[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1194 Introduced in House (IH)]

103d CONGRESS
  1st Session
                                H. R. 1194

To amend title XVIII of the Social Security Act to provide coverage of 
self-management training services under part B of the medicare program 
                     for individuals with diabetes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 3, 1993

Mr. Kopetski introduced the following bill; which was referred jointly 
      to the Committees on Ways and Means and Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
To amend title XVIII of the Social Security Act to provide coverage of 
self-management training services under part B of the medicare program 
                     for individuals with diabetes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Diabetes Outpatient Self-
Management Training Services Coverage Act of 1993''.

SEC. 2. MEDICARE COVERAGE OF DIABETES OUTPATIENT SELF-MANAGEMENT 
              TRAINING SERVICES.

    (a) In General.--Section 1861(s)(2) of the Social Security Act (42 
U.S.C. 1395x(s)(2)) is amended--
            (1) by striking ``and'' at the end of subparagraph (O);
            (2) by adding ``and'' at the end of subparagraph (P); and
            (3) by adding at the end the following new subparagraph:
            ``(Q) diabetes outpatient self-management training services 
        (as defined in subsection (oo)).''.
    (b) Definition.--Section 1861 (42 U.S.C. 1395x) is amended by 
adding at the end the following new subsection:

        ``diabetes outpatient self-management training services

    ``(oo)(1) The term `diabetes outpatient self-management training 
services' means educational and training services furnished to an 
individual with diabetes by or under arrangements with a certified 
provider (as described in paragraph (2)(A)) in an outpatient setting by 
an individual or entity who meets the quality standards described in 
paragraph (2)(B), but only if the physician who is managing the 
individual's diabetic condition certifies that such services are needed 
under a comprehensive plan of care related to the individual's diabetic 
condition to provide the individual with necessary skills and knowledge 
(including skills related to the self-administration of injectable 
drugs) to participate in the management of the individual's condition.
    ``(2) In paragraph (1)--
            ``(A) a `certified provider' is an individual or entity 
        that, in addition to providing diabetes outpatient self-
        management training services, provides other items or services 
        for which payment may be made under this title; and
            ``(B) an individual or entity meets the quality standards 
        described in this paragraph if the individual or entity meets 
        quality standards established by the Secretary, except that the 
        individual or entity shall be deemed to have met such standards 
        if the individual or entity meets applicable standards 
        established by the National Diabetes Advisory Board or is 
        certified by the American Diabetes Association as qualified to 
        furnish the services.''.
    (c) Consultation With Organizations in Establishing Payment Amounts 
for Services Provided by Physicians.--In establishing payment amounts 
under section 1848(a) of the Social Security Act for physicians' 
services consisting of diabetes outpatient self-management training 
services, the Secretary of Health and Human Services shall consult with 
appropriate organizations, including the American Diabetes Association, 
in determining the relative value for such services under section 
1848(c)(2) of such Act.
    (d) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after January 1, 1994.

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