113 HR 1274 IH: Access to Quality Diabetes Education Act of 2013
U.S. House of Representatives
2013-03-19
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Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.This Act may be cited as the Access
to Quality Diabetes Education Act of 2013
.
2.Congress makes the following
findings:
(1)The Centers for Disease Control and
Prevention (hereinafter CDC
) report that nearly 26,000,000
Americans have diabetes, in addition to an estimated 79,000,000 Americans who
have prediabetes, an increase of 24,000,000 Americans with either diabetes or
prediabetes since 2008. People with prediabetes are at increased risk of
developing Type 2 diabetes or cardiovascular disease.
(2)Diabetes impacts 8.3 percent of all
Americans and 11.3 percent of American adults. The CDC estimates that as many
as 1 in 3 Americans will have diabetes by 2050 if current trends
continue.
(3)According to the American Diabetes
Association, the total costs of diagnosed diabetes have risen to $245 billion
in 2012 from $174 billion in 2007, when the cost was last examined by the CDC.
This figure represents a 41 percent increase over a five-year period.
(4)One in 3 Medicare dollars is currently
spent on people with diabetes.
(5)There were 11.3 million diabetes related
emergency room visits in 2008, compared with 9.5 million in 2000, an increase
of 11 percent.
(6)According to the CDC, health care providers
are finding statistically significant increases in the prevalence of Type 2
diabetes in children and adolescents.
(7)Diabetes self-management training
(hereinafter DSMT
), also called diabetes education, provides
critical knowledge and skills training to patients with diabetes, helping them
manage medications, address nutritional issues, facilitate diabetes-related
problem solving, and make other critical lifestyle changes to effectively
manage their diabetes. Evidence shows that individuals participating in DSMT
programs are able to progress along the continuum necessary to make sustained
behavioral changes in order to manage their diabetes.
(8)A certified diabetes educator is a State
licensed or registered health care professional who specializes in helping
people with diabetes develop the self-management skills needed to stay healthy
and avoid costly acute complications and emergency care, as well as
debilitating secondary conditions caused by diabetes.
(9)Diabetes self-management training has been
proven effective in helping to reduce the risks and complications of diabetes
and is a vital component of an overall diabetes treatment regimen. Patients who
have received training from a certified diabetes educator are better able to
implement the treatment plan received from a physician skilled in diabetes
treatment.
(10)Lifestyle
changes, such as those taught by certified diabetes educators, directly
contribute to better glycemic control and reduced complications from diabetes.
Evidence shows that the potential for prevention of the most serious medical
complications caused by diabetes to be as high as 90 percent (blindness), 85
percent (amputations), and 50 percent (heart disease and stroke) with proper
medical treatment and active self-management.
(11)In recognition of the important role of
DSMT programs, the CDC in 2012 awarded funding to expand the National Diabetes
Prevention Program to help prevent the onset of Type 2 diabetes for individuals
at high risk.
(12)The net savings to the Medicare program of
ensuring that beneficiaries have access to quality DSMT is estimated to be
$2,000,000,000 over 10 years.
(13)Despite its effectiveness in reducing
diabetes-related complications and associated costs, diabetes self-management
training has been recognized by the Centers for Medicare & Medicaid
Services as an underutilized Medicare benefit, even after more than a decade of
coverage.
(14)Enhancing access to diabetes
self-management training programs that are certified as necessary by the
patient’s treating physician and taught by certified diabetes educators is an
important public policy goal that can help improve health outcomes, ensure
quality, and reduce escalating diabetes-related health costs.
3.Recognition of
certified diabetes educators as authorized providers of Medicare diabetes
outpatient self-management training services
(a)Section 1861(qq) of the Social Security Act (42 U.S.C.
1395x(qq)) is amended—
(1)in paragraph (1), by striking by a
certified provider (as described in paragraph (2)(A)) in an outpatient
setting
and inserting in an outpatient setting by a certified
diabetes educator (as defined in paragraph (3)) or by a certified provider (as
described in paragraph (2)(A))
; and
(2)by adding at the
end the following new paragraphs:
(3)For purposes of paragraph (1), the
term certified diabetes educator means an individual—
(A)who is licensed or registered by the State
in which the services are performed as a certified diabetes educator; or
(B)who—
(i)is licensed or registered by the
State in which the services are performed as a health care professional;
(ii)specializes in teaching
individuals with diabetes to develop the necessary skills and knowledge to
manage the individual’s diabetic condition; and
(iii)is certified as a diabetes
educator by a recognized certifying body (as defined in paragraph (4)).
(4)For purposes of paragraph (3)(B)(iii), the
term recognized certifying body means a certifying body for
diabetes educators which is recognized by the Secretary as authorized to grant
certification of diabetes educators for purposes of this subsection pursuant to
standards established by the
Secretary.
.
(b)Treatment as a
practitioner, including for telehealth servicesSection 1842(b)(18)(C) of the such Act (42
U.S.C. 1395u(b)(18)(C)) is amended by adding at the end the following new
clause:
(vii)A certified diabetes educator (as defined
in section
1861(qq)(3)).
.
(c)
(1)The
Comptroller General of the United States shall conduct a study to identify the
barriers that exist for Medicare beneficiaries with diabetes in accessing
diabetes self-management training services under the Medicare program,
including economic and geographic barriers and availability of appropriate
referrals and access to adequate and qualified providers.
(2)Not
later than 1 year after the date of the enactment of this Act, the Comptroller
General of the United States shall submit to Congress a report on the study
conducted under paragraph (1).
(d)AHRQ development
of recommendations for outreach methods and report
(1)Development of
recommendationsThe Director
of the Agency for Healthcare Research and Quality shall, through use of a
workshop and other appropriate means, develop a series of recommendations on
effective outreach methods to educate physicians and other health care
providers as well as the public about the benefits of diabetes self-management
training in order to promote better health outcomes for patients with
diabetes.
(2)Not
later than 1 year after the date of the enactment of this Act, the Director of
the Agency for Healthcare Research and Quality shall submit to Congress a
report on the recommendations developed under paragraph (1).
(e)The amendments made by
this section shall apply to items and services furnished after the end of the
12-month period beginning on the date of the enactment of this Act.