[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6231 Introduced in House (IH)]








109th CONGRESS
  2d Session
                                H. R. 6231

  To catalyze change in the care and treatment of diabetes in America.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 28, 2006

    Mr. Fitzpatrick of Pennsylvania (for himself and Mr. Chandler) 
 introduced the following bill; which was referred to the Committee on 
                          Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
  To catalyze change in the care and treatment of diabetes in America.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS; AND FINDINGS.

    (a) Short Title.--This Act may be cited as the ``Catalyst to Better 
Diabetes Care Act of 2006''.
    (b) Table of Contents.--The table of contents is as follows:

Sec. 1. Short title; table of contents; and findings.
Sec. 2. Advisory group regarding diabetes and chronic illness employee 
                            wellness incentivization and disease 
                            management best practices.
Sec. 3. National diabetes report card.
Sec. 4. Medicare diabetes screening collaboration and outreach program.
Sec. 5. Improvement of diabetes mortality data collection.
Sec. 6. Study on appropriate level of diabetes medical education.
    (c) Findings.--The Congress finds as follows:
            (1) Diabetes is a chronic public health problem in the 
        United States that is getting worse.
            (2) According to the Centers for Disease Control and 
        Prevention:
                    (A) One in three Americans born in 2006 will get 
                diabetes.
                    (B) One in two American minorities born in 2006 
                will get diabetes.
                    (C) 1.5 million new cases of diabetes were 
                diagnosed in adults in 2005.
                    (D) In 2005, 20.8 million Americans had diabetes, 
                which is 7 percent of the population of the United 
                States.
                    (E) 6.2 million Americans are currently 
                undiagnosed.
                    (F) About one in every 500 children and adolescents 
                have type 1 diabetes.
                    (G) African-Americans are nearly twice as likely as 
                whites to have diabetes.
                    (H) Nearly 13 percent of American Indians and 
                Alaska Natives over 20 years old have diagnosed 
                diabetes.
                    (I) In States with significant Asian populations, 
                Asians were 1.5 to 2 times as likely as whites to have 
                diagnosed diabetes.
            (3) Diabetes carries staggering costs:
                    (A) In 2002, the total direct and indirect costs of 
                diabetes was estimated at $132 billion according to the 
                American Diabetes Association.
                    (B) 18 percent of the Medicare population has 
                diabetes but spending on this group of people consumes 
                32 percent of the Medicare budget according to the 
                Center for Medicare and Medicaid Services.
            (4) Diabetes is deadly. According to the Centers for 
        Disease Control and Prevention:
                    (A) In 2002, according to death certificate 
                reports, diabetes contributed to an official number of 
                224,092 deaths.
                    (B) Diabetes is likely to be seriously 
                underreported as studies have found that only 35 
                precent to 40 percent of decedent with diabetes had it 
                listed anywhere on the death certificate and only about 
                10 percent to 15 percent had it listed as the 
                underlying cause of death.
            (5) Diabetes complications carry staggering economic and 
        human costs for our country and health system:
                    (A) According to death certificate reports, 
                diabetes contributes to over 224,000 death a year, 
                although this number is likely vastly underreported.
                    (B) The risk for stroke is 2 to 4 times higher 
                among people with diabetes.
                    (C) Diabetes is the leading cause of new blindness 
                in America, causing approximately 18,000 new cases of 
                blindness each year.
                    (D) Diabetes is the leading cause of kidney failure 
                in America, accounting for 44 percent of new cases in 
                2002.
                    (E) In 2002, 44,400 Americans with diabetes began 
                treatment for end-stage kidney disease and a total of 
                153,730 were living on chronic dialysis or with a 
                kidney transplant as a result of their diabetes.
                    (F) In 2002, approximately 82,000 amputations were 
                performed on Americans with diabetes.
                    (G) Poorly controlled diabetes before conception 
                and during the first trimester of pregnancy can cause 
                major birth defects in 5 percent to 10 percent of 
                pregnancies and spontaneous abortions in 15 percent to 
                20 percent of pregnancies.
            (6) Diabetes is unique because its complications and 
        tremendous costs are preventable with currently available 
        medical treatment:
                    (A) According to the Agency for Healthcare Research 
                and Quality, appropriate primary care for diabetes 
                complications could have saved the Medicare and 
                Medicaid programs $2,500,000,000 in hospital costs in 
                2001 alone.
                    (B) According to the Diabetes Prevention Program 
                sponsored by the National Institutes of Health, 
                lifestyle interventions such as diet and moderate 
                physical activity for those with pre-diabetes reduced 
                the development of diabetes by 58 percent; among 
                Americans aged 60 and over, lifestyle interventions 
                reduced diabetes by 71 percent.
                    (C) Research shows detecting and treating diabetic 
                eye disease can reduce the development of severe vision 
                loss by 50 percent to 60 percent.
                    (D) Research shows comprehensive foot care programs 
                can reduce amputation rates by 45 percent to 85 
                percent.
                    (E) Research shows detecting and treating early 
                diabetic kidney disease by lowering blood pressure can 
                reduce the decline in kidney function by 30 percent to 
                70 percent.

