; (2) in subparagraph (P), by striking the semicolon at the end and inserting , and ; and (3) by adding at the end the following new subparagraph: (Q) in the case of medical nutrition therapy services (as defined in section 1861(vv)), which are not furnished for the prevention, management, or treatment of a disease or condition specified in paragraph (4) of such section; . (c) Effective date The amendments made by this section shall apply with respect to items and services furnished in years beginning on or after the date that is 2 years after the date of the enactment of this Act.