Mapping the World of Nutrition. An Overview Of Federal Funding For Nutrition Programs

Transcription

1 Mapping the World of Nutrition An Overview Of Federal Funding For Nutrition Programs

2 The Academy of Nutrition and Dietetics The Academy of Nutrition and Dietetics is the world s largest organization of food and nutrition professionals with over 75,000 members. The Academy is committed to improving the nation s health and advancing the profession of dietetics through research, education and advocacy. Public policy and advocacy are core functions of the Academy and are critical to achieving its mission empowering its members to be the nation s food and nutrition leaders and its vision optimizing the nation s health through food and nutrition. The Academy supports research and monitoring to develop the evidence base that guides our policy decisions. The Academy of Nutrition and Dietetics legislative and public policy priorities focus on four areas: > > Disease Prevention and Treatment >Lifecycle > Nutrition > > Healthy Food Systems and Access > > Quality Health Care This map has been developed to give a better understanding of our federal public policy issues that will help us meet our commitment to improving the nation s health. For more information about the Academy of Nutrition and Dietetics public policy efforts, visit our website: EatrightPRO.org.

3 Richard B. Russell National School Lunch Act (2010 Healthy Hunger-Free Kids Act) Reauthorized next in 2015 SENATE Committee on Agriculture, Nutrition and Forestry; Subcommittee on Nutrition, Specialty Crops, Food and Agriculture Research HOUSE Education and the Workforce Committee; Subcommittee on Early Childhood Elementary and Secondary Education US Department of Agriculture (USDA) National School Lunch Program Summer Food Service Program Child and Adult Care Food Program (CACFP) $12.65 billion * $464.9 million * $3.1 billion * > > Childcare providers and centers > > Farm-to-institution advocates > > Hunger, poverty, public health, senior, and children s advocates > > Local: School districts, government agencies, camps, residential child care institutions, or school health private/non-profit organizations > > School nutrition services > > State: Departments of Health, Human Services, Agriculture, and Education 30.4 million total students; 21.7 million (71.6%)* of these students qualify for free or reduced-price meals.** 2.6 million children under 18* and people with mental or physical disabilities over 18 who participate in school programs (based on July 2014 peak participation).* 3.8 million children and adults* attending child and adult day care centers, family child care homes, after school programs, and homeless shelters; 81.9% whom qualify for free or reduced-price meals.** *FY 2014 Data ** Note: Household incomes at or below 130 percent of the poverty level are eligible for free meals; household incomes between 130 percent and 185 percent of the poverty level are eligible for reduced-price meals 3

4 Child Nutrition Act of 1966 (2010 Healthy Hunger-Free Kids Act) Reauthorized next in 2015 SENATE Committee on Agriculture, Nutrition and Forestry Subcommittee on Nutrition, Specialty Crops, Food and Agriculture Research HOUSE Education and the Workforce Committee Subcommittee on Early Childhood Elementary and Secondary Education U.S. Department of Agriculture (USDA) Fresh Fruit and Vegetable Snack Program WIC Farmers Market Nutrition Program Special Supplemental Food Program for Women, Infants and Children (WIC) Special Milk Program School Breakfast Program $174.5 million $18.7 million $6.82 billion $10.5 million $3.68 billion > > Farmers Markets > > Farm-to-institution advocates > > Hunger, poverty, public health, and children s advocates > > Lactation advocates > > Local: Schools, WIC agencies, residential child care institutions, > > Retailers > > School nutrition services > > State: Departments of Health, Agriculture, or Education; Indian Tribal Organizations Over 4 million children at selected schools that have at least 50% population that qualifies for free and reducedprice meal*** 1.5 million women, infants, and children enrolled in the WIC program** 8.2 million pregnant and post-partum women, infants and children with family incomes less than 185% of Federal Poverty Income Guidelines (FPIG), and judged to be nutritionally at-risk*** Children in schools, child care institutions and eligible camps that do not participate in other Federal child nutrition meal service programs (3900 outlets served 50 million half pints)*** 13.6 million students total; 11.5 million (85%***) of these students qualify for free or reduced-price meals (see note)* * Note: Household incomes at or below 130 percent of the Federal Poverty Income Guidelines (FPIG) are eligible for free meals; household incomes between 130 percent and 185 percent of the FPIG are eligible for reduced-price meals **FY 2013 Data ***FY 2014 Data 4