SEC. 2. ADVISORY GROUP REGARDING DIABETES AND CHRONIC ILLNESS EMPLOYEE 
              WELLNESS INCENTIVIZATION AND DISEASE MANAGEMENT BEST 
              PRACTICES.

    (a) Establishment.--The Secretary of Commerce shall establish an 
advisory group consisting of representatives of the public and private 
sector. The advisory group shall include representatives from the 
Department of Commerce, the Department of Health and Human Services, 
the Small Business Administration, and public and private sector 
entities with experience in administering or operating employee 
wellness and disease management programs.
    (b) Duties.--The advisory group established under subsection (a) 
shall examine and make recommendations of best practices of chronic 
illness employee wellness incentivization and disease management 
programs in order to--
            (1) provide public and private sector entities with 
        improved information in assessing the role of employee wellness 
        incentivization and disease management programs in saving money 
        and improving quality of life for patients with chronic 
        illnesses; and
            (2) encourage the adoption of effective chronic illness 
        employee wellness and disease management programs.
    (c) Report.--Not later than 1 year after the date of the enactment 
of this Act, the advisory group shall submit to the Secretary of Health 
and Human Services, the Speaker and minority leader of the House of 
Representatives, and the majority leader and minority leader of the 
Senate, the results of the examination under subsection (b)(1).

SEC. 3. NATIONAL DIABETES REPORT CARD.

    (a) In General.--The Secretary of Health and Human Services 
(referred to in this section and sections 4 through 6 as the 
``Secretary''), in collaboration with the Director of the Centers for 
Disease Control and Prevention (referred to in this section as the 
``Director''), shall prepare a national diabetes report card (referred 
to in this section as a ``Report Card'') for the Nation and, to the 
extent possible, for each State on a biennial basis, that includes the 
statistically valid aggregate health outcomes related to individuals 
diagnosed with diabetes including--
            (1) HbA1c level;
            (2) LDL;
            (3) blood pressure; and
            (4) complications and comorbidities.
    (b) Report.--The Secretary, in collaboration with the Director, 
shall--
            (1) submit each Report Card to Congress; and
            (2) make each Report Card readily available in print and 
        electronically to each State and to the public.
    (c) Adaptable.--Each Report Card shall be able to be adapted by 
State and, where possible, local agencies in order to rate or report 
local diabetes care, costs, and prevalence.
    (d) Updated Report.--Each Report Card that is prepared after the 
initial Report Card shall include trend analysis for the Nation, and, 
to the extent possible, for each State, in order to track progress in 
meeting established national goals and objectives for improving 
diabetes care, costs, and prevalence (including Healthy People 2010), 
and to inform policy and program development.

