[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[S. 491 Introduced in Senate (IS)]







104th CONGRESS
  1st Session
                                 S. 491

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


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

              March 2 (legislative day, February 22), 1995

Mr. Breaux (for himself, Mr. Hollings, Mr. Inouye, Mr. Cochran, and Mr. 
    Chafee) introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
To amend title XVIII of the Social Security Act to provide coverage of 
   outpatient 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 Act of 1995''.

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) (as 
        redesignated by section 147(f)(6)(B)(iii)(II) of the Social 
        Security Act Amendments of 1994 (Pub. Law 103-432)); and
            (2) 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 the Social Security 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)) if--
            ``(A) the services are furnished in an outpatient setting 
        by an individual or entity meeting the quality standards 
        described in paragraph (2)(B); and
            ``(B) the physician who is managing the individual's 
        diabetic condition certifies that the 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 furnishing 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--
                    ``(i) meets quality standards established by the 
                Secretary;
                    ``(ii) meets applicable standards developed by the 
                National Diabetes Advisory Board, including any 
                revision of such standards by the organizations that 
                participated in the original development of the 
                applicable standards; or
                    ``(iii) is recognized by the American Diabetes 
                Association as being 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, 1996.
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