5 Farm Bill (Agricultural Act of 2014) Reauthorized next in 2018 SENATE Committee on Agriculture, Nutrition and Forestry Subcommittee on Nutrition, Specialty Crops, Food and Agricultural Research HOUSE Agriculture Committee Subcommittee on Department Operations, Oversight and Nutrition U.S. Department of Agriculture (USDA) Commodity Supplemental Food Program (CSFP) Supplemental Nutrition Assistance Program (SNAP) Supplemental Nutrition Assistance Program Education (SNAP-Ed) Food Distribution Program on Indian Reservations (FDPIR) Senior Farmers Market Nutrition Program (SFMNP) The Emergency Food Assistance Program (TEFAP) $197.9 million *** $74 billion *** $407 million *** $110.5 million ** $21 million ** $629.1 million *** > > Hunger, poverty, public health and senior advocates > > Local: Public and private non-profit organizations >State: > Departments of Health, Social Services, Agriculture, or Education; Indian Tribal Organizations > > Retailers > > Hunger, poverty, and public health advocates > > Local: SNAP offices > > State: Departments of Health or Social Services >Producers > > > Retailers > > Hunger, poverty, and public health advocates > > Local: SNAP offices > > State: Departments of Health or Social Services > > Advocates for Native Americans > > Hunger, poverty, and public health advocates > > State: Departments of Health or Agriculture; Indian Tribal Organizations > > Hunger, poverty, public health and senior advocates >Local: > Area Agencies on Aging > > State: Departments of Health or Agriculture; State Units on Aging; Indian Tribal Organizations > > Hunger, poverty, and public health advocates > > Local: Emergency food organizations (food banks and pantries, shelves, soup kitchens, shelters) > > State: Departments of Health, Social Services, Education, or Agriculture thousand individuals over 60 years of age with incomes less than 130% of Federal Poverty Income Guidelines (FPIG) (459,900) and 10 thousand pregnant and breastfeeding women, new mothers, infants, children at or below 185 percent of the FPIG*** 46.5 million individuals, with gross incomes below 130% of poverty*** 6.3 million individuals with gross income below 130% of poverty* 85.4 thousand low-income Native Americans living on Indian Reservations or other designated areas*** 835 thousand individuals that are at least 60 years old with incomes below 185% of FPIG** Low-income people: income eligibility set by states, usually 185% of poverty or less*** *FY 2011 **FY 2013 ***FY

6 Older Americans Act Title III Reauthorization Expired SENATE Committee on Health, Education, Labor and Pensions Subcommittee on Primary Health and Aging HOUSE Committee on Education and the Workforce Subcommittee on Higher Education and Workforce Training U.S. Department of Health and Human Services (HHS) Administration for Community Living (ACL) (formerly, Administration on Aging (AoA)) Home-Delivered Nutrition Services Program Nutrition Services Incentive Program Congregate Nutrition Services Program $216.4 million * $160.1 million * $438.2 million * > > Aging Network > > Area Agencies on Aging > > Hunger, poverty, public health, and senior advocates > > Local Meal Programs > > Retailers > > State Units on Aging Seniors over 60 years are eligible. There are no income guidelines, although the program is focused on low-income and minority seniors. Spouses of seniors may also participate. In FY 2012, million home-delivered meals were served to older adults nationwide. States, territories, and Indian tribal organizations can use these additional funds to purchase food or to cover the cost of food commodities provided by the USDA for the Home-Delivered and Congregate Nutrition Services Programs. Seniors over 60 years are eligible. There are no income guidelines, although the program is focused on low-income and minority seniors. Spouses of seniors and disabled persons who live in congregate meal sites may also participate. In FY 2012, 83.5 million meals were served to older adults nationwide. *FY 2015 Allocation 6