SEC. 4. MEDICARE DIABETES SCREENING COLLABORATION AND OUTREACH PROGRAM.

    (a) Establishment.--With respect to diabetes screening tests 
provided for under the Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003 and for the purposes of reducing the number 
of undiagnosed beneficiaries with diabetes or prediabetes in the 
Medicare program, the Secretary, in collaboration with the Director of 
the Centers for Disease Control and Prevention, shall establish an 
outreach program--
            (1) to identify existing efforts to increase awareness 
        among Medicare beneficiaries and providers of the diabetes 
        screening benefit;
            (2) to maximize economies of scale, cost-effectiveness, and 
        resource allocation in increasing utilization of the Medicare 
        diabetes screening program; and
            (3) build upon ongoing efforts of the private and non-
        profit sector;
    (b) Consultation.--In carrying out this section, the Secretary and 
the Director shall consult with--
            (1) various units of the Federal Government, including the 
        Centers for Medicare & Medicaid Services, the Surgeon General 
        of the Public Health Service, the Agency for Health Research 
        and Quality, the Health Resources and Services Administration, 
        and the National Institutes of Health; and
            (2) entities with an interest in diabetes, including 
        industry, voluntary health organization, trade associations, 
        and professional societies.

SEC. 5. IMPROVEMENT OF DIABETES MORTALITY DATA COLLECTION.

    (a) In General.--The Secretary, acting through the Director of the 
Centers for Disease Control and Prevention, and in collaboration with 
appropriate agencies, shall conduct, support, and promote the 
collection, analysis, and publication of biennial data on the 
prevalence and incidence of type 1 and 2 diabetes and of pre-diabetes.
    (b) Improvement of Mortality Data Collection.--
            (1) Assessment.--The activities described in subsection (a) 
        shall include an assessment of diabetes as a primary or 
        underlying cause of death and analysis of any under-reporting 
        of diabetes as a primary or underlying cause of death in order 
        to provide an accurate estimate of yearly deaths related to 
        diabetes.
            (2) Death certificate additional language.--In carrying out 
        the activities described in subsection (b)(1), the Secretary 
        may promote the addition of language to death certificates to 
        improve collection of diabetes mortality data, including adding 
        questions for the individual certifying to the cause of death 
        regarding whether the deceased had diabetes and whether 
        diabetes was an immediate, underlying, or contributing cause of 
        or condition leading to death.
    (c) Report.--
            (1) In general.--The Secretary and the Director shall 
        submit to the Committee on Health, Education, Labor, and 
        Pensions of the Senate and the Committee on Energy and Commerce 
        of the House of Representatives annual reports describing the 
        activities undertaken under this section.
            (2) Content.--The reports shall include an--
                    (A) analysis of any under-reporting of diabetes as 
                a primary or underlying cause of death in order to 
                provide an accurate estimate of yearly deaths related 
                to diabetes; and
                    (B) projections regarding trends in each of the 
                areas described in subparagraph (A).
            (3) Availability.--The Secretary and the Director shall 
        make such reports publicly available in print and on the 
        Internet site of the Centers for Disease Control and 
        Prevention.

SEC. 6. STUDY ON APPROPRIATE LEVEL OF DIABETES MEDICAL EDUCATION.

    (a) In General.--The Secretary shall, in collaboration with the 
Institute of Medicine and appropriate associations and councils, 
conduct a study of the impact of diabetes on the practice of medicine 
in the United States and the appropriateness of the level of diabetes 
medical education that should be required prior to licensure, board 
certification, and board recertification
    (b) Report.--Not later than 2 years after the date of the enactment 
of this Act, the Secretary shall submit a report on the study under 
subsection (a) to the Committees on Ways and Means and Energy and 
Commerce of the House of Representatives and the Committees on Finance 
and Health, Education, Labor, and Pensions of the Senate.
                                 <all>