coinsurance factors.
(c) The Mayor, pursuant to Title I of the District of Columbia Administrative Procedure
Act, approved October 21, 1968 (82 Stat. 1204; D.C. Official Code 2-501 et seq.), may issue
rules to implement the provisions of this act.
(d) For the purposes of this section, the term:
(1) Health benefits plan means any accident and health insurance policy or
certificate, hospital and medical services corporation contract, health maintenance organization
subscriber contract, plan provided by a multiple employer welfare arrangement, or plan provided
by another benefit arrangement. The term health benefit plan does not include accident only,
credit, or disability insurance; coverage of Medicare services or federal employee health plans,
pursuant to contracts with the United States government; Medicare supplemental or long-term
care insurance; dental only or vision only insurance; specified disease insurance; hospital
confinement indemnity coverage; limited benefit health coverage; coverage issued as a
supplement to liability insurance, insurance arising out of a workers compensation or similar
law; automobile medical payment insurance; medical expense and loss of income benefits; or
insurance under which benefits are payable with or without regard to fault and that is statutorily
required to be contained in any liability insurance policy or equivalent self-insurance.
(2) Health insurer means a person that provides one or more health benefit
plans or insurance in the District, including an insurer, a hospital and medical services
corporation, a fraternal benefit society, a health maintenance organization, a multiple employer
welfare arrangement, or any other person providing a plan of health insurance subject to the
authority of the Department of Insurance, Securities, and Banking.
(3) Medically necessary food means food, including a low-protein modified
food product or an amino acid preparation product, a modified fat preparation product, or a
nutritional formula that is specially formulated and processed for the partial or exclusive feeding
of an individual by means of oral intake or enteral feeding by tube, and intended for dietary
management of an individual who, because of therapeutic or chronic medical needs, has limited
or impaired capacity to ingest, digest, absorb, or metabolize ordinary foodstuffs or certain
nutrients or who has other specially medically determined nutrient requirements, the dietary
management of which cannot be achieved by modification of the normal diet alone.
Sec. 3. Fiscal impact statement.
The Council adopts the fiscal impact statement in the committee report as the
fiscal impact statement required by section 4a of the General Legislative Procedures Act of 1975,
approved October 16, 2006 (120 Stat. 2038; D.C. Official Code 1-301.47a).
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Sec. 4. Effective date.
This act shall take effect following approval by the Mayor (or in the event of veto by
the Mayor, action by the Council to override the veto), a 30-day period of congressional review
as provided in section 602(c)(l) of the District of Columbia Home Rule Act, approved December
24, 1973 (87 Stat. 813; D.C. Official Code 1-206.02(c)(l)), and publication in the District of
Columbia Register.
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Chairman
Council of the District of Columbia
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Mayor
District of Columbia
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