7 Ryan White HIV/AIDS Treatment Extension Act of 2009 Reauthorization Expired SENATE Committee on Health, Education, Labor and Pensions HOUSE Committee on Energy and Commerce Subcommittee on Health U.S. Department of Health and Human Services (HHS): Health Resources and Services Administration (HRSA) Part A: Grants to Urban Areas. Provides funding for services (including medical nutrition therapy) to Eligible Metropolitan Areas (EMAs) and Transitional Grant Areas (TGAs) most severely affected by HIV/AIDS. Part B: Grants to States. Provides funding for services (including medical nutrition therapy) to all 50 States, U.S. Territories, and the District of Columbia. Part C: Early Intervention Services. Provides funds to service providers (including community- and faith-based health clinics) for medical and support services. Part D: Women, Infants, Children, and Youth. Provides funding for familycentered outpatient care (including family-centered support services) for women, infants, children, and youth with HIV/AIDS. Part F: Demonstration and Training. Provides health and support services to underserved HIV populations through the Special Projects of National Significance (SPNS). $631.9 million * $1,301.6 million * $196.9 million * $73.3 million * $32.4 million * > > HIV/AIDS advocates > > Hunger, poverty, public health, and children s advocates > > Local: Community-based organizations that provide nutrition services (i.e. food banks, pantries, and kitchens; home-delivered meal services; nutrition education and counseling, etc.) > > Regional: Funding goes to EMAs (Eligible Metropolitan Areas) or TGAs (Transitional Grant Areas) Individuals living with HIV/AIDS. The program serves more than half a million low-income individuals with HIV/AIDS each year. The Ryan White Program is a payer of last resort meaning that it fills the gaps for people who have no other source of health coverage. 67% of clients are at or below the Federal Poverty Level. *FY 2013 Appropriations by programs 7

8 Benefits Improvement and Protection Act of 2000 Medical Nutrition Therapy SENATE Committee on Health, Education, Labor and Pensions; Committee on Finance HOUSE Committee on Energy and Commerce; Committee on Ways and Means U.S. Department of Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS) Benefits Improvement and Protection Act of 2000 Guarantees coverage of medical nutrition therapy for diabetes and non-end stage renal disease for Medicare beneficiaries. Since the passage of BIPA, many private insurers have followed Medicare s lead and provide coverage of medical nutrition therapy for diabetes and non-end stage renal disease for non-medicare patients. Reimbursement through Medicare Part B and the Medicare Trust Fund. > > Chronic Disease Prevention Advocates > > Local: Insurance Departments/Commissioners > > Medicare beneficiaries > > Private insurance companies > > Self-funded employers > > State: Departments of Health and/or Social Services; Insurance Departments/Commissioners Medicare beneficiaries with diabetes and/or non-end stage renal disease. 8

