[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4264 Introduced in House (IH)]







                                    


104th CONGRESS
  2d Session
                                H. R. 4264

  To amend title XVIII of the Social Security Act to improve Medicare 
 treatment and education for beneficiaries with diabetes by providing 
 coverage of diabetes outpatient self-management training services and 
uniform coverage of blood-testing strips for individuals with diabetes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 27, 1996

Mr. Nethercutt (for himself, Mr. Weldon of Pennsylvania, Mr. Gingrich, 
 Mr. Watts of Oklahoma, Mr. Bonilla, and Mr. Bilirakis) 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 improve Medicare 
 treatment and education for beneficiaries with diabetes by providing 
 coverage of diabetes outpatient self-management training services and 
uniform coverage of blood-testing strips 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 Education and 
Treatment Amendments of 1996''.

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 subparagraphs (M) and 
        (O), and
            (2) by inserting after subparagraph (O) the following new 
        subparagraph:
            ``(R) 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, 1997.

SEC. 3. MEDICARE COVERAGE OF BLOOD-TESTING STRIPS FOR INDIVIDUALS WITH 
              DIABETES.

    (a) Including Strips as Durable Medical Equipment.--Section 1861(n) 
of the Social Security Act (42 U.S.C. 1395x(n)) is amended by striking 
the semicolon in the first sentence and inserting the following: ``, 
and includes blood-testing strips for individuals with diabetes without 
regard to whether the individual has Type I or Type II diabetes (as 
determined under standards established by the Secretary in consultation 
with the American Diabetes Association);''.
    (b) Payment for Strips Based on Methodology for Inexpensive and 
Routinely Purchased Equipment.--Section 1834(a)(2)(A) of such Act (42 
U.S.C. 1395m(a)(2)(A)) is amended--
            (1) by striking ``or'' at the end of clause (ii);
            (2) by adding ``or'' at the end of clause (iii); and
            (3) by inserting after clause (iii) the following new 
        clause:
                            ``(iv) which is a blood-testing strip for 
                        an individual with diabetes,''.
    (c) Effective Date.--The amendments made by this section shall 
apply to blood-testing strips furnished on or after July 1, 1997.
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