[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1073 Introduced in House (IH)]







104th CONGRESS
  1st Session
                                H. R. 1073

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


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           February 28, 1995

    Ms. Furse (for herself, Mr. Gejdenson, Mr. Nethercutt, and Mr. 
  Lipinski) introduced the following bill; which was referred to the 
 Committee on Commerce and, in addition, to the Committee on Ways and 
 Means, for a period to be subsequently determined by the Speaker, in 
   each case for consideration of such provisions as fall within the 
                jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


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

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

SECTION 1. 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)), as amended by section 147(f)(6)(B) of the Social 
Security Act Amendments of 1994, is amended--
            (1) by striking ``and'' at the end of subparagraph (N);
            (2) by striking ``and'' at the end of subparagraph (O); and
            (3) by inserting after subparagraph (O) the following new 
        subparagraph:
            ``(P) diabetes outpatient self-management training services 
        (as defined in subsection (oo)); and''.
    (b) Definition.--Section 1861 of such Act (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 
        originally established by the National Diabetes Advisory Board 
        and subsequently revised by organizations who participated in 
        the establishment of standards by such Board, or is recognized 
        by the American Diabetes Association as meeting standards for 
        furnishing 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, 1996.
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