9 The Affordable Care Act of 2010 SENATE Committee on Health, Education, Labor and Pensions; Committee on Finance HOUSE Committee on Energy and Commerce; Committee on Ways and Means U.S. Department of Health and Human Services (HHS); Centers for Disease Control and Prevention (CDC); Food and Drug Administration (FDA) Prevention Services. Enables preventive services, including intensive behavioral counseling (which mirrors the Academy s definition of medical nutrition therapy) for obesity and cardiovascular disease, recommended by the U.S. Preventive Services Task Force (USPSTF) with a Grade A or Grade B rating to be covered by Medicare, Medicaid, and non-grandfathered private insurance plans, and to be included in the package of essential health benefits in every plan available through state health insurance marketplaces. Requires preventive services to be provided without copayments or deductibles. Prevention and Public Health Fund: Community Transformation Grants. ( ) This grant program helped local governments, tribes, and territories address chronic diseases and health disparities using evidence-based strategies. Healthy eating and prevention and control of high blood pressure and high cholesterol were two of the grant s five priority areas. Community Transformation Grants (CGT) were funded by the Prevention and Public Health Fund, which was established by the ACA. CTG is expected to reach more than 4 out of 10 people in the US (approximately 130 million people). Restaurant Menu Labeling (not yet implemented). Restaurants and food vendors with 20 or more outlets nationwide will be required to post calories on menus and menu boards (including drive-through), with additional nutritional information (fat, saturated fat, carbohydrates, sodium, protein, and fiber) available in writing upon request. These requirements will also apply to vending machines managed by companies that operate at least 20 vending machines. Employee Wellness Programs. The ACA expands the ability of employers to reward employees who achieve health improvement goals. Programs include participatory wellness programs which are available to employees regardless of individual health status (i.e. programs that reimburse the cost of gym membership), and nondiscriminatory health-contingent wellness programs which require individuals to meet a specific standard related to their health to attain a reward (i.e. programs that reward workers for achieving a specified cholesterol level or weight). Reimbursement through Medicare Part B, the Medicare Trust Fund, Medicaid, private insurance companies, and state health insurance marketplaces. Specific expenditure will depend on use of service. The Omnibus Appropriations Act of 2014 reallocated funds originally allocated to the CTGs to the Center for Disease Control and Prevention s diabetes and stroke prevention programs, while also providing $80 million in new Community Prevention Grants to help communities build multisector partnerships to improve community health. None. Restaurants and vendors that operate more than 20 outlets or machines will be responsible for covering the cost of posting calories. None. Employers may opt to offer wellness programs or not. The expense of employer-provided wellness programs for employees is deductible as a business expense (as was true prior to the passage of the ACA). > > Chronic disease prevention advocates > > Consumers > > Hunger, poverty, public health, senior, and children s advocates > > Local: Departments of Health and/or Social Services; Insurance Departments/Commissioners > > Private employers > > Private insurance companies > > Restaurant industry > > Self-funded employers > > State: Departments of Health and/or Social Services; Insurance Departments/Commissioners > > Worker, labor, and consumer advocates Medicare and Medicaid beneficiaries, and individuals purchasing health insurance through state health insurance marketplaces. Schools and school districts, transportation experts, businesses, faith based organizations Consumers who eat meals or snacks frequently or only intermittently at chain restaurants or vending machines. Employers that choose to offer wellness programs, and employees who participate. 9

10 Health Information Technology for Economic and Clinical Health (HITECH) Act American Recovery and Reinvestment Act (2009) COMMITTEES WITH JURISDICTION HOUSE Energy and Commerce Committee Centers for Medicare and Medicare Services (CMS) Office of the National Coordinator of Health Information Technology (ONC) Standards and Interoperability Framework Providing open participation in development of health information technology standards. Electronic Health Records (EHR) Certification Program Assures EHR technologies meet the defined standards and functionality of the Meaningful Use (MU) objectives. Stage 1 and Stage 2 Meaningful Use (MU) Medicare/Medicaid Financial Incentive Program Financial Incentive Program for qualifying Eligible Professionals (EP) and Eligible Hospitals (EH)* Financial Incentives for Medicare Eligible hospitals, Eligible Critical Access Hospitals and Eligible Providers (EP) who adopt and prove meaningful use of electronic health record technology according to the requirements set forth in stages (1-3) of EHR adoption. Medicare penalties take effect in 2015 for those who do not adopt EHR technology. Medicaid incentives for Medicaid eligible providers who adopt and prove meaningful use of EHR technology according the requirements set forth in stages 1-3 of EHR adoption. Medicaid penalties take effect in 2015 for those who do not adopt EHR technology. > > Consumers/Patients > > Eligible Professional and Hospitals who adopt EHRs via the HITECH Program > > Health Information Technology Standards Development Organizations > > Quality Improvement Organizations > > Standardized Health Care Terminology Organization *Programs to adopt and use EHRs in a meaningful way according to the mandated health information technology standards and terminologies authorized through regulations from ONC and CMS. 10

11 These federal laws are also included in our policy efforts. The Academy carefully monitors any proposed changes or necessary reauthorizations to assure alignment with the Academy s goals. National Nutrition Monitoring and Related Research Act (NNMRRA). This legislation was enacted by Congress in 1990 to measure the health and nutrition status of the U.S. population, to assess knowledge and attitudes about diet and health, and to measure food consumption and quality of the food supply. Today, more than 50 surveillance systems are operative. Goals of NNMRRA included the scientific evaluation of outcomes; the collection, analysis, and dissemination of data related to outcomes; the identification of at-risk groups/populations; the establishment of baseline/progressive data; and the provision of data to assess impacts of policy and programming. This data is used in the report as the basis of the Dietary Guidelines for Americans (DGA), which are utilized to structure most nutrition assistance programs (i.e. WIC, School Meals). There are five components to this legislation: 1. Nutritional status and nutrition-related health measurements (National Health and Nutrition Examination Survey [NHANES]); 2. Food/nutrient consumption (What We Eat In America [WWEA], Total Diet Study [TDS]); 3. Knowledge, attitudes, and behavior assessments (Behavioral Risk Factor Surveillance System [BRFSS]); 4. Food composition and nutrient data bases (USDA National Nutrient Data Base [NNDB]); 5. Food supply determinations (Functional Needs Support Services [FNSS]). Federal Food, Drug, and Cosmetic Act (FFDCA). Passed to ensure that drugs are both safe and effective before they enter the marketplace, FFDCA became law in 1938 and has since been amended many times. Drugs that can be regulated under FFDCA include compound drugs, such as total parenteral nutrition (TPN). In 2013, the Drug Quality and Security Act amended the FFDCA to ensure greater access to compound drugs and to improve the quality of these drugs. Food Safety Modernization Act (FSMA). Signed into law in 2011, FSMA is the most comprehensive reform of our food safety system in more than 70 years. The law addresses gaps in our food safety system by expanding FDA authority to regulate foods through more inspections at food facilities, mandated product recalls, increased oversight to certain farms, and tightened record-keeping requirements. The law requires food processing, manufacturing, and shipping facilities to analyze safety hazards, and to design and implement risk-based controls to prevent outbreaks from occurring. FSMA contains several provisions related to dietary supplements, subject to regulations for food under the Federal Food, Drug, and Cosmetic Act. The ultimate goal of FSMA is to ensure the safety of our nation s food supply by shifting the focus to the prevention of rather than strictly response to food contamination and disease outbreak. The Food and Drug Administration will continue to issue proposed rules for the implementation of FSMA, which are available for public comment. This Act has not been fully funded. Nutrition Labeling and Education Act (NLEA) was signed into law in 1990, and requires the nutrition label on food and beverage items to include: (1) the serving size; (2) the number of servings or other units per container; (3) the number of calories per serving and derived from total fat and saturated fat; (4) the amount of total fat, saturated fat, cholesterol, sodium, total carbohydrates, complex carbohydrates, sugars, total protein, and dietary fiber per serving or other unit; and (5) subject to conditions, vitamins, minerals or other nutrients. It also required certain vitamins and minerals to include nutrient information in their labeling. The information provided on the nutrition label must also be conveyed in a way that is easily understood by the public. The Nutrition Facts Panel is currently being updated. Proposals submitted by the FDA includes the inclusion of new categories on the label such as added sugars, sodium change levels, and other items. NLEA sets forth the circumstances under which nutrition and health claims may be made for foods, and regulates how claims, including claims involving cholesterol, saturated fat, or fiber are presented on the label. NLEA provides an important nutrition education tool for the public, the nutrition facts label, and has far reaching impacts for dietitians in all areas of practice. Title V of the Social Security Act (SSA) was enacted by Congress in Title V provides Maternal and Child Health Services block grants to states, to promote and improve the health of mothers and children, as well as build state and community-level capacity and systems (i.e. state departments of health). HHS s Health Resources and Services Administration (HRSA) administer these state grants. The specific aims of the Title V Maternal and Child Health program are to: assure access to quality care, especially for those with low-incomes or limited availability of care; reduce infant mortality; provide and ensure access to comprehensive prenatal and postnatal care to women (especially low-income and at risk pregnant women); increase the number of children receiving health assessments and follow-up diagnostic and treatment services; provide and ensure access to preventive and child care services as well as rehabilitative services for certain children; implement family-centered, community-based, systems of coordinated care for children with special healthcare needs; and provide toll-free hotlines and assistance in applying for services to pregnant women with infants and children who are eligible for Title XIX (Medicaid).

12 Headquarters Academy of Nutrition and Dietetics 120 South Riverside Plaza Suite 2000 Chicago, Illinois Toll-Free: Phone: Washington, D.C. Office Academy of Nutrition and Dietetics 1120 Connecticut Avenue, NW Suite 460 Washington, D.C Toll-Free: Phone: Updated May 2015